Improving the Course of Depressive Symptoms After Inpatient Psychotherapy Using Adjunct Web-Based Self-Help: Follow-Up Results of a Randomized Controlled Trial.

BACKGROUND: We recently showed in a randomized controlled trial that Web-based self-help as an adjunct improved the effectiveness of multimodal inpatient psychotherapy for depression. OBJECTIVE: The aims of this study were (1) to determine whether a Web-based self-help adjunctive to multimodal inpatient psychotherapeutic treatment could also improve the course of depressive symptoms and (2) to identify predictors of residual depressive symptoms at follow-up. METHODS: Overall, 229 patients were randomized either to the Web-based self-help intervention group (Deprexis) or an active control group (Web-based information about depression and depressive symptoms) in addition to multimodal inpatient psychotherapy. Participants in both groups were able to access their respective Web-based programs for 12 weeks, which meant that they typically had access after discharge from the inpatient unit (mean hospitalization duration: 40 days, T1). Follow-up was performed 6 months after study intake (T3). RESULTS: At follow-up, participants of the Web-based self-help group had considerably lower symptom load regarding depressive symptoms (d=0.58) and anxiety (d=0.46) as well as a better quality of life (d=0.43) and self-esteem (d=0.31) than participants of the control group. Nearly 3 times as many participants of the intervention group compared with the control group achieved remission in accordance with less deterioration. The number needed to treat based on the Beck Depression Inventory-II (BDI-II) improved over time (T1: 7.84, T2: 7.09, and T3: 5.12). Significant outcome predictors were BDI at discharge and treatment group. CONCLUSIONS: Web-based self-help as an add-on to multimodal inpatient psychotherapy improved the short-term course of depressive symptoms beyond termination. Residual symptoms at discharge from inpatient treatment and utilization of the Web-based self-help were the major predictors of depressive symptoms at follow-up. Challenges and barriers (eg, costs, therapists' concerns, or technical barriers) of adding Web-based interventions to inpatient treatment have to be addressed. TRIAL REGISTRATION: ClinicalTrials.gov NCT02196896; https://clinicaltrials.gov/ct2/show/NCT02196896.

Online Self-Help as an Add-On to Inpatient Psychotherapy: Efficacy of a New Blended Treatment Approach.

BACKGROUND: Depression is one of the most frequent and costly mental disorders. While there is increasing evidence for the efficacy of online self-help to improve depression or prevent relapse, there is little evidence in blended care settings, especially combined with inpatient face-to-face psychotherapy. Therefore, we evaluated whether an evidence-based online self-help program improves the efficacy of inpatient psychotherapy. METHODS: A total of 229 depressed patients were randomly allocated either to an online self-help program (intervention group [IG]; Deprexis) or an active control group (CG; weekly online information on depression) in addition to inpatient psychodynamic psychotherapy. Both groups had access to their respective experimental intervention for 12 weeks, regardless of inpatient treatment duration. Reduction of depressive symptoms, as measured with the Beck Depression Inventory-II, was the primary outcome at the end of the intervention (T2). RESULTS: Depressive symptoms were statistically significantly lower in the IG compared to the active CG at T2 with a moderate between-group effect size of d = 0.44. The same applied to anxiety (d = 0.33), quality of life (d = 0.34), and self-esteem (d = 0.38) at discharge from inpatient treatment (T1). No statistically significant differences were found regarding dysfunctional attitudes (d = 0.14) and work ability (d = 0.08) at T1. CONCLUSIONS: This is the first evidence for blended treatment combining online self-help with inpatient psychotherapy. The study opens new and promising avenues for increasing the efficacy of inpatient psychotherapy. Future studies should determine how integration of online self-help into the therapeutic process can be developed further.

Evaluation of a video-based Internet intervention as preparation for inpatient psychosomatic rehabilitation: study protocol for a randomized controlled trial.

BACKGROUND: Patients' treatment expectations are a key factor in psychotherapy. Several studies have linked higher expectations to better treatment success. Therefore, we want to evaluate the impact of a targeted video-based intervention on patients' expectations and the treatment success of inpatient rehabilitation. METHODS/DESIGN: All patients who will be referred to inpatient psychosomatic rehabilitation in three clinics will receive a study flyer with information about how to log in to the study platform together with the usual clinic information leaflet. Patients will receive the study information and informed consent upon login and will be randomized into the intervention or the control group. The intervention group (n = 394) will get access to our virtual online clinic, containing several videos about inpatient rehabilitation, until their admission to inpatient rehabilitation. The control group (n = 394) will receive no special treatment preparation. Questionnaires will be given at study inclusion (T0), two weeks before admission to (T1), and at the end of (T2) inpatient rehabilitation. The primary outcome is the outcome expectancy measured with the Credibility Expectancy Questionnaire at T1. Secondary outcomes include treatment motivation, mental health, work ability, depression, anxiety, and satisfaction with and usage of the Internet platform. DISCUSSION: We expect the intervention group to benefit from the additional preparation concerning their outcome expectancy. If successful, this approach could be used in the future to enhance the efficacy of inpatient rehabilitation. TRIAL REGISTRATION: ClinicalTrials.gov: NCT02532881 . Registered on 25 August 2015.

