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1.
Br J Clin Psychol ; 2021 Apr 06.
Artigo em Inglês | MEDLINE | ID: mdl-33822376

RESUMO

OBJECTIVES: This review sought to evaluate the effectiveness of the 'Stress Control' (SC) large psychoeducational 6-session group programme developed to increase access to treatment for patients with anxiety and depression. DESIGN: Systematic review and meta-analysis (Prospero registration: CRD42020173676). METHODS: Pre-post and post-treatment follow-up effect sizes were extracted and synthesized in a random effects meta-analysis, and variations in effect sizes were investigated via moderator analyses. Secondary analyses synthesized between-group effect sizes from controlled studies containing comparator treatments and calculated the average dropout rate. The quality of the meta-analysis was assessed using the GRADE approach. RESULTS: Nineteen studies with pre-post treatment outcomes were included. The average group size was N = 39, and the average dropout rate was 34%. Pooled effect sizes indicated moderate pre-post treatment reductions in anxiety (ES = 0.58; CI 0.41 to 0.75; N = 5597; Z = 7.13; p < .001), moderate reductions in depression (ES = 0.62; CI 0.44 to 0.80; N = 5538, Z = 7.30; p < .001), and large reductions in global distress (ES = 0.86; CI 0.61 to 1.11; N = 591; Z = 7.41; p < .001). At follow-up, improvements in anxiety, depression, and global distress were maintained. When SC was compared to active and passive controls, outcomes were equivalent for anxiety (ES = 0.12, 95% CI -0.25 to 0.49, Z = -0.70; p = .482) and depression (ES = 0.15, 95% CI -0.24 to 0.54, Z = 0.84; p = .401). CONCLUSIONS: SC appears to be a clinically effective and durable low-intensity group intervention that facilitates access to treatment for large patient numbers. However, conclusions are limited by the low methodological quality of the evidence. PRACTITIONER POINTS: The stress control version of large group psychoeducation is appropriate and effective for mild-to-moderate anxiety and depression The evidence base for stress control is predominantly made up of practice-based studies Stress control needs to form one component of the overall offer made to patients presenting with mild-to-moderate anxiety and depression The competencies required to deliver such groups need better specification.

2.
Body Image ; 37: 28-37, 2021 Feb 03.
Artigo em Inglês | MEDLINE | ID: mdl-33548664

RESUMO

This study examined whether rumination, shame, self-criticism, and perfectionism mediate the previously established link between self-compassion and both eating and body image concerns. A cross-sectional online survey was completed by a community sample of non-clinical adult women (n = 369) and men (n = 201). Participants completed standardised measures of self-compassion (predictor), rumination, external shame, perfectionism and self-criticism (mediating variables), and eating pathology and body image (criterion variables). Path analyses confirmed that higher self-compassion was serially linked to lower eating pathology and body dissatisfaction through comparative self-criticism and external shame. Compared with women, the association between higher self-compassion and lower body dissatisfaction was weaker in men. However, there were no mediating effects of rumination, perfectionism, or internalized self-criticism. Overall results indicate notable similarities between women and men, and emphasise the potential value of targeting external shame during eating disorder prevention and treatment. Longitudinal study of these constructs is warranted in future research.

