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S2214782914000128 | Ethnic minorities are underrepresented in mental health research, especially in randomized controlled trials. Recruiting ethnic minorities is challenging and there is a need to develop effective recruitment strategies. This study used data from a randomized controlled trial examining the effectiveness of an online guided self-help intervention for Turkish migrants with depressive symptoms. The recruitment process comprised six strategies in Dutch and Turkish: 1) a press release; 2) digital mailing; 3) the distribution of research information leaflets; 4) advertisements; 5) the Internet (in general terms); and 6) Facebook (FB). We describe the content and approach of each of the strategies and how effective they were in recruiting participants for our study. FB is evaluated in a step-by-step description of the recruitment strategy, together with its results in terms of effectiveness, specifically regarding data of FB Friends and messages received by FB Friends through FB. Results showed that a total of 287 applied for the trial. The majority of applicants were recruited through FB (75.6%, n=224), of whom 74 (33%, n=224) were included in the trial. Traditional recruitment strategies were far less successful, yielding only 16.4% (n=47) of the total of 287 applicants, of whom only 3 (3.1%) were included in the trial. Traditional recruitment strategies, such as research information leaflets and advertisements in newspapers, appear ineffective in recruiting ethnic minority groups for research purposes. The use of FB proved to be a more successful method. Future research should examine the factors that account for the potential effectiveness of FB as a recruitment method for hard-to-reach populations. | Reaching and recruiting Turkish migrants for a clinical trial through Facebook: A process evaluation |
S221478291400013X | The aims of the current study were to 1) establish the efficacy of two Internet-based prevention programmes to reduce anxiety and depressive symptoms in adolescents; and 2) investigate the distribution of psychological symptoms in a large sample of Australian adolescents prior to the implementation of the intervention. A cluster randomised controlled trial was conducted with 976 Year 9–10 students from twelve Australian secondary schools in 2009. Four schools were randomly allocated to the Anxiety Internet-based prevention programme (n=372), five schools to the Depression Internet-based prevention programme (n=380) and three to their usual health classes (n=224). The Thiswayup Schools for Anxiety and Depression prevention courses were presented over the Internet and consist of 6–7 evidence-based, curriculum consistent lessons to improve the ability to manage anxiety and depressive symptoms. Participants were assessed at baseline and post-intervention. Data analysis was constrained by both study attrition and data corruption. Thus post-intervention data were only available for 265/976 students. Compared to the control group, students in the depression intervention group showed a significant improvement in anxiety and depressive symptoms at the end of the course, whilst students in the anxiety intervention demonstrated a reduction in symptoms of anxiety. No significant differences were found in psychological distress. The Thiswayup Schools Depression and Anxiety interventions appear to reduce anxiety and depressive symptoms in adolescents using a curriculum based, blended online and offline cognitive behavioural therapy programme that was implemented by classroom teachers. Given the study limitations, particularly the loss of post-intervention data, these findings can only be considered preliminary and need to be replicated in future research. | Preventing anxiety and depression in adolescents: A randomised controlled trial of two school based Internet-delivered cognitive behavioural therapy programmes |
S2214782914000141 | Procrastination is defined as a voluntarily delay of an intended course of action despite expecting to be worse-off for the delay, and is considered a persistent behavior pattern that can result in major psychological suffering. About one-fifth of the adult population and half of the student population are presumed having substantial difficulties due to recurrent procrastination in their everyday lives. However, chronic and severe procrastinators seldom receive adequate care due to preconceptions and the lack of understanding regarding procrastination and the treatment interventions that are assumed beneficial. Cognitive-behavioral therapy is often deemed a treatment of choice, although the evidence supporting its use is scarce, and only one randomized controlled trial has been performed. The primary aim of the proposed study is therefore to test the efficacy of cognitive-behavioral therapy delivered as either a group intervention or via the Internet. Participants will consist of students recruited through the Student Health Centre at Karolinska Institutet. A randomized controlled trial with a sample size of 100 participants divided into blocks of thirty will be used, comparing an eight-week Internet-based cognitive-behavioral therapy intervention, and an eight-week group cognitive-behavioral therapy based intervention. It is believed that the proposed study will result in two important findings. First, different treatment interventions in cognitive-behavioral therapy are assumed to be helpful for people suffering from problems caused by procrastination. Second, both an Internet-based cognitive-behavioral therapy intervention and a group intervention are presumed suitable for administering treatment for procrastination, which is considered important as the availability of adequate care is limited, particularly among students. The proposed study will increase the knowledge regarding the efficacy of different treatments of procrastination, as well as enhance the overall comprehension of the difficulties related to dilatory behavior. | Group versus Internet-based cognitive-behavioral therapy for procrastination: Study protocol for a randomized controlled trial |
S2214782914000153 | Emerging evidence of the validity of collecting data in natural settings using smartphone applications has opened new possibilities for psychological assessment, treatment, and research. In this study we explored the feasibility and effectiveness of using a mobile application for self-supervised training of auditory attention. In addition, we investigated the neural underpinnings of the training procedure with functional magnetic resonance imaging (fMRI), as well as possible transfer effects to untrained cognitive interference tasks. Subjects in the training group performed the training task on an iPod touch two times a day (morning/evening) for three weeks; subjects in the control group received no training, but were tested at the same time interval as the training group. Behavioral responses were measured before and after the training period in both groups, together with measures of task-related neural activations by fMRI. The results showed an expected performance increase after training that corresponded to activation decreases in brain regions associated with selective auditory processing (left posterior temporal gyrus) and executive functions (right middle frontal gyrus), indicating more efficient processing in task-related neural networks after training. Our study suggests that cognitive training delivered via mobile applications is feasible and improves the ability to focus attention with corresponding effects on neural plasticity. Future research should focus on the clinical benefits of mobile cognitive training. Limitations of the study are discussed including reduced experimental control and lack of transfer effects. | Self-supervised, mobile-application based cognitive training of auditory attention: A behavioral and fMRI evaluation |
S2214782914000165 | Background Research has shown that computerized cognitive behavior therapy (cCBT), including internet-delivered CBT), can be effective. However, less is known about clinicians' attitudes towards this mode of treatment delivery. The aim of this study was to explore the attitudes of clinicians within child- and adolescent psychiatry towards cCBT and to explore if attitudes differed depending on rurality or theoretical orientation. Methods A random sample of Swedish child- and adolescent mental health services was selected for a survey study (N=15). A total number of 156 surveys were collected. Results Results showed a generally low knowledge of cCBT. A majority of clinicians were positive to cCBT as a prevention program (73%), and as treatment for mild to moderate problems (75%). More caution was reported with regard to more severe mental health problems. Treatment orientation, but not rurality, had a significant effect on several ratings. Thematic analyses showed concerns regarding for example lack of human support and the restricted usefulness of cCBT regarding age and complexity of symptoms. Perceived advantages were for example increased availability and possibility of an alternative way of communication. Conclusions This study adds to the limited literature on attitudes towards cCBT. The emerging picture is of a mainly positive attitude and prerequisites for dissemination are promising. | Attitudes towards the use of computerized cognitive behavior therapy (cCBT) with children and adolescents: A survey among Swedish mental health professionals |
S2214782914000177 | Stress is a major health problem in today's workplace. Recent studies suggest that acceptance and commitment therapy (ACT) is effective for reducing stress at work, specifically among managers. Moreover, smartphone-delivered treatments have been developed and increasingly used in research. The objective of our study was to evaluate the efficacy of an ACT-based smartphone treatment among middle managers at medium- and large-sized companies (>50 employees) in Sweden. A total of 73 participants were randomized to either receive the six-week stress intervention (n =36) or to a waitlist control group (n =37). Results showed small to moderate within-group effect sizes (Cohen's d range 0.37–0.62) for the treatment group, and small to moderate between group effects (Cohen's d range 0.41–0.50). In conclusion, the study indicates that a smartphone administered stress intervention based on ACT can reduce perceived stress and increase general health among Swedish middle managers in the private sector. | Stress management for middle managers via an acceptance and commitment-based smartphone application: A randomized controlled trial |
S2214782914000189 | Depression and alcohol use problems represent two of the major causes of disease burden in young people today. These conditions frequently co-occur and this co-occurrence is associated with increased risks and poorer outcomes than either disorder in isolation. Integrated treatments have been shown to be effective, however, there remains a significant gap between those in need of treatment and those receiving it, particularly in young people. The increased availability of Internet-based programmes to complement health care presents a unique opportunity in the treatment of these conditions. This paper presents the findings of a development stage of the first Internet-based programme for young people (aged 18–25years) with co-occurring depression and alcohol use problems: the DEAL Project (DEpression-ALcohol). This stage involved engaging young people and mental health professionals to provide feedback regarding the acceptability and feasibility of a draft version of the programme. The 4-module draft programme incorporated evidence-based cognitive-behavioural therapy techniques and motivational enhancement principles. A series of focus groups with young people (n=25) and interviews of key professionals (n=6) were conducted. The feedback provided by this phase of testing was used to inform revisions to the programme. Overall, the DEAL Project programme was well-received and provides an innovative new platform for the treatment of co-occurring depression and alcohol use problems in young people. The next phase will include an evaluation of programme efficacy. If found to be efficacious, the programme has the potential to improve outcomes, reduce disease burden, and increase treatment uptake in this vulnerable group. | Developing an integrated, Internet-based self-help programme for young people with depression and alcohol use problems |
S2214782914000190 | Depressive disorders are highly prevalent in the working population and lead to excessive costs. Online interventions have shown to be effective treatments for depression but are not often applied in the work setting, despite the importance of work related aspects in the development and perpetuation of depression. We developed a worker-directed web-based intervention for employees with depressive symptoms named Happy@Work. A process evaluation was conducted alongside a randomized controlled trial to assess the feasibility of the intervention and to explore barriers and facilitators for further implementation of the intervention. Employees from different companies in the Netherlands who experienced elevated depressive symptoms and were not on sick leave were eligible to take part in this study. Happy@Work contains six lessons and every lesson has several assignments. When completed, a coach provides feedback to assignments via the website. Process measures investigated were: reach, dose delivered, dose received, and fidelity. Recruitment methods and participant satisfaction with the intervention were described and analyzed as well. Data was collected at baseline and 8weeks later via online questionnaires and data registrations on the website. The implementation score of the intervention was sufficient, but reach of the target population was low. The dose delivered was high, with 93.1% of participants who used the intervention components that were offered to them. However, adherence to the intervention was low; the dose received was 57.8%. The fidelity of the implementation of the intervention was satisfactory. Recruitment of companies and participants was difficult. Participants were satisfied with the different aspects of the intervention, especially with the feedback from the coach. The results of this process evaluation showed that the intervention was conducted according to protocol and seems feasible for further implementation. Potential barriers to further implementation of the intervention include the reach of the target population, intervention adherence and the quality of the feedback. Based on the results of the effectiveness of the intervention, we do not recommend further implementation of the intervention in its current form. | Feasibility of a worker-directed web-based intervention for employees with depressive symptoms |
S2214782914000207 | Functional gastrointestinal disorders (FGID), including irritable bowel syndrome, functional dyspepsia and functional abdominal pain, are common in adolescents and are associated with substantially decreased quality of life. Cognitive behavior therapy for children and adolescents with FGID is one of few treatments that have shown effect, but treatment access is limited. In adults with irritable bowel syndrome, exposure-based internet-delivered CBT (ICBT) leads to reduced symptoms and increased quality of life, but studies in children are lacking. This open pilot aimed to evaluate feasibility and the potential efficacy of an exposure-based ICBT-program for adolescents with pain-predominant FGID. Twenty-nine adolescents (age 13–17), with FGID were included. The ICBT-program lasted for 8weeks with weekly online therapist support. The protocol for adolescents included exposure to abdominal symptoms, while the protocol for parents aimed at increasing parents' attention to adolescent healthy behaviors. Assessment points were baseline, post-treatment and 6-month follow-up. The primary outcome was the Gastrointestinal Symptoms Rating Scale-IBS (GSRS-IBS). Effect sizes were calculated using Cohen's d in an intent to treat analysis. GSRS-IBS improved significantly from baseline to post-treatment (mean difference 6.48; 95% CI [2.37–10.58]) and to follow-up (mean difference 7.82; 95% CI [3.43–12.21]), corresponding to moderate effect sizes (within-group Cohen's d =0.50; 95% CI [0.16–0.84] and d =0.63; 95% CI [0.24–1.02], respectively). Treatment adherence was high with 22 of 29 (76%) adolescents completing the entire treatment period. High adherence indicates acceptability of format and content, while symptomatic improvement suggests potential efficacy for this ICBT intervention in adolescents with FGID. | Internet-delivered cognitive behavior therapy for adolescents with functional gastrointestinal disorders — An open trial |
S2214782914000219 | Pressure ulcers (PrUs) in people with spinal cord injury (SCI) are a common, mostly preventable, skin complication with serious health consequences. This paper presents the development, theoretical bases, and perceived usefulness and effectiveness data for iSHIFTup.org, a skin care Internet intervention to prevent pressure ulcers in adults with SCI. Participants (n=7) were, on average, 36years old (SD=10.09), tetraplegic (71%), paraplegic (29%), and caucasian (86%), with an average time since injury of 10.43years (SD=9.64years). During the six weeks of program access, participants' usage of the program was tracked and analyzed. Participants subsequently completed measures focused on usability, likeability, and usefulness (the Internet Evaluation and Utility Questionnaire; IEUQ), and on their perceptions of the impact of the program on targeted behaviors (using the Internet Impact and Effectiveness Questionnaire; IIEQ). Participants generally reported positive experiences using iSHIFTup, indicating it to be useful, effective, easy to use, and understandable. All participants reported that iSHIFTup helped them to manage their skin care, improved their skin care routine, and supported healthy skin care activities. A majority of users indicated that they were able to implement program recommendations, and all users believed the Internet was a good method for delivering pressure ulcer prevention programs. This is the first paper to focus on a skin care Internet intervention for adults with SCI. | Development and perceived utility and impact of a skin care Internet intervention |
S2214782914000220 | The current study is a qualitative follow-up of a study on guided internet-delivered cognitive behavior therapy (ICBT) for social anxiety disorder (SAD), conducted four years after treatment completion. The main aim was to capture participants' description of their experiences of the treatment, their view on treatment effects, memories of the treatment, and whether they continued using the gained knowledge after treatment. Sixty participants were selected from the original study's treatment group. A criterion based sampling approach was used based on the obtained treatment effect, and with a minimum of five completed treatment modules. E-mail invitations were sent, with information about the follow-up and the instruction to respond if interested in participating. Twelve semi-structured interviews were made and the material was analyzed using an approach based on grounded theory. The results showed that all participants found the treatment to have some effect, but they also found it to be demanding, difficult, and hard. Many appreciated to hear of the experiences of other participants in the online forum. Under the theme of memory, most could describe the setup of the treatment in general terms. The exposure module was mentioned by all, cognitive restructuring by most, and some also reported memories of the psychoeducation. A core process was identified which involved how the attained treatment effect was viewed over the time, and how this view changed from treatment completion to current time. The findings outlined in this study describe how treatment effects can be sustained via an active approach to the treatment and the symptoms of SAD. | Experiences of internet-delivered cognitive behavior therapy for social anxiety disorder four years later: A qualitative study |
S2214782914000232 | Background Generalised Anxiety Disorder (GAD) is a high prevalence, chronic disorder that can be treated effectively through a number of web-based programs. However, online web programs for GAD have not been compared to standard pharmacological treatment. The present study compares an Internet Intervention (Active Website) for GAD and a selective serotonin re-uptake inhibitor (SSRI) (Sertraline), with an online attention placebo condition (Control Website). Objective To evaluate the effectiveness of a web-based intervention for GAD in comparison to standard antidepressant medication and an online attention placebo condition over a 10week period, and with a follow-up at 6 and at 12months. Methods The study was part of a larger scale prevention program. 152 people aged 18–30years who met the criteria for GAD on the MINI received referrals to the treatment sub-study. The primary outcome was anxiety symptoms measured by the Generalised Anxiety Disorder 7-item Scale (GAD-7), and the secondary outcome was depression measured by the Center for Epidemiologic Studies Depression Scale (CES-D). Results There was very poor uptake to the trial (around 14% of those referred). However, even in this small sample, Sertraline compared to the Control Website was significant at post-test and 6months, and the Internet Intervention was significant at post-test. Relative to the Control Website condition at post-test, for the GAD-7 and CES-D respectively, the between group effect sizes were d =2.43 and d =0.68 for the Active Website condition, and 3.00 and 0.20 for the Sertraline condition. The within group effect size for the Control Website from baseline to post-test was −0.04 for the GAD-7 and 0.31 for CES-D respectively. Conclusions The findings will need to be extended and confirmed in a larger trial. However, they do suggest that both standard pharmacological treatment and online interventions for GAD are effective in samples with a diagnosis of GAD recruited via online methods. The low rate of engagement for face-to-face treatment by those who opt first for a web program suggests that treatment preferences are important in help-seeking. | The effectiveness of an online e-health application compared to attention placebo or Sertraline in the treatment of Generalised Anxiety Disorder |
