Editorial

3 pages, 149 KiB

Open AccessEditorial

Innovative Technology Based Interventions for Psychological Treatment of Common Mental Disorders

by Tara Donker and Annet Kleiboer

J. Clin. Med. 2020, 9(10), 3075; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm9103075 - 24 Sep 2020

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The present Special Issue of Journal of Clinical Medicine includes a series of important papers that aim to further the evidence base of innovative technological advances in the screening and treatment of mental health, and to further our understanding of their implications for [...] Read more.

The present Special Issue of Journal of Clinical Medicine includes a series of important papers that aim to further the evidence base of innovative technological advances in the screening and treatment of mental health, and to further our understanding of their implications for mental health care [...] Full article

(This article belongs to the Special Issue Innovative Technology Based Interventions for Psychological Treatment of Common Mental Disorders)

Research

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13 pages, 441 KiB

Open AccessArticle

Analysis of Usage Data from a Self-Guided App-Based Virtual Reality Cognitive Behavior Therapy for Acrophobia: A Randomized Controlled Trial

by Tara Donker, Chris van Klaveren, Ilja Cornelisz, Robin N. Kok and Jean-Louis van Gelder

J. Clin. Med. 2020, 9(6), 1614; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm9061614 - 26 May 2020

Cited by 13 | Viewed by 3396

Abstract

This study examined user engagement with ZeroPhobia, a self-guided app-based virtual reality (VR) Cognitive Behavior Therapy for acrophobia symptoms using cardboard VR viewers. Dutch acrophobic adults (n = 96) completed assessments at baseline and immediately following treatment. Primary outcome measures were the [...] Read more.

This study examined user engagement with ZeroPhobia, a self-guided app-based virtual reality (VR) Cognitive Behavior Therapy for acrophobia symptoms using cardboard VR viewers. Dutch acrophobic adults (n = 96) completed assessments at baseline and immediately following treatment. Primary outcome measures were the Acrophobia Questionnaire (AQ) and the Igroup Presence Questionnaire (IPQ). Usage data consisted of number of VR sessions practiced, practice time, and fear ratings directly after practicing. Results show that of the 66 participants who played at least one level, the majority continued to finish all levels, spending on average 24.4 min in VR. Self-reported fear consistently decreased between the start and finish of levels. Post-test AQ scores depended quadratically on time spent in VR. Higher pre-test AQ scores were significantly associated with subjective anxiety after the first level and a reduction of post-test AQ scores, but not with number of sessions, suggesting it might be more beneficial to play one level for a longer time period instead of practicing many VR levels. Results also show an optimum exposure level at which increasing practice time does not result in increased benefit. Self-guided VR acrophobia treatment is effective and leads to consistent reductions in self-reported anxiety both between levels and after treatment. Most participants progressed effectively to the highest self-exposure level, despite the absence of a therapist. Full article

(This article belongs to the Special Issue Innovative Technology Based Interventions for Psychological Treatment of Common Mental Disorders)

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16 pages, 1197 KiB

Open AccessArticle

Using the Personalized Advantage Index for Individual Treatment Allocation to Blended Treatment or Treatment as Usual for Depression in Secondary Care

by Nadine Friedl, Tobias Krieger, Karine Chevreul, Jean Baptiste Hazo, Jérôme Holtzmann, Mark Hoogendoorn, Annet Kleiboer, Kim Mathiasen, Antoine Urech, Heleen Riper and Thomas Berger

J. Clin. Med. 2020, 9(2), 490; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm9020490 - 11 Feb 2020

Cited by 8 | Viewed by 3531

Abstract

A variety of effective psychotherapies for depression are available, but patients who suffer from depression vary in their treatment response. Combining face-to-face therapies with internet-based elements in the sense of blended treatment is a new approach to treatment for depression. The goal of [...] Read more.

