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Town R, Hayes D, March A, Fonagy P, Stapley E. Self-management, self-care, and self-help in adolescents with emotional problems: a scoping review. Eur Child Adolesc Psychiatry 2024; 33:2929-2956. [PMID: 36641785 PMCID: PMC9840811 DOI: 10.1007/s00787-022-02134-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 12/22/2022] [Indexed: 01/16/2023]
Abstract
This study aimed to review the existing published and grey literature describing the concepts of self-management, self-care, and self-help, and to capture strategies or techniques related to these concepts, for adolescents with emotional problems. Emotional problems are rising amongst adolescents, yet timely access to specialist mental health treatment is limited to those with greater severity of mental health difficulties. Self-management, self-care, and self-help strategies may be used by adolescents with emotional problems both in terms of those waiting for treatment and to prevent relapse. Given the overlap in existing definitions and the lack of clarity around these concepts in an adolescent mental health context, a scoping review of the literature is warranted to provide clarity. Eligible studies were those involving adolescents aged 10 to 19 years with symptoms of emotional problems. Studies referenced self-management, self-care, or self-help, not involving a professional, in this population. Quantitative, qualitative, economic, and mixed methods studies, as well as systematic, scoping, and literature reviews, from 2000 onwards and in the English language, were eligible for inclusion. A systematic search was conducted of both published and grey literature. Databases searched included PsycINFO, Medline, Embase, Web of Science, and CINAHL Plus. Mednar was also searched for unpublished studies and grey literature. Tables of themes, terms, and associated strategies are presented alongside a thematic analysis of the results. 62 articles were included. These were 20 quantitative studies, 14 systematic reviews, 10 qualitative studies, five review papers, four book chapters, four mixed methods studies, two dissertations, two meta-analyses and one scoping review and systematic review. Most of the included articles referenced self-help (n = 51), followed by self-management (n = 17) and self-care (n = 6). A total of 12 themes were identified from a reflexive thematic analysis of descriptions (and associated strategies) of self-management, self-help, or self-care in included texts. This scoping review provides clarity on the similarities and differences between how these concepts are discussed, and the strategies which are associated with each of these concepts in the relevant literature. Implications for policy and intervention development for adolescents' self-management, self-help, and self-care of their mental health are discussed. There is considerable overlap in both the ways in which these concepts are described, and the strategies or approaches proposed in relation to them, supporting previous research suggesting these strategies should be grouped under a single term, such as "self or community approaches." More research is needed for self-management, self-help, and self-care amongst marginalized groups as these adolescents may have the highest unmet need for mental health support.
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Affiliation(s)
- Rosa Town
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK.
| | - Daniel Hayes
- Research Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | - Anna March
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Emily Stapley
- Evidence Based Practice Unit, Anna Freud Centre and University College London, London, UK
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Weidle B, Babiano-Espinosa L, Skokauskas N, Wolters LH, Henriksen M, Arntzen J, Skare A, Ivarsson T, Groff T, Skarphedinsson G. Online CBT Versus Standard CBT for Pediatric Obsessive-Compulsive Disorder. Child Psychiatry Hum Dev 2024:10.1007/s10578-024-01745-8. [PMID: 39152274 DOI: 10.1007/s10578-024-01745-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/02/2024] [Indexed: 08/19/2024]
Abstract
Obsessive-compulsive disorder (OCD), characterized by recurring obsessions and compulsions, affects 1-3% of the childhood population, often leading to severe impairment and reduced quality of life. Cognitive behavioral therapy (CBT) is well-documented as first choice treatment for pediatric OCD. Traditionally delivered face-to-face CBT has limitations in terms of accessibility, availability, and quality of delivery. Online CBT using video conferencing (online-CBT) at home aims to address some of these barriers. In this pilot study, we aimed to compare acceptability, feasibility and effectiveness of online CBT against face-to-face CBT. Online CBT outcomes of 29 children with OCD were analyzed benchmarked against outcomes of face-to-face CBT (n = 269) from the Nordic Long-term OCD Treatment Study, the largest CBT follow up study in pediatric OCD to date. Acceptability rated by online CBT participants and their parents was very high (Client Satisfaction Questionnaire total scores about 30, range 8-32). Feasibility assessed as dropout rate was comparable to NordLOTS (10.3% versus 9.7%). The online CBT group compared to NordLOTS showed a higher response rate (90% versus 60%; p = .002) and remission rate (81% versus 53%; p = .231). Our results suggest that the trusting therapeutic relationship necessary for demanding exposure-based treatment can be established by online CBT. Online CBT seems to be at least as effective in reducing OCD symptoms than standard CBT. Trial ID: ISRCTN37530113.