S2214782914000244 | Introduction The aim of this study was to systematically review the impact of guidance on the efficacy of Internet-based interventions. Methods Included were RCTs with a comparison of (1) guided vs. unguided interventions, (2) different doses of guidance, (3) different qualification levels of e-coaches, and (4) synchronous vs. asynchronous communication mode. Outcomes were symptom severity, completer rates and number of completed intervention modules. A systematic search of MEDLINE, CENTRAL and PsycINFO, PsycARTICLES and Psyndex (search date 4th June 2013) was conducted, as well as a hand search of trial-registers and the reference lists of included articles. Methodological quality was rated using the Cochrane Risk of Bias tool. Relevant study characteristics and outcome data were extracted. Random-effects analyses were conducted if appropriate. Results 5328 articles were retrieved of which 14 fulfilled inclusion criteria. Guided interventions were significantly superior to unguided interventions ((symptom severity: standardized mean difference (SMD)=−.27 [95% CI: −.45; −.10]), n=8; completed modules: SMD =.52 [.37; .67], n=7; completer rate: OR =2.76 [1.68; 4.53], n=6). The four trials that examined different levels of e-coach qualification showed no significant differences on either of the outcome measures. Only one trial each examined the remaining two research questions, without significant effects on either of the outcome measures. Conclusions Guidance is a beneficial feature of Internet-based interventions, although its effect is smaller than reported before when compared to unguided interventions. The qualification of the e-coaches seems of minor importance. However, methodological limitations need to be considered when interpreting these findings. Overall, the number of studies was small and mainly limited to depression and social phobia restricting the generalizability of the findings. | The impact of guidance on Internet-based mental health interventions — A systematic review |
S2214782914000256 | Background Internet-administered cognitive behavioural therapy (iCBT) is an effective treatment of depression, yet much remains to be learned about the specific mechanisms influencing symptom reduction. Although previous research has consistently shown that therapist-guided iCBT is more effective than unguided iCBT, it is unknown whether the medium used for therapist-client communication has an impact on results. Methods Thirty-eight subjects with major depression were recruited from the waiting list of another iCBT study and randomised to a guided iCBT program with therapist guidance either by telephone calls (n =19) or e-mail correspondence (n =19). Outcome measures were self-rated measures of depression, anxiety and quality of life. Results At post-treatment, both groups showed significant and large symptom reductions yet did not differ from each other. Neither was there any between-group difference in client-rated therapeutic alliance or treatment engagement. Symptom reductions were maintained at a three-month follow-up. Conclusion Therapist guidance by telephone does not appear to differ from therapist guidance by e-mail in iCBT for depression, although further research featuring larger samples is necessary to draw more definite conclusions. Trial registration: None | The impact of telephone versus e-mail therapist guidance on treatment outcomes, therapeutic alliance and treatment engagement in Internet-delivered CBT for depression: A randomised pilot trial |
S2214782914000268 | Internet interventions provide an option for those who either cannot or choose not to engage with traditional treatments. Most research on internet interventions involves guided or supported interventions. However, unsupported interventions offer considerably more scalability and cost-effectiveness, which makes them attractive for large-scale implementation. In this study, 309 participants recruited via Google AdWords entered an unsupported cognitive–behavioral internet intervention for depressive symptoms. To maximize the ecological validity of the study, participants received no incentives or live contact with study personnel. Furthermore, the study was open to individuals at any level of depressive symptoms, and all participants received the active intervention. The main outcome measures were depressive symptom level and self-efficacy in managing depressive symptoms. At follow-up, depression scores were significantly lower than baseline scores at each follow-up point (1, 2, 4, and 7months), with pre–post effect sizes ranging from medium to large. Follow-up depression self-efficacy scores were significantly higher than baseline scores at each follow-up point, with pre–post effect sizes in the medium range. The results remained significant when analyzing only participants with depression scores indicative of a presence of a major depressive episode; results likewise remained significant when employing the conservative last observation carried forward convention, even in the presence of high attrition observed in this study. The results illustrate the potential of unsupported internet intervention to address the health needs of the global community. | Results from a trial of an unsupported internet intervention for depressive symptoms |
S221478291400027X | Sustainable online peer-to-peer support groups require engaged members. A metric commonly used to identify these members is the number of posts they have made. The 90-9-1 principle has been proposed as a ‘rule of thumb’ for classifying members using this metric with a recent study demonstrating the applicability of the principal to digital health social networks. Using data from a depression Internet support group, the current study sought to replicate this finding and to investigate in more detail the model of best fit for classifying participant contributions. Our findings replicate previous results and also find the fit of a power curve (Zipf distribution) to account for 98.6% of the variance. The Zipf distribution provides a more nuanced image of the data and may have practical application in assessing the ‘coherence’ of the sample. | Describing the distribution of engagement in an Internet support group by post frequency: A comparison of the 90-9-1 Principle and Zipf's Law |
S2214782914000281 | Men with prostate cancer are not routinely offered psychosocial support despite strong evidence that being diagnosed with prostate cancer poses significant quality of life concerns and places the patient at elevated risk of developing a range of mental health disorders. The objective of this study was to develop an online psychological intervention for men with prostate cancer and to pilot test the feasibility and acceptability of the intervention. Development of the intervention involved a multidisciplinary collaboration, adapting face-to-face and group intervention strategies for an online format. The full online intervention and moderated forum were pilot tested with 64 participants who were recruited from urology practices in Melbourne, Victoria, Australia. After consenting to participate and creating a personal account in the online programme, participants completed baseline demographic questionnaires. Participants were provided access to the programme for 6–12weeks. After completing the programme participants completed an online survey to assess intervention and forum utilisation and satisfaction, as well as suggest intervention refinements following their use of the intervention. Patient satisfaction was calculated using mean responses to the satisfaction questionnaire. The intervention was received positively with 47.82% of participants highly satisfied with the programme, and 78.26% said they would recommend it to a friend. Participants' qualitative feedback indicated good acceptability of the online intervention. A number of technical and participant engagement issues were identified and changes recommended as a result of the feasibility testing. | Development, feasibility and usability of an online psychological intervention for men with prostate cancer: My Road Ahead |
S2214782914000293 | Objective Well-being is an important prerequisite for the mental health and work functioning of nurses and allied health professionals. The objective of this study was to examine the effectiveness of a workers' health surveillance (WHS) module that offers screening, tailored feedback and online interventions targeting positive mental health and mental health complaints. WHS is a strategy at the workplace to implement preventive action by identifying and treating health complaints. Methods All wards of one hospital were randomized, and all nurses and allied health professionals working in these wards (N=1140) were invited to participate in either the Online Intervention group (OI) or the Waitlisted control group (WL). Primary outcome was positive mental health (Mental Health Continuum — Short Form, MHC-SF); secondary outcomes were work engagement (Utrecht Work Engagement Scale, UWES), a specific well-being measure (WHO-5 Well-being Index) and mental health symptoms (Brief Symptom Inventory, BSI). Online self-report measurements were conducted at baseline, and after three and six months. Results Participation rate for the intervention at baseline was 32% (NOI =178; NWL =188). The intervention significantly enhanced positive mental health, in comparison to the control group (F=3.46, p=0.03). Cohen's d was 0.37 at post-test and 0.28 at follow-up, which can be considered as a moderate effect and a small effect respectively. In particular, psychological well-being (a subscale on the MHC-SF) was enhanced (Cohen's d 0.43 at post-test and 0.50 at follow-up). No significant or relevant differences between groups on secondary outcomes were found. The uptake and compliance of the online interventions was very low (28/178, 16% logged in; 9/178, 5% started with one or more modules within an intervention). Conclusion We can conclude that the intervention was capable of enhancing positive mental health. However, due to a high attrition rate, especially in the intervention group, this result should be considered with caution. Improvement of the screening instrument, more use of persuasive technology within the interventions and individual guidance to support engagement and compliance may be recommended. | Workplace mental health promotion online to enhance well-being of nurses and allied health professionals: A cluster-randomized controlled trial |
S221478291400030X | There is evidence from randomized control trials that internet-based cognitive behavioral therapy (iCBT) is efficacious in the treatment of anxiety and depression, and recent research demonstrates the effectiveness of iCBT in routine clinical care. The aims of this study were to implement and evaluate a new pathway by which patients could access online treatment by completing an automated assessment, rather than seeing a specialist health professional. We compared iCBT treatment outcomes in patients who received an automated pre-treatment questionnaire assessment with patients who were assessed by a specialist psychiatrist prior to treatment. Participants were treated as part of routine clinical care and were therefore not randomized. The results showed that symptoms of anxiety and depression decreased significantly with iCBT, and that the mode of assessment did not affect outcome. That is, a pre-treatment assessment by a psychiatrist conferred no additional treatment benefits over an automated assessment. These findings suggest that iCBT is effective in routine care and may be implemented with an automated assessment. By providing wider access to evidence-based interventions and reducing waiting times, the use of iCBT within a stepped-care model is a cost-effective way to reduce the burden of disease caused by these common mental disorders. | The use of automated assessments in internet-based CBT: The computer will be with you shortly |
S2214782914000311 | Social anxiety disorder (SAD) is a common, chronic and disabling mental disorder. Cognitive Behaviour Therapy (CBT) is a highly effective treatment of SAD and internet CBT (iCBT) offers a cost-effective and convenient alternative to face to face approaches, with high fidelity and demonstrated efficacy. The aim of the current paper was to evaluate the effectiveness of an iCBT programme for SAD (The This Way Up Clinic Shyness Programme) when delivered in routine practice through two different pathways. Patients in the prescription pathway (Study 1, N=368, 50% female, mean age=34) were ‘prescribed’ the Shyness Programme by a registered practitioner of the This Way Up Clinic who supervised their progress throughout the programme. Patients in the referral pathway (Study 2, N=192, 50% female, mean age=36) were referred to the This Way Up Clinic and supervised by a specialist CBT clinician at the clinic. Intention-to-treat marginal model analyses demonstrated significant reductions in primary outcomes of social anxiety symptoms (Mini-SPIN) and psychological distress (K10), corresponding to large effect sizes (Cohen's d =.82–1.09, 95% CIs .59–1.31) and secondary outcomes of impairment (WHODAS-II) and depressive symptoms (PHQ9), corresponding to small effect sizes (Cohen's d =.36–.46, 95% CIs .19–.68) for patients in both pathways. Results provide evidence of the effectiveness of iCBT for social anxiety disorder when delivered in routine practice. | The effectiveness of internet cognitive behaviour therapy (iCBT) for social anxiety disorder across two routine practice pathways |
S2214782914000323 | Self-guided internet-delivered cognitive behavior therapy (iCBT) has considerable public health potential for treating anxiety and depression. However, no research has examined the use of self-guided iCBT, that is, treatment without contact with a clinician, specifically for older adults. The aim of the present study was to undertake a preliminary examination of the acceptability, efficacy and health economic impact of two entirely self-guided iCBT programs for adults over 60years of age with anxiety and depression. Two separate single-group feasibility open trials of self-guided iCBT were conducted, the Anxiety Trial (n=27) and the Depression Trial (n=20), using the control groups of two randomized controlled trials. The online treatment packages consisted of five online educational lessons, which were delivered over 8weeks without clinical contact. Participants rated the interventions as acceptable with more than 90% reporting the course was worth their time and more than 70% of participants completing at least 3 of the 5 lessons within the eight weeks. Significant reductions on measures of anxiety (Generalized Anxiety Disorder 7-item; GAD-7) and depression (Patient Health Questionnaire 9-item; PHQ-9) were observed from pre-treatment to post-treatment in both the Anxiety Trial (GAD-7 Cohen's d =1.17; 95% CI: 0.55 to 1.75) and the Depression Trial (PHQ-9 Cohen's d =1.06; 95% CI: 0.33 to 1.73). The economic analyses indicated that there was statistically significant improvement in health-related quality of life compared to baseline and marginally higher costs associated with treatment for both the Anxiety Trial ($69.84; 95% CI: $4.24 to $135.45) and the Depression Trial ($54.98; 95% CI: $3.84 to $106.12). The results provide preliminary support for the potential of entirely self-guided iCBT for older adults with anxiety and depression and indicate larger scale and controlled research trials are warranted. | Examining self-guided internet-delivered cognitive behavior therapy for older adults with symptoms of anxiety and depression: Two feasibility open trials |
S2214782914000335 | Women with postnatal depression (PND) face significant barriers to treatment that may be overcome by internet based delivery of treatment. Demand for a self-help internet postnatal treatment offered via a parenting site was high, but attrition rates were also high. To gain patient perspectives on engagement and barriers to the Netmums' “Helping with Depression” treatment. Semi-structured interviews were conducted with 17 participants selected from the Netmums trial. Thematic analysis revealed motivators and barriers to treatment. Women reported that the flexibility and anonymity of internet interventions fit with their postnatal circumstances. They identified that the relevance of the intervention to their personal circumstances, expectations of motherhood, stigma about depression and motherhood, hopelessness about their ability to improve, previous negative experiences with treatment and treatment seeking, and a lack of practical and emotional support contributed to feelings of being overwhelmed. Women who felt more overwhelmed were more likely to discontinue treatment. Women suggested that support would reduce the impact of barriers and improve adherence. Open access, self-help internet interventions are acceptable to women with postnatal depression, but it is critical to provide tailoring and support to help overcome barriers and improve treatment adherence. | Women's experiences of factors affecting treatment engagement and adherence in internet delivered Behavioural Activation for Postnatal Depression |
S2214782914000347 | Objective To evaluate an online intervention for adults with ADHD that aimed to improve organizational skills and attention with the help of smartphone applications. Method Participants (n=57) were recruited and assessed through questionnaires and telephone interviews. Diagnoses of ADHD were confirmed for 83% of the participants, 5% most probably had the diagnoses, and 12% did not fulfill all diagnostic criteria despite high levels of symptoms. Participants were randomized between the intervention (n=29) and a wait-list control group (n=28). The 6-week intervention involved support from a coach in finding a routine for organizing everyday life with the help of smartphone applications. The primary outcome measure was ASRS Inattention. Secondary outcomes were ASRS sub-scale Hyperactivity and measures of depression, anxiety, stress, quality of life and general level of functioning. Blind evaluators also assessed improvement in organization and inattention at post treatment. Result The participants receiving the Living Smart course reduced their average scores on ASRS-Inattention from 28.1 (SD=4.5) to 22.9 (SD=4.3) which was a significantly larger reduction than found in the control group. 33% of participants were considered clinically significantly improved according to the blind evaluator, compared to 0% in the control group. The same results were found when only participants with a confirmed diagnose were included in the analyses. Conclusion Adults with ADHD seem to be able to use smartphone applications to organize their everyday life and can be taught how to do this via online interventions. | Living SMART — A randomized controlled trial of a guided online course teaching adults with ADHD or sub-clinical ADHD to use smartphones to structure their everyday life |
S2214782914000359 | Background Acceptance and Commitment Therapy (ACT) is an effective intervention for the treatment of chronic pain. Internet-based pain interventions might be an effective and cost-effective way to overcome treatment barriers of traditional face-to-face pain interventions such as the lack of availability and accessibility. However, little is known about the general (cost-)effectiveness of internet-based pain interventions and the specific (cost-) effectiveness of guided and unguided pain interventions. Therefore, the aim of this study is to investigate the effectiveness and cost-effectiveness of a guided and unguided ACT-based online intervention for persons with chronic pain (ACTonPain). Methods ACTonPain is a pragmatic three-armed randomised controlled trial comparing ACTonPain with or without therapist guidance against a waitlist control group. Both active conditions differ only with regard to guidance provided by an eCoach, who sends feedback after each module. This study aims to include 300 participants. Randomisation and allocation will be performed using permuted block randomisation with variable block sizes. The intervention contains seven ACT-based modules with interactive exercises, and audio and video clips. Furthermore, the participants have the opportunity to receive daily text messages. Online self-assessments will take place at pre- and post-treatment, as well as at 6month follow-up. The primary outcome is pain interference. Secondary outcomes include physical and emotional functioning, pain intensity, ACT-related variables as well as health-related quality of life. Moreover, a cost-effectiveness analysis will be conducted from a societal perspective. Demographic and medical variables will be assessed on the basis of self-reports in order to detect potential moderators or mediators of the effects. The data will be analysed on an intention-to-treat basis and also using per-protocol analyses. Discussion This study will contribute to the evidence base of internet-based pain interventions and provide valuable information about the treatment success and cost-effectiveness regarding the intervention's level of guidance (self-help only vs. guided self-help). If ACTonPain is shown to be effective, investigations in different healthcare settings should follow, to examine possible ways of implementing ACTonPain into existing healthcare systems. The implementation of ACTonPain could help to shorten waiting times, expand access to pain treatment and, potentially, also reduce treatment costs. | Effectiveness and cost-effectiveness of a guided and unguided internet-based Acceptance and Commitment Therapy for chronic pain: Study protocol for a three-armed randomised controlled trial. |