A variety of effective psychotherapies for depression are available, but patients who suffer from depression vary in their treatment response. Combining face-to-face therapies with internet-based elements in the sense of blended treatment is a new approach to treatment for depression. The goal of this study was to answer the following research questions: (1) What are the most important predictors determining optimal treatment allocation to treatment as usual or blended treatment? and (2) Would model-determined treatment allocation using this predictive information and the personalized advantage index (PAI)-approach result in better treatment outcomes? Bayesian model averaging (BMA) was applied to the data of a randomized controlled trial (RCT) comparing the efficacy of treatment as usual and blended treatment in depressive outpatients. Pre-treatment symptomatology and treatment expectancy predicted outcomes irrespective of treatment condition, whereas different prescriptive predictors were found. A PAI of 2.33 PHQ-9 points was found, meaning that patients who would have received the treatment that is optimal for them would have had a post-treatment PHQ-9 score that is two points lower than if they had received the treatment that is suboptimal for them. For 29% of the sample, the PAI was five or greater, which means that a substantial difference between the two treatments was predicted. The use of the PAI approach for clinical practice must be further confirmed in prospective research; the current study supports the identification of specific interventions favorable for specific patients. Full article

(This article belongs to the Special Issue Innovative Technology Based Interventions for Psychological Treatment of Common Mental Disorders)

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15 pages, 616 KiB

Open AccessArticle

Working Alliance in Blended Versus Face-to-Face Cognitive Behavioral Treatment for Patients with Depression in Specialized Mental Health Care

by Lisa Kooistra, Jeroen Ruwaard, Jenneke Wiersma, Patricia van Oppen and Heleen Riper

J. Clin. Med. 2020, 9(2), 347; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm9020347 - 27 Jan 2020

Cited by 12 | Viewed by 3983

Abstract

This study investigates working alliance in blended cognitive behavioral therapy (bCBT) for depressed adults in specialized mental health care. Patients were randomly allocated to bCBT (n = 47) or face-to-face CBT (n = 45). After 10 weeks of treatment, both patients [...] Read more.

This study investigates working alliance in blended cognitive behavioral therapy (bCBT) for depressed adults in specialized mental health care. Patients were randomly allocated to bCBT (n = 47) or face-to-face CBT (n = 45). After 10 weeks of treatment, both patients and therapists in the two groups rated the therapeutic alliance on the Working Alliance Inventory Short-Form Revised (WAI-SR; Task, Bond, Goal, and composite scores). No between-group differences were found in relation to either patient or therapist alliance ratings, which were high in both groups. In the full sample, a moderate positive association was found between patient and therapist ratings on Task (ρ = 0.41, 95% CI 0.20; 0.59), but no significant associations emerged on other components or composite scores. At 30 weeks, within-and between-group associations between alliance and changes in depression severity (QIDS, Quick Inventory of Depressive Symptomatology) were analyzed with linear mixed models. The analyses revealed an association between depression over time, patient-rated alliance, and group (p < 0.001). In face-to-face CBT, but not in bCBT, lower depression scores were associated with higher alliance ratings. The online component in bCBT may have led patients to evaluate the working alliance differently from patients receiving face-to-face CBT only. Full article

(This article belongs to the Special Issue Innovative Technology Based Interventions for Psychological Treatment of Common Mental Disorders)

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14 pages, 827 KiB

Open AccessArticle

Experienced Burden of and Adherence to Smartphone-Based Ecological Momentary Assessment in Persons with Affective Disorders

by Claire R. van Genugten, Josien Schuurmans, Femke Lamers, Harriëtte Riese, Brenda W. J. H. Penninx, Robert A. Schoevers, Heleen M. Riper and Johannes H. Smit

J. Clin. Med. 2020, 9(2), 322; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm9020322 - 23 Jan 2020

Cited by 33 | Viewed by 4589

Abstract

(1) Background: The use of smartphone-based ecological momentary assessment (EMA) questionnaires in affective disorder research has rapidly increased. Though, a thorough understanding of experienced burden of and adherence to EMA is crucial in determining the usefulness of EMA. (2) Methods: Persons with current [...] Read more.

(1) Background: The use of smartphone-based ecological momentary assessment (EMA) questionnaires in affective disorder research has rapidly increased. Though, a thorough understanding of experienced burden of and adherence to EMA is crucial in determining the usefulness of EMA. (2) Methods: Persons with current affective disorders (n = 100), remitted persons (n = 190), and healthy controls (n = 94) participated in a smartphone-based EMA two-week monitoring period. Our primary outcomes were (momentary) perceived burden of and adherence to EMA. (3) Results: In the whole sample, lower positive and higher negative affect were associated with slightly higher levels of perceived momentary burden (B = −0.23 [95%CI = −0.27–0.19], B = 0.30 [95%CI = 0.24–0.37], respectively). The persons with current affective disorders reported slightly higher levels of experienced momentary burden (Mdn = 1.98 [IQR = 1.28–2.57]), than the remitted persons (Mdn = 1.64 [IQR = 1.11–2.24]) and healthy controls (Mdn = 1.28 [IQR = 1.04–1.92]). Nevertheless, the persons with current affective disorders still showed very high adherence rates (Mdn = 94.3% [IQR = 87.9–97.1]), at rates on a par with the remitted persons (Mdn = 94.3% [IQR = 90.0–97.1]) and healthy controls (Mdn = 94.3% [IQR = 90.0–98.6]). (4) Discussion: Frequent momentary questionnaires of mental well-being are slightly more burdensome to the persons with current affective disorders, but this does not seem to have a negative impact on adherence. Their high rate of adherence to EMA—which was similar to that in remitted persons and healthy controls —suggests that it is feasible to apply (short-duration) EMA. Full article

