Pub Date : 2025-03-11DOI: 10.1016/j.invent.2025.100818
Sophie Christine Eicher, Manuel Heinrich, Pavle Zagorscak, Annette Brose, Christine Knaevelsrud
Background
Internet-Based Interventions (IBIs) are effective treatments for mental disorders, but their implementation faces challenges, particularly in addressing high dropout rates. Adding more human support or guidance might reduce treatment dropout rates in IBIs, but it may also limit scalability. Therefore, small, easy-to-implement, guidance-based add-on interventions are warranted to reduce dropout rates. This study tests if offering one additional brief phone contact reduces treatment dropout rates in an IBI for depressive symptoms with written guidance.
Methods
We analyze data from N = 394 individuals participating in an IBI for depression. The intervention comprises seven CBT-based modules with module-wise written semi-standardized feedback from psychotherapists (guided IBI). Previous research applying the same IBI in adults with self-reported symptoms of depression found increased dropout rates after the second module. In the study group, therapists offered an additional brief phone call after the second module (n = 206). In the control group, no additional phone calls were offered (n = 188). We present descriptive statistics regarding the intervention course for both groups. We conducted a logistic regression to examine the preventive effect of the additional phone call on treatment dropout.
Results
Pooled dropout rates in the study group were 30.5 % (n = 63), and in the control group 36.1 % (n = 68), with a risk difference of about 6 % points favoring the study group. The odds ratios ranged from 1.25 to 1.33, and the relative risks ranged from 1.08 to 1.10. However, all confidence intervals overlap zero, indicating that all effect estimates are statistically non-significant.
Conclusion
We tested a strategy of additional human contact to reduce treatment dropout rates in a guided IBI for depressive symptoms. All estimates descriptively favored the study group, but were small and non-significant. Further research is needed to determine how additional contact can be employed to reduce treatment dropout.
{"title":"Is one additional phone call enough? - Effectiveness of additional human support to reduce dropout from an internet-based intervention for depressive symptoms: A randomized-controlled trial","authors":"Sophie Christine Eicher, Manuel Heinrich, Pavle Zagorscak, Annette Brose, Christine Knaevelsrud","doi":"10.1016/j.invent.2025.100818","DOIUrl":"10.1016/j.invent.2025.100818","url":null,"abstract":"<div><h3>Background</h3><div>Internet-Based Interventions (IBIs) are effective treatments for mental disorders, but their implementation faces challenges, particularly in addressing high dropout rates. Adding more human support or guidance might reduce treatment dropout rates in IBIs, but it may also limit scalability. Therefore, small, easy-to-implement, guidance-based add-on interventions are warranted to reduce dropout rates. This study tests if offering one additional brief phone contact reduces treatment dropout rates in an IBI for depressive symptoms with written guidance.</div></div><div><h3>Methods</h3><div>We analyze data from <em>N</em> = 394 individuals participating in an IBI for depression. The intervention comprises seven CBT-based modules with module-wise written semi-standardized feedback from psychotherapists (guided IBI). Previous research applying the same IBI in adults with self-reported symptoms of depression found increased dropout rates after the second module. In the study group, therapists offered an additional brief phone call after the second module (<em>n</em> = 206). In the control group, no additional phone calls were offered (<em>n</em> = 188). We present descriptive statistics regarding the intervention course for both groups. We conducted a logistic regression to examine the preventive effect of the additional phone call on treatment dropout.</div></div><div><h3>Results</h3><div>Pooled dropout rates in the study group were 30.5 % (<em>n</em> = 63), and in the control group 36.1 % (<em>n</em> = 68), with a risk difference of about 6 % points favoring the study group. The odds ratios ranged from 1.25 to 1.33, and the relative risks ranged from 1.08 to 1.10. However, all confidence intervals overlap zero, indicating that all effect estimates are statistically non-significant.</div></div><div><h3>Conclusion</h3><div>We tested a strategy of additional human contact to reduce treatment dropout rates in a guided IBI for depressive symptoms. All estimates descriptively favored the study group, but were small and non-significant. Further research is needed to determine how additional contact can be employed to reduce treatment dropout.</div></div>","PeriodicalId":48615,"journal":{"name":"Internet Interventions-The Application of Information Technology in Mental and Behavioural Health","volume":"40 ","pages":"Article 100818"},"PeriodicalIF":3.6,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143620211","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-03DOI: 10.1016/j.invent.2025.100816
Pontus Bjurner , Nils Hentati Isacsson , Fehmi Ben Abdesslem , Magnus Boman , Erik Forsell , Viktor Kaldo