3.
Eat Weight Disord ; 2021 Feb 18.
Artigo em Inglês | MEDLINE | ID: mdl-33604880

RESUMO

PURPOSE: This longitudinal study aims to determine what factors mediate the previously established link between self-compassion and eating pathology/body image concerns, over a 6-month period. METHODS: A community sample of 274 adult women (M = 29.50 years) completed standardised validated measures of self-compassion (Self-Compassion Scale), rumination (Ruminative Thought Style Questionnaire), shame (Other as Shamer Scale), perfectionism (Short Form of the Revised Almost Perfect Scale), self-criticism (Levels of Self-Criticism Scale), eating pathology (Eating Disorder Examination Questionnaire) and body image (Body Shape Questionnaire). They reported levels of: self-compassion at Time 1, potential mediators (rumination, shame, self-criticism, perfectionism) at 3 months; and eating pathology and body dissatisfaction a further 3 months later. Missing data were handled using multiple imputation. Stepwise multiple regression showed that shame was the most consistent mediator. RESULTS: Shame acted as a full mediator of the self-compassion-eating/body image relationship {respectively, [B = .04, SE = .01, t(268) = 3.93, p < .001], [B = .33, SE = .15, t(268) = 2.25, p < .05]}. Discrepancy perfectionism also played a mediating role in the link between self-compassion and body image dissatisfaction [B = .59, SE = .28, t(268) = 2.10, p < .05]. CONCLUSION: These results support the hypothesis that self-compassion is relevant to eating pathology and body image disturbance, and demonstrate that shame is an important mechanism in that relationship. This pattern suggests that interventions that reduce shame should be considered when addressing issues relating to self-compassion and its links to eating disorders. LEVEL OF EVIDENCE: Level IV, multiple time series without intervention.

4.
Behav Cogn Psychother ; : 1-13, 2021 Feb 16.
Artigo em Inglês | MEDLINE | ID: mdl-33588976

RESUMO

BACKGROUND: Whilst the delivery of low-intensity group psychoeducation is a key feature of the early steps of the Improving Access to Psychological Therapies (IAPT) programme, there is little consensus regarding the skills and competencies demanded. AIMS: To identify the competencies involved in facilitating CBT-based group psychoeducation in order to inform future measure development. METHOD: A Delphi study in which participants (n = 36) were relevant IAPT stakeholders and then an expert panel (n = 8) review of the competencies identified within the Delphi study to create a shortened, more practical list of competencies. RESULTS: After three consultation rounds, consensus was reached on 36 competencies. These competencies were assigned to four main categories: group set-up, content, process and closure. A further expert review produced a shortened 16-item set of psychoeducation group facilitation competencies. CONCLUSIONS: The current study has produced a promising framework for assessing facilitator competency in delivering CBT-based group psychoeducational interventions. Weaknesses in the Delphi approach are noted and directions for future measure development research are identified.

5.
JMIR Ment Health ; 8(2): e20213, 2021 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-33522979

RESUMO

BACKGROUND: Patients can struggle to make good use of psychotherapy owing to deficits in awareness, and digital technologies that support awareness are at a premium. Currently, when patients participate in cognitive analytic therapy (CAT), the technology supporting relational awareness work involves completion of paper-based worksheets as between-session tasks. OBJECTIVE: We aimed to design, with therapists and patients, a prototype digital mobile app. This was to help patients better engage in the "recognition" phase of the CAT treatment model by providing an unobtrusive means for practicing relational awareness with dynamic feedback on progress. METHODS: A national online survey was conducted with CAT therapists (n=50) to determine readiness for adoption of a mobile app in clinical practice and to identify core content, functionality, and potential barriers to adoption. A prototype mobile app based on data and existing paper-based worksheets was built. Initial face-to-face user testing of the prototype system was completed with three therapists and three CAT expatients. RESULTS: Among the therapists surveyed, 72% (36/50) reported not currently using any digital tools during CAT. However, the potential value of a mobile app to support patient awareness was widely endorsed. Areas of therapist concern were data security, data governance, and equality of access. These concerns were mirrored during subsequent user testing by CAT therapists. Expatients generated additional user specifications on the design, functionality, and usability of the app. Results from both streams were integrated to produce five key changes for the reiteration of the app. CONCLUSIONS: The user-centered design process has enabled a prototype CAT-App to be developed to enhance the relational awareness work of CAT. This means that patients can now practice relational awareness in a much more unobtrusive manner and with ongoing dynamic feedback of progress. Testing the acceptability and feasibility of this technological innovation in clinical practice is the next stage in the research process, which has since been conducted and has been submitted. The important challenges of data protection and governance must be navigated in order to ensure implementation and adoption if the CAT-App is found to be acceptable and clinically effective.

