0015
App-based Meal Diary as Treatment Support i Eating Disorder Treatments
1 ,2
2
2
2
Joakim de Man Lapidoth , Ann-Charlotte Wiberg , Karolin Lindberg , Kristoffer Ekström
1
2
Karolinska Institutet, Stockholm, Sweden, Stockhoms centre for eating disorders, Stockholm, Sweden
CBT-based eating disorder treatments largely rely on the idea of Ecological Momentary Interventions
(EMI), where patients are encouraged to identify, analyse and practice behaviours as they happen in real
life. Keeping a meal diary is therefore a fundamental part of all CBT-based eating disorder treatments.
For practical reasons these diaries are commonly registered retrospectively on paper, bringing
shortcomings such as delays in feedback, recall bias or having a negative effect on treatment adherence.
Keeping a meal diary in an application in a smart-phone (APP) is an innovative, readily accessible,
attractive and cheap alternative for treatment support. The APP may make it easier for a patient to
register meals and associated behaviours as they happen, to get immediate feedback on these
registrations, and to get structured feedback on practicing alternative behaviours. An APP may also be
used to easily provide support such as reminders, taking of notes and providing different forms of psycho
education.
The aim of this project has been to develop an APP for meal registration, as a treatment support in eating
disorder treatments. Differences in the experience of using an APP (compared to meal registration on
paper), differences in frequency of registrations, and in treatment effect will be compared between the two
ways of keeping a meal diary.
In this presentation we will demonstrate the APP for treatment support and discuss its use and further
evaluation.
0058
UV4.me: A Tailored Internet Intervention for Skin Cancer Risk Reduction in Young Adults
1
1
2
1
4
1
Carolyn Heckman , Susan Darlow , Lee Ritterband , Teja Munshi , Carolyn Caruso , Stephanie Raivitch ,
3
Sharon Manne
1
2
Fox Chase Cancer Center, Philadelphia, PA, USA, University of Virginia, Charlottesville, VA, USA,
3
4
Rutgers University, New Brunswick, NJ, USA, BeHealth Solutions, Charlottesville, VA, USA
"UV4.me" is a web-based prevention program to improve ultraviolet radiation (UV) exposure and skin
protection behaviors among young adults at moderate to high risk of developing skin cancer. UV4.me
was developed based on Integrative Model (Fishbein & Capella, 2006) constructs such as knowledge,
risk perception, beliefs, norms, self-efficacy, and intentions. The program emphasizes appearance
concerns, known to be the primary motivation for UV exposure and lack of skin protection among young
adults. This is accomplished in part through the use of tailored facial images 1) showing UV damage and
2) computerized age progression images. The intervention includes additional interactive elements
including videos, goal-setting tasks, and a personalized avatar that demonstrates sunburn and skin
protection depending on participant behavior within the website. An RCT was initiated in March, 2014.
0059
Blended Care for Depression in Specialized Mental Healthcare – Results of a Pilot Study
1
2
1
2
5
Lisa Kooistra , Jenneke Wiersma , Jeroen Ruwaard , Patricia van Oppen , Mark Dekker , Lisette van
4
6
1 ,3
1 ,3
Gemert-Pijnen , Filip Smit , Pim Cuijpers , Heleen Riper
1
Department of Clinical Psychology, VU University and the EMGO Institute for Health and Care Research,
2
Amsterdam, The Netherlands, Department of Psychiatry, VU University Medical Center/GGZinGeest and
3
the EMGO Institute for Health and Care Research, Amsterdam, The Netherlands, Department of
4
eMental-health, Leuphana University, Lüneburg, Germany, Department of Clinical Psychology, University
5
6
of Twente, Enschede, The Netherlands, GGZ Friesland, Leeuwarden, The Netherlands, The Trimbos
Institute, Utrecht, The Netherlands
Purpose
Blended treatment for depression combines face-to-face treatment with Internet-based treatment. As of
yet, little is known about the feasibility of this treatment. In the current study, we developed a blended
treatment for depressed patients and assessed the feasibility in specialized mental healthcare (MHC).
Methods
First we performed a needs assessment among patients and therapists (via a literature study and focus
groups), in which we examined the optimal proportion of offline and online components within blended
treatment, preferred treatment duration and intensity, treatment content, and strengths and weaknesses
of face-to-face and online treatment individually.
Subsequently, we combined these results with evidence-based, face-to-face cognitive behavioural
therapy (CBT) and online CBT protocols, resulting in a blended treatment protocol for depression, which
we implemented in a secure web-based treatment platform.
Finally, we conducted an uncontrolled pilot study in which the blended protocol was tested among
depressed patients that were recruited in routine practice. Validated outcome measures, which took place
at baseline and after 10 weeks, assessed pre-treatment patient expectations, post-treatment satisfaction,
and changes in symptoms of depression and anxiety, general well-being and mastery. In addition,
interviews were held with participating patients and therapists concerning the potential benefits and
challenges of blended treatment.
Results and Discussion
The needs assessment resulted in a 10-week blended CBT protocol of 10 face-to-face and 10 online
sessions that are provided alternately on a weekly basis. At the time of writing we have included 14
patients. Data collection will be completed July 2014. Preliminary results highlight the importance of
cognitive elements and proper balancing of both face-to-face and online sessions. Based on our findings
the blended treatment protocol will be revised. At the ISRII conference we will discuss the final study
results as well as the cost-effectiveness trial protocol on the revised blended treatment for depressed
adults (N= 150).
0118
Mental Health Online: An Australian Online Clinic for Singular and Multiple-Disorder Treatment
with Synchronous and Asynchronous Online Support
Jo Abbott, Neil Thomas, Klaire Wallace
Swinburne University of Technology, Hawthorn, Victoria, Australia
Mental Health Online is an Australian online mental health clinic that provides free online mental health
assessment and cognitive behavioural treatment self-help treatment to adults internationally. Australian
residents can also obtain low-cost therapist assistance while completing the online cognitive behavioural
treatments. This demonstration of Mental Health Online, https://www.mentalhealthonline.org.au includes
provision of a snapshot of online programs offered through Mental Health Online, the introduction of a
multiple-disorder treatment program offering treatment for up to 3 mental health conditions
simultaneously. New communication capabilities are demonstrated, including communication through
video chat, audio chat, online chat and virtual reality environments. Ways that health professionals can
benefit from resources within Mental Health Online are illustrated.
0124
PROSTMATE: A New Prostate Cancer Portal to Support Men with Prostate Cancer
Addie Wootten
Australian Prostate Cancer Research, East Melbourne, Australia
Purpose
Access to appropriate information and support remains problematic for many men diagnosed with
prostate cancer, especially in rural and remote areas of Australia. We have developed an online clinical
support program, PROSTMATE, which aims to overcome these barriers to access. PROSTMATE is a
secure portal that provides telehealth consultations with nurses and psychologists, tailored information, a
place to record treatments, test results and appointments, online tracking tools and self-directed support
programs to improve health and wellbeing.
Methodology
PROSTMATE (www.prostmate.org.au) is freely accessible to men affected by prostate cancer, their
families and others interested in prostate cancer. PROSTMATE launched in November 2013 and we
have monitored its uptake, user engagement and participant feedback.
Results
Over 700 people have registered. 72% of members are from metropolitan areas, 22.5% from regional or
remote areas. The majority of members (56.5%) are men who have been diagnosed with prostate cancer.
Self-reported problems at registration indicated that 17.2% of men with prostate cancer reported at risk
levels of mood problems and 41.4% reported at risk levels of sexual intimacy problems. 23.5% of partners
reported at risk levels of relationship problems and 41.2% reported at risk levels of sexual intimacy
problems. Telehealth consultations have steadily grown and appear to be an acceptable delivery mode
for men and their families.
Conclusions
PROSTMATE shows promise in supporting men and offering access to specialist prostate cancer nurses
and allied health services. This demonstration will provide an opportunity for others to see the program
and explore how PROSTMATE could provide a novel way of improving care, and potentially see the
integration of these systems into routine care.
0165
Self-Management and Recovery Technology (SMART) System: Developing Online Resources for
Use within Secondary Mental Health Care
1 ,7
2 ,8
1
1
3
4
Neil Thomas , John Farhall , Fiona Foley , Nuwan Leitan , Cassy Nunan , David Castle , Susan
1 ,7
1
3
3
2
5
6
Rossell , Leon Sterling , Emma Ladd , Sue Farnan , Ellie Fossey , Lisa Brophy , Cathy Mihalopoulos ,
7
1
1
1
Jayashri Kulkarni , Greg Murray , Denise Meyer , Michael Kyrios
1
2
Swinburne University, Melbourne, Victoria, Australia, La Trobe University, Melbourne, Victoria, Australia,
3
4
Mental Illness Fellowship of Victoria, Melbourne, Victoria, Australia, St Vincent's Hospital, Melbourne,
5
6
Victoria, Australia, Mind Australia, Melbourne, Victoria, Australia, Deakin University, Melbourne, Victoria,
7
8
Australia, Alfred Health, Melbourne, Victoria, Australia, NorthWestern Mental Health, Melbourne,
Victoria, Australia
In integrating Internet interventions with healthcare systems, one key area of development is to develop
interventions which can be embedded within specialist mental health services. Primarily targeting people
with severe mental health problems, secondary mental health care in Australia involves regular support
from practitioners within a case management role. These services also have a developing remit to
promote personal recovery, a process of adaptation to persisting mental health problems. The SelfManagement and Recovery Technology (SMART) program is a research program to develop and trial
online resources for integration within mental health services in the state of Victoria in Australia. SMART
has been designed to complement routine mental health care provision, with an emphasis on multimedia
and therapeutic exercises which can be used flexibly within sessions on a tablet computer, and accessed
by the client between sessions via their own computer. This demonstration presentation introduces this
system, including its content and functions in relation to personal recovery as a therapeutic target.
