Category Archive: Publications

Hulpverlening voor Psychische Problematiek via het World Wide Web (2009)

Lange, A., Ruwaard, J., & Schrieken, B. (2009). Hulpverlening voor Psychische Problematiek via het World Wide Web [Help for psychological problems via the World Wide Web]. De Psycholoog, 44(12), 634-640.

Abstract

Experimenten met online therapie zijn bijna zo oud als het internet. Maar eMental Health kreeg pas echt een vlucht met de ontwikkeling van het World Wide Web, midden jaren 90. Inmiddels zijn er zoveel initiatieven dat het gevaar dreigt dat cliënten door de bomen het bos niet meer zien. Er zijn echter duidelijke verschillen. De beschikbare programma’s variëren van pure zelfhulp (komt geen behandelaar aan te pas), via begeleide zelfhulp (beperkt contact met behandelaars, via email, telefoon of face-to-face), tot pure geprotocolleerde psychotherapie. Aan de hand van de literatuur geven we een kort overzicht van de effectiviteit van deze soorten en de implementatie van online hulpverlening in de reguliere gezondheidszorg. Nederland loopt daarin voorop, wat we illustreren met een beschrijving van de werkwijze en resultaten van de Amsterdamse Interapy kliniek.

Standardized Web-Based CBT of Mild to Moderate Depression: An RCT with a Long-Term Follow-Up (2009)

Ruwaard, J., B. Schrieken, M. Schrijver, J. Broeksteeg, J. Dekker, H. Vermeulen and A. Lange (2009). Standardized Web-Based Cognitive Behavioural Therapy of Mild to Moderate Depression: A Randomized Controlled Trial with a Long-Term Follow-Up. Cognitive Behaviour Therapy 38(4): 206-221.

ABSTRACT Background: Depression is common but undertreated. Web-based self-help provides a widely accessible treatment alternative for mild to moderate depression. However, the lack of therapist guidance may limit its efficacy. Objective: To assesses the efficacy of therapist-guided web-based Cognitive Behavioural Treatment (Web-CBT) of mild to moderate depression. Design: A randomised waiting-list controlled trial, with an 18-month follow-up. Participants: The study included a community sample of 54 participants with chronic, moderate depression (immediate treatment: n = 36, waiting-list control: n = 18). Outcome Measures: Primary outcome measures were the Beck Depression Inventory (BDI-IA) and the Depression scale of the Symptom Check List – Revised (SCL 90-R DEP). Secondary outcome measures were the Depression Anxiety Stress Scales (DASS-42) and the Well-being Questionnaire (W-BQ12). Results: In the RCT, 5 participants (9%) dropped out. Intention-to-treat ANCOVA’s revealed that participants in the treatment condition improved significantly more than the participants in the waiting-list control condition (.011 < p < .015). With regard to the primary measures, between-group effects were d = 0.7 (BDI-IA) and d = 1.1 (SCL-90-R DEP). Post-test SCL90-R DEP scores indicated recovery of 49% of the participants in the treatment group, compared to 6% in the control group (Odds Ratio = 14.5; p < .004). On average, the effects were stable up to 18 months (n = 39), although medication was a strong predictor of relapse. Conclusion: The results demonstrate the efficacy of Web-CBT of mild to moderate depression, and the importance of therapist guidance in psychological interventions.

E-mailed standardized cognitive behavioural treatment of work-related stress: a randomized controlled trial (2007)

Ruwaard, J., A. Lange, M. Bouwman, J. Broeksteeg and B. Schrieken (2007). E-mailed standardized cognitive behavioural treatment of work-related stress: a randomized controlled trial. Cognitive Behaviour Therapy 36(3): 179-192.

ABSTRACT The aim of this study was to assess the effects of a 7-week standardized cognitive behavioural treatment of work-related stress conducted via e-mail. A total of 342 people applied for treatment in reaction to a newspaper article. Initial screening reduced the sample to a heterogeneous (sub)clinical group of 239 participants. Participants were assigned randomly to a waiting list condition (n = 62), or to immediate treatment (n = 177). A follow-up was conducted 3 years after inception of the treatment. The outcome measures used were the Depression Anxiety Stress Scales (DASS-42) and the Emotional Exhaustion scale of the Maslach Burnout Inventory – General Survey (MBI-GS). Fifty participants (21%) dropped out. Both groups showed statistically significant improvements. Intention-to-treat analysis of covariance (ANCOVAs) revealed that participants in the treatment condition improved significantly more than those in the waiting control condition (0.001<p < or = 0.025). In the treatment group, the effects were large to moderate (0.9 (stress) > or = d > or = 0.5 (anxiety)). The between-group effects ranged from d = 0.6 (stress) to d = 0.1 (anxiety). At follow-up, the effects were more pronounced, but this result requires replication in view of high attrition at follow-up. The results warrant further research on Internet-driven standardized cognitive behavioural therapy for work-related stress. Such research should include the direct comparison of this treatment with face-to-face treatment, and should address the optimal level of therapist contact in Internet-driven treatment.

Interapy: diagnostiek en geprotocolleerde behandeling van welomschreven stoornissen via internet (2005)

Lange, A., Schrieken, B., Scheijde, R., Broeksteeg, J., Ruwaard, J., Schrijver, M. S., Ven, J.-P. van de, & Emmelkamp, P. M. G. (2005). Interapy: diagnostiek en geprotocolleerde behandeling van welomschreven stoornissen via internet. Tijdschrift voor Pyschotherapie 31(5): 355-376.

FULL TEXT

ABSTRACT The first Interapy treatment through the internet, concerning posttraumatic stress, was published in 1999. Many studies and publications followed. This paper describes the general background of the Interapy treatments, the screening, the procedures, the instruments, the treatment elements and results of three randomised controlled outcome studies on posttraumatic stress, work related chronic stress and depression. The effects are strong. The treatment of one patient (depression) is presented as an illustration. Subsequently, we present data of the clients’ subjective evaluations of the different treatment elements, the procedures and the therapists. Finally, the results are discussed.

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