6.
Eat Weight Disord ; 2021 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-33523399

RESUMO

PURPOSE: The main aim of this study was to test the feasibility of an adapted version of the Body Project for young Saudi women as their eating and body issues are comparable to western culture and linked to internalization of westernization. The study also aims to assess predictors of attrition and preliminary effectiveness. METHOD: The intervention was adapted to local culture in collaboration with a co-director of the Body Project Collaborative. 48 Saudi undergraduate females were recruited, mean age was 19.16 years (SD = 1.23), baseline BMI was (M = 24.42, SD = 5.46). Eating pathology, body image, and comorbidities were assessed pre and post the intervention with adapted self-report measures. RESULTS: The Body Project is feasible for young Saudi women. Participants were willing to enrol, they found the intervention useful, understandable, and enjoyable. There was no difference between completers and non-completers. The preliminary effect sizes are similar or higher than other effectiveness trials in other cultures. CONCLUSION: A cognitive dissonance-based eating disorders prevention can be applicable across cultures where westernization is an influence. The effectiveness is yet to be affirmed. Future research is needed to investigate effectiveness in further robust studies and a bigger sample. EVIDENCE-BASED MEDICINE: Level IV (evidence obtained from multiple time series with or without the intervention, such as case studies. Dramatic results in uncontrolled trials might also be regarded as this type of evidence).

7.
Psychol Psychother ; 2021 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-33448617

RESUMO

BACKGROUND: Managing the alliance is considered to be a core competency and central therapeutic change process during cognitive analytic therapy (CAT). This study examined latent trajectories of change in the alliance and their relationship to depression treatment outcomes. DESIGN: Secondary analysis of a randomized controlled trial. METHODS: A sample of N = 79 depressed participants completed standardized alliance (WAI-SF) and depression symptom measures (PHQ-9) every session during an 8-session CAT intervention. Growth mixture modelling was applied to model alliance trajectories and to classify cases into different latent classes. Associations between alliance class and post-treatment PHQ-9 scores were examined using hierarchical linear regression, controlling for confounders. RESULTS: There were two classes of alliance trajectories. The majority class (91%) displayed stable alliance trajectories, whilst a minority class (9%) had initially poor alliance ratings that significantly improved during treatment. Baseline severity and early change in depression symptoms significantly predicted treatment outcomes, but early alliance and longitudinal alliance change did not. CONCLUSIONS: Alliance trajectories did not significantly predict depression treatment outcomes after controlling for initial symptom severity and early change. An important limitation concerns the small sample size, so future replication in larger samples is necessary.

8.
Behav Ther ; 52(1): 15-27, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33483113

RESUMO

Despite the vastly increased dissemination of the low-intensity (LI) version of cognitive behavior therapy (CBT) for the treatment of anxiety and depression, no valid and reliable indices of the LI-CBT clinical competencies currently exist. This research therefore sought to develop and evaluate two measures: the low-intensity assessment competency scale (LIAC) and the low-intensity treatment competency scale (LITC). Inductive and deductive methods were used to construct the competency scales and detailed rating manuals were prepared. Two studies were then completed. The first study used a quantitative, fully-crossed design and the second a multi-center, quantitative longitudinal design. In study one, novice, qualified, and expert LI-CBT practitioners rated an LI-CBT assessment session (using the LIAC) and an LI-CBT treatment session (using the LITC). Study two used the LIAC and LITC across four training sites to analyze the competencies of LI-CBT practitioners over time, across raters, and in relation to the actor/patients' feedback concerning helpfulness, the alliance, and willingness to return. Both the LIAC and LITC were found to be single factor scales with good internal, test-retest reliability and reasonable inter-rater reliability. Both measures were sensitive to measuring change in clinical competence. The LIAC had good concurrent, criterion, discriminant, and predictive validity, while the LITC had good concurrent, criterion, and predictive validity, but limited discriminant validity. A score of 18 accurately delineated a minimum level of competence in LI-CBT assessment and treatment practice, with incompetent practice associated with patient disengagement. These observational ratings scales can contribute to the clinical governance of the burgeoning use of LI-CBT interventions for anxiety and depression in routine services and also in the methods of controlled studies.