0168
Demonstration SilverCloud Platform
David O'Callaghan, James Bligh
SilverCloud Health Ltd., Dublin, Ireland
SilverCloud is a novel platform that provides tools to rapidly prototype and implement a wide range of
online computer supported treatment programmes. Programmes created with SilverCloud aim to provide
a more engaging and supportive experience to users. To date several treatment programmes have been
developed - a psycho- educational programme for self-esteem and body image difficulties; and a CBTbased therapeutic programme for depression, another for anxiety disorders that employs a
transdoagnostic CBT protocol. We are currently developing programmes for LTCs such as CVD and
diabetes.
SilverCloud would welcome the opportunity to present the platform and demonstrate its functionality, this
will include the user end and also the supporter/ clinician end. In addition, we would like to present our
history: arising out of 10+ years of academic research and clinical practice. We would like to present our
design methodology that we use in the creation of new and innovative programmes. The presentation will
also include demonstrations of the platform in its web and mobile versions. Lastly, through our
collaboration with the Anna Freud CAMHS service we will present some of our recent innovations for the
platform that have been developed for use with children and adolescents.
0189
Demonstration of an Internet Intervention for Adults Coping with Cancer-Related Distress
1 ,2
2 ,1
2
2
1 ,2
Suzanne Chambers , Jeffrey Dunn , Joanne Aitken , Paul Scuffham , Bronwyn Morris , Peter
2
2
3
3
Baade , Philippa Youl , Frances Thorndike , Lee Ritterband
1
2
Griffiths University, Gold Coast, Queensland, Australia, Cancer Council Queensland, Queensland,
3
Australia, University of Virginia, Charlottesville, VA, USA
Cancer is the leading cause of burden of disease and injury in Australia, accounting for nearly one-fifth of
the total disease burden. Based on population growth alone the number of cancers diagnosed is
expected to increase by 60% in the next 15 years. This picture is not unique to Australia but instead is a
common scenario around the world. Approximately 35% of cancer patients experience persistent clinically
significant distress; and unmet psychological supportive care needs in Australian cancer patients are
highly prevalent. There is a clinical imperative to provide accessible evidence-based psychosocial
therapies to patients, not only while they are in the acute health care system but also as they progress
though survivorship. A population-based and scalable intervention is needed, and the Internet presents a
potentially feasible method of delivering this care by overcoming many existing barriers. To test whether
an innovative Internet-based psychological intervention for distressed cancer patients can be an
efficacious method to decrease distress, this research team is developing an interactive, automated
Internet intervention. Development will be complete by time of the ISRII meeting and a large populationbased RCT will begin in 2015 with colorectal and melanoma patients who either have or are at risk of
having elevated psychological distress.
The Internet intervention, CancerCope, is modelled after an effective phone-delivered intervention. It is
being developed by a large multi-disciplinary team of cancer experts, psychologists, eHealth researchers,
instructional designers, and software developers. CancerCope is an 8-week intervention that includes
weekly Cores covering mindfulness, managing stress, relaxation, cognitive restructuring, problem-solving,
and self-care (exercise, sleep, nutrition). A Daily Journal allows users to monitor their distress and
progress toward goals. In the Demo, we will showcase the Internet intervention, emphasizing
development of the patient vignettes, expert videos, and interactive instructional design elements.
0200
Demonstration of an Internet Intervention for Youth with Irritable Bowel Disease
1
1
2
2
Kevin Hommel , Jamie Ryan , Frances Thorndike , Lee Ritterband
1
2
Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA, University of Virginia,
Charlottesville, VA, USA
Poor self-management of pediatric chronic illness is a pervasive and detrimental problem resulting in poor
health outcomes and treatment nonadherence, increased risk of relapse, and greater healthcare costs.
Adolescents are particularly nonadherent to treatment regimens. In inflammatory bowel disease (IBD), up
to 88% of adolescents demonstrate significant medication nonadherence, missing approximately 40-50%
of prescribed doses. The significant public health issue and long-term consequences that nonadherence
presents underscore the need to effectively improve the self-management skills of adolescents with IBD.
Given wide spread access and high interest in technology among youth, web-based interventions have
significant potential to improve pediatric self-management of chronic diseases, offering coordinated
intervention information to caregivers and clinicians. To test this possibility, the current team has been
developing an Internet intervention for youth with IBD (age 11-18 years) and their caregivers, including a
clinician component whereby clinicians can receive relevant treatment information and monitor patient
progress. This Internet intervention is a 6-week program that includes 3 required Cores and a series of 14
Modules assigned weekly based on user symptoms and progress. A daily diary allows users to track their
adherence and monitor progress toward goals. The program covers pill swallowing training, problem
solving training, adherence monitoring (patient and caregiver), goal setting, behavioral contracting, and
other key components of managing chronic disease. In the Demo, we will showcase the fully functioning
Internet intervention, highlighting the user-centered design of the program. We will also answer questions
about design and development.
0247
Demonstration of an Internet Support Group for Primary Care Patients with Mood and Anxiety
Disorders
Bruce Rollman, Bea Belnap, Jordan Karp, Charlene Xie, Michael Spring, Armando Rotondi
University of Pittsburgh, Pittsburgh, PA, USA
Background: Internet support groups (ISGs) enable individuals with similar conditions to exchange
information and provide emotional support from anywhere they have Internet access, and evidence
suggests that ISG participants experience reduced social isolation and decreased psychological
distress. We are presently testing the effectiveness of a password-protected, moderated ISG embedded
within a collaborative care intervention in our NIMH-funded Online Treatments for Mood and Anxiety
Disorders Trial.
The Online Treatments Trial uses an EpicCare electronic medical record system-generated prompt
triggered by a visit diagnosis of depression, anxiety, or panic that encourages physicians at 26 University
of Pittsburgh Medical Center-affiliated primary care offices to refer their patients aged 18-75 with these
conditions to our Trial at the time of the office visit. Of the 700 patients with Internet access and at least a
moderate level of mood or anxiety symptoms (PHQ-9 and/or GAD-7 ≥10) we expect to enroll by 9/1/14,
we will randomize 300 to our ISG where they will have access to: (1) various discussion boards; (2) links
to reliable and pertinent consumer health information, multimedia, crisis hotlines, ask-an-expert,
pharmacy, and other resources; and (3) a computerized cognitive behavioral therapy program among
other resources.
Objectives: The presenting author will demonstrate the desktop and smartphone versions of our ISG to
raise attendees’ awareness of: (1) how an ISG linked to patients’ usual source of primary care can be
utilized to help treat common mental health and other medical conditions; and (2) various design
elements within our ISG and other strategies we use to promote patient log-ins, page views, posts, and
other metrics of engagement.
0261
Automating the Research Process: Demonstration of the Goji Trial Management Software
Jeremy Gibson
Queensland University of Technology, Brisbane, Queensland, Australia
Randomised control trials (RCTs) are the gold standard of clinical health research and are considered
optimal is assessing the efficacy and/or effectiveness of an intervention or treatment. With complex
research studies however, it is difficult to keep track of participants and ensure consistency and continuity
of study protocols and procedures at all stages of a trial. This is a particular issue where a study involves
complex participant criteria matching, the application of multilevel randomization protocols, and multiple
assessments, follow-ups, and clinicians. The Goji Trial Management software was developed to address
these issues and to automate and track participants throughout a research trial.
The developers of the Goji Research Trial software will demonstrate how the software can be applied
across a range of health related research trials - from simple two group designs through to complex
multilevel study trials. They will demonstrate a range of automated features within the Goji program
including:
• Random allocation,
• Registration and enrollment
• Custom variables, and
• Auto-scheduling reminders, emails, SMSs, appointments
The Goji Trial Management software has been contracted for use in multiple research trials within
Australia including trials presently being conducted by the Young and Well Cooperative Research Centre
and beyondblue. The demonstration will provide the audience with an opportunity to see how this
software can ease the research and staff burden and ensure consistency and continuity of the study
protocols and procedures in a time and cost effective manner.
0008
iFightDepression: Improving Awareness and Enhancing the Capacity for Self-Management of
Depression with the Use of an Internet-based Programme in Europe
1
2
2
2
3
4
Annabel Cebria , Ella Arensman , Gillian Karwig , Celine Larkin , Margaret Maxwell , Ricardo Gusmão ,
5
6
7
8
9
Chantal Van Audenhove , Angela Ibelshaeuser , András Székely , Irina Todorova , Airi Värnik , Peeter
9
10
1
11
12
Värnik , Daniel Witte , Diego J Palao , Victor Perez , Ulrich Hegerl
1
2
Parc Taulí Sabadell Hospital Universitari, Sabadell, Barcelona, Spain, National Suicide Research
3
4
Foundation, Cork, Ireland, University of Stirling, Stirling, UK, Faculdade de Ciências Médicas 5
Universidade NOVA de Lisboa, Lisboa, Portugal, Katholieke Universiteit Leuven LUCAS, Leuven,
6
7
Belgium, Gesellschaft für Psychische Gesundheit - pro mente tirol, Innsbruch, Austria, Semmelweis
8
University, Institute of Behavioural Sciences Budapest, Budapest, Hungary, Health Psychology Research
9
Center, Sofia, Bulgaria, Estonian-Swedish Mental Health and Suicidology Institute, Tallin, Estonia,
10
11
Centre de Recherche Public Santé, Luxembourg, Luxembourg, Parc de Salut Mar, Barcelona, Spain,
12
University of Leipzig, Leipzig, Germany
nd
Purpose: Depression incurs significant morbidity and is expected to reach 2 place in the ranking of
Disability Adjusted Life Years (DALYs) for all ages and both sexes by the year 2020. However, only a
minority of patients receive appropriate treatment according to established guidelines. Internet-based
interventions could represent a cost-effective, accessible approach to both reducing deficits in therapeutic
services and complementing current forms of treatment. However, despite growing evidence endorsing
the effectiveness of online interventions such as self-help programmes based on cognitive-behavioural
therapy techniques, a major challenge is participants’ adherence to these interventions.