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Affiliation(s)
- Bernhard Weidle
- Regional Centre for Child and Youth Mental Health and Child Welfare, Department of Mental Health, Norwegian University of Science and Technology, Klostergata 46, Trondheim, 7030, Norway.
- Department of Child and Adolescent Psychiatry, St. Olav's University Hospital, Trondheim, Norway.
| | - Lucía Babiano-Espinosa
- Regional Centre for Child and Youth Mental Health and Child Welfare, Department of Mental Health, Norwegian University of Science and Technology, Klostergata 46, Trondheim, 7030, Norway
| | - Norbert Skokauskas
- Regional Centre for Child and Youth Mental Health and Child Welfare, Department of Mental Health, Norwegian University of Science and Technology, Klostergata 46, Trondheim, 7030, Norway
- Department of Child and Adolescent Psychiatry, St. Olav's University Hospital, Trondheim, Norway
| | - Lidewij H Wolters
- Faculty of Behavioural and Social Sciences, Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, the Netherlands
- Accare Child Study Center, Groningen, the Netherlands
| | - Marit Henriksen
- Department of Child and Adolescent Psychiatry, St. Olav's University Hospital, Trondheim, Norway
| | - Jostein Arntzen
- Department of Child and Adolescent Psychiatry, St. Olav's University Hospital, Trondheim, Norway
| | - Anne Skare
- Department of Child and Adolescent Psychiatry, St. Olav's University Hospital, Trondheim, Norway
| | - Tord Ivarsson
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Saman Y, Pascual-Vera B, Corberán M, Arnáez S, Roncero M, García-Soriano G. A mobile app to challenge obsessional beliefs in adolescents: a protocol of a two-armed, parallel randomized controlled trial. BMC Psychiatry 2024; 24:265. [PMID: 38594680 PMCID: PMC11003130 DOI: 10.1186/s12888-024-05735-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 04/03/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Adolescence is a crucial stage for the development of OCD symptoms that, in most cases, persist into adulthood. This requires designing preventive strategies tailored to this population. Therefore, we aim to describe the study protocol that will be used to examine the effectiveness of a mobile health application to challenge obsessional beliefs in adolescents. METHODS A two-armed randomized controlled trial will be conducted on an adolescent sample from the general population. The experimental group will use the intervention module (GGOC-AD) of a mobile app on the GGtude platform for 14 days whereas the control group will use a non-active module (GGN-AD) of said app. Primary outcome measures will be obsessional beliefs and obsessive-compulsive symptoms, and secondary measures will be self-esteem and emotional symptoms. Three assessment points will be conducted at baseline, post-intervention, and one-month follow-up. A linear multiple regression model with an intention to treat approach will be used. The expected total sample size will be 55 participants. DISCUSSION We expect that the intervention group will show a reduction in obsessional beliefs and OCD-symptoms at post and follow-up in comparison with the control group. Additionally, we expect that the app will improve participants' self-esteem. This study could provide an accessible mobile health tool to prevent OCD-related symptoms in adolescents. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT06033391 . Registered September 4, 2023.
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Affiliation(s)
- Yuliya Saman
- Departamento de Personalidad, Evaluación y Tratamientos Psicológicos, Universitat de València, Avda. Blasco Ibáñez, 21, Valencia, 46010, Spain
| | - Belén Pascual-Vera
- Departamento de Personalidad, Evaluación y Tratamientos Psicológicos, Universidad Nacional de Educación a Distancia, C/ Bravo Murillo, 38, Madrid, 28015, Spain
| | - Marta Corberán
- Departamento de Personalidad, Evaluación y Tratamientos Psicológicos, Universitat de València, Avda. Blasco Ibáñez, 21, Valencia, 46010, Spain
| | - Sandra Arnáez
- Departamento de Personalidad, Evaluación y Tratamientos Psicológicos, Universitat de València, Avda. Blasco Ibáñez, 21, Valencia, 46010, Spain
| | - María Roncero
- Departamento de Personalidad, Evaluación y Tratamientos Psicológicos, Universitat de València, Avda. Blasco Ibáñez, 21, Valencia, 46010, Spain
| | - Gemma García-Soriano
- Departamento de Personalidad, Evaluación y Tratamientos Psicológicos, Universitat de València, Avda. Blasco Ibáñez, 21, Valencia, 46010, Spain.
