Development of a New Approach to Guided Self-Help via the Internet: The Swedish Experience

ABSTRACT

This article describes the development and empirical status of guided Internet-delivered self-help. The treatment approach combines the benefits of bibliotherapy with book-length text materials and the support given online via web pages and e-mail. Interactive features such as online registrations, tests, and online discussion forums are also included. Cognitive behavior therapy (CBT) guided the research and clinical implementations of this approach, as it lends itself more easily to the self-help format compared with other presently available psychotherapy approaches. We include an overview of the research, current issues and research in service delivery, lessons learned through a program of research, and directions for future investigations.     

Evaluating a Web-Based Cognitive-Behavioral Therapy for Maladaptive Perfectionism in University Students

Abstract

Objective: This study assessed a Web-based cognitive-behavioral therapy (CBT) for maladaptive perfectionism, investigating perfectionism, anxiety, depression, negative automatic thoughts, and perceived stress. Participants: Participants were undergraduate students defined as maladaptive perfectionists through a screening questionnaire at an urban university. The data were collected from July 2009 to August 2010. Methods: Forty-seven maladaptive perfectionists were randomly assigned to a 12-week CBT or a wait-list control group and assessed via questionnaires at pre- and postintervention. Statistical procedures included t tests, Pearson correlations, and analysis of covariance. Results: At the postintervention measure, the CBT group demonstrated significant decreases in anxiety sensitivity and negative automatic thoughts compared to the control group. Within the CBT group, changes in perfectionism scores were significantly correlated with positive changes in depression, anxiety, stress, and automatic thoughts. Conclusions: The treatment group improved on psychological outcomes, demonstrating the effectiveness of a Web-based CBT for perfectionism in a university setting.     

A pilot study of CBT versus escitalopram combined with CBT in the treatment of pathological gamblers

We conducted a randomised controlled trial pilot study (N = 30) with two treatment groups: (1) Manualised cognitive behavioural therapy (CBT) (n = 15) and (2) escitalopram combined with CBT (n = 15). Treatment was administered individually and the CBT included weekly sessions for eight consecutive weeks. The treatment with escitalopram lasted for a minimum of 16 weeks (20 mg/day), with an optional continuation for a 6-month follow-up period. Repeated measures ANOVA with modified intent-to-treat analyses were conducted. Results showed significant time effects on all measures for both treatment conditions, although no significant group or time × group effects. The results indicated that both treatments were effective in the short term (effect sizes (ES) ranging from 0.45 to 0.91 for the CBT group and 0.27 to 0.72 for the escitalopram+CBT group), and that adding CBT to escitalopram had no additional statistically significant effect (between-group ES of 0.11 and 0.29 for primary outcome measures at 16-weeks post-treatment).     

Internet-based Cognitive Behavioral Therapy for DSM-IV Sexual Dysfunctions in Breast Cancer Survivors: Predictors of Treatment Response

Abstract

Objectives: We evaluated factors predictive of the effect of internet-based cognitive behavioral therapy (CBT) in breast cancer survivors with a sexual dysfunction. Methods: Fifty-five women completed questionnaires assessing sexual functioning and distress at baseline and post-CBT. Results: Higher therapy compliance and better partner baseline sexual functioning predicted better post-CBT sexual functioning. Higher therapy compliance and higher partner relationship satisfaction predicted lower sexual distress. Therapy compliance, in turn, was predicted by active partner involvement in therapy and a stronger therapeutic relationship. Conclusions: To increase the effect of internet-based CBT, we recommend partner involvement in therapy and establishing a strong therapeutic relationship.     

The Use of Computerized Self-Help Packages to Treat Adolescent Depression and Anxiety

Despite the efficacy of cognitive-behavioral therapy (CBT) in treating adolescent anxiety, few sufferers seek treatment. Barriers to accessing psychologists include a shortage of skilled therapists, long waiting lists, and affordability. The Internet is a medium possibly able to address issues of accessibility and affordability. This study aimed to assess the efficacy of online therapy in the treatment and prevention of adolescent anxiety and depression. Participants (N = 38) were randomly allocated to one of four conditions: online CBT, face-to-face CBT, combined face-to-face/online CBT, and control. Combined face-to-face/online CBT is more effective in treating symptoms of depression and anxiety compared to stand-alone online or face-to-face therapy. The present study suggests that for those who are unable to access face-to-face therapy, computerized therapy may be a viable option. This is an important finding, especially in light of current capacity to treat and accessibility problems faced in the treatment of adolescent depression and anxiety.     