Method: A multilingual internet-based intervention (the iFightDepression guided self-management tool)
was developed for adolescents and adults experiencing mild to moderate depression. A multilingual,
multifaceted iFightDepression website was also developed to increase awareness of depression and
provide related information. The tool was initially implemented through primary care services in eight EU
countries.
Results: Preliminary results from satisfaction questionnaires and focus group evaluations demonstrated
acceptability of the tool and feasibility of its use with both general practitioners and patients, and
generated suggestions for future implementation.
Discussion: Feedback from mental health professionals, general practitioners and patients is currently
being used to optimize the tool and evaluation procedures for a second phase of implementation in 8
European regions. Furthermore, plans to conduct a future randomized controlled trial of the
iFightDepression tool in Spain are currently underway.
Conclusions: The iFightDepression Internet-based programme, comprising the self-management tool
and awareness website, represent an innovative and promising approach to the treatment of mild to
moderate depression.
0011
Adjustment Disorders: Frequently Diagnosed and Uniquely Suited for E-Health Interventions
1
1
2
Andreas Maercker , Rahel Bachem , Thomas Berger
1
2
University of Zurich, Zurich, Switzerland, University of Berne, Berne, Switzerland
Adjustment disorders (AD) are amongst the most frequently diagnosed mental disorders in psychiatry and
clinical psychology worldwide. They are also commonly diagnosed in clients engaging in deliberate selfharm and in those consulting general practitioners. However, its reputation in research-oriented mental
health remains weak due to several identifiable factors. This may change when ICD-11 by WHO will be
introduced, including a new conceptualization of AD as stress-response disorders. In the literature, there
are several recent intervention approaches for AD available. Only very few already use e-health
applications (e.g. guided self-help, virtual reality intervention). The paper will present the new ICD-11
concept of AD, preparatory work for an ongoing Cochrane report on AD-interventions, an overview of
evidence-based AD interventions and the outline of a study planned in Zurich and Berne (guided self-help
for burglary victims with AD).
0012
Web-based Distress Management Program for Implantable Cardioverter Defibrillator Patients
(WEBCARE): Long-term Follow-up of a Randomized Controlled Trial
1
1
2
4
3
Mirela Habibovic , Wobbe Zijlstra , Dominic Theuns , Marco Alings , Pepijn van der Voort , Leon
5
6
7
8
1
9 ,10
Bouwels , Jean-Paul Herrman , Suzanne Valk , Pim Cuijpers , Johan Denollet , Susanne Pedersen
1
2
Tilburg University, Tilburg, The Netherlands, Erasmus Medical Center, Rotterdam, The Netherlands,
3
4
5
Catharina Hospital, Eindhoven, The Netherlands, Amphia Hospital, Breda, The Netherlands, Canisius6
Wilhelmina Hospital, Nijmegen, The Netherlands, Onze Lieve Vrouwe Gasthuis Hospital, Amsterdam,
7
8
The Netherlands, Vlietland Hospital, Schiedam, The Netherlands, Vrije University, Amsterdam, The
9
10
Netherlands, University of Southern Denmark, Odense, Denmark, Odense University Hospital, Odense,
Denmark
Purpose: Sudden cardiac arrest is one of the leading causes of death worldwide, costing more than 7
million lives each year. To prevent sudden cardiac arrest, implantable cardioverter defibrillators (ICDs) are
considered as standard care. ICD treatment is generally well accepted by the majority of patients,
however, a subgroup (1 in 4) experiences psychological distress post implantation. Psychological distress
within the ICD population has shown to be associated with adverse health outcomes and mortality.
The WEB-based distress management program for ICD patients (WEBCARE) was developed to mitigate
distress (e.g. anxiety and depression) and enhance health-related quality of life in ICD patients. This
study investigates the treatment effectiveness at 6- and 12-months follow-up for generic and disease
specific outcome measures. In addition, subgroup analyses will be performed.
Methods: Consecutive patients implanted with first-time ICD from six referral hospitals (N=289) in The
Netherlands were randomized to either the ‘WEBCARE' (N=146) or ‘Usual Care' (N=143) group. Patients
in the WEBCARE group received an online, 12-weeks fixed, 6 lesson behavioral treatment based on the
problem solving principles of cognitive behavioral therapy. Five of the 6 lessons were accompanied by
homework assignments which were, after submission, provided with personalized therapist feedback. In
addition, the WEBCARE group was provided with relaxation training exercises on CD which they were
encouraged to use.
Results: Results of the long-term primary outcomes at 6- and 12-months follow up will be presented at
the meeting. By that time, we expect to have complete data for 289 patients on anxiety, depression, and
health-related quality of life.
Conclusions: This is the first randomized trial to examine the (long-term) effectiveness of a web-based
behavioural intervention for ICD patients. Current findings will inform the clinical practice on the use of
web-based behavioural treatments as additional care post ICD implant.
Trial registration: http://www.ClinicalTrials.gov. Identifier: NCT00895700
0014
Praten Online (Talking Online): The Effectiveness of an Online Chat Treatment for Depressed
Young People (RCT)
Jeannet Kramer
Trimbos-institute, Utrecht, The Netherlands
Purpose
Praten Online (talking online) (www.pratenonline.nl) is a web-based treatment for young people aged 1222 with symptoms of depression. The treatment module is based on Solution Focused Brief Therapy
(SFBT). The Praten Online treatment consists of a maximum of 5 web chats with youth support workers.
The objective of the study is to evaluate the efficacy of the web-based intervention Praten Online. The
central research question is: Is the web-based intervention Praten Online effective in terms of a decrease
in symptoms of depression.
Methods
The study is a randomised controlled trial with two conditions:
1) the web-based intervention (Praten Online)
2) a waiting list control group
The measurements took place 9 weeks (t1), and 4.5 months (t2) after the initial measurement (t0). At 7.5
months a measurement was done in the chat group only. The control group had access to the chat
intervention by then. Outcomes measures included depressive symptoms and perceived competence as
dealing with others, self-esteem, undertaking activities and school or study performances.
Results
After 9 weeks, results showed that the chat group improved a bit more than the waiting list group in
depressive symptoms. They also showed more improvements on 2/3 of the competence areas. After 4.5
months, the improvement of the chat group became more evident: now they improved more than the
waiting list group in both depressive symptoms and on all competence areas. At 7.5 months depressive
symptoms decreased even further in the chat group.
Conclusions
This study indicates that Praten Online can be an effective intervention for decreasing symptoms of
depression in young adults.
0016
Development and Testing of an E-learning Module on the Assessment and Treatment of Suicidal
Behavior
1
1
1
1
2
Derek de Beurs , Jeroen Ruwaard , Robin Kenter , Marieke de Groot , Jos de Keijser , Ad Kerkhof
1
2
VU Amsterdam, Amsterdam, The Netherlands, GGZ friesland, Leeuwarden, The Netherlands
1
Purpose
In this paper we describe the development and feasibility of an e-learning module and a multimedia
guideline adherence scale.
Method
First, we describe the development of the e-learning module and the guideline adherence scale. Next, we
tested the feasibility amongst 400 undergraduate psychology students in a randomized controlled study
with 1 month and 3 month follow up. In the second study, we offered the module to 411 mental health
care professional who also followed a face-to-face training on suicide guideline adherence. Use and
appreciation of the module were assesses at three months follow up.
Results
The guideline adherence scale showed good internal consistency and a two factor structure. At 1 month
follow-up, students who received the module improved significantly on guideline adherence, confidence
and knowledge when compared to the control condition. The effects were maintained at 3 month follow
up. In the second study among mental health professionals, we found that in all departments, the ICT
environment was not sufficient to display the video vignettes of the module. Still, 55% (n = 133) of the
239 respondents used the e-learning module for an average time of 40 minutes.
Conclusions
The effect of training of professionals can be assessed by using a multimedia guideline assessment
scale. Our e-learning module has the potential to improve suicide skills of undergraduate students. The
module was highly evaluated by both professionals and students. ICT of the departments was not
sufficient to display e-learning.
0019
Effectiveness of Internet-based Guided Self-help for Patients with Major Depressive Disorder Who
are Awaiting Regular Treatment at Specialized Mental Health Centers: Short-term Results from a
Randomized Controlled Trial
1 ,2
1 ,2
3 ,2
1 ,2
Robin Kenter , Annemieke van Straten , Aartjan Beekman , Pim Cuijpers
1
VU Univeristy, Faculty of Psychology and Education, Department of Clinical Psychology, Amsterdam,
2
The Netherlands, EMGO institute for Health Care and Research, VU University Medical Centre,
3
Amsterdam, The Netherlands, Department of Psychiatry, VU University Medical Centre, Amsterdam, The
Netherlands
Purpose: Efficacy and effectiveness of Internet-based guided self-help for depression has been
demonstrated in several randomized clinical trials. However knowledge on the effectiveness of the
treatment when delivered within routine mental health care is scarce. The aim of this study was to
investigate the clinical effectiveness of a guided online self-help intervention, when offered to patients
with major depressive who are awaiting regular face-to-face treatment at specialized mental health
centers.
Methods: We conducted a randomized controlled trial with 269 patients identified with a DSM-IV
diagnosis of major depression disorder. 136 received Internet-based guided self-help treatment and 133
received an unguided self-help book based on problem solving treatment before the start of regular
treatment in an outpatient clinic. The primary outcome was symptoms of depression as measured by the
CES-D. Secondary outcome measures were diagnosis of depression, symptoms of anxiety, insomnia,
quality of life and mastery. Assessments took place at baseline and eight weeks after baseline.
Results and Conclusions: Data analysis is ongoing, short-term results will be presented.