Assuntos
Terapia Cognitivo-Comportamental , Ansiedade , Transtornos de Ansiedade , Competência Clínica , Humanos , Reprodutibilidade dos Testes
10.
Br J Clin Psychol ; 60(2): 194-211, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33458855

RESUMO

OBJECTIVES: To investigate the effectiveness of an 8-session cognitive analytic therapy (CAT) protocol for patients with anxiety and depression in the context of relational problems, personality disorder traits, or histories of adverse childhood experiences and then to compare outcomes with cognitive behavioural therapy (CBT). METHODS: The study was conducted in a single Improving Access to Psychological Therapies (IAPT) service and used sessional outcome monitoring. Propensity score matching was used to derive equivalent CAT (N = 76) and CBT (N = 73) samples through matching intake characteristics. Longitudinal multilevel modelling (LMLM) compared patterns of symptomatic change over time between the two therapies. RESULTS: LMLM found no significant differences between CAT and CBT in depression, anxiety, and functional impairment outcomes and showed similar symptom change trajectories. Small between-therapy post-treatment effects and medium-to-large within-therapy effects were found. CAT patients attended significantly more sessions, and the CAT dropout rate was significantly lower. CONCLUSIONS: Brief CAT appears acceptable and effective for patients with anxiety and depression in the context of complex relational problems when delivered within the high intensity tier of an IAPT service. The potential added value of CAT in IAPT services is discussed. PRACTITIONER POINTS: Practitioners (under appropriate supervision) could use 8-session CAT when treating patients with anxiety and depression in the context of clinical complexity. The 8-session CAT model holds organizational promise in IAPT services. Brief CAT interventions should retain theoretical integrity.

11.
JMIR Ment Health ; 7(12): e19888, 2020 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-33337342

RESUMO

BACKGROUND: There has been a lack of technological innovation regarding improving the delivery of integrative psychotherapies. This project sought to evaluate an app designed to replace previous paper-based methods supporting relational awareness and change during cognitive analytic therapy (CAT). OBJECTIVE: We aimed to assess patients' and therapists' experience of using the technology (ie, the "CAT-App") and to evaluate the relationship between app usage and clinical outcome. METHODS: The design was a mixed methods case series. Patients completed the Clinical Outcomes in Routine Evaluation-Outcome Measure pre- and post-CAT. Mood data plus the frequency and effectiveness of relational awareness and change were collected via the app. Therapists and patients were interviewed about their experiences using the app. RESULTS: Ten patients (treated by 3 therapists) were enrolled; seven completed treatment and 4 had a reliable improvement in their mental health. App usage and mood change did not differ according to clinical outcome, but there was a statistically significant difference in app usage between completers and dropouts. The qualitative themes described by the therapists were (1) the challenge of incorporating the technology into their clinical practice and (2) the barriers and benefits of the technology. Clients' themes were (1) data protection, (2) motivation and engagement, and (3) restrictions versus flexibility. CONCLUSIONS: The CAT-App is capable of supporting relational awareness and change and is an upgrade on older, paper-based formats. Further clinical evaluation is required.