A Population-Wide Screening and Tailored Intervention Platform for Eating Disorders on College Campuses: The Healthy Body Image Program

Abstract

Objectives: This article presents a new approach to intervention for eating disorders and body image concerns on college campuses, using a model of integrated eating disorder screening and intervention. Formative data on implementation feasibility are presented. Participants: College students enrolled at 2 universities between 2011 and 2012. Methods: The Healthy Body Image program is an evidence-based screening and intervention platform, enacted via community and online resources. An online screen was used to identify students at varying levels of risk or eating disorder symptom status; responses were used to direct students to universal or targeted online interventions or further evaluation. Universal prevention programs to improve healthy weight regulation and body image culture were offered to all students. Results: Formative data from 1,551 students illustrates the application of this model. Conclusions: The Healthy Body Image program is feasible to deliver and provides a comprehensive system of screening, evidence-based intervention, and community culture change.     

Telehealth for Patients with Chronic Pain: Exploring a Successful and an Unsuccessful Outcome

Abstract

Cognitive-behavioral therapy (CBT) is effective for treating chronic pain, but little is known about the mechanisms that might facilitate or hinder its utility when delivered by videoconference. In a single-case experimental design, we explored the outcomes of two adults with chronic pain who were provided with videoconference-based CBT. The goal was to examine the relationship between therapeutic alliance as well as presence felt and clinical outcomes. Therapeutic alliance was high overall for both participants; however, only the successful case’s alliance ratings significantly increased over treatment. Levels of presence felt in videoconferencing were also high, but were not related to therapy outcome.     

Introduction

The present study investigates whether hypothesized cognitive mechanisms of change mediate the efficacy of cognitive-behavioral therapy (CBT) delivered online for treating depression and anxiety disorders. Articles were included by searching MEDLINE, PsychInfo and PsychArticles databases from January 1980 to March 2011. The inclusion criteria were as follows: (a) randomized clinical trials investigating the role of CBT delivered online, (b) patient sample had clinical or subclinical intensity emotional problems, (c) at least one measure of cognitions was included, (d) the inclusion of a control group, and (e) sufficient data provided to allow calculation of effect sizes. Eleven articles were selected. Results revealed a moderate overall effect size of CBT (d = .67, P < .05) on the combined cognitive and emotional outcomes. A positive impact of online CBT on cognitive factors (d = .69, P < .05) and emotional outcomes (d = .63, P < .05) was independently demonstrated. In conclusion, cognitive-behavioral therapy delivered online can be used as an efficacious treatment for patients with emotional disorders. Assuming causal effects, the data indicate that cognitive factors are an important mechanism of change in online CBT. Future online CBT focusing on changing cognitions are likely to be efficacious.     

Implementation of an intimate partner violence screening program in a university health care clinic

Abstract

Objectives: To examine whether an intimate partner violence (IPV) screening program is related to a positive change in health care providers’ knowledge, attitudes, and self-efficacy of IPV screening. Participants: Eleven health care providers at a university health care clinic participated in the IPV screening program. Methods: A one-group pretest-posttest design was used to examine whether an IPV screening program was related to a change in health care providers’ knowledge, attitudes, and self-efficacy of IPV screening. Results: Findings indicated that there was a significant difference (p?<?000) between the posttest scores and the pretest scores on the Domestic Violence Healthcare Provider Survey Scale. Domain analysis of the scale revealed a significant difference in perceived self-efficacy (p?=?.001), system support (p?=?<.002), victim provider safety (p?=?.015), and beliefs of blaming victims (p?=?<.004). No statistical difference was found in professional role resistance/fear of offending (p?=?.158). Conclusions: A university health care clinic IPV screening program was related to a positive change in health care providers’ knowledge, attitudes, and self-efficacy of IPV screening.     

The Need for Web-Based Cognitive Behavior Therapy Among University Students

ABSTRACT

This study investigates students' need for a web-based cognitive-behavior therapy (CBT) intervention program for preventing depression, the mental health status of those who felt a need for such a program, and underlying factors of the intention to use web-based self-help. A conceptual model for explaining intention to use web-based self-help is proposed. Nearly half of the participants reported a need for help with psychological problems, but only a third of these actually sought help from traditional mental health services. In conclusion, there is a need for web-based self-help, and web-based CBT has the potential to attract a group of students who, so far, have not been reached by traditional mental health services.     