0023
"Net-step"- A Therapist Delivered Internet-Psychotherapy for Depression and Anxiety Disorders in
Primary Care
Ulrich Sprick, Martin KÖHNE
St. Alexius/St. Josef Clinic, Neuss, Germany
Purpose: Internet psychotherapy (IPT) especially with CBT methods has been used with success in
various countries. In Germany, however, there are only very few approaches so fare using internet
psychotherapy in primary care. This is mainly due to local law restrictions. For implementation of IPT as a
useful tool in primary care more research is needed. Acknowledged as a therapy model by the ministry of
health NRW and by AOK (health insurance company) the therapist delivered IPT "net-step" will be used
as an alternative approach.
Methods: In a randomized trial 90 individuals suffering from depression, 60 individuals with panic
disorder and 60 individuals with social phobia take part in the study. Patients having IPT (n=90) are
compared with controls (n=90) having no therapy at all and other controls (n=30)who have face to face
therapy.
Patients with a confirmed diagnosis of depression, social phobia or panic disorder are recruited from
practitioners, the hospital ambulance or from the internet. Every patient has a personal talk and is being
tested face to face in the hospital´s ambulance. Participants are then randomly assigned to 12 weeks
CBT online or face to face-CBT for the same period of time. The waiting group is retested after 12 weeks
and receives online-CBT after the waiting period.
Results: This is work in progress. In a pre-trial 72% of the individuals suffering from depression
recovered during the 12-weeks online- treatment period. This was equal to the recovery rate of patients in
the face to face group.
Conclusions: We believe that "net-step" as a therapist delivered CBT-internet-psychotherapy may
become an effective tool for the treatment of depression, panic disease and social phobia. It is an attempt
to combine advantages of a solitary online-psychotherapy with beneficial effects of face to face therapy.
0026
Smartphone-Supported Versus Full Behavioural Activation for Depression: A Randomised
Controlled Non-Inferiority Trial
1
1
1
1
2
3
Kien Hoa Ly , Naira Topooco , Hanna Cederlund , Anna Wallin , Jan Bergström , Olof Molander , Per
2
1 ,4
Carlbring , Gerhard Andersson
1
Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden,
2
3
Department of Psychology, Stockholm University, Stockholm, Sweden, Wemind Psykiatri Stockholm,
4
Stockholm, Sweden, Department of Clinical Neuroscience, Center for Psychiatry Research, Karolinska
Institute, Stockoholm, Sweden
Purpose
In light of the research support for behavioral activation, and the promising findings of smartphonedelivered psychological interventions in the treatment of depression, we evaluated a smartphone
depression application as an adjunct to four face-to-face sessions (blended treatment) for mild to
moderate depression. The blended treatment was compared to a full 10-session treatment with no
support from a smartphone.
Methods
This was a non-inferiority study with unrestricted randomization in a 1:1 ratio. The study was conducted at
three clinics in Sweden. 45 participants diagnosed with major depressive disorder received the blended
treatment, and 43 participants received the full 10-session treatment. Main outcome measures were the
BDI-II and the PHQ-9.
Results
Results showed significant improvements in both groups across time on the primary outcome measures
(within-group Cohen’s d range 1.51–1.80; between group d range −0.21– 0.01), indicating non-inferiority
of the blended treatment, and at the same time with an average 44.6% reduction of therapist time.
Conclusions
The blended treatment was non-inferior to the full behavioural treatment, and at the same time reduced
therapist time. This may have important implications for planning psychological services. Moreover, from
a theoretical point of view, the trial could be important as it tests the possibility to integrate modern
information technology with face-to-face therapy.
0027
A Randomized Trial to Reduce Problematic Use of Amphetamine Type Stimulants
1 ,2
Robert Tait
1
National Drug Research Institute, Faculty of Health Sciences, Curtin University, Perth, WA, Australia,
2
3
Centre for Mental Health Research, Australian National University, Canberra, ACT, Australia, Centre for
Research on Ageing, Health and Wellbeing, Australian National University, Canberra, ACT, Australia,
4
National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia,
5
entre for Translational Neuroscience and Mental Health, University of Newcastle, Newcastle, NSW,
6
Australia, Black Dog Institute, University of New South Wales and Prince of Wales Hospital,, Sydney,
NSW, Australia
Purpose: Globally, the use of amphetamine type stimulants (ATS) places a considerable burden on
health and treatment services. No pharmacotherapies for ATS problems have yet been approved, but
some face-to-face psychotherapies are effective. Web-based interventions are effective for some
substance use problems (e.g. alcohol) but none has specifically targeted ATS. We aimed to evaluate the
effectiveness of a web-based intervention (Breakingtheice) for ATS users at three months post enrolment.
Methods: We used a randomized controlled trial design comparing a web-based intervention with a
waitlist control group. The intervention was three fully automated, self-guided modules based on cognitive
behavioral therapy and motivation enhancement. The primary outcome measure was self-reported ATS
use assessed with the Alcohol, Smoking, Substance Involvement Screening Test (ASSIST). Other
measures were psychological distress (K-10 score) quality of life (EUROHIS score), days out of role, polydrug use, general help-seeking intentions, actual help-seeking and ‘readiness to change'. We used an
intention-to-treat analysis with a group-by-time interaction as the critical assessment.
Results: We randomized 160 people (intervention n=81, control n=79). At three months, 35 (43%)
intervention and 45 (57%) control participants provided data. In the intervention group, 51 (63%)
completed at least one module. There were no significant group-by-time interactions. The pre-post
change effect sizes showed small changes (range d=0.14 to 0.40) favoring the intervention group for
poly-drug use, distress, actual help-seeking and days out of role. The control group was favored by
reductions in ATS use, improvements in quality of life and increases in help-seeking intentions (range
d=0.09 to 0.16).
Conclusions: This web-based intervention for ATS use produced no significant changes on any
measure, but high levels of attrition prevent definitive assertions. There were moderate but non-significant
reductions in poly-drug use, distress, days out of role, and increases in help seeking.
Trial registration number: ACTRN12611000947909
0029
Efficacy of a Web-based Computer Tailored Physical Activity Intervention, Based on Motivational
Interviewing and Self-Determination Theory
1
2
1
1
Stijn Friederichs , Anke Oenema , Catherine Bolman , Lilian Lechner
1
Open University of the Netherlands, Faculty of Psychology and Educational Sciences, Heerlen, The
2
Netherlands, Maastricht University, Department of Health Promotion, Maastricht, The Netherlands
Purpose:
Currently, the majority of web-based computer tailored physical activity (PA) interventions have been
grounded on traditional health behavioral theories such as the trans theoretical model (TTM) and the
theory of planned behavior (TPB). Recent research in the realm of PA, however, increasingly shows the
value of self-determination theory (SDT) and in motivational interviewing (MI). In order to gain more
insight on the value of SDT and MI in web-based computer tailoring, we developed the I Move
intervention, a web-based computer tailored PA intervention, based on SDT and MI principles. The
present study aims to evaluate the efficacy of the I Move intervention.
Methods:
A randomized controlled trial was conducted comparing three research conditions: 1) the I Move
intervention; 2) the Active Plus intervention, a web-based computer tailored PA intervention, that is based
on traditional theories such as TTM and TPB; and 3) a waiting list control group. Self-reported PA was
assessed at baseline, 3 months, 6 months and 12 months using web-based questionnaires.
Results:
In total, 3162 individuals completed the baseline questionnaire. At three months participants from both
intervention conditions increased their PA level while participants from the control condition did not
increase their PA level. Compared to the control condition, both interventions were significantly effective
in increasing PA. Between the intervention conditions no significant differences were observed. The
results of the six month data - that will be available from June 2014 - will be presented.
Conclusion:
The I Move intervention provides an example of how SDT and MI can be translated into web-based
computer tailoring. The results of the randomized controlled trial will provide more insight into the value of
this novel intervention type. This knowledge can then be used for further development and optimization of
web-based PA interventions.
0030
The Role of Support in Web-based Treatment for Depression and Anxiety in Adults: CostEffectiveness Analysis Alongside a Randomized Trial
1 ,2
2
1 ,2
Joran Lokkerbol , Annet Kleiboer , Filip Smit
1
2
Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands, VU University,
Amsterdam, The Netherlands
Background: Economic and demographic developments highlight the need to identify interventions
capable of reducing the disease burden of depression and anxiety, while putting minimal pressure on
capacity.
Objective: To identify the role of support regarding the cost-effectiveness of a web-based intervention
aimed at treating depression and anxiety in adults.
Method: Three intervention arms with Care As Usual (CAU) plus an eHealth intervention with different
levels of support (no support, support on request, weekly support) were compared with a control condition
of CAU plus non-specific chat or email support in a randomized controlled trial. Cost-effectiveness was
assessed over 12-months to identify the conditions associated with the least incremental cost per
additional utility gained.
Results: All intervention arms had a large probability of being more cost-effective than the control
condition. There was no apparent difference between the three intervention arms, though the web-based
intervention with support on request seemed to have a slightly higher probability of being more costeffective (50% versus 20-30%) for higher levels of willingness to pay (>€15,000) per QALY. Due to high
levels of dropout, our results are only tentative at this stage.
Conclusion: The web-based intervention is more cost-effective than the control condition in treating
patients with depression and anxiety. The fact that the intervention group receiving weekly support did not
dominate the other conditions in terms of cost-effectiveness indicates that there may be much to gain
when opting for interventions that are less demanding with regard to therapists' involvement. This may not
only be more cost-effective, but may in addition amount to treating more patients with a fixed capacity.
More research is needed to see whether high dropout rates biased our results and whether adherence
can be improved to further increase the impact of the web-based intervention.
0031
MoodGroup: An Online Group Therapy Intervention for Australian Adults with Depression
Kerry Arrow, Andrea Chester, Keong Yao
RMIT University, Melbourne, Victoria, Australia
Purpose:
Depression is a serious mental health condition affecting approximately 4.1% of Australian adults . Group
cognitive behavioural therapy (gCBT) delivered online has the potential to provide affordable, accessible
and efficacious treatment to people living with depression. Online gCBT is however an emerging
treatment modality and as such, further literature regarding its utility and efficacy is required. Usability
testing provides unique insight into the way participants accept, understand and use an intervention.