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Balan R, Dobrean A, Poetar CR. Use of automated conversational agents in improving young population mental health: a scoping review. NPJ Digit Med 2024; 7:75. [PMID: 38503909 PMCID: PMC10951258 DOI: 10.1038/s41746-024-01072-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 03/07/2024] [Indexed: 03/21/2024] Open
Abstract
Automated conversational agents (CAs) emerged as a promising solution in mental health interventions among young people. Therefore, the objective of this scoping review is to examine the current state of research into fully automated CAs mediated interventions for the emotional component of mental health among young people. Selected databases were searched in March 2023. Included studies were primary research, reporting on development, feasibility/usability, or evaluation of fully automated CAs as a tool to improve the emotional component of mental health among young population. Twenty-five studies were included (N = 1707). Most automated CAs applications were standalone preventions targeting anxiety and depression. Automated CAs were predominantly AI-based chatbots, using text as the main communication channel. Overall, the results of the current scoping review showed that automated CAs mediated interventions for emotional problems are acceptable, engaging and with high usability. However, the results for clinical efficacy are far less conclusive, since almost half of evaluation studies reported no significant effect on emotional mental health outcomes. Based on these findings, it can be concluded that there is a pressing need to improve the existing automated CAs applications to increase their efficacy as well as conducting more rigorous methodological research in this area.
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Affiliation(s)
- Raluca Balan
- The International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Babeș-Bolyai University, Cluj-Napoca, Romania
- Department of Clinical Psychology and Psychotherapy, Babeş-Bolyai University, Cluj-Napoca, Cluj, Romania
| | - Anca Dobrean
- The International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Babeș-Bolyai University, Cluj-Napoca, Romania.
- Department of Clinical Psychology and Psychotherapy, Babeş-Bolyai University, Cluj-Napoca, Cluj, Romania.
| | - Costina R Poetar
- The International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Babeș-Bolyai University, Cluj-Napoca, Romania
- Department of Clinical Psychology and Psychotherapy, Babeş-Bolyai University, Cluj-Napoca, Cluj, Romania
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Kathiravan S, Chakrabarti S. Development of a protocol for videoconferencing-based exposure and response prevention treatment of obsessive-compulsive disorder during the COVID-19 pandemic. World J Psychiatry 2023; 13:60-74. [PMID: 36925949 PMCID: PMC10011942 DOI: 10.5498/wjp.v13.i2.60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 11/01/2022] [Accepted: 12/06/2022] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND The existing literature indicates that psychotherapeutic treatment, especially exposure and response prevention (ERP) is efficacious in treating obsessive-compulsive disorder (OCD). The coronavirus disease 2019 pandemic adversely impacted many patients with OCD and disrupted their usual treatment. Moreover, the pandemic forced a global switch to telemental health (TMH) services to maintain the standards and continuity of care. Consequently, clinicians are increasingly using TMH-based psychotherapeutic treatments to treat OCD. However, several challenges have made it difficult for them to implement these treatments in the changed circumstances imposed by the pandemic. AIM To describe the formulation, implementation, feasibility, and usefulness of videoconferencing-based ERP (VC-ERP) treatment for OCD during the coronavirus disease 2019 pandemic. METHODS This prospective, observational study was conducted in the psychiatric unit of a multi-specialty hospital in north India over 12 mo (July 2020-June 2021). All patients with OCD were assessed using the home-based TMH services of the department. The VC-ERP protocol for OCD was the outcome of weekly Zoom meetings with a group of clinicians involved in administering the treatment. After a systematic evaluation of the available treatment options, an initial protocol for delivering VC-ERP was developed. Guidelines for clinicians and educational materials for patients and their families were prepared. The protocol was implemented among patients with OCD attending the TMH services, and their progress was monitored. The weekly meetings were used to upgrade the protocol to meet the needs of all stakeholders. Feasibility and efficacy outcomes were examined. RESULTS All patients were diagnosed with OCD as a primary or a comorbid condition according to the International Classification of Diseases, 10th version criteria. Out of 115 patients who attended the services during the study period, 37 were excluded from the final analysis. Of the remaining 78 patients, VC-ERP was initiated in 43 patients. Six patients dropped out, and three were hospitalized for inpatient ERP. Eleven patients have completed the full VC-ERP treatment. One patient completed the psychoeducation part of the protocol. VC-ERP is ongoing in 22 patients. The protocol for VC-ERP treatment was developed and upgraded online. A large proportion of the eligible patients (n = 34/43; 79%) actively engaged in the VC-ERP treatment. Drop-out rates were low (n = 6/43; 14%). Satisfaction with the treatment was adequate among patients, caregivers, and clinicians. Apart from hospitalization in 3 patients, there were no other adverse events. Hybrid care and stepped care approaches could be incorporated into the VC-ERP protocol. Therefore, the feasibility of VC-ERP treatment in terms of operational viability, service utilization, service engagement, need for additional in-person services, frequency of adverse events, and user satisfaction was adequate. The VC-ERP treatment was found to be efficacious in the 11 patients who had completed the full treatment. Significant reductions in symptoms and maintenance of treatment gains on follow-up were observed. CONCLUSION This study provided preliminary evidence for the feasibility and usefulness of VC-ERP in the treatment of OCD. The results suggest that VC-ERP can be a useful option in resource-constrained settings.
