Internet-based therapy with FearFighter for anxiety disorders: a randomised clinical trial.

Background: Internet-based cognitive behavioural self-help psychotherapy (ICBT) can be an important alternative or supplement to ordinary face-to-face therapy.Aim: To assess effectiveness of ICBT for adults with an anxiety disorder.Methods: Sixty-four participants were randomised to 9 weeks with the FearFighter ICBT program (n = 32) or no intervention (n = 32). Outcomes included complete remission, severity of symptoms and occurrence of adverse events.Results: No difference (p = 1.00) in remission between groups following 10 weeks of intervention nor at 37 weeks follow-up was found. There was significant reduction in the severity of symptoms (p < 0.05) at end of intervention of ICBT compared to the control group, while the reduction in symptoms at 37 weeks follow-up was equal for the two groups. Two participants in the ICBT group and none in the control group reported adverse events.Conclusion: We found no difference in remission, but a reduction of symptoms in the ICBT group compared with the control group at end of intervention. At six months follow-up the two groups showed the same level in the reduction of symptoms. Trial registration: Clinicaltrials.gov: NCT02499055. Registered 01 July 2015.

An analysis of the effects of a campaign supporting use of a health symbol on food sales and shopping behaviour of consumers.

BACKGROUND: Since 2009, the green Keyhole symbol has been a joint Nordic initiative for signalling healthfulness of specific food products. In 2014, the Danish Ministry of Food, Agriculture and Fisheries carried out a campaign aimed mainly at men over 35 with a low level of education, encouraging them to use the Keyhole in their shopping process. The objective of the study is to evaluate the campaign by measuring its effect on consumer behaviour in the store. METHODS: The impact of the Keyhole campaign was measured in selected retail stores. Sales data were analysed to ascertain whether sales of Keyhole labelled products changed during and after the campaign. Observations and interviews were conducted in the same stores. RESULTS: The campaign had a positive effect on sales of Keyhole-labelled products in two out of three retail chains investigated. In these two retail chains, sales of Keyhole labelled products rose by about 20%. In the third chain, there was a slight decrease of sales of Keyhole labelled products. The effect differed considerably between product categories. Analysis of the interview data indicated that by the end of the campaign, shoppers with a short education had a higher likelihood of mentioning health as a purchase motive, and there was a higher general tendency to look for nutrition information. CONCLUSIONS: Results suggest that the campaign did have effects on shopper behaviour and that it is possible to address shoppers with a short education by a tailored campaign. However, long-term effect of the campaign was not ascertained.

A register-based study of long-term healthcare use before and after psychotherapy.

BACKGROUND: Psychotherapeutic treatment for non-psychotic disorders is associated with significant reduction in patients' symptoms, and therefore it is believed that treatment improves health and decreases the need for additional healthcare. However, little is known about long-term changes in utilization of healthcare services. AIM: To investigate long-term changes in utilization of public healthcare services for patients referred to psychotherapeutic treatment. METHODS: A pre-post study with 761 consecutive patients and 15,220 matched individuals in a matched population reference group. Data from a comprehensive set of healthcare services were collected from central registries for 4 years prior to intake and for 4 years after completion of treatment. RESULTS: Of the 761 patients, 216 did not show up for treatment and 545 completed treatment. Completer patients achieved a substantial reduction in symptoms (effect size, ES = 0.99). However, completer patients increased their use of all healthcare services by 296% (ES = 0.58) in the 4th year pre-post comparison, while the reference group increased usage by 99% (ES = 0.23). Completer patients had significantly higher increase in contacts with psychiatric hospitals (P < 0.008), contacts with primary care psychologists (P < 0.001), psychotropic medication (P < 0.001) and contacts with primary care physicians (P < 0.001) than the reference group at the 4th year pre-post comparison. CONCLUSION: Over a long-term period, patients who completed psychotherapeutic treatment increased utilization of healthcare services. Studies are needed to clarify how and why psychotherapeutic treatment does not necessarily lead to a reduction in the utilization of healthcare services for the average patient and to evaluate other potential interventions for patients with mental problems and include efficiency studies in this evaluation.

No-shows, drop-outs and completers in psychotherapeutic treatment: demographic and clinical predictors in a large sample of non-psychotic patients.