<div><h3>Introduction</h3><div>Therapist-supported internet-based Cognitive Behavioural Therapy (ICBT) has strong scientific support, but all patients are not helped, and further improvements are needed. Personalized medicine could enhance ICBT. One promising approach uses a Machine learning (ML) based predictive decision support tool (DST) to help therapists identify patients at risk of treatment failure and adjust their treatments accordingly. ICBT is a suitable clinical context for developing and testing such predictive DST's, since its delivery is quite flexible and can quickly be adapted for probable non-responders, for example by increasing the level and nature of therapist support, to avoid treatment failures and improve overall outcomes. This type of strategy has never been tested in a triple-blind randomised controlled trial (RCT) and has rarely been studied in ICBT.</div><div>The aim of this protocol is to expand on previous registered protocols with more detailed descriptions of methods and analyses before analyses is being conducted.</div></div><div><h3>Methods and analysis</h3><div>A triple blind RCT comparing ICBT with a DST (DST condition), to ICBT as usual (TAU condition). The primary objective is to evaluate if the DST condition is superior to the TAU condition in decreasing diagnose-specific symptoms among patients identified to be at risk of failure. Secondary objectives are to evaluate if the DST improves functioning, interaction, adherence, patient satisfaction, and therapist time efficiency and decreases the number of failed treatments. Additionally, we will investigate the therapists' experience of using the DST.</div><div>Patients and therapists have been recruited nationally. They were randomised and given a sham rationale for the trial to ensure allocation blindness. The total number of patients included was 401, and assessments were administered pre-treatment, weekly during treatment, at post-treatment and at 12-month follow-up. Primary outcome is one of the three diagnosis-specific symptom rating scales for respective treatment and primary analysis is difference in change from pre- to post-treatment for at-risk patients on these scales.</div></div><div><h3>Human ethics and consent to participate</h3><div>Informed consent to participate in the study was obtained from all participants. Both therapists and patients are participants in this trial. For patients, informed consent to participate in the study was obtained when they registered interest for the study via the study's secure web platform and carried out initial screening before the diagnostic and fit for treatment assessment, they first received the research subject information and were asked for consent by digitally signing that they had read and understood the information. For therapists who were part of the study, consent was requested after they had registered their interest. Therapists then received an email with a link to the study's secure web platform with
{"title":"Study protocol for a triple-blind randomised controlled trial evaluating a machine learning-based predictive clinical decision support tool for internet-delivered cognitive behaviour therapy (ICBT) for depression and anxiety","authors":"Pontus Bjurner , Nils Hentati Isacsson , Fehmi Ben Abdesslem , Magnus Boman , Erik Forsell , Viktor Kaldo","doi":"10.1016/j.invent.2025.100816","DOIUrl":"10.1016/j.invent.2025.100816","url":null,"abstract":"<div><h3>Introduction</h3><div>Therapist-supported internet-based Cognitive Behavioural Therapy (ICBT) has strong scientific support, but all patients are not helped, and further improvements are needed. Personalized medicine could enhance ICBT. One promising approach uses a Machine learning (ML) based predictive decision support tool (DST) to help therapists identify patients at risk of treatment failure and adjust their treatments accordingly. ICBT is a suitable clinical context for developing and testing such predictive DST's, since its delivery is quite flexible and can quickly be adapted for probable non-responders, for example by increasing the level and nature of therapist support, to avoid treatment failures and improve overall outcomes. This type of strategy has never been tested in a triple-blind randomised controlled trial (RCT) and has rarely been studied in ICBT.</div><div>The aim of this protocol is to expand on previous registered protocols with more detailed descriptions of methods and analyses before analyses is being conducted.</div></div><div><h3>Methods and analysis</h3><div>A triple blind RCT comparing ICBT with a DST (DST condition), to ICBT as usual (TAU condition). The primary objective is to evaluate if the DST condition is superior to the TAU condition in decreasing diagnose-specific symptoms among patients identified to be at risk of failure. Secondary objectives are to evaluate if the DST improves functioning, interaction, adherence, patient satisfaction, and therapist time efficiency and decreases the number of failed treatments. Additionally, we will investigate the therapists' experience of using the DST.</div><div>Patients and therapists have been recruited nationally. They were randomised and given a sham rationale for the trial to ensure allocation blindness. The total number of patients included was 401, and assessments were administered pre-treatment, weekly during treatment, at post-treatment and at 12-month follow-up. Primary outcome is one of the three diagnosis-specific symptom rating scales for respective treatment and primary analysis is difference in change from pre- to post-treatment for at-risk patients on these scales.</div></div><div><h3>Human ethics and consent to participate</h3><div>Informed consent to participate in the study was obtained from all participants. Both therapists and patients are participants in this trial. For patients, informed consent to participate in the study was obtained when they registered interest for the study via the study's secure web platform and carried out initial screening before the diagnostic and fit for treatment assessment, they first received the research subject information and were asked for consent by digitally signing that they had read and understood the information. For therapists who were part of the study, consent was requested after they had registered their interest. Therapists then received an email with a link to the study's secure web platform with","PeriodicalId":48615,"journal":{"name":"Internet Interventions-The Application of Information Technology in Mental and Behavioural Health","volume":"40 ","pages":"Article 100816"},"PeriodicalIF":3.6,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143549420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1016/j.invent.2025.100817