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Affiliation(s)
- Sanjana Kathiravan
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
| | - Subho Chakrabarti
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
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Adam J, Goletz H, Viefhaus P, Woitecki K, Döpfner M. Webcam-Based Online Coaching with Children and Adolescents with Obsessive-Compulsive Disorders – A Single-Case Study. ZEITSCHRIFT FÜR KINDER- UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2022; 51:207-221. [PMID: 36259642 DOI: 10.1024/1422-4917/a000904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract. Objective: Although there is clear evidence-based knowledge regarding state-of-the-art treatment for pediatric obsessive-compulsive disorder (OCD), two main issues remain in clinical practice: (1) Exposure-based cognitive behavioral therapy (CBT) is limited in terms of availability and accessibility or is not adequately provided, and (2) despite large effect sizes of exposure-based CBT, the achieved recovery rates of 50–60 % still show room for improvement. These issues have prompted an increasing focus on delivering exposure-based CBT in new and innovative ways. This study aims to evaluate an intensive therapist-administered online coaching program consisting of exposure with response prevention via video teleconferencing (VTC) as an add-on to weekly outpatient CBT (blended therapy). Method: The blended therapy is examined in n = 5 children and adolescents with OCD using an AB design and multi-informant ratings. Results: This single-case study shows promising results, indicating that a decrease in OCD severity and related functional impairment can be attributed to blended therapy. Moreover, satisfaction with online coaching was high. Conclusions: Despite some principal limitations, the results support the effectiveness and feasibility of blended therapy.
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Affiliation(s)
- Julia Adam
- School of Child and Adolescent Cognitive Behavior Therapy (AKiP), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
| | - Hildegard Goletz
- School of Child and Adolescent Cognitive Behavior Therapy (AKiP), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
| | - Paula Viefhaus
- School of Child and Adolescent Cognitive Behavior Therapy (AKiP), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
| | - Katrin Woitecki
- School of Child and Adolescent Cognitive Behavior Therapy (AKiP), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
| | - Manfred Döpfner
- School of Child and Adolescent Cognitive Behavior Therapy (AKiP), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
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Ramshaw G, McKeown A, Lee R, Conlon A, Brown D, Kennedy PJ. Introduction of Technology to Support Young People’s Care and Mental Health—A Rapid Evidence Review. CHILD & YOUTH CARE FORUM 2022; 52:509-531. [PMID: 35966643 PMCID: PMC9362215 DOI: 10.1007/s10566-022-09700-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2022] [Indexed: 11/23/2022]
Abstract
Background Technology and its use within mental health services has advanced dramatically over recent years. Opportunities for mental health services to utilise technology to introduce novel, effective, and more efficient means of delivering assessment, and treatment are increasing. Objective The current rapid-evidence paper reviews evidence regarding the introduction of novel technology to support young people’s mental health and psychological well-being. Methods A rapid evidence review was conducted. PSYCHINFO and CINAHL were searched for research articles between 2016 and 2021 that were specific to young people, mental health, and technology developments within this domain. N = 27 studies which explored the introduction, feasibility, and value of technology for mental health purposes were included in a narrative synthesis. Quality or risk of bias analyses were not completed. Results Overall, technological advancements in young people’s care were considered positive and engaging for young people. Factors including resources, efficiency of care, engagement, therapeutic effectiveness, ethical considerations, therapeutic alliance, and flexibility were considered within this review. Nevertheless, potential barriers include clinician concerns, socioeconomic factors, and motivation. Conclusion Effective and sustained use of technology within young people’s mental health services will depend on the technology’s usability, efficiency, and ability to engage young people. This paper expands on existing research by reviewing a broader range of technology proposed to support young people’s mental health and well-being. This will assist in the application of novel technological advancements by indicating effectiveness, preferences, potential barriers, and recommendations for the feasibility and efficacy of introducing technology into young people’s services.
