Online CBT of Bulimic Symptoms: An RCT (2012/2013)

Ruwaard, J., Lange, A., Broeksteeg, J., Renteria-Agirre, A., Schrieken, B., Dolan, C.V., & Emmelkamp, P. (2013). Online cognitive behavioral treatment of bulimic symptoms: A randomized controlled trial. Clinical Psychology & Psychotherapy, 20, 4, 308-318. doi: 10.1002/cpp.1767

Abstract Background Manualized cognitive–behavioural treatment (CBT) is underutilized in the treatment of bulimic symptoms. Internet-delivered treatment may reduce current barriers. Objective This study aimed to assess the efficacy of a new online CBT of bulimic symptoms. Method Participants with bulimic symptoms (n = 105) were randomly allocated to online CBT, bibliotherapy or waiting list/delayed treatment condition. Data were gathered at pre-treatment, post-treatment and 1-year follow-up. Outcome Measures The primary outcome measures were the Eating Disorder Examination Questionnaire (EDE-Q) and the frequency of binge eating and purging episodes. The secondary outcome measure was the Body Attitude Test. Results Dropout from Internet treatment was 26%. Intention-to-treat ANCOVAs of post-test data revealed that the EDE-Q scores and the frequency of binging and purging reduced more in the online CBT group compared with the bibliotherapy and waiting list groups (pooled between-group effect size: d = 0.9). At 1-year follow-up, improvements in the online CBT group had sustained. Conclusion This study identifies online CBT as a viable alternative in the treatment of bulimic symptoms.

Key Practitioner Message

  • In comparison with no treatment and unsupported bibliotherapy, online CBT induces strong reductions in bulimic symptoms.
  • Internet-delivered treatment may provide an acceptable treatment alternative for bulimic patients who are reticent about face-to-face contact.
  • Therapist support appears to be a critical determinant of treatment adherence and effectiveness.
  • Unsupported bibliotherapy may have only small immediate effects but may increase the probability of recovery in the long term by promoting positive attitudes towards treatment.

Online behandeling van seksueel misbruikte adolescenten (2011)

Lange, A., Ruwaard, J., Schrieken, B., de Haas, S., Broeksteeg, J., Renteria Agirre, A., & Kuyper, A. (2011). Online behandeling van seksueel misbruikte adolescenten: Ethische dilemma’s en resultaten van een geprotocolleerde trial. Directieve Therapie, 31(3), 259-279. [article at journal site]

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ABSTRACT Dit artikel omvat twee thema’s. (a) De moeilijkheid om een populatie van getraumatiseerde jongeren in behandeling te krijgen. Hieronder valt de vraag wat men kan doen om te voorkomen dat degenen die interesse in de behandeling tonen zich terugtrekken voordat zij met de behandeling beginnen (pre-treatment withdrawal). (b) De effectiviteit van de behandeling voor degenen die met de behandeling starten. De thema’s lopen door elkaar aangezien zij met elkaar te maken hebben. Zo zijn er in het kader van het eerste thema maatregelen genomen inzake  het design en metingen (het tweede thema). In de beschouwing  gaan we in op de resultaten van degenen die de behandeling zijn begonnen en op wat we hebben geleerd over het patroon van terugtrekking voorafgaand aan de behandeling. Hier worden beide thema’s weer gescheiden.

Efficacy and Effectiveness of Online CBT: A decade of Interapy Research (2011)

Ruwaard, J., A. Lange, B. Schrieken and P. Emmelkamp (2011). Efficacy and Effectiveness of Online Cognitive Behavioral Treatment: A decade of Interapy Research. Annual Review of Cybertherapy and Telemedicine 2011. Advanced Technologies in Behavioral, Social and Neurosciences. B.K. Wiederhold, S. Bouchard and G. Riva. Amsterdam, The Interactive Media Institute and IOS Press: 9-14.

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Abstract Since 1996, researchers of the Interapy research group of the University of Amsterdam have been examining the effects of online cognitive behavioral treatment (online CBT). Over the years, the group conducted nine controlled trials of online CBT of a variety of mental health disorders, among a total of 840 participants. These studies suggest that online CBT is a viable and effective alternative to face to face treatment. Treatment adherence was 82%, and reductions in psychopathology represented a large between-group effect size of SMD = 0.9 (95% CI: .7 to 1.1), which were maintained over long periods. The research culminated in the foundation of the Interapy clinic, which received Dutch health regulatory body approval in 2005. Since then, costs of online CBT are reimbursed through public health insurance. A large study of treatment outcome of 1500 patients of the Interapy clinic showed that effects in clinical practice are similar to those observed in the controlled trials, and comparable to selected benchmarks of naturalistic studies of face to face CBT. The accumulated evidence provides compelling support for the efficacy and effectiveness of online CBT.