The role of cognitive distortion in online game addiction among Chinese adolescents

The aim of the present study was to examine the role of cognitive distortions in the development of on-line game addiction among Chinese adolescents. In Study 1, the sample comprised 495 adolescents aged 12 to 19 who recruited from two middle schools in Guangzhou, China. They were administered questionnaires relating background variables, the Internet Addiction Scale (IAS), Cognitive Distortions Scale (CDS) and Online Game Cognitive Addiction Scale (OGCAS). In Study 2, Twenty eight adolescents with excessive on-line game play recruited from a local mental hospital were randomly divided into to a CBT group (N = 14) and a clinical control group (N = 14). Measures of severity of on-line game playing, anxiety, depression, and cognitive distortions were assessed on baseline and after the 6 week intervention. Results of the present study showed that rumination and short-term thinking were the most predictors of online game addiction, and all-or-nothing thinking predict online game addiction at marginal significant levels. Males are at a greater risk of developing online game addiction than do females. CBT and basic counseling had different treatment effects on the all-or-nothing thinking scores, online comfort scores and short-term thinking scores, SDS scores and SAS scores. Interestingly, CBT and basic counseling had similar treatment effects on IAS scores and OGCAS scores. Applications of these findings to etiological research and clinical treatment programs are discussed.     

Network structures in cross-movement talk: Democracy Now!, 2003-2013

ABSTRACT

As organizers often remind us, we need to work across movements if we are to make substantive social change. Such talk is central to how we understand what social movements are and how we can work together. But how is that talk structured, and how might we theorize structural change over time as movements emerge and subside? This paper outlines several key considerations in the social construction of cross-movement relations between 2003 and 2013 on a daily independent broadcast news magazine program in the United States. Drawing on relational sociology and network studies, I offer a framework for understanding the changing structure of cross-movement talk as an interplay of a) the narrative clustering of movement labels, and b) the bridging of cross-cluster narrative divisions. Using positional network analysis, I first chart the movement canon – those movement labels that were used year after year for structuring the cross-movement field – and trace how key labels were used as bridging leaders during two periods of mass-mobilization. I then compare the narrative environment over time as it moved between more segmented and pluralistic structural characteristics, culminated in periods of narrative convergence in 2008 and 2011 around the Obama presidential election and the Occupy movement. By examining the overall structure of cross-movement talk in broadcast news programming, I illustrate how movement labels themselves are used by hosts and guests to facilitate the social construction of emergent movement clusters, and point to strategies for future application and analysis in cross-movement organizing.     

Interactive Media for Child Care and Counselling: New Resources,New Opportunities

SUMMARY

A familiar children's story in the UK–Bruce's Story, about the adventures of a puppy moving into the unknown world as he grows up–is converted into a multimedia program designed to help children in out of home care talk (or write) about their own experiences coming into the child welfare system and into foster and adoptive families.     

Predicting Human Papillomavirus Vaccine Intentions of College-Aged Males: An Examination of Parents’ and Son's Perceptions

Abstract

Objective: To examine male students’ and their parents’ human papillomavirus (HPV) vaccine communication in relation to males’ willingness to discuss the vaccine with their health care provider and the likelihood of being vaccinated. Participants: Dyads (n = 111) of students and parents. Methods: Participants completed a HPV vaccine survey based on the risk perception attitude framework in 2009. Results: Male students’ perceived susceptibility for HPV and self-efficacy to talk to their provider were directly related to their intention to discuss the HPV vaccine, and their intention was directly related to their likelihood of being vaccinated. Parents’ perceived self-efficacy to talk to their son and response efficacy of the vaccine were directly related to their intention to talk to their son; however, parents’ intention was not related to the likelihood of their son being vaccinated. Conclusions: College males may benefit from HPV vaccine educational programs that include communication skills training to discuss the HPV vaccine with their parents.     

Evaluation of an avatar-based training program to promote suicide prevention awareness in a college setting

Objective: Training programs exist that prepare college students, faculty, and staff to identify and support students potentially at risk for suicide. Kognito is an online program that trains users through simulated interactions with virtual humans. This study evaluated Kognito's effectiveness in preparing users to intervene with at-risk students. Participants: Training was completed by 2,727 university students, faculty, and staff from April, 2014 through September, 2015. Methods: Voluntary and mandatory participants at a land-grant university completed Kognito modules designed for higher education, along with pre- and post-assessments. Results: All modules produced significant gains in reported Preparedness, Likelihood, and Self-Efficacy in intervening with troubled students. Despite initial disparities in reported abilities, after training participants reported being similarly capable of assisting at-risk students, including LGBTQ and veteran students. Conclusions: Kognito training appears to be effective, on a large scale, in educating users to act in a facilitative role for at-risk college students.     