Vilgot Huhn , Erik Andersson , Tove Wahlund , Erik Forsell
Generalized Anxiety Disorder (GAD) is a common and debilitating anxiety disorder with a chronic course and a low rate of spontaneous remission. Previous internet-delivered treatments for GAD in clinical routine care has been shown to be effective but tend to use a mix of many different treatment components, often based in several theoretical models. Another approach could be to instead develop more focused and theory driven treatments, potentially allowing the protocol to be shorter and less demanding for patients. In this pilot-feasibility-trial we implemented a treatment focusing on one target core construct (intolerance of uncertainty) at the internet psychiatry clinic in Stockholm. The treatment was administered to 22 individuals with GAD. We found a significant reduction in GAD symptoms of similar effect size to previous studies of CBT and ICBT for GAD in routine clinical care. Patients rated overall high levels of treatment satisfaction and treatment credibility. Only two patients dropped out from the treatment. Among the remaining patients a median of 7.5 out of 8 modules were completed. We conclude that the treatment protocol is preliminarily effective, acceptable to patients and clinicians, and feasible to implement in routine psychiatric care.
{"title":"Initial effectiveness of an ICBT-protocol for GAD in psychiatric care – A feasibility-pilot study","authors":"Vilgot Huhn , Erik Andersson , Tove Wahlund , Erik Forsell","doi":"10.1016/j.invent.2025.100817","DOIUrl":"10.1016/j.invent.2025.100817","url":null,"abstract":"<div><div>Generalized Anxiety Disorder (GAD) is a common and debilitating anxiety disorder with a chronic course and a low rate of spontaneous remission. Previous internet-delivered treatments for GAD in clinical routine care has been shown to be effective but tend to use a mix of many different treatment components, often based in several theoretical models. Another approach could be to instead develop more focused and theory driven treatments, potentially allowing the protocol to be shorter and less demanding for patients. In this pilot-feasibility-trial we implemented a treatment focusing on one target core construct (intolerance of uncertainty) at the internet psychiatry clinic in Stockholm. The treatment was administered to 22 individuals with GAD. We found a significant reduction in GAD symptoms of similar effect size to previous studies of CBT and ICBT for GAD in routine clinical care. Patients rated overall high levels of treatment satisfaction and treatment credibility. Only two patients dropped out from the treatment. Among the remaining patients a median of 7.5 out of 8 modules were completed. We conclude that the treatment protocol is preliminarily effective, acceptable to patients and clinicians, and feasible to implement in routine psychiatric care.</div></div>","PeriodicalId":48615,"journal":{"name":"Internet Interventions-The Application of Information Technology in Mental and Behavioural Health","volume":"40 ","pages":"Article 100817"},"PeriodicalIF":3.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143549356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-18DOI: 10.1016/j.invent.2025.100815
Ece Atik , Silvan Hornstein , Elisabeth Reinking , Magnus Schückes
Blended cognitive behavioral therapy (bCBT), which involves the use of a digital application to support face-to-face psychotherapy, is increasingly offered to patients with depression amid a growing body of research on its efficacy. However, there is still limited understanding of the factors that influence the efficacy of this novel treatment method. To investigate the effects of potential factors such as patient satisfaction with the received treatment, patients' self-rated working alliance with their therapist, and patients' rating of system usability of the digital application, this secondary analysis study focused on a sample of 66 university students who completed an effective 6-week bCBT program that included weekly sessions with a therapist and access to a digital mental health application. We examined whether those three potential factors predict patients' improvement in depressive symptoms in a bCBT treatment. Patient satisfaction and working alliance are known predictors of treatment success in standard psychotherapy, yet their importance in blended treatment is largely unstudied. System usability is a factor that is frequently addressed while describing digital treatment programs, yet its contribution to the success of treatments has been mostly omitted. All the variables analyzed displayed a significant positive correlation with improvement in depressive symptoms. When taken together, all the factors account for 16.6 % of the variance in the outcome. However, when three variables were added in the backward multiple linear regression with stepwise elimination, only patient satisfaction emerged as a predictor of the outcome. Although there are significant correlations between working alliance and system usability and the improvement of depression in the bCBT program, their lack of predictive power in comparison to patient satisfaction renders the results inconclusive. Future studies could explore the potential contribution of additional variables to the improvement of depressive symptoms.