Enhancing inpatient psychotherapeutic treatment with online self-help: study protocol for a randomized controlled trial.

BACKGROUND: Depression is one of the most debilitating and costly mental disorders. There is increasing evidence for the efficacy of online self-help in alleviating depression. Knowledge regarding the options of combining online self-help with inpatient psychotherapy is still limited. Therefore, we plan to evaluate an evidence-based self-help program (deprexis®; Gaia AG, Hamburg, Germany) to improve the efficacy of inpatient psychotherapy and to maintain treatment effects in the aftercare period. METHODS/DESIGN: Depressed patients (n = 240) with private internet access aged between 18 and 65 are recruited during psychosomatic inpatient treatment. Participants are randomized to an intervention or control group at the beginning of inpatient treatment. The intervention group (n = 120) is offered an online self-help program with 12 weekly tasks, beginning during the inpatient treatment. The control group (n = 120) obtains access to an online platform with weekly updated information on depression for the same duration. Assessments are conducted at the beginning (T0) and the end of inpatient treatment (T1), at the end of intervention (T2) and 6 months after randomization (T3). The primary outcome is the depression score measured by the Beck Depression Inventory-II at T2. Secondary outcome measures include anxiety, self-esteem, quality of life, dysfunctional cognitions and work ability. DISCUSSION: We expect the intervention group to benefit from additional online self-help during inpatient psychotherapy and to maintain the benefits during follow-up. This could be an important approach to develop future concepts of inpatient psychotherapy. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02196896 (registered on 16 July 2014).

Evaluation of an internet-based aftercare program to improve vocational reintegration after inpatient medical rehabilitation: study protocol for a cluster-randomized controlled trial.

BACKGROUND: Mental disorders are the main reasons for rising proportions of premature pension in most high-income countries. Although inpatient medical rehabilitation has increasingly targeted work-related stress, there is still a lack of studies on the transfer of work-specific interventions into work contexts. Therefore, we plan to evaluate an online aftercare program aiming to improve vocational reintegration after medical rehabilitation. METHODS: Vocationally strained patients (n = 800) aged between 18 and 59 years with private internet access are recruited in psychosomatic, orthopedic and cardiovascular rehabilitation clinics in Germany. During inpatient rehabilitation, participants in stress management group training are cluster-randomized to the intervention or control group. The intervention group (n = 400) is offered an internet-based aftercare with weekly writing tasks and therapeutic feedback, a patient forum, a self-test and relaxation exercises. The control group (n = 400) obtains regular e-mail reminders with links to publicly accessible information about stress management and coping. Assessments are conducted at the beginning of inpatient rehabilitation, the end of inpatient rehabilitation, the end of aftercare, and 9 months later. The primary outcome is a risk score for premature pension, measured by a screening questionnaire at follow-up. Secondary outcome measures include level of vocational stress, physical and mental health, and work capacity at follow-up. DISCUSSION: We expect the intervention group to stabilize the improvements achieved during inpatient rehabilitation concerning stress management and coping, resulting in an improved vocational reintegration. The study protocol demonstrates the features of internet-based aftercare in rehabilitation. TRIAL REGISTRATION: International Standard Randomised Controlled Trial Number Register (ISRCTN:ISRCTN33957202).

[Dropout behavior in inpatient psychosomatic rehabilitation: how and when do inpatients terminate psychotherapy?]. / Behandlungsabbrüche in der stationären psychosomatischen Rehabilitation: Auf welche Art und wann beenden Patienten vorzeitig eine stationäre Psychotherapie?

UNLABELLED: Despite its clinical and health economic importance, only few studies have analyzed the problem of dropout behavior from treatment in psychosomatic medicine and psychotherapy. For quality-assurance purposes and in light of limited resources in our medical system, it is important to identify future dropouts and to intervene appropriately during ongoing inpatient treatment. In a representative sample taken from inpatient psychosomatic rehabilitation, we evaluated the prevalence of dropout behavior as well as characteristics of patients who drop out compared to patients who complete the treatment regularly. OBJECTIVES: Data of 2059 inpatients from the Psychosomatic Hospital Bad Neustadt/Saale were analyzed as to rates and dates of dropout and other patient characteristics. RESULTS: Overall 15.7 % of the patients dropped out of inpatient psychosomatic rehabilitation after a mean treatment duration of 28 days. Patients who dropped out tended to be younger, reported less distress, were less motivated, and had been diagnosed less often with an affective disorder as main diagnosis. Compared with patients who completed therapy regularly, they also profited less from both self- as well as external assessment of symptom change. It was shown that it is useful to differentiate the method and time of dropout. CONCLUSIONS: A differentiation of dropout characteristics is important for developing interventions to reduce dropout rates.