A Comprehensive Review and a Meta-Analysis of the Effectiveness of Internet-Based Psychotherapeutic Interventions

ABSTRACT

Internet-based psychotherapeutic interventions have been used for more than a decade, but no comprehensive review and no extensive meta-analysis of their effectiveness have been conducted. We have collected all of the empirical articles published up to March 2006 (n = 64) that examine the effectiveness of online therapy of different forms and performed a meta-analysis of all the studies reported in them (n = 92). These studies involved a total of 9,764 clients who were treated through various Internet-based psychological interventions for a variety of problems, whose effectiveness was assessed by different types of measures. The overall mean weighted effect size was found to be 0.53 (medium effect), which is quite similar to the average effect size of traditional, face-to-face therapy. Next, we examined interacting effects of various possible relevant moderators of the effects of online therapy, including type of therapy (self-help web-based therapy versus online communication-based etherapy), type of outcome measure, time of measurement of outcome (post-therapy or follow-up), type of problem treated, therapeutic approach, and communication modality, among others. A comparison between face-to-face and Internet intervention as reported on in 14 of the studies revealed no differences in effectiveness. The findings of this meta-analysis, and review of additional Internet therapy studies not included in the meta-analysis, provide strong support for the adoption of online psychological interventions as a legitimate therapeutic activity and suggest several insights in regard to its application. Limitations of the findings and recommendations concerning Internet-based therapy and future research are discussed.     

Student Reflections on Vulnerability and Self-awareness in a Social Work Skills Course

Self-awareness is generally considered core to effective social work education and professional practice. This paper examines student reflections on personal vulnerability and self-awareness in social, educational, and professional contexts. Ethics approval and student consent was obtained to analyse entries from the online learning component of a second year interpersonal skills course. The week 7 workshop, which focused on the concept of self-awareness, was contextualised and triggered by an online viewing of a relevant TED talk on the power of vulnerability. Qualitative analysis of student entries from this week revealed three core themes: (a) a provocative stimulus, which emphasised the usefulness and challenging nature of the TED talk in the context of workshop learning; (b) vulnerability, scarcity, and blame, which highlighted student identification with stimuli material and their emerging self-awareness; and (c) the importance of self-awareness and connection, which illuminated the students’ beginning applications of theory to practice.

IMPLICATIONS

• Interpersonal skills courses can be well supported by a diverse range of online and classroom stimuli.

• The intentional scaffolding of self-reflective activities can support early skills development and promote self-awareness.

• The analysis of student reflections can contribute to effective and responsive curriculum design.

     

A pilot study of a preventive program for depressive and anxious symptoms during the postsecondary transition

Abstract

Objective: To examine the effects of the indicated level of the prevention program Zenétudes: making a healthy transition to college on anxious and depressive symptoms. Participants: 65 college students participated in the study, from September 2014 to August 2016. From that initial sample, 53 students (ages 16–34) were included in analyses. Methods: First-year students were screened for anxious and depressive symptoms at the beginning of their semester. Students who scored higher than the cutoff score were invited to be part of the study. Both treatment and comparison groups completed pretest, post-test, and follow-up questionnaires. Results: Results show significant differences between treatment and comparison groups in both depressive and anxious symptoms at follow-up. Conclusion: The results of this pilot study support the positive effects of Zenétudes on anxious and depressive symptoms. Larger studies should be conducted to identify which components of the program mediate its efficacy.     

Risk Factors Associated With Overweight and Obesity in College Students

College obesity is increasing, but to the authors' knowledge, no researchers to date have evaluated risk factors in this population. Objective: The authors assessed whether abnormal eating perceptions and behaviors were associated with overweight in college students. Participants and Methods: A sample of undergraduates (N = 4,201) completed an online survey containing demographic questions and the Eating Attitudes Test-26 (EAT-26) questionnaire. The authors stratified participants into normal-weight and overweight/obese groups and evaluated physical activity, EAT-26 score, purging behaviors, and answers to selected overweight screening questions on the basis of body mass index. A modified EAT-26 score of ≥ 11 was associated with overweight (p = .016). Results: Compared with normal-weight peers, overweight participants displayed an increased fear of bingeing, preoccupation with food, desire to be thinner, and engagement in dieting behavior. Mean body mass index also increased with age and physical inactivity (p < .001). Conclusions: Because physical inactivity, disordered eating perceptions, and disordered behaviors are associated with increased rates of overweight and obesity, identification of these risk factors in obese youths may increase understanding of weight loss barriers and facilitate the treatment of adolescent obesity.