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Wan Mohd Yunus WMA, Matinolli HM, Waris O, Upadhyaya S, Vuori M, Korpilahti-Leino T, Ristkari T, Koffert T, Sourander A. Digitalized Cognitive Behavioral Interventions for Depressive Symptoms During Pregnancy: Systematic Review. J Med Internet Res 2022; 24:e33337. [PMID: 35195532 PMCID: PMC8908191 DOI: 10.2196/33337] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 11/12/2021] [Accepted: 12/13/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Studies have shown a high prevalence of depression during pregnancy, and there is also evidence that cognitive behavioral therapy (CBT) is one of the most effective psychosocial interventions. Emerging evidence from randomized controlled trials (RCTs) has shown that technology has been successfully harnessed to provide CBT interventions for other populations. However, very few studies have focused on their use during pregnancy. This approach has become increasingly important in many clinical areas due to the COVID-19 pandemic, and our study aimed to expand the knowledge in this particular clinical area. OBJECTIVE Our systematic review aimed to bring together the available research-based evidence on digitalized CBT interventions for depression symptoms during pregnancy. METHODS A systematic review of the Web of Science, Cochrane Central Register of Controlled Trials, CINAHL, MEDLINE, Embase, PsycINFO, Scopus, ClinicalTrials.gov, and EBSCO Open Dissertations databases was carried out from the earliest available evidence to October 27, 2021. Only RCT studies published in English were considered. The PRISMA (Preferred Reporting Items of Systematic Reviews and Meta-analyses) guidelines were followed, and the protocol was registered on the Prospective Register of Systematic Reviews. The risk of bias was assessed using the revised Cochrane risk-of-bias tool for randomized trials. RESULTS The review identified 7 studies from 5 countries (the United States, China, Australia, Norway, and Sweden) published from 2015 to 2021. The sample sizes ranged from 25 to 1342 participants. The interventions used various technological elements, including text, images, videos, games, interactive features, and peer group discussions. They comprised 2 guided and 5 unguided approaches. Using digitalized CBT interventions for depression during pregnancy showed promising efficacy, with guided intervention showing higher effect sizes (Hedges g=1.21) than the unguided interventions (Hedges g=0.14-0.99). The acceptability of the digitalized CBT interventions was highly encouraging, based on user feedback. Attrition rates were low for the guided intervention (4.5%) but high for the unguided interventions (22.1%-46.5%). A high overall risk of bias was present for 6 of the 7 studies. CONCLUSIONS Our search only identified a small number of digitalized CBT interventions for pregnant women, despite the potential of this approach. These showed promising evidence when it came to efficacy and positive outcomes for depression symptoms, and user feedback was positive. However, the overall risk of bias suggests that the efficacy of the interventions needs to be interpreted with caution. Future studies need to consider how to mitigate these sources of biases. Digitalized CBT interventions can provide prompt, effective, evidence-based interventions for pregnant women. This review increases our understanding of the importance of digitalized interventions during pregnancy, including during the COVID-19 pandemic. TRIAL REGISTRATION PROSPERO International Prospective Register of Systematic Reviews CRD42020216159; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=216159.