12.
J Med Internet Res ; 22(10): e17049, 2020 Oct 28.
Artigo em Inglês | MEDLINE | ID: mdl-33112238

RESUMO

BACKGROUND: There is a disconnect between the ability to swiftly develop e-therapies for the treatment of depression, anxiety, and stress, and the scrupulous evaluation of their clinical utility. This creates a risk that the e-therapies routinely provided within publicly funded psychological health care have evaded appropriate rigorous evaluation in their development. OBJECTIVE: This study aims to conduct a meta-analytic review of the gold standard evidence of the acceptability and clinical effectiveness of e-therapies recommended for use in the National Health Service (NHS) in the United Kingdom. METHODS: Systematic searches identified appropriate randomized controlled trials (RCTs). Depression, anxiety, and stress outcomes at the end of treatment and follow-up were synthesized using a random-effects meta-analysis. The grading of recommendations assessment, development, and evaluation approach was used to assess the quality of each meta-analytic comparison. Moderators of treatment effect were examined using subgroup and meta-regression analysis. Dropout rates for e-therapies (as a proxy for acceptability) were compared against controls. RESULTS: A total of 24 studies evaluating 7 of 48 NHS-recommended e-therapies were qualitatively and quantitatively synthesized. Depression, anxiety, and stress outcomes for e-therapies were superior to controls (depression: standardized mean difference [SMD] 0.38, 95% CI 0.24 to 0.52, N=7075; anxiety and stress: SMD 0.43, 95% CI 0.24 to 0.63, n=4863), and these small effects were maintained at follow-up. Average dropout rates for e-therapies (31%, SD 17.35) were significantly higher than those of controls (17%, SD 13.31). Limited moderators of the treatment effect were found. CONCLUSIONS: Many NHS-recommended e-therapies have not been through an RCT-style evaluation. The e-therapies that have been appropriately evaluated generate small but significant, durable, beneficial treatment effects. TRIAL REGISTRATION: International Prospective Register of Systematic Reviews (PROSPERO) registration CRD42019130184; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=130184.

14.
Cogn Behav Ther ; : 1-18, 2020 Sep 21.
Artigo em Inglês | MEDLINE | ID: mdl-32954958

RESUMO

Cognitive behavioural therapy (CBT) is an effective psychological treatment for anxiety-related disorders (anxiety disorders, post-traumatic stress disorder, and obsessive-compulsive disorder). However, relapse of anxiety symptoms is common following completion of treatment. This study aimed to identify predictors of relapse of anxiety after CBT for adult (18+) patients to enable the identification of "at-risk" patients who could potentially benefit from relapse prevention interventions. A systematic review and meta-analysis were conducted, including studies found in PsycINFO, PubMed, Scopus, and Web of Science, and through hand-searches of references lists and reverse citations. Nine studies met eligibility criteria (N = 532 patients). On average, 23.8% of patients experienced relapse following completion of CBT. A total of 21 predictors were identified and grouped into seven categories: residual symptoms; personality disorders; medication; clinical features; stressful life-events; degree of improvement; and demographics. A meta-analysis of residual symptoms as a predictor of relapse yielded a moderate but non-significant-pooled effect size (r = 0.35; 95% CI -0.21, 0.74, p =.08). Further research with adequately powered samples and standardised operationalisations of relapse are required to identify robust predictors.

15.
Behav Cogn Psychother ; : 1-15, 2020 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-32930088

RESUMO

BACKGROUND: Outcome studies of the treatment of compulsive buying disorder (CBD) have rarely compared the effectiveness of differing active treatments. AIMS: This study sought to compare the effectiveness of cognitive behavioural therapy (CBT) and person-centred experiential therapy (PCE) in a cross-over design. METHOD: This was an ABC single case experimental design with extended follow-up with a female patient meeting diagnostic criteria for CBD. Ideographic CBD outcomes were intensively measured over a continuous 350-day time series. Following a 1-month baseline assessment phase (A; 28 days; three sessions), CBT was delivered via 13 out-patient sessions (B: 160 days) and then PCE was delivered via six out-patient sessions (C: 63 days). There was a 99-day follow-up period. RESULTS: Frequency and duration of compulsive buying episodes decreased during active treatment. CBT and PCE were both highly effective compared with baseline for reducing shopping obsessions, excitement about shopping, compulsion to shop and improving self-esteem. When the PCE and CBT treatment phases were compared against each other, few differences were apparent in terms of outcome. There was no evidence of any relapse over the follow-up period. A reliable and clinically significant change on the primary nomothetic measure (i.e. Compulsive Buying Scale) was retained over time. CONCLUSIONS: The study suggests that both CBT and PCE can be effective for CBD. Methodological limitations and suggestions for future CBD outcome research are discussed.