(This article belongs to the Special Issue Innovative Technology Based Interventions for Psychological Treatment of Common Mental Disorders)

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22 pages, 608 KiB

Open AccessArticle

Why Uptake of Blended Internet-Based Interventions for Depression Is Challenging: A Qualitative Study on Therapists’ Perspectives

by Mayke Mol, Claire van Genugten, Els Dozeman, Digna J. F. van Schaik, Stasja Draisma, Heleen Riper and Jan H. Smit

J. Clin. Med. 2020, 9(1), 91; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm9010091 - 30 Dec 2019

Cited by 27 | Viewed by 4984

Abstract

(1) Background: Blended cognitive behavioral therapy (bCBT; online and face-to-face sessions) seems a promising alternative alongside regular face-to-face CBT depression treatment in specialized mental health care organizations. Therapists are key in the uptake of bCBT. This study focuses on therapists’ perspectives on usability, [...] Read more.

(1) Background: Blended cognitive behavioral therapy (bCBT; online and face-to-face sessions) seems a promising alternative alongside regular face-to-face CBT depression treatment in specialized mental health care organizations. Therapists are key in the uptake of bCBT. This study focuses on therapists’ perspectives on usability, satisfaction, and factors that promote or hinder the use of bCBT in routine practice; (2) Methods: Three focus groups (n = 8, n = 7, n = 6) and semi-structured in-depth interviews (n = 15) were held throughout the Netherlands. Beforehand, the participating therapists (n = 36) completed online questionnaires on usability and satisfaction. Interviews were analyzed by thematic analysis; (3) Results: Therapists found the usability sufficient and were generally satisfied with providing bCBT. The thematic analysis showed three main themes on promoting and hindering factors: (1) therapists’ needs regarding bCBT uptake, (2) therapists’ role in motivating patients for bCBT, and (3) therapists’ experiences with bCBT; (4) Conclusions: Overall, therapists were positive; bCBT can be offered by all CBT-trained therapists and future higher uptake is expected. Especially the pre-set structure of bCBT was found beneficial for both therapists and patients. Nevertheless, therapists did not experience promised time-savings—rather, the opposite. Besides, there are still teething problems and therapeutic shortcomings that need improvement in order to motivate therapists to use bCBT. Full article

(This article belongs to the Special Issue Innovative Technology Based Interventions for Psychological Treatment of Common Mental Disorders)

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16 pages, 917 KiB

Open AccessArticle

ZIEL: Internet-Based Self-Help for Adjustment Problems: Results of a Randomized Controlled Trial

by Christian Moser, Rahel Bachem, Thomas Berger and Andreas Maercker

J. Clin. Med. 2019, 8(10), 1655; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm8101655 - 11 Oct 2019

Cited by 19 | Viewed by 2970

Abstract

Adjustment Disorder (AjD) represents a healthcare paradox. On the one hand, it is one of the most diagnosed mental disorders worldwide. On the other hand, AjD and its possible treatment options remain a severely neglected field of research. In this context, we developed [...] Read more.

Adjustment Disorder (AjD) represents a healthcare paradox. On the one hand, it is one of the most diagnosed mental disorders worldwide. On the other hand, AjD and its possible treatment options remain a severely neglected field of research. In this context, we developed a self-guided online intervention for adjustment problems, named ZIEL, and tested its efficacy. It is based on and extends a bibliotherapeutic treatment approach for symptoms of AjD. In our study, a total of 98 individuals who had experienced a life event in the last two years, were randomly assigned to care as usual (CAU) or an online intervention group (CAU + online intervention). The primary endpoint was AjD symptom severity measured by Adjustment Disorder–New Module 20 (ADNM-20). Secondary endpoints were depressive symptoms, quality of life and other variables such as satisfaction and usability. Both the intervention and the control group improved comparably well regarding the severity of adjustment disorder symptoms post-treatment. However, participants in the intervention group showed significantly fewer depressive symptoms and a significantly higher quality of life (Cohen’s d: 0.89 (BDI) and −0.49 (SF-12)). The intervention was well-received by users with an above average usability rating. Overall, the results suggest that the ZIEL intervention has the promise to contribute to the treatment of AjD and reduce symptom burden by means of a scalable low-barrier approach. Full article