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Affiliation(s)
- Wan Mohd Azam Wan Mohd Yunus
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland.,INVEST Research Flagship, University of Turku, Turku, Finland.,Department of Psychology, School of Human Resource Development & Psychology, Faculty of Social Sciences & Humanities, Universiti Teknologi Malaysia, Johor, Malaysia
| | - Hanna-Maria Matinolli
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland.,INVEST Research Flagship, University of Turku, Turku, Finland
| | - Otto Waris
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland.,INVEST Research Flagship, University of Turku, Turku, Finland.,Turku University of Applied Sciences, Turku, Finland
| | - Subina Upadhyaya
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland.,INVEST Research Flagship, University of Turku, Turku, Finland
| | - Miika Vuori
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland.,INVEST Research Flagship, University of Turku, Turku, Finland.,Department of Teacher Education, Turku Institute for Advanced Studies, University of Turku, Turku, Finland
| | - Tarja Korpilahti-Leino
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland.,INVEST Research Flagship, University of Turku, Turku, Finland
| | - Terja Ristkari
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland.,INVEST Research Flagship, University of Turku, Turku, Finland
| | - Tarja Koffert
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland
| | - Andre Sourander
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland.,INVEST Research Flagship, University of Turku, Turku, Finland.,Turku University Hospital, Turku, Finland
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Conzelmann A, Hollmann K, Haigis A, Lautenbacher H, Bizu V, App R, Nickola M, Wewetzer G, Wewetzer C, Ivarsson T, Skokauskas N, Wolters LH, Skarphedinsson G, Weidle B, de Haan E, Torp NC, Compton SN, Calvo R, Lera-Miguel S, Alt A, Hohnecker CS, Allgaier K, Renner TJ. Internet-based psychotherapy in children with obsessive-compulsive disorder (OCD): protocol of a randomized controlled trial. Trials 2022; 23:164. [PMID: 35189937 PMCID: PMC8860270 DOI: 10.1186/s13063-022-06062-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 01/29/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Obsessive-compulsive disorder (OCD) in children can lead to a huge burden on the concerned patients and their family members. While successful state-of-the art cognitive behavioral interventions exist, there is still a lack of available experts for treatment at home, where most symptoms manifest. Internet-based cognitive behavioral therapy (iCBT) could overcome these restrictions; however, studies about iCBT in children with OCD are rare and mostly target computerized self-help resources and only email contact with the therapist. Therefore, we intended to build up and to evaluate an iCBT approach for children with OCD, replacing successful elements of traditional in-office face-to-face CBT, with face-to-face teleconferences, online materials, and apps.
Methods
With the help of a pilot feasibility study, we developed the iCBT consisting of 14 teleconference sessions with the child and parents. The sessions are supported by an app assessing daily and weekly symptoms and treatment course completed by children and parents. Additionally, we obtain heart rate and activity scores from the child via wristbands during several days and exposure sessions. Using a waiting list randomized control trial design, we aim to treat and analyze 20 children with OCD immediately after a diagnostic session whereas the control group of another set of 20 OCD patients will be treated after waiting period of 16 weeks. We will recruit 30 patients in each group to take account for potential dropouts. Outcomes for the treatment group are evaluated before randomization (baseline, t0), 16 weeks (end of treatment, t1), 32 weeks (follow-up 1, t2), and 48 weeks after randomization (follow-up 2, t3). For the waiting list group, outcomes are measured before the first randomization (baseline), at 16 weeks (waiting list period), 32 weeks (end of treatment), 48 weeks after the first randomization (follow-up I), and 64 weeks after the first randomization (follow-up II).
Discussion
Based on our experience of feasibility during the pilot study, we were able to develop the iCBT approach and the current study will investigate treatment effectiveness. Building up an iCBT approach, resembling traditional in-office face-to-face therapy, may ensure the achievement of well-known therapy effect factors, the acceptance in both patients and clinicians, and the wide distribution within the health system.
Trial registration
ClinicalTrials.govNCT05037344. Registered May 2019, last release August 13th, 2021.