Furthermore, usability tests inform the adaptation of interventions to better meet the needs of different
users. Controlled trials are needed to determine the efficacy of online gCBT interventions.
This study aimed to evaluate the usability and efficacy of MoodGroup; an online gCBT intervention to
reduce depression in Australian adults.
Method:
Australian adults with depression applied to MoodGroup and were randomly assigned to either a
treatment or wait-list control (WLC) group. Provisional psychologists delivered the treatment intervention
with groups of up to eight participants at a time. MoodGroups were hosted in online classrooms and ran
for two hours a week over a course of nine weeks. Participants completed weekly readings and
homework activities. They also completed regular outcome measures assessing their depressive
symptoms, general mental health and quality of life. The usability of the intervention was assessed using
weekly online session evaluation questionnaires. A mixed-method approach including linear mixed
modelling and thematic content analyses assessed the efficacy and usability of MoodGroup.
Results:
The findings support the efficacy of MoodGroup. Treatment recipients were more improved than those in
the WLC on all variables, with medium to large effect sizes (d = 0.54-1.26) noted. Furthermore, strong
acceptability and usability ratings were reported.
Conclusion:
In general, MoodGroup shows good usability and efficacy.. Importantly, the data obtained from this study
will further enhance the acceptability, structure and content of further online gCBT interventions.
0032
Development of Minimal and Best Practice Quality Standards for Internet Addiction Counselling
Michael Schaub
University of Zurich, Zurich, Switzerland
Background
Web-based self-help programs that reduce problematic consumption are able to reach "hidden" consumer
groups in the general population, which is also of great importance from a public health point of view.
Particularly the combination of counseling in addition to self-help interventions seem promising according
to recent randomized controlled trials.
Aims
Last year, the Swiss federal office of public health started the national e-addiction portal Safe Zone. Part
of this project is also the development of minimal (MQS) and best practice quality standards (BPQS) for
the future quality assurance of internet-based addiction counselling services.
Methods
Based on the on the development study of an EU framework for MQS and benchmarks in drug demand
reduction (EQUS), an exhaustive literature review, national law conditions and professional codes we
developed lists with specific quality standards for online addiction counselling. Trained internet addiction
counselors involved in this Swiss addiction portal were asked to rate these standards in a thorough
internet survey for different counselling offers for qualification as MQS or BPQS for Internet addiction
counselling.
Results
Forty addiction counselors specialized in all fields of substance use participated in this survey. A high
level of acceptance was found for the MQS. The final lists were based on at least 70% of overall
acceptance. Almost all structural standards were accepted as MQS (13 of 15) and BPQS (13 of 15).
There was less agreement for the process standards (MQS: 11 of 17, BPQS 9 of 17) and only half of the
outcome standards were accepted (each 2 of 4). Detailed quality standard formulations will be presented
at the conference.
Conclusions
There was a high consensus on national MQS and BPQS for Internet addiction counselling. These quality
standards build a suitable framework for the implementation of quality assurance for Internet addiction
counselling on the Swiss addiction portal.
0034
Effectiveness in Primary Care - Online Therapy Solutions for Depression, Insomnia and Worry
1
2
3 ,4
3 ,4
3 ,4
Kristofer Vernmark , Marie Kivi , Maria Eriksson , Dominique Hange , Eva-Lisa Petersson , Boo
2
3 ,4
1
1
1
Johansson , Cecilia Björkelund , Marielle Ryberg , Fredrik Malmaeus , Celia Young
1
2
Psykologpartners W&W, Linkoping, Sweden, University of Gothenburg, department of Psychology,
3
Gothenburg, Sweden, Institute of Medicine, the Sahlgrenska Academy,, Gothenburg, Sweden,
4
University of Gothenburg, Department of Primary Health Care/Public Health and Community Medicine,
Gothenburg, Sweden
Purpose
To give an overview of the research done on three online therapy programs in the Swedish primary care.
Methods
Three pilot studies will be presented and conclusions will be drawn about effectiveness when online
therapy is implemented in regular health care setting. Also, implementation strategies based on data
gathered from these studies will be discussed. Study nr 1 is an accepted manuscript comparing online
therapy for Depression with treatment as usual (TAU). Study nr 2 is a pilot study on insomia and study nr
3 is a pilot study on generalized anxiety (GAD).
Results
All three pilot studies show promising effects and evidence that online therapy could be a useful
intervention in primary care.
Conclusions
Online therapy can be an effective way to treat depression, insomnia and generalized anxiety in a primary
care setting. Results are preliminary and more research is needed in this area.
0036
Predictors of Treatment Dropout in Self-Guided Web-based Interventions for Depression: An
‘‘Individual Patient Data’’ Meta-Analysis
1 ,2
1 ,3
1 ,2
1 ,2
4
5
Eirini Karyotaki , Filip Smit , Annet Kleiboer , David Turner , Adriana Mira Pastor , Tomas Berger ,
4
1 ,2
8
9
11
12 ,13
Cristina Botella , Tara Donker , Louise Farrer , Bjorn Meyer , Viola Spek , Kristofer Vernmark
, Pim
1 ,2
Cuijpers
1
2
Department of Clinical Psychology, Vu University, Amsterdam, The Netherlands, EMGO Institute for
3
Health and Care Research, Amsterdam, The Netherlands, Trimbus Institute, Utrecht, The Netherlands,
4
5
Department of Psychology and Technology, Jaume University, Castellon, Spain, Department of Clinical
6
Psychology and Psychotherapy, University of Bern, Bern, Switzerland, Department of Clinical
Psychological Science, Faculty of Psychology, Maastricht University, Maastricht, The Netherlands,
7
Department of Medical Psychology & Psychotherapy, Erasmus Medical Center, Rotterdam, The
8
Netherlands, Centre for Mental Health Research, ANU College of Medicine, Biology and Environment,
9
the Australian National University, Canberra, Australia, Department of Psychosomatic Medicine and
10
Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany, GAIA AG,
11
12
Hamburg, Germany, Avans Hogeschool, University of Tilburg, Tilburg, The Netherlands, Department of
13
Behavioural Sciences and Learning, Linkoping University, Linkoping, Sweden, Psykologpartners,
Linkoping, Sweden
Purpose: Although it is well known that web-based interventions can be effective for depression, dropout
rates are also known to be high, especially in self-guided web-based interventions where no coach or
therapist is available. Rigorous empirical evidence regarding factors influencing dropout in self-guided
web-based interventions is lacking owing to small study sample sizes. In this paper we examined
predictors of dropout in an individual patient data (IPD) meta-analysis.
Methods: We conducted a comprehensive literature search for all Randomized Controlled Trials (RCTs)
of psychotherapy for adults with depression from 2006 to January 2013. Then we approached authors to
collect the primary data of selected studies. Then we examined predictors of adherence, such as gender,
education level, severity of depression, co-morbid anxiety, age, status of relationship, employment,
number of intervention modules and type of intervention.
Results: We analysed data of 2705 participants across ten RCTs of self-guided web-based interventions
for depression. 69.5% of the participants dropped out of the intervention before completing at least 75%
of the treatment modules. The multivariate analysis indicated that male gender (RR=1.07), lower
educational level (RR=1.22), CBT-based intervention (RR=1.21) and comorbid anxiety symptoms (RR=
1.20) significantly increased the risk of dropping out, while for every additional four years of age, the risk
of dropping out significantly decreased (RR=.98).
Conclusions: Dropout can be predicted by several variables and it is not randomly distributed. This
knowledge may inform tailoring of online self-help interventions to prevent dropout in identified groups at
risk.
Keywords: predictors, adherence, attrition, dropout, self-help, self-guided, web-based psychotherapy,
depression
0039
Effectiveness and Outcome Moderators of Computer-based Interventions in Health Education: A
Systematic Review of Meta-Analytic Studies
1
2
3
Leontien Vreeburg , René Diekstra , Clemens Hosman
1
2
The Hague University, Den Haag, The Netherlands, The Hague University, Den Haag, The Netherlands,
3
Maastricht University /Radbout University Nijmegen, Maastricht/Nijmegen, The Netherlands
This article presents findings from a review of meta-analyses on outcome studies of computer-based
interventions in health education.
Purpose: Its purpose is twofold. First to provide an overview of the efficacy of computer-based
educational health interventions and second, to identify moderators of effects.
Methods: A systematic literature search for meta-analyses resulted in 12 meta-analyses. The metaanalyses were analysed with regard to reported (overall) effect sizes, confidence intervals, interaction
effects, heterogeneity and effect moderators.
Results: Results indicate that there is a positive relation between computer-based interventions and
improvement in health related outcomes (e.g. disease symptoms, weight loss, alcohol consumption,
disease specific self-efficacy) for participants, with overall effect sizes varying from very small to large,
and mostly small or moderate. The sustainability of effects is demonstrated until six months. Moderators
of computer-based educational interventions were clustered in three categories: intervention features,
study features and participants characteristics. No relation to effectiveness was found for theoretical
background, location of participation, self-monitoring, age and gender of the participant.
Conclusion: In general, more research regarding moderators of effect and long term outcomes is
needed, to investigate how computer-based health educational interventions can live up to their status of
promising intervention, equal to or under certain conditions even surpassing the impact of traditional
educational methods. Limitations of this review are discussed in the light of uncertainties regarding the
technique of systematic review of meta-analyses, heterogeneity in used meta-analyses, mix of online and
non-online computer-based interventions in one sample and participants.