S2214782914000360 | Background Parkinson's disease (PD) is often associated with depression and anxiety. The availability of evidence-based psychological interventions is low. Objective This pilot study investigates the feasibility and preliminary effect of internet-based cognitive behavioral therapy (ICBT) for depression and anxiety in PD. Methods 9 patients with PD with comorbid symptoms on the relevant subscale of Hospital Anxiety and Depression Scale (HADS), of either depression (HADS-D>7) or anxiety (HADS-A>7) received 12weeks of ICBT, specially adapted for depression and anxiety in PD. Primary outcome was change in depression and anxiety symptoms, measured with HADS total score. Effects on non-motor symptoms, PD specific health and quality of life and insomnia were explored, plus the participant's involvement, satisfaction, and subjective evaluation of the treatment. Results Participants reported lower symptoms on HADS after ICBT (Cohen's d =0.79, p<0.05). However, levels of inactivity were rather high and questionnaires and comments from participants suggested that the treatment can be improved, for example by adding more therapist support. Conclusions The results suggest that ICBT could be a feasible way to alleviate depression and anxiety in PD. However, a somewhat simplified treatment and different ways to provide support to enhance adherence and outcome are warranted. | Internet-based cognitive behavioral therapy for depression and anxiety in Parkinson's disease — A pilot study |
S2214782914000372 | Internet-based problem-solving training (IPST) effectively reduces depressive symptoms in employees. Yet, it is unknown which employees benefit most from this particular treatment. The study aimed to identify predictors and moderators of treatment outcome in IPST offered to employees with depressive symptoms. Within a randomized controlled trial (N=150), designed to test the effectiveness of IPST, variables that predict and moderate the effects of IPST when compared with a waitlist control group (WLC) were explored. The outcome was change in depression severity, assessed using the Center for Epidemiological Studies Depression Scale (CES-D). Both depression severity and other psychopathological symptoms and potential predictors/moderators were assessed as self-reports at baseline (t1) and in follow-up assessments after seven weeks (t2), three months (t3) and six months (t4). Higher depression severity at baseline predicted improvement in depressive symptomology in follow-up assessments after seven weeks, and three- and six months. Depression severity moderated the effectiveness of IPST assessed at six-month follow-up. Simple slope analyses revealed that the long-term effectiveness of the intervention was more pronounced among participants with high (CES-D range: 33–44, M=37.0, SD=3.2) and moderate (CES-D range: 14–32, M=23.1, SD=5.6) depression baseline scores, compared to participants displaying low depression baseline scores (CES-D range: 5–13, M=9.0, SD=2.2). No indication was found that participants presenting low depression severity at baseline significantly benefitted from IPST in the long-term. IPST might be appropriate for employees with a wide range of different characteristics. While there appears to be no reason to exclude employees with severe depression from Internet-based occupational mental health interventions, for employees low in depression severity, watchful waiting or potentially no intervention should be considered. These findings may not apply to other low-intensity interventions and/or target groups. | For whom are internet-based occupational mental health interventions effective? Moderators of internet-based problem-solving training outcome |
S2214782914000396 | Recently, a number of studies have investigated treatments administered via smartphones showing that this treatment format has a potential to be effective. However, we still have limited knowledge of how patients experience this treatment format. The objective of this study was to explore participants' views of a smartphone-based behavioral activation treatment. In-depth interviews were conducted with 12 strategically (participants with different overall experiences) selected participants, suffering from major depression according to the DSM-IV. The interview data were processed with the aid of thematic analysis. The analysis generated the three main themes: Commitment, Treatment and Lack of important components, with attached subthemes. In conclusion, the findings from the current study correspond with existing knowledge in the field of internet-based treatment. Considering that this kind of treatment is still quite new, the need for further research and development is considerable. Nevertheless, its availability, assimilation into users' everyday lives and possible motivational qualities speak of its potential. | Experiences of a guided smartphone-based behavioral activation therapy for depression: A qualitative study |
S2214782914000414 | Introduction Promising Web-based interventions for smokeless tobacco cessation have emerged. We describe a randomized controlled trial (RCT) testing the relative benefits of adding the nicotine lozenge as an adjunct to the MyLastDip Web-based smokeless tobacco cessation intervention. Methods 407 smokeless tobacco users who wanted to quit were recruited, screened online, and randomly assigned to one of two conditions: (a) the interactive MyLastDip Web-based intervention (Web Only; n =202), or (b) the website plus the offer of nicotine lozenges (Web+Lozenge; n =205). MyLastDip program content is grouped according to three sequential frames: preparing to quit, quitting, and staying quit. If a participant reported a lapse then the program would provide tailored content on lessons learned and starting over (“retooling”). The primary outcome was 7-day point prevalence tobacco abstinence measured at follow-up assessments that occurred 3months and 6months post-enrollment. Results Assessment completion rates were 71.5% at 3months, 72.9% at 6months, and 65.1% for both 3 and 6months, and did not differ by condition. Using Intent to Treat analyses, the Web+Lozenge condition was associated with a significantly higher 7-day point prevalence tobacco abstinence rate than the Web Only condition at 3months (43.4% vs. 29.7%, p =.004), at the combined 3 and 6month assessment of repeated point prevalence (35.6% vs. 23.3%, p =.007), but not at 6months (44.4% vs. 35.1%, p =.057). Similar results were obtained for smokeless tobacco abstinence. Participants reported being satisfied with their programs and the Web+Lozenge condition participants visited the MyLastDip program more often (p <.001). A composite engagement measure of the number and duration of program visits was positively related to 6-month tobacco abstinence (p =.009). Conclusions Consistent with previous research, the MyLastDip Web-based tobacco cessation intervention encouraged long-term levels of tobacco and smokeless tobacco abstinence. The addition of nicotine lozenges significantly improved both participant engagement and self-reported 7-day point prevalence tobacco abstinence at 3months and when considering 3- and 6-month repeated point prevalence tobacco abstinence. | Randomized controlled trial examining the adjunctive use of nicotine lozenges with MyLastDip: An eHealth smokeless tobacco cessation intervention |
S2214782915000020 | Objective Research has convincingly demonstrated that Internet interventions are effective for anxiety and depression and it is suggested that these interventions can reduce therapist time and thus save costs. Therefore, many Dutch mental health organizations have started to implement these treatments into their services. They usually apply the Internet interventions in combination with the face-to-face treatments, i.e. blended treatments. To date, no empirical work has examined if implementing blended treatments actually contributes to treatment effects and cost savings. The objective of this naturalistic study was to examine this issue, using routine mental health care data for patients with depression or anxiety. Methods All 4448 records of patients with depression or anxiety seeking help at a large mental health service between October 2009 and December 2012 were obtained. Data on GAF-index, therapist time, and therapist costs of patients who received face-to-face treatments were compared with those who received blended care, using propensity score matching. Results Blended care was applied in 3.6% of all patients and was given more frequently to younger patients and patients with an anxiety disorder. There were no significant differences in symptom severity at baseline between the two treatment groups, nor were there significant differences between the two groups in symptom improvement. Patients who received blended care had more treatment sessions (face-to-face plus online sessions) than patients who received standard treatment, which resulted in significantly more treatment time and higher costs. Conclusion Findings suggest that in this sample blended care is more expensive compared to established face-to-face treatments and doesn't lead to additional benefits in terms of general functioning. This might be caused by suboptimal implementation strateges. | Costs and effects of Internet cognitive behavioral treatment blended with face-to-face treatment: Results from a naturalistic study |
S2214782915000032 | mHealth interventions that deliver content via mobile phones represent a burgeoning area of health behavior change. The current paper examines two themes that can inform the underlying design of mHealth interventions: (1) mobile device functionality, which represents the technological toolbox available to intervention developers; and (2) the pervasive information architecture of mHealth interventions, which determines how intervention content can be delivered concurrently using mobile phones, personal computers, and other devices. We posit that developers of mHealth interventions will be able to better achieve the promise of this burgeoning arena by leveraging the toolbox and functionality of mobile devices in order to engage participants and encourage meaningful behavior change within the context of a carefully designed pervasive information architecture. | From black box to toolbox: Outlining device functionality, engagement activities, and the pervasive information architecture of mHealth interventions |
S2214782915000044 | A number of health problems are associated with significant stigma, a social phenomenon in which individuals become the object of negative stereotypes. In addition to experiencing negative reactions from others, stigmatised individuals and groups can experience harmful consequences when they internalise these negative prevailing attitudes. The objective of this paper was to consider the potential to develop Internet-based health-related interventions explicitly targeting the effects of stigma on the individual. A review of the literature was conducted to synthesise current conceptualisations of stigma and self-stigma across a number of groups, and to identify current intervention developments. Self-stigma reduction strategies developed for in-person services include cognitive reframing, myth busting, contact with other members of the stigmatised group, and disclosure promotion. The development and provision of interventions targeting self-stigma within an online environment is in its infancy. Our review considers there to be particular potential of online interventions for this target, associated with the capacity of the Internet to promote having contact with peers within one’s stigmatised group, and for user interaction and empowerment. We conclude that self-stigma is a domain in which there is significant potential for innovation with health-related interventions, and provide a number of recommendations for online intervention development. | Developing Internet interventions to target the individual impact of stigma in health conditions |
S2214782915000056 | While Internet interventions can improve health behaviors, their impact is limited by program adherence. Supporting program adherence through telephone counseling may be useful, but there have been few direct tests of the impact of support. We describe a Telephone Motivational Interviewing (MI) intervention targeting adherence to an Internet intervention for drivers with Type 1 Diabetes, DD.com, and compare completion of intervention benchmarks by those randomized to DD.com plus MI vs. DD.com only. The goal of the pre-intervention MI session was to increase the participant's motivation to complete the Internet intervention and all its assignments, while the goal of the post-treatment MI session was to plan for maintaining changes made during the intervention. Sessions were semi-structured and partially scripted to maximize consistency. MI Fidelity was coded using a standard coding system, the MITI. We examined the effects of MI support vs. no support on number of days from enrollment to program benchmarks. Results show that MI sessions were provided with good fidelity. Users who received MI support completed some program benchmarks such as Core 4 (t176 df =−2.25; p<.03) and 11 of 12 monthly driving diaries significantly sooner, but support did not significantly affect time to intervention completion (t177 df =−1.69; p<.10) or rates of completion. These data suggest that there is little benefit to therapist guidance for Internet interventions including automated email prompts and other automated minimal supports, but that a booster MI session may enhance collection of follow-up data. | Motivational Interviewing support for a behavioral health internet intervention for drivers with type 1 diabetes |
S2214782915000068 | Anxiety and depression are prevalent among university students and many universities offer psychological services to assist students. Unfortunately, students can experience barriers that prevent access to these services and many university services experience difficulties meeting demand. The present pragmatic randomised controlled trial examined the preliminary efficacy and acceptability of a transdiagnostic and internet-delivered cognitive behavioural therapy (CBT) programme for university students seeking help with anxiety and depression. Participants were randomly allocated to either a treatment group (n =30) or a waitlist-control group (n =23). The treatment group received weekly contact with a therapist, via telephone or a secure messaging system, as well as automated emails that guided their progress through the programme. Significant reductions were found on standard measures of anxiety (Cohen's d =0.66; 95% CI: 0.13 to 1.17) and depression (Cohen's d =0.81; 95% CI: 0.27 to 1.32) among the treatment group participants, but no significant differences were found between the treatment and control groups at post-treatment. However, more pronounced reductions were found among treatment group participants with clinical level symptoms of anxiety (Cohen's d =1.33; 95% CI: 0.62 to 1.99) and depression (Cohen's d =1.59; 95% CI: 0.81 to 2.30), who reported significantly lower levels of symptoms than control group participants at post-treatment. These reductions were maintained at 3-month follow-up and participants rated the intervention as acceptable. The results provide preliminary support for the potential of iCBT for university students with anxiety and depression. However, larger scale implementation trials considering a broader range of outcomes are required. Trial registration Australian and New Zealand Clinical Trials Registry: ACTRN12612000212853. | The UniWellbeing course: A randomised controlled trial of a transdiagnostic internet-delivered cognitive behavioural therapy (CBT) programme for university students with symptoms of anxiety and depression |
S221478291500007X | Growth models (also known as linear mixed effects models, multilevel models, and random coefficients models) have the capability of studying change at the group as well as the individual level. In addition, these methods have documented advantages over traditional data analytic approaches in the analysis of repeated-measures data. These advantages include, but are not limited to, the ability to incorporate time-varying predictors, handle dependence among repeated observations in a very flexible manner, and to provide accurate estimates with missing data under fairly unrestrictive missing data assumptions. The flexibility of the growth curve modeling approach to the analysis of change makes it the preferred choice in the evaluation of direct, indirect and moderated intervention effects. Although offering many benefits, growth models present challenges in terms of design, analysis and reporting of results. This paper provides a nontechnical overview of growth models in the analysis of change in randomized experiments and advocates for their use in the field of internet interventions. Practical recommendations for design, analysis and reporting of results from growth models are provided. | Modeling individual differences in randomized experiments using growth models: Recommendations for design, statistical analysis and reporting of results of internet interventions |
S2214782915000081 | The relationship between what a client writes when communicating with an online therapist and treatment outcome in internet-based cognitive behavior therapy (ICBT) is largely unknown. The aim of this study was to address if written correspondence from the client to the therapist correlates with outcome and treatment completion. A total of 29 participants with mild to moderate depression were included from an ongoing randomized controlled trial targeting depression. Content analysis involving ten categories was performed on all emails and module responses sent by the participants to their internet therapist. A total of 3756 meaning units were identified and coded. Significant positive correlations were found between change in depression and statements in the two categories “observing positive consequences” (r =.49) and “alliance” (r =.42). Treatment module completion correlated with seven categories. The result suggests that text dealing with alliance and observing positive consequences can be used as indicators of how the treatment is progressing. This study suggests that written correspondence from an online client can be divided into ten categories and the frequency of those can be used by internet therapists to individualize treatment and perhaps make ICBT more effective. | A content analysis of client e-mails in guided internet-based cognitive behavior therapy for depression |
S2214782915000093 | Background Use of smokeless tobacco (moist snuff and chewing tobacco) is a significant public health problem but smokeless tobacco users have few resources to help them quit. Web programs and telephone-based programs (Quitlines) have been shown to be effective for smoking cessation. We evaluate the effectiveness of a Web program, a Quitline, and the combination of the two for smokeless users recruited via the Web. Objectives To test whether offering both a Web and Quitline intervention for smokeless tobacco users results in significantly better long-term tobacco abstinence outcomes than offering either intervention alone; to test whether the offer of Web or Quitline results in better outcome than a self-help manual only Control condition; and to report the usage and satisfaction of the interventions when offered alone or combined. Methods Smokeless tobacco users (N=1683) wanting to quit were recruited online and randomly offered one of four treatment conditions in a 2×2 design: Web Only, Quitline Only, Web+Quitline, and Control (printed self-help guide). Point-prevalence all tobacco abstinence was assessed at 3- and 6-months post enrollment. Results 69% of participants completed both the 3- and 6-month assessments. There was no significant additive or synergistic effect of combining the two interventions for Complete Case or the more rigorous Intent To Treat (ITT) analyses. Significant simple effects were detected, individually the interventions were more efficacious than the Control in achieving repeated 7-day point prevalence all tobacco abstinence: Web (ITT, OR=1.41, 95% CI=1.03, 1.94, p =.033) and Quitline (ITT: OR=1.54, 95% CI=1.13, 2.11, p =.007). Participants were more likely to complete a Quitline call when offered only the Quitline intervention (OR=0.71, 95% CI=.054, .093, p =.013), the number of website visits and duration did not differ when offered alone or in combination with Quitline. Rates of program helpfulness (p <.05) and satisfaction (p <.05) were higher for those offered both interventions versus offered only Quitline. Conclusion Combining Web and Quitline interventions did not result in additive or synergistic effects, as have been found for smoking. Both interventions were more effective than a self-help Control condition in helping motivated smokeless tobacco users quit tobacco. Intervention usage and satisfaction were related to the amount intervention content offered. Usage of the Quitline intervention decreased when offered in combination, though rates of helpfulness and recommendations were higher when offered in combination. Trial registration Clinicaltrials.gov. NCT00820495; http://clinicaltrials.gov/ct2/show/NCT00820495. | Randomized controlled trial of the combined effects of Web and Quitline interventions for smokeless tobacco cessation |
S221478291500010X | Many trials on Internet-delivered psychological treatments have had problems with nonadherence, but not much is known about the subjective reasons for non-adhering. The aim of this study was to explore participants' experiences of non-adherence to Internet-delivered psychological treatment. Grounded theory was used to analyze data from seven in-depth interviews with persons who had non-adhered to a study on Internet-delivered cognitive behavioral therapy for generalized anxiety disorder. The process of non-adherence is described as an interaction between patient factors and treatment factors. A working model theory was generated to illustrate the experience of nonadherence. The model describes a process where treatment features such as workload, text-content complexity and treatment process don't match personal prerequisites regarding daily routines, perceived language skills and treatment expectations respectively, resulting in the decision to nonadhere. Negative effects were also stated as a reason for non-adherence. Several common strategies used for increasing adherence to Internet-delivered therapy in general are by these non-completers regarded as factors directly related to their reason for non-adherence. | Experiences of non-adherence to Internet-delivered cognitive behavior therapy: A qualitative study |