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Hollmann K, Allgaier K, Hohnecker CS, Lautenbacher H, Bizu V, Nickola M, Wewetzer G, Wewetzer C, Ivarsson T, Skokauskas N, Wolters LH, Skarphedinsson G, Weidle B, de Haan E, Torp NC, Compton SN, Calvo R, Lera-Miguel S, Haigis A, Renner TJ, Conzelmann A. Internet-based cognitive behavioral therapy in children and adolescents with obsessive compulsive disorder: a feasibility study. J Neural Transm (Vienna) 2021; 128:1445-1459. [PMID: 34432173 PMCID: PMC8386338 DOI: 10.1007/s00702-021-02409-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 08/13/2021] [Indexed: 12/17/2022]
Abstract
Cognitive behavioral therapy (CBT) is the first choice of treatment of obsessive–compulsive disorder (OCD) in children and adolescents. However, there is often a lack of access to appropriate treatment close to the home of the patients. An internet-based CBT via videoconferencing could facilitate access to state-of-the-art treatment even in remote areas. The aim of this study was to investigate feasibility and acceptability of this telemedical approach. A total of nine children received 14 sessions of CBT. The first session took place face-to-face, the remaining 13 sessions via videoconference. OCD symptoms were recorded with a smartphone app and therapy materials were made accessible in a data cloud. We assessed diagnostic data before and after treatment and obtained measures to feasibility, treatment satisfaction and acceptability. Outcomes showed high acceptance and satisfaction on the part of patients with online treatment (89%) and that face-to-face therapy was not preferred over an internet-based approach (67%). The majority of patients and their parents classified the quality of treatment as high. They emphasized the usefulness of exposures with response prevention (E/RP) in triggering situations at home. The app itself was rated as easy to operate and useful. In addition to feasibility, a significant decrease in obsessive–compulsive symptoms was also achieved. Internet-based CBT for pediatric OCD is feasible and well received by the patients and their parents. Furthermore, obsessive–compulsive symptomatology decreased in all patients. The results of this study are encouraging and suggest the significance of further research regarding this technology-supported approach, with a specific focus on efficacy. Trial registration number: Clinical trials AZ53-5400.1-004/44.
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Affiliation(s)
- Karsten Hollmann
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Tübingen, Osianderstr. 5, 72076, Tübingen, Germany
| | - Katharina Allgaier
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Tübingen, Osianderstr. 5, 72076, Tübingen, Germany
| | - Carolin S Hohnecker
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Tübingen, Osianderstr. 5, 72076, Tübingen, Germany
| | | | - Verena Bizu
- Section for Information Technology, University Hospital Tübingen, Tübingen, Germany
| | | | - Gunilla Wewetzer
- Child and Adolescent Psychiatry and Psychotherapy, Clinics of the City of Cologne, Cologne, Germany
| | - Christoph Wewetzer
- Child and Adolescent Psychiatry and Psychotherapy, Clinics of the City of Cologne, Cologne, Germany
| | - Tord Ivarsson
- Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Norbert Skokauskas
- Regional Centre for Child and Youth Mental Health and Child Welfare Faculty of Medicine and Health Sciences, Trondheim, Norway
| | - Lidewij H Wolters
- Regional Centre for Child and Youth Mental Health and Child Welfare Faculty of Medicine and Health Sciences, Trondheim, Norway
| | | | - Bernhard Weidle
- Regional Centre for Child and Youth Mental Health and Child Welfare, Trondheim, Norway
| | - Else de Haan
- Academic Center for Child and Adolescent Psychiatry, Amsterdam, The Netherlands
| | - Nor Christan Torp
- Centre for Child and Adolescent Mental Health, Eastern and Southern, Division of Mental Health and Addiction, Oslo, Norway.,Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway
| | | | - Rosa Calvo
- Department of Child and Adolescent Psychiatry and Psychology, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Sara Lera-Miguel
- Department of Child and Adolescent Psychiatry and Psychology, Hospital Clinic of Barcelona, Barcelona, Spain.,CIBERSAM, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Anna Haigis
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Tübingen, Osianderstr. 5, 72076, Tübingen, Germany
| | - Tobias J Renner
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Tübingen, Osianderstr. 5, 72076, Tübingen, Germany
| | - Annette Conzelmann
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Tübingen, Osianderstr. 5, 72076, Tübingen, Germany. .,Department of Psychology (Clinical Psychology II), PFH-Private University of Applied Sciences, Göttingen, Germany.