Keywords. Cognitive Behavior Therapy; Computer assisted protocol directed therapy; Effectiveness Studies; Follow-Up Studies; Internet; Randomized controlled trial; Treatment Outcome;

Ethical dilemmas in online research and treatment of sexually abused adolescents (2010)

Ruwaard, J., A. Lange, B. Schrieken and P. Emmelkamp (2011). Efficacy and Effectiveness of Online Cognitive Behavioral Treatment: A decade of Interapy Research. Annual Review of Cybertherapy and Telemedicine 2011. Advanced Technologies in Behavioral, Social and Neurosciences. B.K. Wiederhold, S. Bouchard and G. Riva. Amsterdam, The Interactive Media Institute and IOS Press9-14.

ABSTRACT BACKGROUND: In a recent uncontrolled trial of a new therapist-assisted Web-based treatment of adolescent victims of sexual abuse, the treatment effects were found to be promising. However, the study suffered a large pretreatment withdrawal rate that appeared to emanate from reluctance among the participants to disclose their identity and obtain their parents’ consent. OBJECTIVE: Our objectives were to confirm the effects of the online treatment in a controlled trial and to evaluate measures to reduce pretreatment withdrawal in vulnerable populations including young victims of sexual abuse. METHODS: The study was designed as a within-subject baseline-controlled trial. Effects of an 8-week attention-placebo intervention were contrasted with the effects of an 8-week treatment episode. Several measures were taken to reduce pretreatment dropout. RESULTS: Pretreatment withdrawal was reduced but remained high (82/106, 77%). On the other hand, treatment dropout was low (4 out of 24 participants), and improvement during treatment showed significantly higher effects than during the attention placebo control period (net effect sizes between 0.5 and 1.6). CONCLUSIONS: In treatment of vulnerable young populations, caregivers and researchers will have to come to terms with high pretreatment withdrawal rates. Possible measures may reduce pretreatment withdrawal to some degree. Providing full anonymity is not a viable option since it is incompatible with the professional responsibility of the caregiver and restricts research possibilities.

Web-based therapist-assisted cognitive behavioral treatment of panic symptoms

Ruwaard, J., Broeksteeg, J., Schrieken, B., Emmelkamp, P., & Lange, A. (2010). Web-based therapist-assisted cognitive behavioral treatment of panic symptoms: A randomized controlled trial with a three-year follow-up. Journal of Anxiety Disorders, 24, pp. 387-396. doi: 10.1016/j.janxdis.2010.01.010

Abstract BACKGROUND Internet-delivered treatment may reduce barriers to care in those unwilling or unable to access traditional forms of treatment. OBJECTIVE To assesses the efficacy of web-based therapist-assisted cognitive behavioral treatment (web-CBT) of panic symptoms. DESIGN A randomized waiting-list controlled trial with an uncontrolled three-year follow-up. PARTICIPANTS A community sample of 58 participants with chronic panic symptoms of varying severity (immediate treatment: n = 27, waiting-list control: n = 31). OUTCOME MEASURES The primary outcome measures were a one-week Panic Diary and the Panic Disorder Severity Scale – Self-Report (PDSS-SR); secondary measures were the Agoraphobic Cognitions Questionnaire (ACQ), the Body Sensations Questionnaire (BSQ), the Mobility Inventory – Alone subscale (MI-AAL), and the Depression Anxiety Stress Scales (DASS-42). RESULTS In the RCT, 54 participants (93%) completed posttest measurements. With regard to the primary outcome measures, intention-to-treat ANCOVAs revealed that participants in the treatment condition improved more than the participants in the waiting-list control condition (p < .03), with a pooled between-group effect size of d = .7. After three years (n = 47; 81% study compliance), effects were more pronounced. CONCLUSION The results demonstrate the efficacy of therapist-assisted web-CBT in the treatment of panic symptoms.

 

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Keywords Cognitive behavior therapy; Computer assisted protocol directed therapy; Controlled clinical trials; Randomized; Follow-up studies; Internet intervention; Panic disorder; Treatment outcome