{"title":"Influence of patient satisfaction, system usability, and working alliance on depressive symptom improvement in blended cognitive behavioral therapy (bCBT): Secondary analysis of an open trial data","authors":"Ece Atik , Silvan Hornstein , Elisabeth Reinking , Magnus Schückes","doi":"10.1016/j.invent.2025.100815","DOIUrl":"10.1016/j.invent.2025.100815","url":null,"abstract":"<div><div>Blended cognitive behavioral therapy (bCBT), which involves the use of a digital application to support face-to-face psychotherapy, is increasingly offered to patients with depression amid a growing body of research on its efficacy. However, there is still limited understanding of the factors that influence the efficacy of this novel treatment method. To investigate the effects of potential factors such as patient satisfaction with the received treatment, patients' self-rated working alliance with their therapist, and patients' rating of system usability of the digital application, this secondary analysis study focused on a sample of 66 university students who completed an effective 6-week bCBT program that included weekly sessions with a therapist and access to a digital mental health application. We examined whether those three potential factors predict patients' improvement in depressive symptoms in a bCBT treatment. Patient satisfaction and working alliance are known predictors of treatment success in standard psychotherapy, yet their importance in blended treatment is largely unstudied. System usability is a factor that is frequently addressed while describing digital treatment programs, yet its contribution to the success of treatments has been mostly omitted. All the variables analyzed displayed a significant positive correlation with improvement in depressive symptoms. When taken together, all the factors account for 16.6 % of the variance in the outcome. However, when three variables were added in the backward multiple linear regression with stepwise elimination, only patient satisfaction emerged as a predictor of the outcome. Although there are significant correlations between working alliance and system usability and the improvement of depression in the bCBT program, their lack of predictive power in comparison to patient satisfaction renders the results inconclusive. Future studies could explore the potential contribution of additional variables to the improvement of depressive symptoms.</div></div>","PeriodicalId":48615,"journal":{"name":"Internet Interventions-The Application of Information Technology in Mental and Behavioural Health","volume":"39 ","pages":"Article 100815"},"PeriodicalIF":3.6,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143437523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-18DOI: 10.1016/j.invent.2025.100814
Helene Høgsdal , Sabine Kaiser , Geraldine Mabille , Monica Martinussen , Reidar Jakobsen , Henriette Kyrrestad
Opp is a universal mental health-promoting mobile application (app) developed for adolescents, with the aim of promoting mental health and well-being and preventing mental health problems. In this randomized controlled trial, the effectiveness of Opp was tested among Norwegian adolescents aged 13 to 25 years. Mental health, well-being, self-efficacy, self-esteem, help-seeking behavior, and sleep quality were assessed at two measurement points (T1 and T2), that were approximately 11 weeks apart. Only the participants that answered at both measurement points were included in the main analyses (N = 399; 75 % girls; Mage = 16.90 years, SD = 1.40). The results demonstrated a statistically significant effect of the app on mental health, as measured by the SDQ Total Difficulties scale (F(1,790) = 4.35, p = .037), while no statistically significant effects were observed on the other outcomes. These results provide important insights, and a broader understanding of how mental health apps can influence the mental health and well-being of a general sample of adolescents.
{"title":"The effect of a universal mobile application on adolescents' mental health and well-being","authors":"Helene Høgsdal , Sabine Kaiser , Geraldine Mabille , Monica Martinussen , Reidar Jakobsen , Henriette Kyrrestad","doi":"10.1016/j.invent.2025.100814","DOIUrl":"10.1016/j.invent.2025.100814","url":null,"abstract":"<div><div>Opp is a universal mental health-promoting mobile application (app) developed for adolescents, with the aim of promoting mental health and well-being and preventing mental health problems. In this randomized controlled trial, the effectiveness of Opp was tested among Norwegian adolescents aged 13 to 25 years. Mental health, well-being, self-efficacy, self-esteem, help-seeking behavior, and sleep quality were assessed at two measurement points (T1 and T2), that were approximately 11 weeks apart. Only the participants that answered at both measurement points were included in the main analyses (<em>N</em> = 399; 75 % girls; <em>Mage</em> = 16.90 years, <em>SD</em> = 1.40). The results demonstrated a statistically significant effect of the app on mental health, as measured by the SDQ Total Difficulties scale (<em>F</em>(1,790) = 4.35, <em>p</em> = .037), while no statistically significant effects were observed on the other outcomes. These results provide important insights, and a broader understanding of how mental health apps can influence the mental health and well-being of a general sample of adolescents.</div></div>","PeriodicalId":48615,"journal":{"name":"Internet Interventions-The Application of Information Technology in Mental and Behavioural Health","volume":"40 ","pages":"Article 100814"},"PeriodicalIF":3.6,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143549357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-12DOI: 10.1016/j.invent.2025.100809
H.D. Hadjistavropoulos , V. Peynenburg , R.P. Sapkota , E. Valli , M. Nugent , M.T. Keough , C. Sundström , M.P. Schaub , N. Titov , B.F. Dear
Background
Additional resources and stories are sometimes incorporated into Internet-delivered cognitive behaviour therapy (ICBT) for alcohol misuse to enhance treatment. Little is known, however, about how patients use and evaluate additional resources and stories, and how use and evaluation of additional resources and stories relates to satisfaction and outcomes.