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Seshu U, Khan HA, Bhardwaj M, Sangeetha C, Aarthi G, John S, Thara R, Raghavan V. A qualitative study on the use of mobile-based intervention for perinatal depression among perinatal mothers in rural Bihar, India. Int J Soc Psychiatry 2021; 67:467-471. [PMID: 33059490 DOI: 10.1177/0020764020966003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Perinatal depression (PND) is one of the most common psychiatric illnesses in women, with a prevalence around 22% in India. Leveraging mobile-based technologies could help in the prevention and treatment of perinatal depression even in remote places. Understanding the experiences and barriers of using such technology interventions by perinatal mothers could help in the better design and in delivery of these interventions. We aimed to study the experiences of the perinatal women using a mobile phone-based intervention, Interactive Voice Response System (IVRS), for the prevention and management of perinatal depression in a rural district of Bihar, India. MATERIALS AND METHODS A total of 12 in-depth interviews (IDIs) and one focus group discussion (FGD) with eight participants were conducted with perinatal mothers using the mobile-based IVRS to explore the experiences and perspectives of women receiving mobile phone-based interventions for the treatment of PND. Thematic analysis was done to identify major themes. RESULTS Five major themes emerged from the study around accessibility, usability, community participation, cost and preference to either intervention. Women found the mobile-based intervention useful as it made them feel lighter. They considered mental health as a health issue and wanted help to address their problems. They became familiar with terms like anxiety, depression, helplessness and burden and bean using them in their conversations. The patients used therapeutic strategies such as breathing, coping and relaxation. They even agreed to take up sessions for their peer group. CONCLUSION Women in rural Bihar seemed satisfied with the technology-based intervention. It has made mental health issues more visible and acceptable even in the rural hinterlands of Bihar.
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Affiliation(s)
- Uttara Seshu
- Innovators in Health (India) Nagar Panchayat, Dalsinghsarai, Samastipur, Bihar, India
| | - Homam A Khan
- Innovators in Health (India) Nagar Panchayat, Dalsinghsarai, Samastipur, Bihar, India
| | - Manish Bhardwaj
- Innovators in Health (India) Nagar Panchayat, Dalsinghsarai, Samastipur, Bihar, India
| | - C Sangeetha
- Schizophrenia Research Foundation, Chennai, Tamil Nadu, India
| | - G Aarthi
- Schizophrenia Research Foundation, Chennai, Tamil Nadu, India
| | - Sujit John
- Schizophrenia Research Foundation, Chennai, Tamil Nadu, India
| | - R Thara
- Schizophrenia Research Foundation, Chennai, Tamil Nadu, India
| | - Vijaya Raghavan
- Schizophrenia Research Foundation, Chennai, Tamil Nadu, India
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Muroff J, Robinson W. Tools of Engagement: Practical Considerations for Utilizing Technology-Based Tools in CBT Practice. COGNITIVE AND BEHAVIORAL PRACTICE 2020. [DOI: 10.1016/j.cbpra.2020.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Acceptability, feasibility, and efficacy of Internet cognitive behavioral therapy (iCBT) for pediatric obsessive-compulsive disorder: a systematic review. Syst Rev 2019; 8:284. [PMID: 31747935 PMCID: PMC6864940 DOI: 10.1186/s13643-019-1166-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 09/21/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Obsessive-compulsive disorder (OCD) is a chronic mental health disorder characterized by recurring obsessions and compulsions affecting 1-3% of children and adolescents. Current treatment options are limited by accessibility, availability, and quality of care. New technologies provide opportunities to address at least some of these challenges. This paper aims to investigate the acceptability, feasibility, and efficacy of traditional cognitive behavioral therapy with Internet cognitive behavioral therapy (iCBT) for pediatric OCD according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. METHOD We searched EMBASE, Medline, PsycINFO, CENTRAL, LILACS, CINAHL, and Scopus. Results include articles from 1987 to March 2018. Main inclusion criteria were patients aged 4-18, primary diagnosis of OCD, and iCBT. RESULTS Of the 2323 unique articles identified during the initial search, six studies with a total of 96 participants met our inclusion criteria: three randomized controlled trials, one single-case multiple-baseline design, one open-label trial, and one case series. Four studies reported a significant decrease in OCD severity on the Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) following iCBT, one study reported significant decrease in CY-BOCS scores for iCBT relative to waitlist, and the case series reported (some) symptom reduction in all participants. Six studies reported high rates of feasibility, and five studies reported good acceptability of iCBT. CONCLUSION At present, evidence regarding acceptability, feasibility, and efficacy of iCBT for pediatric OCD is limited. Results are promising but need to be confirmed and refined in further research. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD4201808587.
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