0041
Interpretation Bias Training for Social Anxiety - A Pilot Study
1
1
1
Johanna Boettcher , Mona Brettschneider , Pauline Neumann , Thomas Berger
1
2
Freie Universitaet, Berlin, Germany, University of Bern, Bern, Switzerland
2
Purpose: The biased interpretation of ambiguous social situations is thought to be a maintaining factor of
Social Anxiety Disorder (SAD). Studies on the modification of interpretation bias have shown promising
results in laboratory settings. The present study aims at pilot-testing a training that targets interpretation
and judgmental bias and is delivered remotely via the Internet.
Method: Thirty-nine individuals meeting diagnostic criteria for SAD participated in an 8-weeks, unguided
program. Participants were presented with ambiguous social situations, were asked to choose between
possible interpretations and to evaluate costs of potential negative outcomes and received elaborate
automated feedback on their interpretations and judgments. Primary and secondary outcomes were
assessed prior to the intervention, after the intervention and six weeks after the interventions.
Results: The training resulted in a reduction of the targeted cognitive processing biases (d=0.6-0.8) and
in a decrease of social anxiety symptoms (d=0.87). It also produced change in depression and general
psychopathology (d=0.47-0.75). The results held stable accounting for drop-outs (26%) and over the six
weeks follow-up period. Forty-five percent of the completer sample showed clinical significant change and
almost half of the participants (48%) no longer met diagnostic criteria for SAD.
Discussion: Even though the present results exceed those of former computerized trainings, findings do
not recommend the training as stand-alone treatment for SAD. However, it may well serve as a low-cost
and low-barrier add-on to Internet or face-to-face CBT for SAD.
0043
Evaluating the DEAL Project - A Brief, Web-based Intervention for Co-occurring Depression and
Problematic Alcohol Use in Young People: A Randomised Controlled Trial
1
1
1 ,2
1
Mark Deady , Maree Teesson , Frances Kay-Lambkin , Katherine Mills
1
2
University of New South Wales, Sydney, NSW, Australia, University of Newcastle, Newcastle, NSW,
Australia
Background: Depression and alcohol misuse represent two of the major causes of disease burden in
young adults. These conditions frequently co-occur and this co-occurrence is associated with increased
risks and poorer outcomes than either disorder in isolation. Integrated treatments have been shown to be
effective, however, there remains a significant gap between those in need of treatment and those
receiving it, particularly in young people. The increased availability of web-based programs to
complement health care presents a unique opportunity in the treatment of these conditions.
Purpose: To evaluate whether a brief, web-based self-help intervention (the DEAL Project) can be
effective in treating co-occurring depression and problematic alcohol use in young people (aged 18 - 25
years).
Methods: A randomised controlled trial (RCT) compared the DEAL Project with an attention-control
condition (HealthWatch). This trial consisted of a four-week intervention phase and a 24-week follow-up,
conducted entirely online and Australia-wide. Primary outcomes included change in depression
symptoms and alcohol use at 5, 12, and 24 weeks post-baseline. Secondary outcomes included change
in general functioning and quality of life, anxiety/stress symptomatology, and a number of other
depression/alcohol-related outcomes.
Results: A total of 105 participants completed the baseline assessment and were randomised (mean age
= 22; 60% female). Data are currently being analysed and intervention effects will be reported at the ISRII
conference.
Conclusions: This study is the first RCT of a web-based treatment for comorbid depression and
problematic alcohol use in any age group and represents a novel and innovative approach to addressing
the significant harms associated with these conditions. Full conclusions will be drawn after data analysis.
0046
The Development of Eating Disorder Symptoms During an Internet-based Treatment Program for
Patients with Binge Eating Disorder
Anette Kersting
,2
1 ,2
, Ruth Dölemeyer
1 ,2
, Grit Klinitzke
1 ,2
, Jana Steinig
1 ,2
, Michaela Nagl
1 ,2
, Birgit Wagner
1
1
University Hospital Leipzig, Clinic and Policlinic of Psychosomatic Medicine and Psychotherapy,
2
Leipzig/Sachsen, Germany, University of Leipzig Medical Center, IFB Adiposity Diseases,
Leipzig/Sachsen, Germany
Purpose: Internet-based therapist-conducted interventions for eating disorders have been proven to be
effective to treat bulimia nervosa. Thus far, there is, however, no evidence with regard to binge eating
disorder (BED). The aim of the present study was to develop and conduct a therapist-guided online
intervention for individuals with BED and to evaluate its effectiveness.
Methods: Participants were recruited through the Internet via links to the study homepage and eating
disorder-specific centers throughout Germany. After a comprehensive online-diagnostic, included
participants were randomized either to the treatment group or to a waiting-list control group following the
principle of a randomized controlled trial. Participants in the treatment group then received a 16-week
cognitive-behavioral and email-based intervention via the Internet. Eating disorder symptomatology (EDEQ) including the dimensions restraint eating, weight concerns, eating concerns and shape concerns, and
depression (BDI-II) were recorded at the beginning and the end of the treatment.
Results: Overall, 114 patients with BED completed the intervention. When comparing pre- and posttest
values from the treatment group with those from the waiting-list control group, we found a significant
reduction in the number of binge-eating episodes, negative eating-related thoughts and attitudes, and
depressive symptoms with considerably high effects sizes ranging from d=1.07 to d=1.96.
Conclusions: The present findings are a proof of the intervention's effectiveness with regard to eating
disorder symptomatology and depression. Program-immanent variables, e.g., treatment duration, task
obligation and disorder-specific factors, e.g., feelings of shame, mobility limitations, and the therapeutic
alliance are discussed as potential moderators of the treatment outcome. We are currently analyzing data
from the 3-, 6-, and 12-month follow-ups. The results will be available soon and will additionally be
presented.
0050
Development and Usability Testing of an Internet Intervention to Reduce Alcohol-Exposed
Pregnancy Risk
Karen Ingersoll, Lee Ritterband, Christina Frederick, Michelle Hilgart, Gabe Heath, Steve Johnson
University of Virginia, Charlottesville, VA, USA
Purpose
Many women are unaware of their risk for alcohol-exposed pregnancy (AEP) that can result in Fetal
Alcohol Spectrum Disorders. We transformed a F2F intervention to reduce AEP risk into an Internet
intervention targeting drinking and contraception. This presentation will demonstrate interactive
components of the Contraception and Alcohol Risk Reduction Internet intervention (CARRII) and present
usability data collected using Think-Aloud methods.
Methods
Intervention development. Instructional design principles were used to optimize user learning of complex
information like calculating standard drinks or understanding contraception efficacy. Counseling activities
that build momentum for change were transformed into interactions. For example, in the contraception
Core, the user reviews cartoon panels of situations that tempt women to have sex without contraception,
and rates her temptation and confidence in each situation. Users get feedback on higher and lower risk
situations, along with a reflective summary statement, before moving on to an interaction where she
learns about and selects strategies appropriate for her goals.
Usability testing. 5 eligible women were local, of childbearing age, and risky drinkers or at risk for
pregnancy, aged 20 to 28. Users narrated thoughts aloud as they navigated.
Results
Site Navigation. Users could identify buttons, diaries, cores, and other functions from the home screen.
Users navigated to the diaries and completed them accurately. Users liked the sequence and interactive
elements. Design Comments. Users liked the images, characters, diversity, colors, and instructions
embedded in each interaction. They provided critiques of graphics for feedback. Changes
Recommended. Users identified solutions such as “go back” and “more instructions” buttons or overlays
to clarify navigation or orient users more simply, and suggested minor design modifications.
Conclusions
The draft CARRII intervention was usable and appealing to women from the targeted population. By the
time of this presentation, we will have launched it in a pilot RCT.
0052
Outcomes of a One-Year Text Message Intervention for Obese English and Spanish-Speaking
Adults: ConTxt
1
1
1
1
1
1
Kevin Patrick , Fred Raab , Cheryl Rock , Greg Norman , Julie Kolodziejczk , Elva Arredondo , William
1
1
1
Griswold , Lindsay Dillon , Michael Donohue
1
2
University of California, San Diego, La Jolla, California, USA, San Diego State University, San Diego,
California, USA
Purpose: Obesity is a major public health problem and Hispanic populations are particularly affected.
Obesity interventions based solely on text messaging (SMS) have been shown to be effective for short
periods of time and in some populations, but limited evidence is available for longer-term outcomes and
for efficacy in Hispanic populations. Also, little is known about the comparative efficacy of obesity
interventions that use SMS vs. SMS plus phone coaching, an important issue when considering the cost
and reach. In this report we present findings from an RCT evaluating an SMS and SMS+Coaching
intervention in obese English and Spanish speaking adults.
Methods: 298 overweight (BMI > 27 to 39.8) adults (age 21-60; 228 Female; 122 Hispanic) were
randomized to one of three conditions: SMS only, SMS+Coach, and Control and assessed at baseline, 6
and 12 months. The SMS interventions offered 2-4 messages/day (in English or Spanish depending on
preference) personalized and tailored on baseline weight management strategies and iterative interactive
messaging supporting self-monitoring of diet and PA, goal setting, like/unlike messaging control and other
strategies. Monthly 10-15 minute Coaching calls focused on goal setting and barriers to weight loss.
Controls received print materials on weight reduction. Treatment effects were assessed at 12 months.
Results: 261 (87.6%) and 253 (84.9%) participants completed the 6 and 12-month visits respectively.
Drop out did not differ by treatment condition. Mean (SD) percent weight loss at 12 months was: Control
condition-0.47% (6.4%); SMS only-1.99% (8.2%); SMS+Coach-3.54% (8.3%). Compared to Controls, and
controlling for BMI at baseline, the SMS only group lost 1.20% more weight (p=.214); and the
SMS+Coach lost 2.99% more weight (p=.003). Additional analyses are being conducted and will be
reported.
Conclusions: A 1-year obesity intervention utilizing daily interactive and tailored SMS was most effective
when messages were coupled with brief monthly phone coaching.