Methods
We examined patient use and evaluation of 8 additional resources and 8 stories among 121 patients who endorsed significant alcohol misuse and were enrolled in a 6-lesson ICBT course for alcohol misuse enhanced with additional resources and stories. The additional resources addressed anger, assertiveness and communication, cannabis use, cognitive coping, grief, PTSD, sleep, and worry. Stories varied by gender, ethnicity, occupation, and severity of alcohol problems. Primary drinking outcomes included the Timeline Follow-Back (TLFB) and heavy drinking days (HDD). Diverse secondary outcomes (e.g., depression, anxiety, cravings, anger, satisfaction) were also assessed.
Results
Large within-group effects for TLFB and HDD were found. Large effects were also observed for depression and cravings, with high treatment satisfaction. 63 % of patients accessed at least one resource (M = 2.27 resources), with anger (35 %), cognitive coping (35 %), sleep (34 %) and worry (30 %) being the most used. When accessed, patients found resources informative and/or helpful to varying degrees (25–67 %). In terms of stories, 85 % of patients indicated they read the stories, and 89 % of those found them worthwhile; 65 % felt less alone and 55 % found they gave them skills to improve wellbeing. Increased use and positive ratings of additional resources were not significantly related to outcomes or satisfaction. However, positive ratings of stories were associated with confidence in managing symptoms and an interest in future treatment. Additionally, reading stories was associated with larger improvements on several secondary outcomes, including PTSD, anger, insomnia, and work and social adjustment.
Conclusions
The findings suggest that adding resources and stories to ICBT is acceptable and worthwhile. A significant number of patients reviewed these materials and found them informative and/or helpful, which suggests it is likely valuable to retain these resources for those in need. Reading stories and positive ratings of stories, rather than use and positive ratings of additional resources, was associated with increased satisfaction and some larger improvements on secondary outcomes. Further research is warranted to identify strategies that will more effectively engage patients with additional resources tailored to their specific needs.
{"title":"Evaluation of additional resources and stories within therapist-assisted internet-delivered cognitive behaviour therapy for alcohol misuse","authors":"H.D. Hadjistavropoulos , V. Peynenburg , R.P. Sapkota , E. Valli , M. Nugent , M.T. Keough , C. Sundström , M.P. Schaub , N. Titov , B.F. Dear","doi":"10.1016/j.invent.2025.100809","DOIUrl":"10.1016/j.invent.2025.100809","url":null,"abstract":"<div><h3>Background</h3><div>Additional resources and stories are sometimes incorporated into Internet-delivered cognitive behaviour therapy (ICBT) for alcohol misuse to enhance treatment. Little is known, however, about how patients use and evaluate additional resources and stories, and how use and evaluation of additional resources and stories relates to satisfaction and outcomes.</div></div><div><h3>Methods</h3><div>We examined patient use and evaluation of 8 additional resources and 8 stories among 121 patients who endorsed significant alcohol misuse and were enrolled in a 6-lesson ICBT course for alcohol misuse enhanced with additional resources and stories. The additional resources addressed anger, assertiveness and communication, cannabis use, cognitive coping, grief, PTSD, sleep, and worry. Stories varied by gender, ethnicity, occupation, and severity of alcohol problems. Primary drinking outcomes included the Timeline Follow-Back (TLFB) and heavy drinking days (HDD). Diverse secondary outcomes (e.g., depression, anxiety, cravings, anger, satisfaction) were also assessed.</div></div><div><h3>Results</h3><div>Large within-group effects for TLFB and HDD were found. Large effects were also observed for depression and cravings, with high treatment satisfaction. 63 % of patients accessed at least one resource (<em>M</em> = 2.27 resources), with anger (35 %), cognitive coping (35 %), sleep (34 %) and worry (30 %) being the most used. When accessed, patients found resources informative and/or helpful to varying degrees (25–67 %). In terms of stories, 85 % of patients indicated they read the stories, and 89 % of those found them worthwhile; 65 % felt less alone and 55 % found they gave them skills to improve wellbeing. Increased use and positive ratings of additional resources were not significantly related to outcomes or satisfaction. However, positive ratings of stories were associated with confidence in managing symptoms and an interest in future treatment. Additionally, reading stories was associated with larger improvements on several secondary outcomes, including PTSD, anger, insomnia, and work and social adjustment.