Does a cognitive-training programme improve the performance of middle-aged employees undergoing in-patient psychosomatic treatment?

PURPOSE: With the ever-increasing average life expectancy and rising age of retirement, cognitive and work capacities in advanced age take on great importance. Cognitive impairments, however, increase with age. The effect of cognitive-training programmes on people with mild cognitive impairment has not been verified in any systematic investigations. METHOD: This study presents a cognitive-training programme designed for middle-aged employees that was implemented and evaluated at the Psychosomatic Clinic Bad Neustadt/Saale in an AB study design (A: no intervention; B: intervention). RESULTS: Memory performance of the intervention group (n = 33) improved significantly between intake and discharge, compared with that of the control group (n = 40), as did self-ratings of memory and work-related attitudes. CONCLUSIONS: A cognitive-training programme is useful and effective in patients with mild cognitive impairment. Future studies should investigate how older or more severely impaired patients benefit from such a programme.

[Utilization of self-help groups and psychotherapy after psychosomatic-psychotherapeutic in-patient treatment]. / Inanspruchnahme von Selbsthilfegruppen und Psychotherapie im Anschluss an eine stationäre psychosomatisch-psychotherapeutische Behandlung.

Until now little is known about the role of participation in self-help groups alone or combined with psychotherapy in post-in-patient care. In the present study 2933 patients were questioned about their experience of self-help groups and psychotherapy after discharge from a clinic for psychosomatic medicine and psychotherapy. Nearly 8 % of them utilized self-help groups (mostly combined with out-patient psychotherapy), and altogether 68 % out-patient psychotherapy following in-patient treatment. Patients without out-patient treatment were psychologically less burdened and had better resources than participants of self-help groups or psychotherapy. Self-help group members differed from patients in out-patient psychotherapy by expressing a more positive opinion of groupwork and higher openness to new experiences. Additionly, they had discussed the topic of self-help groups more frequently with their therapists. This may be a starting-point for promoting more self-help activities of patients in the future.

Psychodynamic focal group treatment for psychosomatic inpatients--with an emphasis on work-related conflicts.

Conflicts arising from the work setting have remained a neglected issue in psychotherapy. To address this, the present study investigated the effectiveness of a manualized focal group treatment for psychotherapeutic inpatients suffering from vocational strains and conflicts and identified predictors of outcome. Cohorts of patients were assigned either to a treatment (N=144) or control condition (N=135). The group therapy intervention was found to be highly accepted by participants who were also more optimistic about returning to work and more favorable in their evaluations of treatment than patients in the treatment-as-usual condition. Group climate was found to be a predictor of favorable outcome. The findings suggest that a group therapy intervention with a strong emphasis on motivations and attitudes about work may be particularly suitable to deal with vocational conflicts and strains.

Vocational training integrated into inpatient psychosomatic rehabilitation--short and long-term results from a controlled study.

PURPOSE: The aim of this study was to determine the impact of a vocational training programme on short- and long-term results after psychosomatic rehabilitation. METHOD: 1,590 inpatients were screened for vocational integration. A high-risk group of 266 patients was randomly assigned to the vocational training programme plus psychosomatic treatment; treatment- as- usual served as a control condition. An occupational training was conducted at local companies, closely integrated into psychosomatic treatment. Vocational attitudes and adjustment were studied at intake, discharge, three, 12 and 24 month follow-ups. RESULTS: More than half of the study participants were unemployment and/or long-term work-disabled harbouring strong negative attitudes toward return to work. Forty-six percent of the intervention group declined from participation, but complied with follow-up investigation. At discharge, participants of the vocational training programme had become more optimistic regarding resuming work. One year following discharge, participants of the training programme reported less absence from work. After 24 months, vocational adjustment had improved considerably among programme participants, and declined among controls and refusers. CONCLUSION: An intensive vocational training programme is effective in promoting positive attitudes to work, reducing work disability and promoting return-to-work. However, a randomized design may be not optimal; evaluation necessitates long-term follow-up.

[Utilization and significance of self-help groups in treatment careers of psychosomatic inpatients]. / Inanspruchnahme von Selbsthilfegruppen durch Patienten einer psychosomatischen Klinik.

OBJECTIVES: Patients' self-help group participation has been neglected in psychotherapy research. This study determines previous self-help group experience, therapist recommendations and plans for future participation. METHODS: 1,604 patients were surveyed by questionnaire at intake and discharge from psychosomatic treatment regarding previous self-help experiences, therapist recommendation and plans for future self-help participation. RESULTS: Patients with self-help experience (12 %) were slightly older and more educated. They reported a longer duration of disease, more previous psychotherapy, more interpersonal problems and less social support compared to non-participants. At discharge, a total of 23 % intended to participate in a self-help group. Therapist recommendations (in 19 %) influenced patients' choices. CONCLUSIONS: The significance of self-help group participation in inpatient care, its significance in treatment careers and implications for consulting patients are discussed.