0053
Emerging Characteristics of Internet-Assisted Psychological Interventions: Analysis of Journal
Publications 1996-2013
Azy Barak
University of Haifa, Haifa, Israel
Purpose: The purpose of this project was to identify some major trends in journal- published papers
related to Internet-assisted psychological interventions over 18 years of professional and scientific
conduct in the area. Unlike typical reviews and meta-analyses, the aim of this mission was to characterize
research development and trends rather than summarize actual research findings. Methods: To pursue
this goal, over 900 English-written papers - published in professional, peer-reviewed journals (printed and
online), from 1996 to 2013 - were surveyed and labeled. The labels included journal name, names of
researchers, authors' country, type of paper (empirical or theoretical), research methodology utilized (or
type of theoretical paper), intervention problem area, online technology (platform), and more. Results:
Size and trends that characterize journal publications along the 18 years of survey were identified,
pointing toward research emphases and shortages. In addition, the data allowed the recognition of
eminent researchers, publication outlets, and countries in which authors operated. Conclusions: The bulk
of publications and the results of these analyses provide interesting insights into emerging trends of
research and publication in the area of Internet-assisted psychological interventions and point out to the
accumulated knowledge as well as to gaps and paucities in this professional area.
0054
HowNutsAreTheDutch (HoeGekIsNL), A Dutch Crowdsourcing Study Exploring Mental Strengths
and Weaknesses in the General Population
1
1
1 ,2
1
1
Lian van der Krieke , Bertus F Jeronimus , Frank J Blaauw , Maria H Schenk , Elisabeth H Bos , Stijn
1
1
1
1
1
de Vos , Klaas J Wardenaar , Rob BK Wanders , Johanna TW Wigman , Peter de Jonge
1
University of Groningen, University Medical Center, University Center for Psychiatry, Groningen, The
2
Netherlands, University of Groningen, Johann Bernoulli Institute for Mathematics and Computer Science,
Groningen, The Netherlands
Background
The DSM has been called into question as it tends to be used as a diagnostic tool, while it is not based on
empirical evidence on psychopathology. Researchers have called for new approaches to increase our
knowledge about mental health and ill-health, and to improve clinical care for those who need it. We are
exploring such a new approach in the research project HowNutsAreTheDutch (HoeGekIsNL), a national
crowdsourcing study in the Netherlands.
Purpose
The purposes of HowNutsAreTheDutch are to map the mental strengths and weaknesses in the Dutch
population irrespective of clinical diagnosis, and to involve the general public in the conceptualization of
mental health.
Methods
In December 2013, the project HowNutsAreTheDutch (HoeGekIsNL) was launched on
www.hoegekis.nl. The website invites all inhabitants of the Netherlands to complete questionnaires about
their mental health and well-being, and to explore their personal profile of mental strengths and
weaknesses. The first part of the project consists of cross-sectional measurements; the second part (from
June 2014 onwards) involves repeated measurements by means of mobile-based ecological momentary
assessments.
Results
In May 2014, over 11.000 people were participating in the project; they completed more than 50.000
questionnaires. Their age ranges from 12 to 82, and 65% of them is female. Preliminary results show that
many participants report some form of mental distress. For instance, more than one third of Dutch
participants report mild depressive symptoms, and 10% suffer from severe depressive symptoms. At the
same time, 75% rate their happiness a 6 or higher, and 25% an 8 or higher (range 0-10). Moreover,
outcomes indicate that mental health and well-being can be presented as a continuum including strengths
and weaknesses.
Conclusion
HowNutsAreTheDutch is an innovative research project that shows how crowdsourcing can be used for
studying mental health in the general population.
0055
Online Psychometric Instruments for Depression, Anxiety and Related Symptoms: A Systematic
Review.
1 ,2
1 ,3
1
2
2
Wouter van Ballegooijen , Heleen Riper , Pim Cuijpers , Patricia van Oppen , Jan Smit
1
Department of Clinical Psychology, VU University Amsterdam, Amsterdam, The Netherlands,
2
Department of Psychiatry, VU University Medical Centre / GGZ inGeest, Amsterdam, The Netherlands,
3
Leuphana University Lüneburg, Lüneburg, Germany
Purpose
Psychometric instruments for depression, anxiety and related mental health problems are increasingly
delivered through the internet. Several pen-and-paper questionnaires have been re-validated for online
use and new instruments have been developed and validated as well. To date, the psychometric
properties of online instruments have not been systematically studied and synthesised. This study is a
systematic review of scientific literature. It aims to provide an overview of the psychometric properties of
online self-report instruments that measure (symptoms of) depression, anxiety disorders, stress disorders,
self-harm and suicidal ideation.
Methods
We searched Medline and PsycINFO for relevant studies using a validated search string. Out of over
3000 unique hits, we included 65 studies that reported psychometric properties of online instruments for
aforementioned disorders. Studies were coded and assessed for quality using the COSMIN checklist.
Results and conclusions will be presented and discussed at the conference.
0057
eCare@home - Tablet-based Ambient Assistance for Older Adults with Bipolar Disorder or
Recurrent Depressive Episodes.
1
2
2 ,1
1
1
Josien Schuurmans , Jeroen Ruwaard , Heleen Riper , Jan Smit , Max Stek
1
2
GGZinGeest/VU Medical Centre, Amsterdam, The Netherlands, VU University, Amsterdam, The
Netherlands
Purpose
Studies show that depression has an unfavorable prognosis in late life, with a higher risk of relapse and
chronicity than in younger populations. Bipolar disorder, though less common, accounts for 8-10% of
psychiatric admissions in late life. Although e-mental health applications may be beneficial for older
patients with severe mental disorders, little is known about requirements for interventions that target the
needs of this specific population. In the ecare@home project, we aim to improve self-management and
relapse prevention, as well as facilitate contact with care through a user-friendly tablet-computer for older
patients with recurrent mood disorders.
Methods
The ecare@home system builds on an existing platform (welltogether.eu) that was designed for older
adults with somatic care needs. To tap the needs of mental health patients and their formal and informal
carers, requirements were systematically assessed through an iterative participatory design approach.
End-users were interviewed at several stages before and during the developmental phase. A feasibility
trial in N=50 patients will be carried out from September onward.
Results
The user assessments revealed a need for quite drastic changes to the existing platform, that was
targeted at managing somatic care needs. Both clinicians and patients express the importance of respect
for the patient's autonomy and need for privacy and the validation of ‘normal' mood swings.
We identified three main pillars for the ecare@home system;



Health-tracking using simple Likert scale one-item questions to detect patterns in mood, activities
and sleep;
Providing online support from formal and informal carers through instant messaging and videoconferencing;
Providing (individualized) information on relapse prevention, disease-management and social
activities.
Conclusions


In building a user-friendly e-health solution for severe mental disorders in late life, less is often
more.
E-health targeted at relapse prevention in mood disorders requires a comprehension of the
sloping scale between normal fluctuations and relapse.
0062
A New Method for Improved Development of eHealth Tools: Expert Assessment of Content
Validity
1 ,2
1 ,2
Nancy Kassam-Adams , Flaura Winston
1
2
Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA, Perelman School of Medicine,
University of Pennsylvania, Philadelphia, Pennsylvania, USA
Purpose
Specifying a model of change (program theory) should precede development of any eHealth intervention
aiming to impact behavior or psychological health, particularly those created de novo, i.e. not adapted
from well-established in-person treatment. Ideally, intervention activities delivered by the eHealth tool
successfully target specific psychological or behavioral processes delineated in the model of change.
Prior to empirical testing of effectiveness, the extent to which experts judge that activities are well-suited
to achieve their intended targets can be thought of as a form of ‘content validity'. We aimed to design a
feasible method to assess eHealth tools' content validity and implement this during development of a
web-based intervention for children.
Methods
Using the Coping Coach intervention, we: 1) Delineated discrete intervention activities and intended
intervention target(s) for each activity; 2) Created a survey tool for expert ratings of each activity's
relevance to its target, likely effectiveness in achieving the target, and age-appropriateness; 3) Invited 15
external content experts to examine the intervention and complete the survey tool rating 15 activity-target
pairings.
Results
This process was feasible and easily implemented. Expert ratings averaged 3.7 on a 0-4 scale for
relevance, 3.2 for likely effectiveness, and 3.6 for age-appropriateness. Results support the content
validity of intervention activities, and point to areas for improvement. Findings complemented child and
parent usability ratings to assist our team in optimizing Coping Coach.
Conclusions
Systematic assessment of content validity as part of eHealth tool design can be a crucial checkpoint to
ensure that activities match the underlying change model they are intended to operationalize. Results can
help hone an intervention under development or address under-performance of existing interventions.
Assessing content validity early in the design process may increase the likelihood that costly further
development will lead to an intervention later found to be effective in rigorous evaluations.
0063
Staying Fit Australia: Efficacy of an Online Weight Management Program for Overweight
Adolescents
1 ,2
3
1
1
1 ,4
Joanne Williams , C. Barr Taylor , Karly Cini , Helena Romaniuk , Susan Sawyer , Katherine Taylor
1
2
Murdoch Childrens Research Institute, Melbourne, Victoria, Australia, Deakin University, Melbourne,
3
4
Victoria, Australia, Stanford Medical Center, Stanford, California, USA, Royal Children's Hospital,
Melbourne, Victoria, Australia
3
Purpose: To decrease the health risks associated with obesity it is critical that interventions that reduce
the prevalence and incidence of unhealthy weight gain are implemented, particularly during the critical
periods for weight gain. Adolescence is one of those critical periods and currently more than 25% of
Australian adolescents are overweight or obese. It is impossible to deliver face-to-face services to all the
young people who need support with weight management, but with 96% of 14-17 year old Australians
having internet access at home, effective online interventions have the potential to significantly impact on
this major public health problem. We conducted a randomised controlled trial to test the efficacy of the
online Staying Fit program in overweight adolescents from Melbourne, Australia.