16.
Psychol Psychother ; 2020 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-32930457

RESUMO

OBJECTIVE: This paper describes the development and summarizes the content of a competence framework for delivery of cognitive analytic therapy (CAT). DESIGN: The framework was developed using the evidence-based method developed by Roth and Pilling (2008, Behavioural and Cognitive Psychotherapy, 36, 129). METHODS: A review of the CAT outcome literature identified where CAT interventions had evidence of efficacy. Standard texts on CAT were primary sources for details of theory and practice. This process was supported by an expert reference group (ERG). The role of the ERG was to provide professional advice on areas where the evidence base was lacking, but where CAT interventions were commonly used by therapists trained in the model. RESULTS: A framework was produced and structured in terms of core knowledge, core skills, and meta-competences (which require therapeutic judgement rather than simple adherence to a treatment protocol). CONCLUSIONS: The framework enables trainees, service users, service managers, and commissioners to better understand a) the core features of CAT and b) what competences need to be in place for CAT to be skilfully delivered in practice. PRACTITIONER POINTS: It is possible to define the core competences of CAT. Whilst generic competences are important, there are five CAT-specific domains of competence. The CAT-specific competences reflect the three-phase structure of the therapy: reformulation, recognition, and revision.

17.
Br J Clin Psychol ; : e12259, 2020 Jun 23.
Artigo em Inglês | MEDLINE | ID: mdl-32578231

RESUMO

OBJECTIVES: Improving Access to Psychological Therapies (IAPT) is a national-level dissemination programme for provision of evidence-based psychological treatments for anxiety and depression in the United Kingdom. This paper sought to review and meta-analyse practice-based evidence arising from the programme. DESIGN: A pre-registered (CRD42018114796) systematic review and meta-analysis. METHODS: A random effects meta-analysis was performed only on the practice-based IAPT studies (i.e. excluding the clinical trials). Subgroup analyses examined the potential influence of particular methodologies, treatments, populations, and target conditions. Sensitivity analyses investigated potential sources of heterogeneity and bias. RESULTS: The systematic review identified N = 60 studies, with N = 47 studies suitable for meta-analysis. The primary meta-analysis showed large pre-post treatment effect sizes for depression (d = 0.87, 95% CI [0.78-0.96], p < .0001) and anxiety (d = 0.88, 95% CI [0.79-0.97], p < .0001), and a moderate effect on functional impairment (d = 0.55, 95% CI [0.48-0.61], p < .0001). The methodological features of studies influenced ESs (e.g., such as whether intention-to-treat or completer analyses were employed). CONCLUSIONS: Current evidence suggests that IAPT enables access to broadly effective evidence-based psychological therapies for large numbers of patients. The limitations of the review and the clinical and methodological implications are discussed. PRACTITIONER POINTS: IAPT interventions are associated with large pre-post treatment effect sizes in depression and anxiety measures. IAPT interventions are associated with moderate treatment effect sizes with regards to work and social adjustment. A reduction in dropout and also the prevention of post-treatment relapse via the offer of follow-up support are important areas for future development.