S2214782915000111 | Background People with mild intellectual disabilities or chronic psychiatric disorders often experience challenges in important aspects of life and need support in daily functioning. In this study, we examined the feasibility of a web-based program enabling professional support of patients with chronic conditions in their daily functioning. Method A triangulated research method was applied involving a combination of the results of semi-structured interviews and standardized questionnaires. We conducted face-to-face interviews with clients (n =11) and telephone interviews with coaches (n =10) on their initial experiences with the program. In addition, clients took an online pre-test (n =39) – post-test questionnaire (n =30) which measured quality of life, empowerment, mastery, social cohesion and satisfaction with care. Clients and coaches both received a questionnaire to report on the perceived usability of the program. Results Clients and coaches used the program and were positive about this new way of communicating. Clients were pleased that they could contact the coach at any time and experienced increased control over the support they received. Coaches reported positive effects on the levels of independence among clients, saved time and experienced greater flexibility in their scheduling. The implementation of the program did not lead to changes in quality of life, empowerment, mastery, social cohesion or satisfaction with care. Clients and coaches reported that the usability of the MPC could be improved through the use of an enhanced Internet connection. Conclusion The initial results of the use of web-based support for this client population seem promising and justify further research on online support for clients with mild intellectual disabilities or chronic psychiatric disorders. | Web-based support for daily functioning of people with mild intellectual disabilities or chronic psychiatric disorders: A feasibility study in routine practice |
S2214782915000123 | Background Sexual and intimate partner violence (IPV) is a leading cause of disease burden, with alcohol use strongly related to these behaviors. Online interventions have been shown to be effective in reducing both alcohol use and some alcohol-related problems. These programs are widely available especially to university students, a particularly high-risk group for sexual or IPV. Aim We aimed to systematically review the evidence for the effectiveness of online alcohol interventions in reducing sexual violence or IPV. Methods We searched electronic databases (PsycInfo, Embase, Global Health, Medline, CINAHI, Pubmed, and ProQuest) and hand searched key reviews. Results From 569 titles, 23 were assessed in detail: five articles (four studies) fulfilled the inclusion criteria. All these studies were undertaken in the USA, with three recruiting college students (n=17,332), and one using an emergency department (n=262) sample of adolescents. We summarized the characteristics of the samples, the interventions and outcomes for alcohol use and sexual violence or IPV. Most interventions were unguided, with only one group receiving a guided intervention. Effect sizes, where they could be calculated, were small (Cohen's d <0.2) or not significantly different to zero for alcohol, sexual violence or IPV outcomes. Conclusions Currently, there are insufficient data to evaluate the effectiveness of online alcohol interventions in reducing sexual or IPV. Given the prevalence of these behaviors and their association with alcohol use, this deficit requires urgent attention. | Online alcohol interventions, sexual violence and intimate partner violence: A systematic review |
S2214782915000135 | Background Smartphone applications for mental illnesses offer great potential, although the actual research base is still limited. Major depressive disorder and bipolar disorder are both common psychiatric illness for which smartphone application research has greatly expanded in the last two years. We review the literature on smartphone applications for major depressive and bipolar disoders in order to better understand the evidence base for their use, current research opportunities, and future clinical trends. Methods We conducted an English language review of the literature, on November 1st 2014, for smartphone applications for major depressive and bipolar disorders. Inclusion criteria included studies featuring modern smartphones running native applications with outcome data related to major depressive or bipolar disorders. Studies were organized by use of active or passive data collection and focus on diagnostic or therapeutic interventions. Results Our search identified 1065 studies. Ten studies on major depressive disorder and 4 on bipolar disorder were included. Nine out of 10 studies on depression related smartphone applications featured active data collection and all 4 studies on bipolar disorder featured passive data collection. Depression studies included both diagnostic and therapeutic smartphone applications, while bipolar disorder studies featured only diagnostics. No studies addressed physiological data. Conclusions While the research base for smartphone applications is limited, it is still informative. Numerous opportunities for further research exist, especially in the use of passive data for, major depressive disorder, validating passive data to detect mania in bipolar disorder, and exploring the use of physiological data. As interest in smartphones for psychiatry and mental health continues to expand, it is important that the research base expands to fill these gaps and provide clinically useful results. | Current research and trends in the use of smartphone applications for mood disorders |
S2214782915000147 | Background Many Internet-based treatments for depression and for alcohol misuse have a positive impact, yet little is known about how these treatments work. Most research on web-based interventions involves efficacy trials which, while important, offer little explanation about how people perceive and use online programs. Objective This study aimed to undertake a qualitative exploration of participants' experience, perceived impact and use of an integrated web-based program for comorbid depression and alcohol misuse. Specifically, it explored users' perspectives on the intensity of their treatment and the level of support they received. Methods Interviewees were drawn from participants in a randomised controlled trial of the OnTrack web-based treatment for depression and alcohol misuse, which compared Brief Self-Guided, Comprehensive Self-Guided and Comprehensive Therapist-Assisted versions of the program. Twenty-nine people (9–11 from each condition) completed semi-structured telephone interviews asking about their impressions and experiences with the program. Interview transcriptions were subject to a 6-step thematic analysis, employing a conceptual matrix to identify thematic differences across groups. Results Positive experiences and outcomes were more pronounced among participants receiving the comprehensive treatments than the brief one, but other responses were relatively consistent across conditions. A major theme was a wish for more individualisation and human contact, even in participants receiving emailed assistance. Some confused follow-up research assessments with therapist support. There was little correspondence between the perceived impact of the program and the amount reportedly completed, and some participants said they used strategies offline or completed exercises mentally. Conclusions This study highlighted discrepancies between how web-based treatments are intended to be used and how people actually engage with them. A challenge for the next wave of these interventions is the provision of individualised responses and coaching that retains an emphasis on self-management and constrains cost. | A qualitative exploration of Internet-based treatment for comorbid depression and alcohol misuse |
S2214782915000159 | Background Severe fatigue may persist for many years in cancer survivors and has a considerable impact on a patient's life. This condition is called cancer-related fatigue (CRF). Mindfulness-Based Cognitive Therapy has shown to significantly reduce CRF in cancer survivors. Internet-delivered interventions can be valuable for fatigued patients who are not able to travel to a healthcare institute because of the lack of energy and/or physical limitations. Therefore, we have developed a web-based, therapist guided individual 9-week Mindfulness-Based Cognitive Therapy (eMBCT) aimed at diminishing CRF. Objective The aim of this study was to evaluate the efficacy of eMBCT in a clinical setting in reducing fatigue severity and distress in cancer survivors. Methods This pilot study was based on data from severely fatigued cancer survivors who applied for eMBCT between 2009 and 2013. Our primary outcome measure was the change in self-reported web-assessed fatigue severity, measured with the Fatigue severity subscale of the Checklist Individual Strength before (baseline) and one month after (post-assessment) eMBCT. The secondary outcome was distress (HADS) and the proportion of participants that showed clinically relevant improvement on fatigue severity. Patients' satisfaction with using eMBCT and reasons for non-adherence were studied. Intention-to-treat analyses were performed using multiple imputations to deal with data loss at post-assessment. All patients had to be severely fatigued at baseline (≥35 on the fatigue severity subscale of the Checklist Individual Strength), were >18years old, had no history of psychosis or current Major Depressive Disorder, finished their last cancer treatment at least six months ago (mixed cancer types), and were not in the terminal phase of illness. Patients were recruited offline as well as online. Results Two-hundred fifty-seven patients (age range 22–79 (M =50.2, SD =10.7), 76% women, 44% breast cancer, most had had surgery, chemo- and/or radiotherapy) met our inclusion criteria. Paired samples t-tests showed that fatigue severity was significantly reduced post-assessment (t(18)=13.27, p <.001, Cohen's d: 1.45 as well as distress (t(46)=7.66, p <.001, Cohen's d: 0.71). Thirty-five percent (n =89) was clinically relevant improved at post-assessment and 62% (n =159) adhered to treatment. This study had a completion rate of 1.5 and a registration rate of 2.3. Conclusion These findings suggest that individual eMBCT may be effective in reducing fatigue in cancer survivors. A randomized controlled study with a large sample and longer follow up is needed to demonstrate the effectiveness of eMBCT for CRF. | Web-based individual Mindfulness-Based Cognitive Therapy for cancer-related fatigue — A pilot study |
S2214782915000160 | Twitter is increasingly investigated as a means of detecting mental health status, including depression and suicidality, in the population. However, validated and reliable methods are not yet fully established. This study aimed to examine whether the level of concern for a suicide-related post on Twitter could be determined based solely on the content of the post, as judged by human coders and then replicated by machine learning. From 18th February 2014 to 23rd April 2014, Twitter was monitored for a series of suicide-related phrases and terms using the public Application Program Interface (API). Matching tweets were stored in a data annotation tool developed by the Commonwealth Scientific and Industrial Research Organisation (CSIRO). During this time, 14,701 suicide-related tweets were collected: 14% were randomly (n =2000) selected and divided into two equal sets (Set A and B) for coding by human researchers. Overall, 14% of suicide-related tweets were classified as ‘strongly concerning’, with the majority coded as ‘possibly concerning’ (56%) and the remainder (29%) considered ‘safe to ignore’. The overall agreement rate among the human coders was 76% (average κ=0.55). Machine learning processes were subsequently applied to assess whether a ‘strongly concerning’ tweet could be identified automatically. The computer classifier correctly identified 80% of ‘strongly concerning’ tweets and showed increasing gains in accuracy; however, future improvements are necessary as a plateau was not reached as the amount of data increased. The current study demonstrated that it is possible to distinguish the level of concern among suicide-related tweets, using both human coders and an automatic machine classifier. Importantly, the machine classifier replicated the accuracy of the human coders. The findings confirmed that Twitter is used by individuals to express suicidality and that such posts evoked a level of concern that warranted further investigation. However, the predictive power for actual suicidal behaviour is not yet known and the findings do not directly identify targets for intervention. | Detecting suicidality on Twitter |
S2214782915000172 | Social anxiety disorder (SAD) and attentional bias are theoretically connected in cognitive behavioral therapeutic models. In fact, there is an emerging field focusing on modifying attentional bias as a stand-alone treatment. However, it is unclear to what degree these attentional biases are present before commencing treatment. The purpose of this study was to measure pre-treatment attentional bias in 153 participants diagnosed with SAD using a home-based Internet version of the dot-probe paradigm. Results showed no significant correlation for attentional bias (towards or away from negative words or faces) and the self-rated version of the Liebowitz Social Anxiety Scale (LSAS-SR). However, two positive correlations were found for the secondary measures Generalized Anxiety Disorder 7 (GAD-7) and Patient Health Questionnaire 9 (PHQ-9). These indicated that those with elevated levels of anxiety and depression had a higher bias towards negative faces in neutral–negative and positive–negative valence combinations, respectively. The unreliability of the dot-probe paradigm and home-based Internet delivery are discussed to explain the lack of correlations between LSAS-SR and attentional bias. Changes to the dot-probe task are suggested that could improve reliability. | Cognitive bias measurement and social anxiety disorder: Correlating self-report data and attentional bias |
S2214782915000184 | Objective Internet-based cognitive behavioral self-help treatments (iCBT) have been shown to successfully reduce the distress associated with tinnitus. Despite this success, little is known about the mechanisms that make iCBT for tinnitus sufferers work. Availability of minimal therapeutic support is assumed to positively influence treatment outcome in iCBT, but the lower limit of required support is not known. In face-to-face therapy, patients' positive outcome expectations have demonstrated an advantageous effect on outcome. The first aim of our study was thus to investigate the role of ‘on demand’ therapeutic guidance vs. no therapeutic support on treatment outcome in an iCBT for tinnitus sufferers. Our second aim was to investigate whether positive outcome expectations can predict treatment outcome. Methods A total of 112 tinnitus patients were randomly assigned to one of two groups (support-on-demand or non-support). Both groups received an established iCBT treatment for tinnitus. While participants in the support group (n=56) could ask a therapist for additional support, those in the other (n=56) received no therapeutic guidance. Tinnitus distress was assessed pre- and post-treatment via the Tinnitus Handicap Inventory (THI) and the Mini-Tinnitus Questionnaire (Mini-TQ). Pre-treatment outcome expectations were assessed using the Patient Questionnaire on Therapy Expectation and Evaluation (PATHEV). Results We observed significantly less tinnitus distress in the THI (support: t(55)=7.51, p≤.001; non-support: t(55)=7.68, p≤.001) and Mini-TQ (support: t(55)=8.24, p≤.001; non-support: t(55)=8.46, p≤.001) in both groups from pre- to post-treatment, but no significant differences between the groups or interactions. The PATHEV subscale “Hope of Improvement” significantly predicted treatment outcome as measured by the THI (β=0.28, p=.027). Conclusions The iCBT self-help program is a good treatment option for tinnitus sufferers whether or not support-on-demand is provided. Furthermore, our results show the importance of outcome expectations to the efficacy of iCBT in tinnitus patients. Future research should focus on discovering further predictors of treatment outcome. | The role of “on demand” therapist guidance vs. no support in the treatment of tinnitus via the internet: A randomized controlled trial |
S2214782915000196 | Background Accumulating evidence indicates that face-to-face physical activity interventions improve the physical and mental health of people with mental disorders. However, it is unclear whether internet-delivered physical activity interventions are also efficacious. Objective Our aim was to determine the effect of online physical activity interventions on the severity of symptoms of mental illness among people experiencing mental disorders. Methods A systematic review of major electronic databases was conducted from inception to January 2015. Randomised controlled trials of internet-delivered interventions to increase physical activity participation in adults (>18years) with a DSM, ICD, clinician-confirmed diagnosis, and/or those receiving specialist mental health treatment were eligible for inclusion. Outcome data for symptom severity (depression) and physical activity participation was extracted. Results Two trials (N =95 participants) met the inclusion criteria, which investigated online clinician-guided interventions of 9–10week duration. Results were discrepant across studies. One study found a moderate between-groups effect size compared to wait-list control on depression outcomes (d =.67) but no differences in physical activity participation. In the other study, there were no significant differences between an online physical activity intervention versus treatment-as-usual in a university counselling service. Conclusion The preliminary findings suggest that online physical activity interventions may have positive effects on depression symptoms, but the size of the effects and mechanism of change remain unclear. Further research is critically needed to explore the efficacy and acceptability of online physical interventions for people with mental disorders. | Online physical activity interventions for mental disorders: A systematic review |
S2214782915000202 | Studies on internet-administered cognitive behavior therapy (ICBT) frequently use several different sources of recruitment, yet no study has investigated whether different recruitment sources produce different clinical and demographic profiles among participants. Using data from a large sample (n=982) seeking ICBT for depression, we compared these characteristics on the basis of self-reported recruitment source. Recruitment sources that imply more active treatment-seeking behaviors (Google searches, viewing postings on mental health websites) presented more severe depression and anxiety than those recruited through more passive sources of information (newspaper advertisements, referrals by friends and family). In addition, a number of demographic differences between groups were found. These findings have important implications for ICBT research projects and clinical programs who employ open recruitment procedures and multi-modal recruitment strategies, and who wish to recruit representative samples or target specific subgroups. Replications in other countries will however be required to establish cross-cultural patterns. | Who seeks ICBT for depression and how do they get there? Effects of recruitment source on patient demographics and clinical characteristics |
S2214782915000214 | Purpose Skin cancer is the most common cancer in the US, and its incidence is increasing. The major risk factor for skin cancer is exposure to ultraviolet radiation (UV). Young adults tend to expose themselves to large amounts of UV and engage in minimal skin protection, which increases their skin cancer risk. Interventions are needed to address risk behaviors among young adults that may lead to skin cancer. The internet offers a cost-effective way to widely disseminate efficacious interventions. The current paper describes the development of an online skin cancer risk reduction intervention (UV4.me) for young adults. Procedures The iterative development process for UV4.me followed best-practice guidelines and included the following activities: individual interviews, focus groups, content development by the expert team, acceptability testing, cognitive interviewing for questionnaires, quality control testing, usability testing, and a pilot randomized controlled trial. Participant acceptability and usability feedback was assessed. Principal results The development process produced an evidence-informed intervention that is individually-tailored, interactive, and multimedia in nature based on the Integrative Model of Behavior Prediction, a model for internet interventions, and other best-practice recommendations, expert input, as well as user acceptability and usability feedback gathered before, during, and after development. Major conclusions Development of an acceptable intervention intended to have a significant public health impact requires a relatively large investment in time, money, expertise, and ongoing user input. Lessons learned and recommendations are discussed. The comprehensive process used may help prepare others interested in creating similar behavioral health interventions. | Development of an internet intervention to address behaviors associated with skin cancer risk among young adults |