</div></div><div><h3>Conclusions</h3><div>The findings suggest that adding resources and stories to ICBT is acceptable and worthwhile. A significant number of patients reviewed these materials and found them informative and/or helpful, which suggests it is likely valuable to retain these resources for those in need. Reading stories and positive ratings of stories, rather than use and positive ratings of additional resources, was associated with increased satisfaction and some larger improvements on secondary outcomes. Further research is warranted to identify strategies that will more effectively engage patients with additional resources tailored to their specific needs.</div></div>","PeriodicalId":48615,"journal":{"name":"Internet Interventions-The Application of Information Technology in Mental and Behavioural Health","volume":"39 ","pages":"Article 100809"},"PeriodicalIF":3.6,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143388229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-08DOI: 10.1016/j.invent.2025.100811
Rocio Herrero , Marvin Franke , Dennis Görlich , Azucena Garcia-Palacios , Rosa Baños , Corinna Jacobi , Thomas Berger , Michael P. Schaub , Tobias Krieger , David D. Ebert , Cristina Botella
<div><div>The college stage is marked by high prevalence of mental disorders, particularly anxiety, low mood, and substance abuse. Despite this, many affected students do not receive treatment, underscoring the need for preventive strategies. In respose, the CORE program, an internet-based intervention, was developed to enhance resilience and coping skills among college students. The present study, part of the ICare project (EU-634757), aims to assess the effectiveness of the CORE intervention in improving resilience and reducing symptoms of anxiety and depression in comparison to a Waiting List (WL) condition. The study was registered at ISRCTN (<u>ISRCTN13856522</u>).</div><div>In the study the unguided internet-based intervention (CORE) was compared to a WL control group in a multicenter two-arm, single-blind, randomized controlled trial (RCT) conducted in Spain, Germany, and Switzerland. Questionnaire based evaluations occurred at baseline (BL), 8 weeks (post-intervention), 6 and 12 months after randomization. A total of 493 students with low levels of resilience participated in the study.</div><div>Participants in the intervention group gained access to an internet-based program aiming to enhance resilience by learning to cope with stressors in daily life, promote self-empowerment, and improve well-being. Participants were instructed to engage in six interactive modules delivered weekly in a sequential order. The program's therapeutic content was developed following the Ryff model of well-being.</div><div>The primary outcome measure used was the Connor-Davidson Resilience Scale (CD-RISC-25). Additionally, anxiety and depressive symptomatology, coping strategies, and well-being were measured. Participants in the CORE condition reported a significant increase in resilience compared to WL condition (Differences post-BL: d = 0.34, <em>p</em> = .0005; 6 M-BL: d = 0.24, <em>p</em> = .0171; 12 M-BL: d = 0.33, <em>p</em> = .0031). Although, a general time trend towards improvement in the resilience was observed in both groups. Participants in the CORE condition, compared to those in the WL condition, showed a significant reduction in anxiety symptoms in the short and long term (differences post-BL: d = 0.30, <em>p</em> = .0015; 6 M-BL: d = 0.18, <em>p</em> = .0857; 12 M-BL: d = 0.23, <em>p</em> = .0312) and depression in the short term. Furthermore, participants in CORE condition showed a significant improvement in positive functioning measurements, such as well-being and self-compassion compared to WL condition. (Differences post-BL: d = 0.25, <em>p</em> = .0123; 6 M-BL: d = 0.16, <em>p</em> = .1505; 12 M-BL: d = 0.13, <em>p</em> = .1835).</div><div>Adherence to fully complete the intervention was approximately 59 %.</div><div>In conclusion, our study revealed promising outcomes for the CORE program, indicating its efficacy. These results position the CORE program as a valuable and validated tool in fostering resilience, offering promising ways for
{"title":"Efficacy of the internet-based intervention “Cultivating our resilience” (CORE) for improving resilience and coping strategies in university students: A randomized controlled trial","authors":"Rocio Herrero , Marvin Franke , Dennis Görlich , Azucena Garcia-Palacios , Rosa Baños , Corinna Jacobi , Thomas Berger , Michael P. Schaub , Tobias Krieger , David D. Ebert , Cristina Botella","doi":"10.1016/j.invent.2025.100811","DOIUrl":"10.1016/j.invent.2025.100811","url":null,"abstract":"<div><div>The college stage is marked by high prevalence of mental disorders, particularly anxiety, low mood, and substance abuse. Despite this, many affected students do not receive treatment, underscoring the need for preventive strategies. In respose, the CORE program, an internet-based intervention, was developed to enhance resilience and coping skills among college students. The present study, part of the ICare project (EU-634757), aims to assess the effectiveness of the CORE intervention in improving resilience and reducing symptoms of anxiety and depression in comparison to a Waiting List (WL) condition. The study was registered at ISRCTN (<u>ISRCTN13856522</u>).