18.
Psychol Psychother ; 2020 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-32543107

RESUMO

OBJECTIVES: This paper sought to conduct a meta-analysis of the effectiveness and durability of cognitive analytic therapy (CAT) and assess the acceptability of CAT in terms of dropout rates. DESIGN: Systematic review and meta-analysis. METHODS: PROSPERO registration: CRD42018086009. Searches identified CAT treatment outcome studies eligible to be narratively synthesized. Pre-post/post-follow-up effect sizes (ESs) were extracted and synthesized in a random-effects meta-analysis. Variations in effect sizes were explored using moderator analyses. Dropout rates were extracted. Secondary analyses synthesized between-group ES from trials of CAT. RESULTS: Twenty-five studies providing pre-post CAT treatment outcomes were aggregated across three outcome comparisons of functioning, depression, and interpersonal problems. CAT produced large pre-post improvements in global functioning (ES = 0.86; 95% CI 0.71-1.01, N = 628), moderate-to-large improvements in interpersonal problems (ES = 0.74, 95% CI 0.51-0.97, N = 460), and large reductions in depression symptoms (ES = 1.05, 95% CI 0.80-1.29, N = 586). All these effects were maintained or improved upon at follow-up. Limited moderators of CAT treatment effect were identified. CAT demonstrated small-moderate, significant post-treatment benefits compared to comparators in nine clinical trials (ES = 0.36-0.53; N = 352). The average dropout rate for CAT was 16% (range 0-33%). CONCLUSIONS: Patients with a range of presenting problems appear to experience durable improvements in their difficulties after undergoing CAT. Recommendations are provided to guide the further progression of the CAT outcome evidence base. PRACTITIONER POINTS: Large pre-post reductions in global functioning and depression outcomes and moderate-large reductions in interpersonal problems are evident after CAT. The effects of CAT appear durable, and interpersonal functioning significantly improves over follow-up time. CAT produces small-moderate benefits compared to trial comparators. CAT appears to be an engaging psychotherapy that maintains patients in treatment.

19.
J Med Internet Res ; 22(5): e16794, 2020 05 27.
Artigo em Inglês | MEDLINE | ID: mdl-32384055

RESUMO

BACKGROUND: The usability and effectiveness of conversational agents (chatbots) that deliver psychological therapies is under-researched. OBJECTIVE: This study aimed to compare the system usability, acceptability, and effectiveness in older adults of 2 Web-based conversational agents that differ in theoretical orientation and approach. METHODS: In a randomized study, 112 older adults were allocated to 1 of the following 2 fully automated interventions: Manage Your Life Online (MYLO; ie, a chatbot that mimics a therapist using a method of levels approach) and ELIZA (a chatbot that mimics a therapist using a humanistic counseling approach). The primary outcome was problem distress and resolution, with secondary outcome measures of system usability and clinical outcome. RESULTS: MYLO participants spent significantly longer interacting with the conversational agent. Posthoc tests indicated that MYLO participants had significantly lower problem distress at follow-up. There were no differences between MYLO and ELIZA in terms of problem resolution. MYLO was rated as significantly more helpful and likely to be used again. System usability of both the conversational agents was associated with helpfulness of the agents and the willingness of the participants to reuse. Adherence was high. A total of 12% (7/59) of the MYLO group did not carry out their conversation with the chatbot. CONCLUSIONS: Controlled studies of chatbots need to be conducted in clinical populations across different age groups. The potential integration of chatbots into psychological care in routine services is discussed.


Assuntos
Internet/instrumentação , Resolução de Problemas/fisiologia , Idoso , Idoso de 80 Anos ou mais , Comunicação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos de Pesquisa
20.
Behav Cogn Psychother ; 48(5): 621-625, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32378494

RESUMO

BACKGROUND: Group psychotherapy for older adults with generalised anxiety disorder is an under-researched area. AIM: This report describes a mixed method evaluation of the acceptability and feasibility of an Overcoming Worry Group. METHOD: The Overcoming Worry Group was a novel adaptation of a cognitive behavioural therapy protocol targeting intolerance-of-uncertainty for generalised anxiety disorder, tailored for delivery to older adults in a group setting (n = 13). RESULTS: The adapted protocol was found to be acceptable and feasible, and treatment outcomes observed were encouraging. CONCLUSIONS: This proof-of-concept study provides evidence for an Overcoming Worry Group as an acceptable and feasible group treatment for older adults with generalised anxiety disorder.


Assuntos
Terapia Cognitivo-Comportamental , Psicoterapia de Grupo , Idoso , Ansiedade , Transtornos de Ansiedade/terapia , Estudos de Viabilidade , Humanos
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