S2214782915000226 | An e-learning supported Train-the-Trainer program was developed to implement the Dutch suicide practice guideline in mental health care. Literature on implementation strategies has been restricted to the final reporting of studies with little opportunity to describe relevant contextual, developmental and supporting work that would allow for a better interpretation of results and enhance the likelihood of successful replication of interventions. Therefore, in this paper we describe the theoretical and empirical background, the material and practical starting points of the program. We monitored the number of professionals that were trained during and after a cluster randomized trial in which the effects of the program have been examined. Each element of the intervention (Train-the-Trainer element, one day face-to-face training, e-learning) is described in detail. During the trial, 518 professionals were trained by 37 trainers. After the trial over 5000 professionals and 180 gatekeepers were trained. The e-learning module for trainees is currently being implemented among 30 mental health care institutions in The Netherlands. These results suggest that an e-learning supported Train-the-Trainer program is an efficient way to uptake new interventions by professionals. The face-to-face training was easily replicable so it was easy to adhere to the training protocol. E-learning made the distribution of the training material more viable, although the distribution was limited by problems with ICT facilities. Overall, the intervention was well received by both trainers and trainees. By thoroughly describing the material and by offering all training materials online, we aim at further dissemination of the program. | An e-learning supported Train-the-Trainer program to implement a suicide practice guideline. Rationale, content and dissemination in Dutch mental health care |
S2214782915000238 | Background Internet interventions for mental health concerns are known to be effective, but how can developing technology be utilised to improve engagement and augment the effectiveness of these programs? One option might be to incorporate feedback about the user's physiological state into the program, via wearable sensors. Objectives This mixed-methods pilot study sought to examine whether the effectiveness of an online intervention for stress in students could be augmented by the use of prototype wearable sensors. Methods Students who were stressed, but not depressed, were allocated to a stress management program alone (n =34), with sensors (n =29), or to no intervention (n =35). Interventions lasted 4weeks. Outcome measures included measures of stress, anxious, and depressive symptoms, and were measured immediately after the interventions and 4weeks later. Participants in the two program groups were interviewed to gain feedback about the program and the sensors. Results Significant pre-post reductions in stress (p =.019) were observed for those in the program alone group. Significant reductions in depressive symptoms were observed among postgraduates (p =.006), but not undergraduates, in the program only group. The program plus sensors group had a broadly similar, but weaker set of results, indicating that the sensors impeded, rather than augmented, the effectiveness of the program. Qualitative data explicate this finding, highlighting participation burden as a key issue. Participants provided detailed feedback about the program, the sensors, and biofeedback exercises, which are summarised and discussed with reference to the quantitative findings. Conclusions The newly developed stress management program could be an effective way to improve student mental health. Wearable sensor technology, particularly biofeedback exercises, may be a useful contribution for the next generation of e-therapies, but further development of the prototypes is needed and their reliability and usability will likely affect user responses to them. | Can the effectiveness of an online stress management program be augmented by wearable sensor technology? |
S221478291500024X | Internet interventions constitute a promising and cost-effective treatment alternative for a wide range of psychiatric disorders and somatic conditions. Several clinical trials have provided evidence for its efficacy and effectiveness, and recent research also indicate that it can be helpful in the treatment of conditions that are debilitating, but do not necessarily warrant more immediate care, for instance, procrastination, a self-regulatory failure that is associated with decreased well-being and mental health. However, providing treatment interventions for procrastination via the Internet is a novel approach, making it unclear how the participants themselves perceive their experiences. The current study thus investigated participants' own apprehension of undergoing Internet-based cognitive behavior therapy for procrastination by distributing open-ended questions at the post-treatment assessment, for instance, “What did you think about the readability of the texts”, “How valuable do you believe that this treatment has been for you?”, and “The thing that I am most displeased with (and how it could be improved) is …”. In total, 75 participants (50%) responded, and the material was examined using thematic analysis. The results indicate that there exist both positive and negative aspects of the treatment program. Many participants increased their self-efficacy and were able to gain momentum on many tasks and assignments that had been deferred in their everyday life. Meanwhile, several participants lacked motivation to complete the exercises, had too many conflicting commitments, and were unable to keep up with the tight treatment schedule. Hence, the results suggest that Internet interventions for procrastination could profit from individual tailoring, shorter and more manageable modules, and that the content need to be adapted to the reading comprehension and motivational level of the participant. | Experiences of undergoing Internet-based cognitive behavior therapy for procrastination: A qualitative study |
S2214782915000251 | Investigations of cyberbullying are beginning to emerge in the scientific literature because of their implications for child and adolescent development. In particular, cyberbullying victimisation has been associated with similar negative consequences to traditional or face-to-face bullying such as lower academic achievement, anxiety, and sometimes even suicide. Research has also started to emerge investigating the impact of such incidences on the life of adults. The literature in this area has been steadily growing over the last decade and this review highlights the current situation in terms of relevant features and the psychological impact on victims. The selection process consisted of a comprehensive search that was conducted in January 2015 in the following databases: PsychInfo, ERIC, Web of Science and Medline. A total of 19 papers were included. We conclude with suggestions for online psychological treatment for victims and bullies as a means of coping with the distress caused from cyberbullying experiences. | A review of cyberbullying and suggestions for online psychological therapy |
S2214782915000263 | Internet-delivered cognitive behavior therapy (iCBT) may reduce barriers to treatment faced by people with obsessive–compulsive disorder (OCD). To date, most research on iCBT for OCD has evaluated clinician-guided treatments. However, self-guided treatments, which do not involve contact with a clinician, have considerable public health potential and may be particularly advantageous for those patients who report stigma as a principal barrier to treatment. The findings of a recent trial of self-guided iCBT for symptoms of OCD highlighted the potential of this approach and found large within-group effect sizes from pre- to post-treatment on the YBOCS-SR (d =1.37), sustained at 3-month follow-up (d =1.17). In addition, 32% of participants met criteria for clinically significant change at 3-month follow-up. The present study reports the long-term outcomes of that trial (N =28). Twelve out of 28 participants (43%) completed the 12month follow-up. A large within-group effect size was found on the YBOCS-SR (d =1.08) and 33% met criteria for clinically significant change at 12-month follow-up. No significant changes in symptoms were found between 3-month follow-up and 12-month follow-up, demonstrating that participants maintained their treatment gains in the long term. These results add to the emerging literature supporting the potential of self-guided iCBT for individuals with symptoms of OCD. | Self-guided internet-delivered cognitive behavior therapy (iCBT) for obsessive–compulsive disorder: 12 month follow-up |
S2214782915000275 | Background Psychotic-like experiences (PLEs) are subclinical delusional ideas and perceptual disturbances that have been associated with a range of adverse mental health outcomes. This study reports a qualitative and quantitative analysis of the acceptability, usability and short term outcomes of Get Real, a web program for PLEs in young people. Methods Participants were twelve respondents to an online survey, who reported at least one PLE in the previous 3months, and were currently distressed. Ratings of the program were collected after participants trialled it for a month. Individual semi-structured interviews then elicited qualitative feedback, which was analyzed using Consensual Qualitative Research (CQR) methodology. PLEs and distress were reassessed at 3months post-baseline. Results User ratings supported the program's acceptability, usability and perceived utility. Significant reductions in the number, frequency and severity of PLE-related distress were found at 3months follow-up. The CQR analysis identified four qualitative domains: initial and current understandings of PLEs, responses to the program, and context of its use. Initial understanding involved emotional reactions, avoidance or minimization, limited coping skills and non-psychotic attributions. After using the program, participants saw PLEs as normal and common, had greater self-awareness and understanding of stress, and reported increased capacity to cope and accept experiences. Positive responses to the program focused on its normalization of PLEs, usefulness of its strategies, self-monitoring of mood, and information putting PLEs into perspective. Some respondents wanted more specific and individualized information, thought the program would be more useful for other audiences, or doubted its effectiveness. The program was mostly used in low-stress situations. Conclusions The current study provided initial support for the acceptability, utility and positive short-term outcomes of Get Real. The program now requires efficacy testing in randomized controlled trials. | The acceptability, usability and short-term outcomes of Get Real: A web-based program for psychotic-like experiences (PLEs) |
S2214782915000287 | Background The current knowledge of internet-based cognitive behavior therapy (ICBT) implemented in primary care settings is sparse. Our objective was to explore primary care therapists' experiences and attitudes of ICBT, the opportunities and conditions for research in primary care, and to identify potential barriers to the implementation of ICBT treatment in primary care. Methods Eleven therapists (of 14) participating in the research and implementation project PRIM-NET completed a survey. Four of them were selected also for a detailed semi-structured interview. Data from the interviews were analyzed qualitatively and according to methods used in implementation science. Results Six general themes were identified in which the therapists considered ICBT as a good treatment that ought to be introduced in primary care. To optimize procedure in primary care settings, several adaptations of ICBT were suggested. Integrating and blending ICBT and face-to-face therapies, for example, would render primary care psychology more efficient. The PRIM-NET study and research within primary care was seen as rewarding and necessary, but challenging. To a large extent primary care still revolves around the general practitioner, with a focus on production, finances, and a somatic aspect of the patients. Five possible barriers to implementation of ICBT were identified which perhaps explains why psychological procedures are not fully integrated into primary care. Conclusions Although the implementation of new methods and routines is typically accompanied by challenges, the overall experience of the therapists supports the implementation of ICBT as an additional treatment in primary care. | Experiences and attitudes of primary care therapists in the implementation and use of internet-based treatment in Swedish primary care settings |
S2214782915000299 | Background Postpartum depression (PPD) is a maternal mental health problem that affects women from all regions of the world. Unfortunately, even in developed countries, half of the cases go undetected and, consequently, untreated. Individuals from low and middle income countries trend toward underutilization of mental health services, partly due to the limited number of available psychological resources. The primary aims of this pilot randomized controlled trial were to adapt to the Internet using the Mothers and Babies Course/Curso Mamás y Bebés, a prevention of PPD intervention, to describe the characteristics of the pregnant women who engaged in the intervention site, and to obtain preliminary data on the efficacy of the Internet intervention to reduce the risk of PPD. Methods Pregnant women, 18years or older who were interested in using the site for themselves were recruited and randomly assigned to a fully-automated self-help Internet intervention or to an information-only control condition. Randomized participants were invited to complete monthly depression assessments up to six months postpartum. To examine the prevention effects of the Internet intervention, pregnant women who did not meet current criteria for a major depressive episode, who engaged with the study website, and who provided depression data during the postpartum follow-up period were included in the study analyses. Results Participants were 111 predominantly Spanish-speaking (82.9%) and Latino/Hispanic (71.3%) pregnant women residing in 23 countries worldwide. The effect of the prevention intervention condition failed to reach significance at the a priori alpha-level. However, the observed coefficient trended in the hypothesized direction (b =−0.514, χ2 (1)=3.43, p =.061; HR=0.598). The benefits of receiving the e-MB Internet intervention were greater for pregnant women reporting high (vs. low) levels of prenatal depression symptoms (b =−0.605, χ2 (1)=5.20, p =.023). Conclusions This study provides preliminary evidence that Internet interventions are a promising method toward expanding the reach of psychological resources to perinatal women at-risk for PPD. | Online prevention of postpartum depression for Spanish- and English-speaking pregnant women: A pilot randomized controlled trial |
S2214782915000305 | Background As a substantial proportion of people with suicidal thoughts does not receive treatment, the internet can be a utilized to reach more people who need support. Aims To examine maintenance of effects of online self-help for suicidal thoughts at 3-month follow-up within the intervention group of a randomized controlled trial (of which between-group 6-week post-test results have previously been reported, showing a small effect of 0.28 for suicidal thoughts in favour of the intervention group), and to investigate acceptability of the intervention through participant evaluation. Methods 236 adults with mild to moderate suicidal thoughts were randomized to the intervention (n=116) or a waitlist control group (n=120). Assessments took place at baseline, post-test (6weeks later), and follow-up (3months after post-test). This paper reports on the intervention group and follow-up assessment only. Results Effects established at 6-week post-test were generally maintained at 3-month follow-up in the intervention group. Participant evaluation revealed that a majority thought their suicidal thoughts had decreased during the study, that adherence to the intervention was below average, and that levels of satisfaction were acceptable. Limitations The control group could not serve as a comparator as they had received access to the intervention at post-test. Conclusions Effects of online self-help for suicidal thoughts can be maintained for up to three months. Participant evaluation indicated that online self-help for suicidal thoughts is acceptable, but there is also room for improvement. | Online self-help for suicidal thoughts: 3-month follow-up results and participant evaluation |
S2214782915000329 | Generalized Anxiety Disorder (GAD) is typically considered a chronic condition characterized by excessive worry. Lifetime prevalence is 4.3–5.9%, yet only a small percentage seeks treatment. GAD is treatable and in recent years internet-delivered treatment interventions have shown promise. This paper aims to systematically search for literature on internet-delivered psychological interventions for the treatment of GAD and conduct a meta-analysis to examine their efficacy. The purpose of the paper is to inform the community of researchers, program developers and practitioners in internet delivered interventions of the current state-of-the-art and research gaps that require attention. A systematic search of the literature was conducted to find all studies of internet-delivered treatments for GAD (N =20). Using Review Manager 5 all Randomized Controlled Trials (RCTs; n =11) that met our established eligibility criteria were included into a meta-analysis that calculated effect sizes via the standardized mean difference. Compared to the waiting-list controls, the results demonstrate positive outcomes for GAD symptoms (d =−0.91) and its central construct of pathological worry (d =−0.74). The meta-analysis supports the efficacy of internet-delivered treatments for GAD including the use of disorder-specific (4 studies) and transdiagnostic treatment protocols (7 studies). Caution is advised regarding the results as the data is limited and highly heterogeneous, but revealing of what future research might be needed. | The efficacy of internet-delivered treatment for generalized anxiety disorder: A systematic review and meta-analysis |
S2214782915000330 | Efforts to prevent depression have become a key health system priority. Currently, there is a high prevalence of depression among adolescents, and treatment has become costly due to the recurrence patterns of the illness, impairment among patients, and the complex factors needed for a treatment to be effective. Primary care may be the optimal location to identify those at risk by offering an Internet-based preventive intervention to reduce costs and improve outcomes. Few practical interventions have been developed. The models for Internet intervention development that have been put forward focus primarily on the Internet component rather than how the program fits within a broader context. This paper describes the conceptualization for developing technology based preventive models for primary care by integrating the components within a behavioral vaccine framework. CATCH-IT (Competent Adulthood Transition with Cognitive-behavioral, Humanistic and Interpersonal Training) has been developed and successfully implemented within various health systems over a period of 14years among adolescents and young adults aged 13–24. | Development of a technology-based behavioral vaccine to prevent adolescent depression: A health system integration model |
S2214782915000342 | Symptoms of stress are common in the general population and associated with health risks and economic costs. Applied relaxation training has shown to be effective for reducing stress and worry both as a self-help treatment and as an internet-based intervention with therapist support. However, what factors may affect the outcome of internet based relaxation training is unclear. The aims of the present study were to investigate the effect of a brief internet based relaxation program for people with symptoms of stress or worry and to assess whether enhancing the quality of intervention presentation or therapist support had an impact on outcomes. Participants were randomized in a full factorial design to either Normal or Enhanced treatment Presentation and either Normal or Enhanced therapist Support in a four-week online program with applied relaxation. The main outcome measures were self-report instruments of stress and worry. A total of 162 participants were included in the study and 94 and 84 participants completed the post and follow-up measurements respectively. Participants in all conditions improved significantly on the main outcome measures, and the different levels of Presentation or therapist Support did not significantly affect treatment outcome. Registered number of completed exercises was a predictor of better treatment outcome, but this effect was independent of treatment condition. Enhancing internet based interventions by improving presentations and the quality of support may thus not be the best way to further improve the effect of internet based interventions. More specific knowledge of the mechanisms that affect outcomes in online psychotherapy is needed. | The effects of therapist support and treatment presentation on the clinical outcomes of an Internet based applied relaxation program |
S2214782915000366 | Background Guided Internet-delivered cognitive behavioural therapy (ICBT) is an effective treatment of social anxiety disorder (SAD). However, the treatment is not effective for all. The amount and type of therapist contact have been highlighted as a possible moderator of treatment outcome. Objective The aim of this study was to examine whether treatment effects of ICBT are enhanced with an initial 90min face-to-face psychoeducation (PE) session for university students with SAD. Method University students with SAD (N =37) were randomized into one out of two conditions: 1) an initial therapist-led face-to-face PE session followed by guided ICBT, 2) guided ICBT without an initial PE session. Data was analysed with an intent-to-treat approach. Results Eight participants (21.6%) dropped out of treatment. A statistically significant reduction in symptoms was found for all outcome measures for both groups. There were no significant additional effects of adding the initial face-to-face PE. Moderate to large within-group effect sizes on self-rated social anxiety symptoms were found at post-treatment (d =0.70–0.95) and at a six month follow-up (d =0.70–1.00). Nearly half of the participants were classified as recovered. Conclusions Notwithstanding limitations due to the small sample size, the findings indicate that guided ICBT is an effective treatment for students with SAD. Adding an initial face-to-face PE session to the guided ICBT did not lead to enhanced outcomes in the present study. | Internet-delivered cognitive behavioural therapy with and without an initial face-to-face psychoeducation session for social anxiety disorder: A pilot randomized controlled trial |