BACKGROUND: A primary challenge in mental health services is a high rate of non-attendance (i.e. no-show and drop-out) for patients referred to treatment for psychiatric disorders. AIM: The aim of the present study was to assess the influence of demographic and clinical variables on mental health treatment attendance and to investigate differences in predictors for no-shows and drop-outs. METHODS: A naturalistic study of 2473 non-psychotic consecutive patients offered psychotherapeutic treatment at a community mental health centre in Denmark. Fifteen demographic and clinical variables were recorded at assessment. Bivariate and multiple logistic regression analyses were conducted to investigate the associations between these variables and no-show and drop-out. RESULTS: Of the 2473 participants, 668 (27.0%) did not show up for treatment, whereas 290 (11.7%) dropped out of treatment. Regression analysis showed that the significant predictors of treatment no-show were: age below 25, no more than the compulsory 9 years of school education, no sick leave, a diagnosis of personality disorder, a Global Assessment of Functioning score (GAF) below 40 or above 70, no previous psychiatric/psychological treatment, no use of antidepressants and substance abuse. The significant predictors of treatment drop-out were: age below 45, no more than the compulsory 9 years of school education or up to 11 years of school education, no vocational/university education, unemployment and substance abuse. CONCLUSION: No-show was predicted by both demographic and clinical factors, whereas drop-out was predicted by demographic factors and substance abuse as the only clinical factor. Results and strategies to reduce non-attendance are discussed.

Internet-based self-help therapy with FearFighter™ versus no intervention for anxiety disorders in adults: study protocol for a randomised controlled trial.

BACKGROUND: Internet-based self-help psychotherapy (IBT) could be an important alternative or supplement to ordinary face-to-face therapy. The findings of randomised controlled trials indicate that the effects of various IBT programmes for anxiety disorders seem better than no intervention and in some instances are equivalent to usual therapy. In Denmark, IBT is part of future treatment plans in mental health care services, but the verification level of the current clinical scientific knowledge is insufficient. The objective of this trial is feasibility assessment of benefits and harms of the Internet-based cognitive behavioural therapy (ICBT) programme FearFighter™ versus no intervention for anxiety disorders in adults. METHODS AND DESIGN: We will conduct an investigator-initiated, feasibility randomised controlled trial. Sixty-four participants are expected to be recruited via an advertisement posted on the homepage of the Student Counselling Service in Denmark. The inclusion criterion for participation in the trial will be the presence of anxiety disorder as assessed with the Mini International Neuropsychiatric Interview. The exclusion criteria will be suicidal risk, an ongoing episode of bipolar disorder or psychosis, concurrent psychological treatment for the anxiety disorder, considered unable to attend the intervention as planned (due to vacation, work/study placement, sickness, or similar occurrences), or lack of informed consent. The intervention group will be offered nine sessions with the ICBT programme FearFighter™ and a weekly telephone contact to support compliance. The control group will receive no intervention. We define the feasibility outcomes as follows: the fraction of randomised participants out of the eligible people (the lower 95 % confidence interval (CI) ≥ 50 %); and the fraction of compliant participants (those receiving at least six out of nine sessions) in the intervention group (the lower 95 % CI ≥ 60 %). The exploratory clinical outcomes are the number of participants no longer meeting the diagnostic criteria for an anxiety disorder at the end of the trial and level of distress (Beck Anxiety Inventory, Symptom Checklist-90-R, WHO Well-Being Index, Sheehan Disability Scale); the number of severe adverse events; and the occurrence of any psychological treatment outside the trial. To prevent bias in design, and in the gathering and analysis of data throughout the trial, we will follow the SPIRIT 2013 statement which defines standard protocol items for clinical trials. DISCUSSION: Based on our findings, we will discuss the feasibility of a future randomised controlled trial examining the benefits and harms of FearFighter™ versus no intervention for anxiety disorders in adults. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02499055 , registered on 1 July 2015.

Cognitive deficits in obsessive-compulsive disorder on tests of frontal lobe functions.

Individuals with obsessive-compulsive disorder (OCD) display frontal lobe deficits, but there are inconsistencies between various tests of frontal lobe functions and between the results from different studies. The objective of this work was to characterize frontal lobe dysfunctions in OCD patients. Fifteen patients and 17 control subjects matched for age, sex and intelligence were tested on classic tests of frontal lobe functions [Wisconsin Card Sorting Test (WCST) and tests of fluency], a smell identification test and one computerized test: the Intra/Extra Dimension test. The Intra/Extra Dimension test showed a significant difference between the two groups in reversal of response. The test of Figural fluency showed a significant difference between the two groups in numbers of produced figures. There were no differences on the WCST, verbal fluency and the smell identification test.