(This article belongs to the Special Issue Innovative Technology Based Interventions for Psychological Treatment of Common Mental Disorders)

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14 pages, 277 KiB

Open AccessArticle

From Research to Practice: Ten Lessons in Delivering Digital Mental Health Services

by Nickolai Titov, Heather D. Hadjistavropoulos, Olav Nielssen, David C. Mohr, Gerhard Andersson and Blake F. Dear

J. Clin. Med. 2019, 8(8), 1239; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm8081239 - 17 Aug 2019

Cited by 75 | Viewed by 10225

Abstract

There is a large body of research showing that psychological treatment can be effectively delivered via the internet, and Digital Mental Health Services (DMHS) are now delivering those interventions in routine care. However, not all attempts to translate these research outcomes into routine [...] Read more.

There is a large body of research showing that psychological treatment can be effectively delivered via the internet, and Digital Mental Health Services (DMHS) are now delivering those interventions in routine care. However, not all attempts to translate these research outcomes into routine care have been successful. This paper draws on the experience of successful DMHS in Australia and Canada to describe ten lessons learned while establishing and delivering internet-delivered cognitive behavioural therapy (ICBT) and other mental health services as part of routine care. These lessons include learnings at four levels of analysis, including lessons learned working with (1) consumers, (2) therapists, (3) when operating DMHS, and (4) working within healthcare systems. Key themes include recognising that DMHS should provide not only treatment but also information and assessment services, that DMHS require robust systems for training and supervising therapists, that specialist skills are required to operate DMHS, and that the outcome data from DMHS can inform future mental health policy. We also confirm that operating such clinics is particularly challenging in the evolving funding, policy, and regulatory context, as well as increasing expectations from consumers about DMHS. Notwithstanding the difficulties of delivering DMHS, we conclude that the benefits of such services for the broader community significantly outweigh the challenges. Full article

(This article belongs to the Special Issue Innovative Technology Based Interventions for Psychological Treatment of Common Mental Disorders)

Review

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26 pages, 571 KiB

Open AccessReview

Current State and Future Directions of Technology-Based Ecological Momentary Assessment and Intervention for Major Depressive Disorder: A Systematic Review

by Desirée Colombo, Javier Fernández-Álvarez, Andrea Patané, Michelle Semonella, Marta Kwiatkowska, Azucena García-Palacios, Pietro Cipresso, Giuseppe Riva and Cristina Botella

J. Clin. Med. 2019, 8(4), 465; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm8040465 - 05 Apr 2019

Cited by 98 | Viewed by 9910

Abstract

Ecological momentary assessment (EMA) and ecological momentary intervention (EMI) are alternative approaches to retrospective self-reports and face-to-face treatments, and they make it possible to repeatedly assess patients in naturalistic settings and extend psychological support into real life. The increase in smartphone applications and [...] Read more.

Ecological momentary assessment (EMA) and ecological momentary intervention (EMI) are alternative approaches to retrospective self-reports and face-to-face treatments, and they make it possible to repeatedly assess patients in naturalistic settings and extend psychological support into real life. The increase in smartphone applications and the availability of low-cost wearable biosensors have further improved the potential of EMA and EMI, which, however, have not yet been applied in clinical practice. Here, we conducted a systematic review, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, to explore the state of the art of technology-based EMA and EMI for major depressive disorder (MDD). A total of 33 articles were included (EMA = 26; EMI = 7). First, we provide a detailed analysis of the included studies from technical (sampling methods, duration, prompts), clinical (fields of application, adherence rates, dropouts, intervention effectiveness), and technological (adopted devices) perspectives. Then, we identify the advantages of using information and communications technologies (ICTs) to extend the potential of these approaches to the understanding, assessment, and intervention in depression. Furthermore, we point out the relevant issues that still need to be addressed within this field, and we discuss how EMA and EMI could benefit from the use of sensors and biosensors, along with recent advances in machine learning for affective modelling. Full article

(This article belongs to the Special Issue Innovative Technology Based Interventions for Psychological Treatment of Common Mental Disorders)

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