S221478291500038X | Objectives The first aim of this study was to describe parental attitudes towards and intentions to access, computer-based therapies for youth mental health problems. The second aim was to assess parental factors (demographic and clinical factors, personality, technology factors, mental health knowledge and attitudes, and knowledge of computer-based therapies) predicting attitudes and intentions to access computer-based therapies for youth. Method Three hundred and seventy-three Australian parents completed an online survey measuring: demographics; mental health service experience; personality; technology factors; mental health knowledge and attitudes; perceived benefits, problems, and helpfulness of computer-based therapies; and intentions to access services. Results Approximately 50% of parents reported accessing support for their child's mental health, yet only 6% had used a computer-based therapy. The majority of parents strongly endorsed all benefits of computer-based therapies, and appeared relatively less concerned by potential service problems. Computer-based therapies were perceived as somewhat to extremely helpful by 87% of parents and 94% indicated that they would utilise a computer-based therapy if their child required support and one was offered to them. Parental knowledge of computer-based therapies significantly predicted perceived helpfulness (∆ F =19.23 (1301), p =<.001) and intentions to access (∆ F =10.91 (1288), p =.001) computer-based therapies, above that of parent demographic characteristics, clinical factors, and engagement with technology. Conclusions Australian parents hold positive attitudes to the use of computer-based therapies. | Logging into therapy: Parent attitudes and intentions to use computer-based therapies for youth mental health |
S2214782915000391 | Internet-based cognitive behaviour therapy (ICBT) is efficacious for treating depression, with therapist guidance identified as important for favourable outcomes. We have limited knowledge, however, about the fundamental components of therapist guidance in ICBT. The purpose of this study was to systematically examine therapist messages sent to patients during the course of ICBT for depressive symptoms in order to identify common “therapist behaviours” and the extent to which these behaviours correlate with completion of modules and improvements in symptoms at post-treatment, one- and two-year follow-up. A total of 664 e-mails from 5 therapists to 42 patients were analysed using qualitative content analysis. The most frequent behaviour was encouraging that accounted for 31.5% of the total number of coded behaviours. This was followed by affirming (25.1%), guiding (22.2%) and urging (9.8%). Less frequently the therapists clarified the internet treatment framework, informed about module content, emphasised the importance of patient responsibility, confronted the patient and made self-disclosures. Six of the nine identified therapist behaviours correlated with module completion. Three behaviours correlated with symptom improvement. Affirming correlated significantly (r =.42, p =.005) with improvement in depressive symptoms at post-treatment and after two years (r =.39, p =.014). Encouraging was associated with outcome directly after treatment (r =.52, p =.001). Self-disclosure was correlated with improvement in depressive symptoms at post-treatment (r =.44, p =.003). The study contributes to a better understanding of therapist behaviours in ICBT for depressive symptoms. Future directions for research are discussed. | Therapist behaviours in internet-based cognitive behaviour therapy (ICBT) for depressive symptoms |
S2214782915000408 | The aim of this study was to compare a web-based computer tailored physical activity intervention based on self-determination theory and motivational interviewing (I Move) to a traditional web-based computer tailored physical activity intervention (Active Plus) with regard to their basic psychological need supporting capabilities. We also aimed to assess the extent to whether self-determination constructs played a stronger mediating role in the effects of I Move than in the effects of Active Plus. A randomized controlled trial was conducted among 3089 participants (age 44.9±12.9, 69.1% women), comparing 1) I Move, 2) Active Plus, and 3) a waiting list control condition. Physical activity behavior (measured at baseline, and at six months after baseline), potential mediators (intrinsic motivation, identified regulation, perceived competence and perceived choice, measured at baseline, and at three months after baseline) and basic psychological need support (measured six weeks and six months after baseline) were assessed through self-report, using web-based questionnaires. I Move was found to be more effective in supporting participants' basic psychological needs (sessions 1 and 2; p =.001; sessions 3 and 4; p =.004). The results of the mediation analyses show that the effects of both interventions were (equally) mediated by perceived competence, but not by intrinsic motivation, identified regulation or perceived choice. | Exploring the working mechanisms of a web-based physical activity intervention, based on self-determination theory and motivational interviewing |
S2214782915000421 | Chronic pain is a major health problem and behavioral based treatments have been shown to be effective. However, the availability of these kinds of treatments is scarce and internet-based treatments have been shown to be promising in this area. The objective of the present systematic review is to evaluate internet-based interventions for persons with chronic pain. The specific aims are to do an updated review with a broad inclusion of different chronic pain diagnoses and to assess disability and pain and also measures of catastrophizing, depression and anxiety. A systematic search identified 891 studies and 22 trials were selected as eligible for review. Two of the selected trials included children/youth and five included individuals with chronic headache and/or migraine. The most frequently measured domain reflected in the primary outcomes was interference/disability, followed by catastrophizing. Result across the studies showed a number of beneficial effects. Twelve trials reported significant effects on disability/interference outcomes and pain intensity. Positive effects were also found on psychological variable such as catastrophizing, depression and anxiety. Several studies (n=12) were assessed to have an unclear level of risk bias. The attrition levels ranged from 4% to 54% where the headache trials had the highest drop-out levels. However, findings suggest that internet-based treatments based on cognitive behavioural therapy (CBT) are efficacious measured with different outcome variables. Results are in line with trials in clinical settings. Meta-analytic statistics were calculated for interference/disability, pain intensity, catastrophizing and mood ratings. Results showed that the effect size for interference/disability was Hedge's g =−0.39, for pain intensity Hedge's g =−0.33, for catastrophizing Hedge's g =−0.49 and for mood variables (depression) Hedge's g =−0.26. | Internet interventions for chronic pain including headache: A systematic review |
S2214782915300014 | Social anxiety disorder (SAD) is a common debilitating mental illness with large negative effects on quality of life and economic productivity. Modern psychotherapy treatments utilizing cognitive–behavioral theory are increasingly delivered over the Internet and more recently using smartphone applications. The Challenger App written natively for the Apple iPhone was developed at the Stockholm University Department of Psychology for the treatment of SAD and uses a number of advanced features not previously seen in past mental health applications; these include real-time location awareness, notifications, anonymous social interaction between users, a high-degree of personalization and use of gamification techniques. This paper explores design considerations for the various components of the app, their theoretical and evidence base, and research opportunities that exist for apps making use of these novel features. | The challenger app for social anxiety disorder: New advances in mobile psychological treatment |
S2214782915300087 | Background Despite the proven efficacy of computerised cognitive behavioural treatment (cCBT) programmes and their potential to provide more people with high quality treatment, their uptake is relatively low. This study had three main objectives: 1. To investigate the impact of Australian mental health worker knowledge of cCBT on a range of attitudes towards these programmes. 2. To determine differences in attitudes towards cCBT between a) those whose primary therapeutic approach was CBT and those whose primary therapeutic approach was not CBT, b) psychologists and non-psychologists and c) those who reported intention to use cCBT programmes compared to those who did not. 3. To determine whether a short presentation on cCBT was effective in changing mental health worker attitudes towards cCBT. Methods One hundred and twenty-four Australian mental health workers completed an online survey that measured: knowledge of cCBT; perceived advantages of cCBT; perceived disadvantages of cCBT; circumstances under which cCBT was perceived to be advantageous; belief in the efficacy of computers in therapy; comfort with using computers in therapy; and intention to use cCBT. Participants were randomly allocated into either the cCBT presentation condition or Control presentation condition. After viewing the presentation, participants again completed the measures. Results Higher knowledge of cCBT was found to be associated with fewer perceived disadvantages of cCBT (t=−4.51, p<.001) and a greater number of circumstances under which cCBT was perceived to be advantageous (t=2.30, p=.021). No differences between psychologists and non-psychologists or between those whose primary therapeutic approach was CBT and those whose primary therapeutic approach was not CBT, were found. Compared to those low in intention to use cCBT, those who reported high intention to use cCBT programmes were found to perceive more advantages of cCBT, F(1119)=9.32, p=.003, fewer disadvantages of cCBT, F(1119)=17.10, p<.001, more circumstances under which cCBT was considered advantageous, F(1119)=17.89, p<.001, reported higher belief in the efficacy of computers in therapy, F(1119)=26.39, p<.001, η2 =.181, endorsed greater comfort with using computers in therapy, F(1119)=7.80, p=.006, and had greater knowledge of cCBT, F(1119)=5.00, p=.027. Finally, compared to Control presentation participants, those who viewed the cCBT presentation demonstrated a significantly greater increase in knowledge of cCBT, F(1119)=13.77, p<.001, a greater increase in the perceived advantages of cCBT, F(1119)=4.82, p=.030, and a greater reduction in the perceived disadvantages of cCBT, F(1119)=4.77, p=.031. Conclusions Australian mental health workers attitudes can be changed through provision of information about, and demonstrations of, cCBT programmes. | Australian mental health worker attitudes towards cCBT: What is the role of knowledge? Are there differences? Can we change them? |
S2214782915300105 | Objective Cancer patients and survivors are assuming active roles in decision-making and digital patient support tools are widely used to facilitate patient engagement. As part of Cancer Information Service Research Consortium's randomized controlled trials focused on the efficacy of eHealth interventions to promote informed treatment decision-making for newly diagnosed prostate and breast cancer patients, and post-treatment breast cancer, we conducted a rigorous process evaluation to examine the actual use of and perceived benefits of two complementary communication channels — print and eHealth interventions. Methods The three Virtual Cancer Information Service (V-CIS) interventions were developed through a rigorous developmental process, guided by self-regulatory theory, informed decision-making frameworks, and health communications best practices. Control arm participants received NCI print materials; experimental arm participants received the additional V-CIS patient support tool. Actual usage data from the web-based V-CIS was also obtained and reported. Results Print materials were highly used by all groups. About 60% of the experimental group reported using the V-CIS. Those who did use the V-CIS rated it highly on improvements in knowledge, patient-provider communication and decision-making. Conclusion The findings show that how patients actually use eHealth interventions either singularly or within the context of other communication channels is complex. Practice implications Integrating rigorous best practices and theoretical foundations is essential and multiple communication approaches should be considered to support patient preferences. | Development and utilization of complementary communication channels for treatment decision making and survivorship issues among cancer patients: The CIS Research Consortium Experience |
S2214782915300117 | Background A burn is one of the most traumatic and painful injuries a child can experience and it is also a very stressful experience for the parents. Given the great psychological distress and perceived lack of multi-professional support experienced by the parents, there is a need for support during in-hospital treatment as well as during recovery. The aim of the study is to develop and evaluate an internet-based information and self-help program for parents of children who have been hospitalized for burn injury. The program aims to decrease parents' symptoms of stress. Methods Participants will consist of parents of children treated for burns between 2009 and 2013 at either of the two specialized Swedish Burn centers. The study is a two-armed randomized controlled trial with a six-week intervention group and an inactive control group, with a pre- and post-assessment, as well as a 3- and 12-month follow-up. The main outcome is stress (post-traumatic stress, general perceived stress and parental stress). The data will be analyzed with the intention-to-treat principle. The intervention is based on Cognitive-Behavior Therapy (CBT) and is inspired by Acceptance and Commitment Therapy (ACT). It is psycho-educational and provides basic skills training in communication and stress management. Conclusion We believe that this program will offer parents of children with burns information and support, decrease symptoms of stress, and that parents will perceive the program as useful. If the program is found to be beneficial, it could be implemented in burn care as it is accessible and cost-effective. | Internet-based information and self-help program for parents of children with burns: Study protocol for a randomized controlled trial |
S2214782915300142 | Background Depressive disorder is a major societal challenge. Despite the availability of clinically and cost-effective treatments including Internet interventions, the number of patients receiving treatment is limited. Evidence-based Internet interventions promise wide availability and high efficiency of treatments. However, these interventions often do not enter routine mental healthcare delivery at a large scale. The MasterMind project aims to provide insight into the factors that promote or hinder the uptake and implementation of evidence-based Internet interventions by mental healthcare practice. Internet-based Cognitive Behaviour Therapy (iCBT) and videoconferencing facilitating collaborative care (ccVC) will be implemented in routine mental healthcare. The services will be offered to 5230 depressed adults in 15 European regions. The current paper describes the evaluation protocol for this large-scale implementation project. Design Current summative evaluation study follows a naturalistic one-group pretest–posttest design and assesses three distinct stakeholders: patients, mental healthcare professionals, and mental healthcare organisations. The Model for Assessment of Telemedicine applications (MAST) will be employed to structure the implementation and evaluation study. The primary focal points of interest are reach, clinical effect, acceptability, appropriateness, implementation costs, and sustainability of the interventions in practice. Mixed-methods are used to provide an understanding of what (quantitative) the implementation projects have achieved and their meaning to various stakeholders (qualitative). Discussion The use of Internet interventions in routine practice is limited. MasterMind attempts to bridge the gap between routine practice and effectiveness research by evaluating the implementation of evidence-based Internet interventions for depressive disorders in routine mental healthcare settings in Europe. | Implementing and up-scaling evidence-based eMental health in Europe: The study protocol for the MasterMind project |
S2214782915300154 | Objectives Audiologists provide professional contact and support between appointments to clients with hearing impairment using telephone and e-mail, but more advanced and flexible technological platforms are also possible. The present study aimed to evaluate the clinical application of an Internet-based support system for audiologists and their first-time hearing aid clients. Design An Internet-based support system developed by Månsson et al. (2013) for psychologists and their clients was adapted for audiologic purposes. Three audiologic clinics in Sweden tested the support system with their clients. Study sample Twenty-three clients managed by four audiologists used and evaluated the support system. In addition, five of the clients and all four audiologists were interviewed and their responses were analyzed using content analysis. Results The clients and the audiologists reported positive experiences and overall satisfaction but audiologists reported that the support system did not address the needs of all clients. More positive experiences and greater satisfaction with the support system were associated with reductions on self-reported consequences of hearing loss and positive hearing aids outcomes. Conclusions An Internet-based support system can be used in audiologic rehabilitation. Both audiologists and clients recognized the system's potential value to offer an online support to the provision of audiologic services. | The initial evaluation of an Internet-based support system for audiologists and first-time hearing aid clients |
S2214782915300166 | Recruiting participants is a challenge for many health, medical and psychosocial research projects. One tool more frequently being used to improve recruitment is the social networking website Facebook. A systematic review was conducted to identify studies that have used Facebook to recruit participants of all ages, to any psychosocial, health or medical research. 110 unique studies that used Facebook as a recruitment source were included in the review. The majority of studies used a cross-sectional design (80%) and addressed a physical health or disease issue (57%). Half (49%) of the included studies reported specific details of the Facebook recruitment process. Researchers paid between $1.36 and $110 per completing participants (Mean=$17.48, SD=$23.06). Among studies that examined the representativeness of their sample, the majority concluded (86%) their Facebook-recruited samples were similarly representative of samples recruited via traditional methods. These results indicate that Facebook is an effective and cost-efficient recruitment method. Researchers should consider their target group, advertisement wording, offering incentives and no-cost methods of recruitment when considering Facebook as a recruitment source. It is hoped this review will assist researchers to make decisions regarding the use of Facebook as a recruitment tool in future research. | Recruiting for health, medical or psychosocial research using Facebook: Systematic review |
S221478291530021X | The aim of this pilot study was to explore the effects of an early and customized CBT intervention, mainly delivered via internet, for adolescents with coexisting recurrent pain and emotional distress (low mood, worry, and/or distress). The intervention was based on a transdiagnostic approach, to concurrently target pain and emotional distress. A single case experimental design (SCED) was employed with six participants, 17–21years old, who were recruited via school health care professionals at the student health care team at an upper secondary school in a small town in Sweden. The intervention consisted of 5–9 modules of CBT, delivered via internet in combination with personal contacts and face to face sessions. The content and length of the program was customized depending on needs. The effects of the program were evaluated based on self-report inventories, which the participants filled out before and after the intervention and at a six month follow-up. They did also fill out a diary where they rated symptoms on a daily basis. The results were promising, at least when considering changes during the intervention as well as pre- and posttest ratings. However, the results were more modest when calculating the reliable change index (RCI), and most of the treatment effects were not sustained at the follow-up assessment, which raises questions about the durability of the effects. Taken together, this study indicates that this type of program is promising as an early intervention for adolescents with pain and concurrent emotional distress, although the outcomes need to be explored further, especially in terms of long-term effects. | Customized CBT via internet for adolescents with pain and emotional distress: A pilot study |