</div><div>In the study the unguided internet-based intervention (CORE) was compared to a WL control group in a multicenter two-arm, single-blind, randomized controlled trial (RCT) conducted in Spain, Germany, and Switzerland. Questionnaire based evaluations occurred at baseline (BL), 8 weeks (post-intervention), 6 and 12 months after randomization. A total of 493 students with low levels of resilience participated in the study.</div><div>Participants in the intervention group gained access to an internet-based program aiming to enhance resilience by learning to cope with stressors in daily life, promote self-empowerment, and improve well-being. Participants were instructed to engage in six interactive modules delivered weekly in a sequential order. The program's therapeutic content was developed following the Ryff model of well-being.</div><div>The primary outcome measure used was the Connor-Davidson Resilience Scale (CD-RISC-25). Additionally, anxiety and depressive symptomatology, coping strategies, and well-being were measured. Participants in the CORE condition reported a significant increase in resilience compared to WL condition (Differences post-BL: d = 0.34, <em>p</em> = .0005; 6 M-BL: d = 0.24, <em>p</em> = .0171; 12 M-BL: d = 0.33, <em>p</em> = .0031). Although, a general time trend towards improvement in the resilience was observed in both groups. Participants in the CORE condition, compared to those in the WL condition, showed a significant reduction in anxiety symptoms in the short and long term (differences post-BL: d = 0.30, <em>p</em> = .0015; 6 M-BL: d = 0.18, <em>p</em> = .0857; 12 M-BL: d = 0.23, <em>p</em> = .0312) and depression in the short term. Furthermore, participants in CORE condition showed a significant improvement in positive functioning measurements, such as well-being and self-compassion compared to WL condition. (Differences post-BL: d = 0.25, <em>p</em> = .0123; 6 M-BL: d = 0.16, <em>p</em> = .1505; 12 M-BL: d = 0.13, <em>p</em> = .1835).</div><div>Adherence to fully complete the intervention was approximately 59 %.</div><div>In conclusion, our study revealed promising outcomes for the CORE program, indicating its efficacy. These results position the CORE program as a valuable and validated tool in fostering resilience, offering promising ways for","PeriodicalId":48615,"journal":{"name":"Internet Interventions-The Application of Information Technology in Mental and Behavioural Health","volume":"39 ","pages":"Article 100811"},"PeriodicalIF":3.6,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143348790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-08DOI: 10.1016/j.invent.2025.100813
Vanessa Fournier , France Talbot , Heather D. Hadjistavropoulos , Nickolai Titov , Blake Dear , Rino Lang , Valérie Saulnier , Hugo Hébert , Gabrielle Cloutier
{"title":"Pragmatic clinical trial of two bilingual therapist-guided transdiagnostic iCBT programs for anxiety and depression in outpatient clinics in Canada","authors":"Vanessa Fournier , France Talbot , Heather D. Hadjistavropoulos , Nickolai Titov , Blake Dear , Rino Lang , Valérie Saulnier , Hugo Hébert , Gabrielle Cloutier","doi":"10.1016/j.invent.2025.100813","DOIUrl":"10.1016/j.invent.2025.100813","url":null,"abstract":"","PeriodicalId":48615,"journal":{"name":"Internet Interventions-The Application of Information Technology in Mental and Behavioural Health","volume":"39 ","pages":"Article 100813"},"PeriodicalIF":3.6,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143388443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
With the aim of universal prevention, there is still a lack of non-clinician-led or self-help interventions designed for the general population experiencing psychological distress. This study aims to address this gap by exploring a convenient, single-session, and effective method for reducing anxiety using ChatGPT feedback. Using a mixed-factorial experimental design, we recruited 98 participants online to compare changes in self-compassion and anxiety before and after the intervention among three groups: self-compassion writing with ChatGPT feedback (Experimental Group 1), self-compassion writing alone (Experimental Group 2), and an Active Control Group. Results showed that both Experimental Group 1 and 2 experienced significant increases in self-compassion and Experimental Group 1 experienced significant decreases in anxiety after the intervention, with Experimental Group 1 showing greater improvements. There were no significant changes in the control group. This study demonstrates that single online self-compassion writing intervention can effectively reduce anxiety and that using ChatGPT to provide highly empathetic feedback can enhance the effectiveness, making psychological support more accessible, cost-effective, and suitable for the general population.