S2214782915300282 | The aim of this study was to describe the adaptation of a program designed to leverage 7 Cups of Tea (7Cups), an available online platform that provides volunteer (i.e., listener) based emotional support, to complement ongoing treatment for people with schizophrenia-spectrum disorders. The adaptation of the program was based on two stages: First, following platform demonstration, six clinicians specializing in the treatment of schizophrenia completed a survey examining attitudes towards the program and suggested modifications. In response to clinicians' feedback, a computerized training program that provides information for listeners supporting people with schizophrenia was developed, and one hundred and sixty eight listeners completed an online knowledge test. In the second stage, 10 outpatients with schizophrenia-spectrum disorders were recruited to chat with listeners, provided post-session open-ended comments as well as usability and usefulness ratings assessed on a five point Likert scale. The additional training significantly increased listeners' knowledge and confidence (0.38<=Cohen's d <=1.14, p <=.024). Patients' attitudes towards the listeners were positive and they expected the platform will be usable and helpful. Most patients expected a positive gain by having the opportunity to receive an outlet for emotions and socialize. The authors conclude that the use of an available digital platform resulted in a feasible intervention in terms of cost and availability, which is now ready for evaluation in real-world settings. | Adaptation of a peer based online emotional support program as an adjunct to treatment for people with schizophrenia-spectrum disorders |
S2214782916000038 | Background Blended care combines face-to-face treatment with web-based components in mental health care settings. Blended treatment could potentially improve active patient participation, by letting patients work though part of the protocol autonomously. Further, blended treatment might lower the costs of mental health care, by reducing treatment duration and/or therapist contact. However, knowledge on blended care for depression is still limited. Objectives To develop a blended cognitive behavioural treatment (bCBT) for depressed patients in an outpatient specialized mental health care centre and to conduct a preliminary evaluation of this bCBT protocol. Method A bCBT protocol was developed, taking recommendations into account from depressed patients (n=3) and therapists and experts in the field of e-health (n=18). Next, an initial evaluation of integrated high-intensive bCBT was conducted with depressed patients (n=9) in specialized mental health care. Patients' clinical profiles were established based on pre-treatment diagnostic information and patient self-reports on clinical measures. Patient treatment adherence rates were explored, together with patient ratings of credibility and expectancy (CEQ) before treatment, and system usability (SUS) and treatment satisfaction after treatment (CSQ-8). During and after treatment, the blended treatment protocol was evaluated in supervision sessions with the participating therapists (n=7). Results Seven out of nine patients started bCBT, of whom five completed ≥90% of treatment. System usability was evaluated as being above average (range 63 to 85), and patients were mostly to very satisfied with bCBT (range 16 to 32). Patients reported improvements in depression, health-related quality of life and anxiety. We observed that therapists evaluated the highly structured blended treatment as a helpful tool in providing evidence-based treatment to this complex patient group. Discussion Although no conclusions can be drawn based on the current study, our observations suggest that a blended CBT approach might shorten treatment duration and has the potential to be a valuable treatment option for patients with severe depression in specialized mental health care settings. Further exploration of the effectiveness of our bCBT protocol by means of a randomized controlled trial is warranted. | Development and initial evaluation of blended cognitive behavioural treatment for major depression in routine specialized mental health care |
S221478291600004X | Psychotherapy process research examines the content of treatment sessions and their association with outcomes in an attempt to better understand the interactions between therapists and clients, and to elucidate mechanisms of behavior change. A similar approach is possible in technology-delivered interventions, which have an interaction process that is always perfectly preserved and rigorously definable. The present study sought to examine the process of participants' interactions with a computer-delivered brief intervention for drug use, from a study comparing computer- and therapist-delivered brief interventions among adults at two primary health care centers in New Mexico. Specifically, we sought to describe the pattern of participants' (N =178) choices and reactions throughout the computer-delivered brief intervention, and to examine associations between that process and intervention response at 3-month follow-up. Participants were most likely to choose marijuana as the first substance they wished to discuss (n =114, 64.0%). Most participants indicated that they had not experienced any problems as a result of their drug use (n =108, 60.7%), but nearly a third of these (n =32, 29.6%) nevertheless indicated a desire to stop or reduce its use; participants who did report negative consequences were most likely to endorse financial or relationship concerns. However, participant ratings of the importance of change or of the helpfulness of personalized normed feedback were unrelated to changes in substance use frequency. Design of future e-interventions should consider emphasizing possible benefits of quitting rather than the negative consequences of drug use, and—when addressing consequences—should consider focusing on the impacts of substance use on relationship and financial aspects. These findings are an early but important step toward using process evaluation to optimize e-intervention content. | Process evaluation of a technology-delivered screening and brief intervention for substance use in primary care |
S2214782916300148 | Ample studies have demonstrated that internet-based cognitive behavioural therapy (iCBT) for anxiety disorders is effective and acceptable in controlled settings. Studies assessing the clinical effectiveness of iCBT for anxiety disorders among routine care populations are, however, not as numerous. The purpose of this study was to assess the effectiveness of iCBT among anxiety patients, who were on a waiting list for intensive outpatient treatment, in a specialised routine care clinic. 1 1 Clinic for OCD and Anxiety disorders, Aarhus University Hospital, DK. A randomised controlled pilot trial was conducted. Recruited patients were on a waiting list and had a primary diagnosis of either social phobia or panic disorder. Participants were randomised into either receiving iCBT with minimal therapist contact (received access to the programme FearFighter® (FF) and received support from a clinician via telephone) or no treatment (stayed on the waiting list). The primary outcome was self-reported symptomatic change of anxiety on Beck Anxiety Inventory (BAI). The secondary outcomes were comorbid depression measured on Beck Depression Inventory (BDI-II) and quality of life measured with the EuroQol one-item visual-analogue scale (EQ-vas). All results were analysed by intention-to-treat analyses using a mixed-effects approach. N =158 patients were assessed for eligibility of which N =67 met all eligibility inclusion criteria, signed informed consent forms, and were randomised. Post-treatment assessment was completed by N =47 (70%). In the intervention group, N =11 (31%) completed all modules of FF. No significant differences of change of symptomatic levels were found between the intervention and control group for anxiety (BAI: mean diff.=2.42; 95% CI −1.03 to 5.86; p =0.17; d =0.06) or for depression (BDI-II: mean diff. 1.87; 95% CI −2.25 to 6.00; p =0.37; d =0.02). A large and significant effect was found in self-reported quality of life in favour of the experimental group (EQ-vas: mean diff. −20.88; 95% CI −30.64 to −11.11; p <0.001; d =0.81). This study was not able to document statistically significant clinical effect of iCBT with minimal therapist contact compared to a waiting list control group in a specialised anxiety clinic in routine care. However, a large and significant effect was seen on self-reported quality of life. Although these results offer an interesting perspective on iCBT in specialised care, they should be interpreted with caution, due to the limitations of the study. A large scale fully powered RCT is recommended. | Internet-based CBT for social phobia and panic disorder in a specialised anxiety clinic in routine care: Results of a pilot randomised controlled trial |
S2214782916300161 | Insomnia and depression is a common and debilitating comorbidity, and treatment is usually given mainly for depression. Guided Internet-based cognitive behavioral therapy for insomnia (ICBT-i) was, in a recent study on which this report is based, found superior to a treatment for depression (ICBT-d) for this patient group, but many patients did not reach remission. Aims To identify facilitating and hindering factors for patients in ICBT-i and ICBT-d and formulate hypotheses for future research. Method Qualitative telephone interviews at the time of the 6-month follow-up. Thirty-five interviews were done and analyzed with a grounded theory approach. Based on the qualitative results, an iterative method-triangulation including quantitative and semi-qualitative was performed. Results The interviews were coded into 738 sentences, condensed into 47 categories and finally 11 themes. Four areas were investigated further with method triangulation: Opinions about treatment, adherence, hindering symptoms and acceptance. Patients in ICBT-i were more positive regarding the treatment than patients in ICBT-d. Using treatment components was positively associated with outcome in both groups. Symptoms of insomnia, depression and other comorbidities were perceived as more hindering for ICBT-d than for ICBT-i. Acceptance of diagnose-related problems as well as negative emotions and cognitions was positively associated with outcome for ICBT-i. Proposed future research hypotheses 1) A combination of CBT for insomnia and CBT for depression is more effective than only one of the treatments. 2) Additional therapist support increases outcomes for patients with more comorbidities. 3) Acceptance is a mechanism of change in CBT-i. | Facilitating and hindering factors in Internet-delivered treatment for insomnia and depression |
S2215098615300872 | This paper deals with studying the effect of powder mixing electrical discharge machining (PMEDM) parameters using copper and graphite electrodes on the white layer thickness (WLT), the total heat flux generated and the fatigue life. Response surface methodology (RSM) was used to plan and design the experimental work matrices for two groups of experiments: for the first EDM group, kerosene dielectric was used alone, whereas the second was treated by adding the SiC micro powders mixing to dielectric fluid (PMEDM). The total heat flux generated and fatigue lives after EDM and PMEDM models were developed by FEM using ANSYS 15.0 software. The graphite electrodes gave a total heat flux higher than copper electrodes by 82.4%, while using the SiC powder and graphite electrodes gave a higher total heat flux than copper electrodes by 91.5%. The lowest WLT values of 5.0 µm and 5.57 µm are reached at a high current and low current with low pulse on time using the copper and graphite electrodes and the SiC powder, respectively. This means that there is an improvement in WLT by 134% and 110%, respectively, when compared with the use of same electrodes and kerosene dielectric alone. The graphite electrodes with PMEDM and SiC powder improved the experimental fatigue safety factor by 7.30% compared with the use of copper electrodes and by 14.61% and 18.61% compared with results using the kerosene dielectric alone with copper and graphite electrodes, respectively. | The effect of SiC powder mixing electrical discharge machining on white layer thickness, heat flux and fatigue life of AISI D2 die steel |
S2215098615302020 | Detecting faults induction machines is crucial for a safe operation of these machines. The aim of this paper is to present a statistical fault detection methodology for the detection of faults in three-phase wound rotor induction machines (WRIM). The proposed fault detection approach is based on the use of principal components analysis (PCA). However, conventional PCA-based detection indices, such as the T 2 and the Q statistics, are not well suited to detect small faults because these indices only use information from the most recent available samples. Detection of small faults is one of the most crucial and challenging tasks in the area of fault detection and diagnosis. In this paper, a new statistical system monitoring strategy is proposed for detecting changes resulting from small shifts in several variables associated with WRIM. The proposed approach combines modeling using PCA modeling with the exponentially weighted moving average (EWMA) control scheme. In the proposed approach, EWMA control scheme is applied on the ignored principal components to detect the presence of faults. The performance of the proposed method is compared with those of the traditional PCA-based fault detection indices. The simulation results clearly show the effectiveness of the proposed method over the conventional ones, especially in the presence of faults with small magnitudes. | A data-based technique for monitoring of wound rotor induction machines: A simulation study |
S2215098615303712 | Rotary hydraulic dashpot used for shut-off rod drive mechanism application of a nuclear reactor has been studied in this paper for impact free operation. The rotary hydraulic dashpot has been modeled as a system with 1 degree of freedom (DOF) and the simulation results are experimentally validated. The dashpot is modeled as a hinge joint with moving and fixed vanes as rigid bodies. Shut-off rods are used to shut-down a nuclear reactor and hydraulic dashpot absorbs the energy of freely falling shut-off rod at the end of rod travel. With the increase in the environmental temperature the dashpot becomes underdamped at a point because of reduction in the viscosity of oil and results into impact on mechanism components. Hydraulic dashpot designs are finalized with an optimum combination of dashpot clearances and oil viscosity to meet the drop time criterion and impact free operation at room temperature as well as at elevated temperature. Also with the change in mechanical loads the dashpot becomes underdamped. So the study is further extended to see the effects of various parameters such as moment of inertia, constraint angle and applied moment on the dashpot. Study is focused on obtaining dashpot responses in terms of relative rotation, relative angular velocity and relative angular acceleration at various environmental temperatures. Finite element commercial code COMSOL Multiphysics 5.1 has been used for numerical simulations. Equations for both rigid body dynamics and heat transfer in solids are solved simultaneously. Thus, energy absorbed and local temperature rise in the dashpot operation is also obtained. Both simulation and experimental results at wide range of environmental temperature are presented and compared in this paper. This study forms a good tool to design a hydraulic dashpot, which gives impact free operation in a shut-off rod free fall. total vane area cubic centimeter specific heat capacity at constant pressure degree Celsius damping coefficient centistokes figure unit matrix Joule effective moment of inertia at the joint source moment of inertia destination moment of inertia inner diameter coefficient of thermal conductivity degree Kelvin kilogram spring constant meter millimeter total dashpot moment damping moment Newton number outer diameter pressure penalty factor Pascal heat sources rotation matrix torque arm radian rotation matrices describing the rotation of source attachments rotation matrices describing the rotation of destination attachments second time absolute temperature torque displacement field convective velocity field displacement vectors for source attachments displacement vectors for destination attachments displacements at the centroid of the source attachments displacements at the centroid of the destination attachments volt joint center positions of centroids for source attachments positions of centroids for destination attachments with respect to Watt energy dissipation rate density of fluid divergence rotation about the axis for source attachments rotation about the axis for destination attachments angular velocity relative rotation pre-deformation advanced heavy water reactor computational fluid dynamics degree of freedom electro-magnetic megawatt electric pressurized heavy water reactor rotation per minute shut-off rod drive mechanism | Modeling and analysis of hydraulic dashpot for impact free operation in a shut-off rod drive mechanism |
S228843001500024X | In this study, a new methodology in predicting a system output has been investigated by applying a data mining technique and a hybrid type II fuzzy system in CNC turning operations. The purpose was to generate a supplemental control function under the dynamic machining environment, where unforeseeable changes may occur frequently. Two different types of membership functions were developed for the fuzzy logic systems and also by combining the two types, a hybrid system was generated. Genetic algorithm was used for fuzzy adaptation in the control system. Fuzzy rules are automatically modified in the process of genetic algorithm training. The computational results showed that the hybrid system with a genetic adaptation generated a far better accuracy. The hybrid fuzzy system with genetic algorithm training demonstrated more effective prediction capability and a strong potential for the implementation into existing control functions. | Hybrid Type II fuzzy system & data mining approach for surface finish |
S2288430015000342 | This paper proposes a novel method for shape design of a Bézier surface with given boundary curves. The surface is defined as the minimizer of an extended membrane functional or an extended thin plate functional under the guidance of a specified normal field together with an initial prescribed surface. For given boundary curves and the guiding normal field, the free coefficients of a Bézier surface are obtained by solving a linear system. Unlike previous PDE based surface modeling techniques which construct surfaces just from boundaries, our proposed method can be used to generate smooth and fair surfaces that even follow a specified normal field. Several interesting examples are given to demonstrate the applications of the proposed method in geometric modeling. | Variational surface design under normal field guidance |
S2288430015000366 | One of the current challenges in the domain of the multicriteria shape optimization is to reduce the calculation time required by conventional methods. The high computational cost is due to the high number of simulation or function calls required by these methods. Recently, several studies have been led to overcome this problem by integrating a metamodel in the overall optimization loop. In this paper, we perform a coupling between the Normal Boundary Intersection – NBI – algorithm with Radial Basis Function – RBF – metamodel in order to have a simple tool with a reasonable calculation time to solve multicriteria optimization problems. First, we apply our approach to academic test cases. Then, we validate our method against an industrial case, namely, shape optimization of the bottom of an aerosol can undergoing nonlinear elasto-plastic deformation. Then, in order to select solutions among the Pareto efficient ones, we use the same surrogate approach to implement a method to compute Nash and Kalai–Smorodinsky equilibria. | Multicriteria shape design of an aerosol can |
S2288430015000378 | Head-and-neck cancer is often treated with intensive irradiation focused on the tumor, while delivering the minimum amount of irradiation to normal cells. Since a course of radiotherapy can take 5–6 weeks or more, the repeatability of the patient posture and the fastening method during treatment are important determinants of the success of radiotherapy. Many devices have been developed to minimize positional discrepancies, but all of the commercial devices used in clinical practice are operated manually and require customized fixtures for each patient. This is inefficient and the performance of the fixture device depends on the operator׳s skill. Therefore, this study developed an automated head-and-neck immobilizer that can be used during radiotherapy and evaluated the positioning reproducibility in a phantom experiment. To eliminate interference caused by the magnetic field from computed tomography hardware, Ni−Ti shape-memory alloy wires were used as the actuating elements of the fixtures. The resulting positional discrepancy was less than 5 mm for all positions, which is acceptable for radiotherapy. | Shape memory alloy (SMA)-based head and neck immobilizer for radiotherapy |