{"title":"Single online self-compassion writing intervention reduces anxiety: With the feedback of ChatGPT","authors":"Tomoko Kishimoto , Ximing Hao , Trimble Chang , Zhiye Luo","doi":"10.1016/j.invent.2025.100810","DOIUrl":"10.1016/j.invent.2025.100810","url":null,"abstract":"<div><div>With the aim of universal prevention, there is still a lack of non-clinician-led or self-help interventions designed for the general population experiencing psychological distress. This study aims to address this gap by exploring a convenient, single-session, and effective method for reducing anxiety using ChatGPT feedback. Using a mixed-factorial experimental design, we recruited 98 participants online to compare changes in self-compassion and anxiety before and after the intervention among three groups: self-compassion writing with ChatGPT feedback (Experimental Group 1), self-compassion writing alone (Experimental Group 2), and an Active Control Group. Results showed that both Experimental Group 1 and 2 experienced significant increases in self-compassion and Experimental Group 1 experienced significant decreases in anxiety after the intervention, with Experimental Group 1 showing greater improvements. There were no significant changes in the control group. This study demonstrates that single online self-compassion writing intervention can effectively reduce anxiety and that using ChatGPT to provide highly empathetic feedback can enhance the effectiveness, making psychological support more accessible, cost-effective, and suitable for the general population.</div></div>","PeriodicalId":48615,"journal":{"name":"Internet Interventions-The Application of Information Technology in Mental and Behavioural Health","volume":"39 ","pages":"Article 100810"},"PeriodicalIF":3.6,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143348789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-06DOI: 10.1016/j.invent.2025.100812
Jorge Grimaldos , Sara Fernández-Buendía , Juana Bretón-López , Clara Miguel , Pim Cuijpers , Soledad Quero
Numerous controlled trials have been conducted to evaluate the effectiveness of virtual reality (VR) in exposure treatment for different anxiety disorders. Additionally, several meta-analyses focusing on VR studies are now available. In contrast, the number of studies that focus exclusively on augmented reality (AR) is smaller, and, to the best of our knowledge, there are currently no systematic reviews or meta-analyses available on this topic. The aim of this work is to conduct a systematic review focused exclusively on studies that evaluate the effectiveness of AR in the exposure treatment of anxiety and related disorders. Systematic searches were carried out in PubMed, PsycINFO, and Embase in January 2025. After the screening of 622 references, thirteen studies were included, twelve of which focused on phobic disorders. Overall, the results of the included studies are promising for the use of AR for conducting the exposure treatment, especially for specific phobias. Furthermore, AR achieved high satisfaction rates and was perceived as less aversive than in vivo exposure based on participants' experiences. However, some limitations should be noted regarding the state of this field of research, especially regarding the small number of included articles and the lack of sufficient RCTs to draw firm conclusions about the efficacy of AR, highlighting the need for further research in this field.
{"title":"Augmented reality exposure treatments in anxiety and related disorders: A systematic review","authors":"Jorge Grimaldos , Sara Fernández-Buendía , Juana Bretón-López , Clara Miguel , Pim Cuijpers , Soledad Quero","doi":"10.1016/j.invent.2025.100812","DOIUrl":"10.1016/j.invent.2025.100812","url":null,"abstract":"<div><div>Numerous controlled trials have been conducted to evaluate the effectiveness of virtual reality (VR) in exposure treatment for different anxiety disorders. Additionally, several meta-analyses focusing on VR studies are now available. In contrast, the number of studies that focus exclusively on augmented reality (AR) is smaller, and, to the best of our knowledge, there are currently no systematic reviews or meta-analyses available on this topic. The aim of this work is to conduct a systematic review focused exclusively on studies that evaluate the effectiveness of AR in the exposure treatment of anxiety and related disorders. Systematic searches were carried out in PubMed, PsycINFO, and Embase in January 2025. After the screening of 622 references, thirteen studies were included, twelve of which focused on phobic disorders. Overall, the results of the included studies are promising for the use of AR for conducting the exposure treatment, especially for specific phobias. Furthermore, AR achieved high satisfaction rates and was perceived as less aversive than in vivo exposure based on participants' experiences. However, some limitations should be noted regarding the state of this field of research, especially regarding the small number of included articles and the lack of sufficient RCTs to draw firm conclusions about the efficacy of AR, highlighting the need for further research in this field.</div></div>","PeriodicalId":48615,"journal":{"name":"Internet Interventions-The Application of Information Technology in Mental and Behavioural Health","volume":"39 ","pages":"Article 100812"},"PeriodicalIF":3.6,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143276976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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