S2288430015000391 | The increase of consumer needs for quality metal cutting related products with more precise tolerances and better product surface roughness has driven the metal cutting industry to continuously improve quality control of metal cutting processes. In this paper, two different approaches are discussed. First, design of experiments (DOE) is used to determine the significant factors and then fuzzy logic approach is presented for the prediction of surface roughness. The data used for the training and checking the fuzzy logic performance is derived from the experiments conducted on a CNC milling machine. In order to obtain better surface roughness, the proper sets of cutting parameters are determined before the process takes place. The factors considered for DOE in the experiment were the depth of cut, feed rate per tooth, cutting speed, tool nose radius, the use of cutting fluid and the three components of the cutting force. Finally the significant factors were used as input factors for fuzzy logic mechanism and surface roughness is predicted with empirical formula developed. Test results show good agreement between the actual process output and the predicted surface roughness. | A novel approach to predict surface roughness in machining operations using fuzzy set theory |
S2288430015000512 | Piecewise linear (G01-based) tool paths generated by CAM systems lack G 1 and G 2 continuity. The discontinuity causes vibration and unnecessary hesitation during machining. To ensure efficient high-speed machining, a method to improve the continuity of the tool paths is required, such as B-spline fitting that approximates G01 paths with B-spline curves. Conventional B-spline fitting approaches cannot be directly used for tool path B-spline fitting, because they have shortages such as numerical instability, lack of chord error constraint, and lack of assurance of a usable result. Progressive and Iterative Approximation for Least Squares (LSPIA) is an efficient method for data fitting that solves the numerical instability problem. However, it does not consider chord errors and needs more work to ensure ironclad results for commercial applications. In this paper, we use LSPIA method incorporating Energy term (ELSPIA) to avoid the numerical instability, and lower chord errors by using stretching energy term. We implement several algorithm improvements, including (1) an improved technique for initial control point determination over Dominant Point Method, (2) an algorithm that updates foot point parameters as needed, (3) analysis of the degrees of freedom of control points to insert new control points only when needed, (4) chord error refinement using a similar ELSPIA method with the above enhancements. The proposed approach can generate a shape-preserving B-spline curve. Experiments with data analysis and machining tests are presented for verification of quality and efficiency. Comparisons with other known solutions are included to evaluate the worthiness of the proposed solution. | A chord error conforming tool path B-spline fitting method for NC machining based on energy minimization and LSPIA |
S2288430015000548 | In this paper, the cutting force calculation of ball-end mill processing was modeled mathematically. All derivations of cutting forces were directly based on the tangential, radial, and axial cutting force components. In the developed mathematical model of cutting forces, the relationship of average cutting force and the feed per flute was characterized as a linear function. The cutting force coefficient model was formulated by a function of average cutting force and other parameters such as cutter geometry, cutting conditions, and so on. An experimental method was proposed based on the stable milling condition to estimate the cutting force coefficients for ball-end mill. This method could be applied for each pair of tool and workpiece. The developed cutting force model has been successfully verified experimentally with very promising results. the diameter of cutter [mm] the diameter of cutter [mm] the number of flutes on the cutter the helix angle on the cutter [deg] the cutter pitch angle [deg] the full axial depth of cut [mm] the differential axial depth of cut [mm] the lag angle at an axial depth of cut z [deg] the lag angle at maximum axial depth of cut z=a [deg] the instantaneous immersion angle of flute number j, ( j = 1 – N f ) [deg] the instantaneous immersion angle of flute number j in z cutting depth, ( j = 1 – N f ) [deg] the instantaneous chip thickness at immersion angle ϕ j [mm] the chip width [mm] the edge length of the cutting segment [mm] the radius of a circle on xy plane at an arbitrary point (P) on cutting edge [mm] the feed per tooth [mm/tooth] the axial immersion angle at z axial depth of cut tangential shearing force coefficient [N/mm2] radial shearing force coefficient [N/mm2] axial shearing force coefficient [N/mm2] tangential edge force coefficient [N/mm] radial edge force coefficient [N/mm] axial edge force coefficient [N/mm] the differential tangential cutting force [N] the differential radial cutting force [N] the differential axial cutting force [N] the differential feed cutting force [N] the differential normal cutting force [N] the cutting force in the feed direction [N] the cutting force in the normal direction [N] the cutting force in the axial direction [N] the average cutting force in the feed direction [N] the components of linear model force in the feed direction [N] the average cutting force in the normal direction [N] the components of linear model force in the normal direction [N] the average cutting force in the axial direction [N] the components of linear model force in the axial direction [N] | A combination method of the theory and experiment in determination of cutting force coefficients in ball-end mill processes |
S228843001500055X | To injection mould polymers, designing mould is a key task involving several critical decisions with direct implications to yield quality, productivity and frugality. One prominent decision among them is specifying sprue-bush conduit expansion as it significantly influences overall injection moulding; abstruseness anguish in its design criteria deceives direct determination. Intuitively designers decide it wisely and then exasperate by optimising or manipulating processing parameters. To overwhelm that anomaly this research aims at proposing an ideal design criteria holistically for all polymeric materials also tend as a functional assessment metric towards perfection i.e., criteria to specify sprue conduit size before mould development. Accordingly, a priori analytical criterion was deduced quantitatively as expansion ratio from ubiquitous empirical relationships specifically a.k.a an exclusive expansion angle imperatively configured for injectant properties. Its computational intelligence advantage was leveraged to augment functionality of perfectly injecting into an impression gap, while synchronising both injector capacity and desired moulding features. For comprehensiveness, it was continuously sensitised over infinite scale as an explicit factor dependent on in-situ spatio-temporal injectant state perplexity with discrete slope and altitude for each polymeric character. In which congregant ranges of apparent viscosity and shear thinning index were conceived to characteristically assort most thermoplastics. Thereon results accorded aggressive conduit expansion widening for viscous incrust, while a very aggressive narrowing for shear thinning encrust; among them apparent viscosity had relative dominance. This important rationale would certainly form a priori design basis as well diagnose filling issues causing several defects. Like this the proposed generic design criteria, being simple would immensely benefit mould designers besides serve as an inexpensive preventive cliché to moulders. Its adaption ease to practice manifests a hope of injection moulding extremely alluring polymers. Therefore, we concluded that appreciating injectant׳s polymeric character to design exclusive sprue bush offers a definite a priori advantage. | Computational design of mould sprue for injection moulding thermoplastics |
S2288430015000561 | Currently composite manufacturing process, such as linear friction welding plus NC machining, is the main method for the manufacturing and repairing of complex parts with integrated structure. Due to different datum position and inevitable distortion from different processes, it is important to ensure sufficient machining allowance for complex parts during the NC machining process. In this paper, a workpiece localization approach for machining allowance optimization of complex parts based on CMM inspection is developed. This technique concerns an alignment process to ensure sufficient stock allowance for the single parts as well as the whole integrated parts. The mathematical model of the constrained alignment is firstly established, and then the symmetric block solution strategy is proposed to solve the optimization model. Experiment result shows that the approach is appropriate and feasible to distribute the machining allowance for the single and whole parts for adaptive machining of complex parts. | An approach for machining allowance optimization of complex parts with integrated structure |
S2288430015000573 | Feature-based NC machining, which requires high quality of 3D CAD model, is widely used in machining aircraft structural part. However, there has been little research on how to automatically detect the CAD model errors. As a result, the user has to manually check the errors with great effort before NC programming. This paper proposes an automatic CAD model errors detection approach for aircraft structural part. First, the base faces are identified based on the reference directions corresponding to machining coordinate systems. Then, the CAD models are partitioned into multiple local regions based on the base faces. Finally, the CAD model error types are evaluated based on the heuristic rules. A prototype system based on CATIA has been developed to verify the effectiveness of the proposed approach. | An automatic 3D CAD model errors detection method of aircraft structural part for NC machining |
S2288430015000585 | Free-form blades are widely used in different industries, such as aero-engine and steam turbine. Blades that are damaged during service or have production deficiencies are usually replaced with new ones. This leads to the waste of expensive material and is not sustainable. However, material and costs can be saved by repairing of locally damaged blades or blades with localized production deficiencies. The blade needs to be further machined after welding process to reach the aerodynamic performance requirements. This paper outlines an adaptive location approach of repaired blade for model reconstruction and NC machining. Firstly, a mathematical model is established to describe the localization problem under constraints. Secondly, by solving the mathematical model, localization of repaired blade for NC machining can be obtained. Furthermore, a more flexible method based on the proposed mathematical model and the continuity of the deformation process is developed to realize a better localization. Thirdly, by rebuilding the model of the repaired blade and extracting repair error, optimized tool paths for NC machining is generated adaptively for each individual part. Finally, three examples are given to validate the proposed method. | Adaptive location of repaired blade for multi-axis milling |
S2288430015000597 | The automated part quality inspection poses many challenges to the engineers, especially when the part features to be inspected become complicated. A large quantity of part inspection at a faster rate should be relied upon computerized, automated inspection methods, which requires advanced quality control approaches. In this context, this work uses innovative methods in remote part tracking and quality control with the aid of the modern equipment and application of support vector machine (SVM) learning approach to predict the outcome of the quality control process. The classifier equations are built on the data obtained from the experiments and analyzed with different kernel functions. From the analysis, detailed outcome is presented for six different cases. The results indicate the robustness of support vector classification for the experimental data with two output classes. | E-quality control: A support vector machines approach |
S2288430015000615 | The current trends of product customization and repair of high value parts with individual defects demand automation and a high degree of flexibility of the involved manufacturing process chains. To determine the corresponding requirements this paper gives an overview of manufacturing process chains by distinguishing between horizontal and vertical process chains. The established way of modeling and programming processes with CAx systems and existing approaches is shown. Furthermore, the different types of possible adaptions of a manufacturing process chain are shown and considered as a cascaded control loop. Following this it is discussed which key requirements of repair process chains are unresolved by existing approaches. To overcome the deficits this paper introduces repair features which comprise the idea of geometric features and defines analytical auxiliary geometries based on the measurement input data. This meets challenges normally caused by working directly on reconstructed geometries in the form of triangulated surfaces which are prone to artifacts. Embedded into function blocks, this allows the use of traditional approaches for manufacturing process chains to be applied to adaptive repair process chains. | Programming of adaptive repair process chains using repair features and function blocks |
S2288430015000627 | Blisk is an essential component in aero engines. To maintain good aero-dynamic performance, one critical machining requirement for blades on blisk is that the generated five-axis tool path should be boundary-conformed. For a blade discretely modeled as a point cloud or mesh, most existing popular tool path generation methods are unable to meet this requirement. To address this issue, a novel five-axis tool path generation method for a discretized blade on blisk is presented in this paper. An idea called Linear Morphing Cone (LMC) is first proposed, which sets the boundary of the blade as the constraint. Based on this LMC, a CC curve generation and expansion method is then proposed with the specified machining accuracy upheld. Using the proposed tool path generation method, experiments on discretized blades are carried out, whose results show that the generated tool paths are both uniform and boundary-conformed. | Five-axis finishing tool path generation for a mesh blade based on linear morphing cone |
S2288430015000652 | Steel nitriding is a thermo-chemical process leading to surface hardening and improvement in fatigue properties. The process is strongly influenced by many different variables such as steel composition, nitrogen potential, temperature, time, and quenching media. In the present study, the influence of such parameters affecting physic-chemical and mechanical properties of nitride steels was evaluated. The aim was to streamline the process by numerical–experimental analysis allowing defining the optimal conditions for the success of the process. Input parameters–output results correlations were calculated through the employment of a multi-objective optimization software, modeFRONTIER (Esteco). The mechanical and microstructural results belonging to the nitriding process, performed with different processing conditions for various steels, are presented. The data were employed to obtain the analytical equations describing nitriding behavior as a function of nitriding parameters and steel composition. The obtained model was validated, through control designs, and optimized by taking into account physical and processing conditions. heat treatment temperature nitrogen potential nitriding temperature nitriding time nitrogen concentration at xxx μm from the surface distance from the surface of the starting point of ε phase distance from the surface of the ending point of ε phase distance from the surface of the starting point of γ′ phase distance from the surface of the ending point of γ′ phase microhardness at xxx μm from the surface residual stresses at xxx μm from the surface | Steel nitriding optimization through multi-objective and FEM analysis |
S2288430015000755 | In this paper, a minimum time path planning strategy is proposed for multi points manufacturing problems in drilling/spot welding tasks. By optimizing the travelling schedule of the set points and the detailed transfer path between points, the minimum time manufacturing task is realized under fully utilizing the dynamic performance of robotic manipulator. According to the start-stop movement in drilling/spot welding task, the path planning problem can be converted into a traveling salesman problem (TSP) and a series of point to point minimum time transfer path planning problems. Cubic Hermite interpolation polynomial is used to parameterize the transfer path and then the path parameters are optimized to obtain minimum point to point transfer time. A new TSP with minimum time index is constructed by using point-point transfer time as the TSP parameter. The classical genetic algorithm (GA) is applied to obtain the optimal travelling schedule. Several minimum time drilling tasks of a 3-DOF robotic manipulator are used as examples to demonstrate the effectiveness of the proposed approach. | Minimum time path planning of robotic manipulator in drilling/spot welding tasks |
S2288430015300117 | In history based parametric CAD modeling systems, persistent identification of the topological entities after design modification is mandatory to keep the design intent by recording model creation history and modification history. Persistent identification of geometric and topological entities is necessary in the product design phase as well as in the re-evaluation stage. For the identification, entities should be named first according to the methodology which will be applicable for all the entities unconditionally. After successive feature operations on a part body, topology based persistent identification mechanism generates ambiguity problem that usually stems from topology splitting and topology merging. Solving the ambiguity problem needs a complex method which is a combination of topology and geometry. Topology is used to assign the basic name to the entities. And geometry is used for the ambiguity solving between the entities. In the macro parametrics approach of iCAD lab of KAIST a topology based persistent identification mechanism is applied which will solve the ambiguity problem arising from topology splitting and also in case of topology merging. Here, a method is proposed where no geometry comparison is necessary for topology merging. The present research is focused on the enhancement of the persistent identification schema for the support of ambiguity problem especially of topology splitting problem and topology merging problem. It also focused on basic naming of pattern features. | Implementation of persistent identification of topological entities based on macro-parametrics approach |
S2288430015300142 | Owing to our rapidly aging society, accessibility evaluation to enhance the ease and safety of access to indoor and outdoor environments for the elderly and disabled is increasing in importance. Accessibility must be assessed not only from the general standard aspect but also in terms of physical and cognitive friendliness for users of different ages, genders, and abilities. Meanwhile, human behavior simulation has been progressing in the areas of crowd behavior analysis and emergency evacuation planning. However, in human behavior simulation, environment models represent only “as-planned” situations. In addition, a pedestrian model cannot generate the detailed articulated movements of various people of different ages and genders in the simulation. Therefore, the final goal of this research was to develop a virtual accessibility evaluation by combining realistic human behavior simulation using a digital human model (DHM) with “as-is” environment models. To achieve this goal, we developed an algorithm for generating human-like DHM walking motions, adapting its strides, turning angles, and footprints to laser-scanned 3D as-is environments including slopes and stairs. The DHM motion was generated based only on a motion-capture (MoCap) data for flat walking. Our implementation constructed as-is 3D environment models from laser-scanned point clouds of real environments and enabled a DHM to walk autonomously in various environment models. The difference in joint angles between the DHM and MoCap data was evaluated. Demonstrations of our environment modeling and walking simulation in indoor and outdoor environments including corridors, slopes, and stairs are illustrated in this study. | Motion-capture-based walking simulation of digital human adapted to laser-scanned 3D as-is environments for accessibility evaluation |
S228843001530018X | Normally all manufacturing and fabrication processes introduce residual stresses in a component. These stresses exist even after all service or external loads have been removed. Residual stresses have been studied elaborately in the past and even in depth research have been done to determine their magnitude and distribution during different manufacturing processes. But very few works have dealt with the study of residual stresses formation during the casting process. Even though these stresses are less in magnitude, they still result in crack formation and subsequent failure in later phases of the component usage. In this work, the residual stresses developed in a shifter during casting process are first determined by finite element analysis using ANSYS® Mechanical APDL, Release 12.0 software. Initially the analysis was done on a simple block to determine the optimum element size and boundary conditions. With these values, the actual shifter component was analyzed. All these simulations are done in an uncoupled thermal and structural environment. The results showed the areas of maximum residual stress. This was followed by the geometrical optimization of the cast part for minimum residual stresses. The resulting shape gave lesser and more evenly distributed residual stresses. Crack compliance method was used to experimentally determine the residual stresses in the modified cast part. The results obtained from the measurements are verified by finite element analysis findings. | Design optimization of precision casting for residual stress reduction |
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