Methods: We recruited 194 overweight adolescents (12-17 years) from the community and using a
computer generated block randomisation program they were randomised to receive the Staying Fit
program or usual care. The Staying Fit online intervention uses a cognitive-behavioral approach; has 12
sessions which include nutrition, physical activity and body image modules; and offers support in a private
and non-stigmatizing way. The usual care group received pamphlets with nutrition and physical activity
advice. Questionnaires addressing eating behaviours, depression, quality of life and substance use were
completed and height, weight and body composition data were measured at baseline and post-program
(3-months). A subsample of 70 adolescents were followed for one year.
Results: Over one year both groups improved but only the intervention group had a significant reduction
in BMI z-score (-1.38, p=0.004) and in percent body fat (-2.3, p=0.03).
Conclusions: BMI z-score changes of the magnitude found in this study have been shown to significantly
improve cardiometabolic risk factors. Staying Fit is inexpensive to administer and could easily be
delivered to all overweight young people who wanted weight loss support.
0067
Consensus Statement on Defining and Measuring Negative Effects of Internet Interventions
1
2 ,3
4
5
6
Alexander Rozental , Gerhard Andersson , Johanna Boettcher , David Daniel Ebert , Pim Cuijpers ,
4
7
3
8
1
Christine Knaevelsrud , Brjánn Ljótsson , Viktor Kaldo , Nickolai Titov , Per Carlbring
1
Division of Clinical Psychology, Department of Psychology, Stockholm University, Stockholm, Sweden,
2
Department of Behavioural Sciences and Learning, Swedish Institute for Disability Research, Linköping
3
University, Linköping, Sweden, Division of Psychiatry, Department of Clinical Neuroscience, Karolinska
4
Institutet, Stockholm, Sweden, Department of Clinical Psychology and Psychotherapy, Freie Universität
5
Berlin, Berlin, Germany, Division of Clinical Psychology and Psychotherapy, Department of Psychology,
6
Philipps University, Marburg, Germany, Department of Clinical Psychology, Vrije Universiteit Amsterdam,
7
Amsterdam, The Netherlands, Division of Psychology, Department of Clinical Neuroscience, Karolinska
8
Institutet, Stockholm, Sweden, MindSpot Clinic, eCentreClinic, Centre for Emotional Health, Department
of Psychology, Macquarie University, Sydney, Australia
Purpose: Internet interventions provide a potential for promoting mental health and alleviating emotional
distress. A large number of clinical trials have demonstrated their efficacy for several psychiatric
conditions, and Internet interventions will likely become a common and valuable alternative within the
regular health care. In the meantime, research has paid little attention to the possibility that some
treatments might be associated with different types of negative effects. Evidence from face-to-face
treatments suggests that 5-10% of all patients deteriorate despite receiving best available care. In
addition, other forms of negative effects may exist as well, e.g., social stigmatization, interpersonal
difficulties, and decreased self-esteem. However, a lack of agreement on how to define and measure
negative effects has left researchers without practical guidelines for monitoring and reporting deterioration
and adverse events in clinical trials, warranting a consensus for conducting research on negative effects.
Method: The objective of the current paper is to provide recommendations that could promote the study of
negative effects in Internet interventions. Ten leading experts in the field of Internet interventions were
invited to participate and share their perspective on how to explore negative effects, using the Delphi
technique to facilitate a dialogue and reach an agreement. Results: The importance of conducting further
research on negative effects is discussed, and suggestions on how to classify and measure negative
effects are provided, involving methods from quantitative and qualitative research. Potential mechanisms
underlying negative effects are also presented, differentiating factors shared with face-to-face treatments
from those unique to treatments delivered via the Internet. Conclusion: Negative effects should be
expected and need to be recognized to a greater extent, and researchers are advised to systematically
probe for negative effects whenever conducting clinical trials involving Internet interventions, as well as to
share their findings in scientific journals.
0069
The Use of Social Media as a Method for Interventions in (Residential) Youth Care for Youth with
Emotional & Behavioral Problems
1 ,2
1 ,2
Davy Nijs , Tom Vandries
1
2
Catholic University College Limbourg, Diepenbeek, Belgium, Association Catholic University Leuven
(KUL), Leuven, Belgium
Purpose
The Catholic University College Limbourg (KHLim) is finishing a 2-year research project (2012-2014) on
the implementation and evaluation of social media used in interventions with youngster in (residential)
youth care. The focus lies on two research questions: (1) what's the best strategy to implement new
(internet based) methods in social work practice? and (2) does implementation and use of social media
ameliorates the relationship between the social educator and the youngster and their does it change their
satisfaction of support?
Methods
An implementation guide was outlined using an international literature research in combination with a
participatory traject in which online methods were implemented in the participating organization (Sporen
vzw). The guide was peer reviewed by several national and international eHealth-experts. The second
question was answered by using a pre-post-test design processing semi-structured interviews in which
social educators and their youngsters evaluated the methods and both effects on satisfaction and
relationship were studied.
Results
All of the respondents see a potential for specific groups of youngsters who will benefit from using social
media in their digital guidance process. Some of the respondents explicitly mention the importance to
combine online tools with face-to-face counselling (blended counselling). A group of youngsters perceive
no specific added value for themselves.
Conclusions
Confronted with digital natives the Internet provides organizations in special youth care with huge
potentials (Van Hecke, 2012). Main conclusion of our research will be that we can no longer ignore the
Internet and social media as being an integral part of our professional toolkit, but in need of more
exploration. Attitudes and skills of the social educator remain most important, but the best fitting online
tool at the right time can facilitate individual coaching! Tools should be user friendly and should be used in
a ‘coaching' environment. Technical issues can impede use.
0070
Internet-based Individually Versus Group Guided Self-Help Treatment for Social Anxiety Disorder:
Results of a Randomized Controlled Trial
Thomas Berger, Ava Schulz, Timo Stolz
University of Bern, Bern, Switzerland
Purpose
Social anxiety disorder (SAD) is one of the most researched disorder in the field of internet-based
treatments. However, there is room for optimizing and improving Internet-based treatments for SAD, as a
considerable number of patients do not recover fully from treatment. Most of the interventions tested
include therapist support, whereas the role of peer support within internet-based self-help has not yet
been fully understood. This study aims at investigating the added value of therapist-guided group support
on the treatment outcome of internet-based self-help for SAD.
Methods
A total of 150 adults with a diagnosis of SAD are randomly assigned to either a waiting-list control group
or one of two active treatment conditions, in which participants use the same internet-based self-help
program, either with individual support by a therapist or therapist-guided group support. In the group
condition, 6 participants communicate with each other in an integrated discussion forum under the
guidance of a therapist. The primary outcome variables are symptoms of SAD and diagnostic status after
the intervention (3 months). Secondary outcomes include general symptomology, depression and quality
of life. Process variables such as group processes and the working alliance are also explored.
Results
The study will be finished in August 2014 and results will be presented.
Conclusions
The results of this study should indicate whether group-guided support could enhance the efficacy of an
internet-based self-help treatment for SAD. This novel treatment format, if shown effective, could
represent a cost-effective option and could further be modified to treat other conditions, as well.
0071
Internet-based Cognitive Behavioral Treatment for Patients with Chronic Somatic Conditions:
Patient Improvement, the Patient-Therapist Relationship and Treatment Preferences
1 ,2
1 ,2
2 ,3
4
3
Sylvia van Beugen , Maaike Ferwerda , Saskia Spillekom-van Koulil , Piet van Riel , Elke de Jong ,
3
1 ,2
1 ,2
Peter van de Kerkhof , Henriët van Middendorp , Andrea Evers
1
Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, Leiden, The
2
Netherlands, Department of Medical Psychology, Radboud university medical center, Nijmegen, The
3
Netherlands, Department of Dermatology, Radboud university medical center, Nijmegen, The
4
Netherlands, IQ healthcare, Radboud university medical center, Nijmegen, The Netherlands
Purpose: In order to support patients with chronic somatic conditions at risk for psychological problems, a
therapist-guided internet-based cognitive behavioral treatment (ICBT) was developed. This diseasegeneric intervention can be tailored to different patient conditions and individual treatment goals. First
indications of self-reported patient improvements, the patient-therapist relationship, and the association
between the two, as well as treatment preferences are presented.
Methods: Post-treatment evaluations of two ongoing trials for patients with psoriasis (n=37) or
rheumatoid arthritis (n=44) were examined, including self-reported improvements in coping and
symptoms, the patient-therapist relationship (Working Alliance Inventory), and preferences for different
treatment modalities (internet, phone, face-to-face).
Results: At post-treatment, the majority of patients reported improvements in coping and symptoms. The
patient-therapist relationship was rated positively and improved during treatment (p <.05), as generally
found in face to face treatments. Furthermore, a more positively rated patient-therapist relationship was
related to more improvements in symptoms and in coping with these symptoms (p <.05). At posttreatment, half of all patients (52.2%) indicated that they would prefer ICBT to other treatment modalities
for future psychological treatment. Women more often reported preferences for ICBT than men (65.8%
2
versus 35.5%; χ = 6.38, p <.05). No further gender or age differences were found.
Conclusions: Preliminary results indicate that ICBT led to self-reported improvements in coping and
symptoms, and that a satisfactory patient-therapist relationship could be established. Furthermore, the
patient-therapist relationship was found to be a possible predictor of self-reported improvements. These
results suggest that the ICBT treatment is a feasible and possibly effective intervention in improving
physical and psychological outcomes in patients with chronic somatic conditions.
0074
Acceptability and Feasibility of an eHealth Self-regulation Intervention for the Promotion of
Physical Activity and Healthy Nutrition
Jolien Plaete, Ilse De Bourdeaudhuij, Maïté Verloigne, Geert Crombez
Ghent University, Ghent, Belgium
Purpose: It is estimated that 80% of the prevalence of heart disease, stroke and type 2 diabetes, and
40% of cancers can be prevented through intervention programmes that address risk factors such as lack
of physical activity and unhealthy nutrition in adults. A promising intervention method to motivate people
to change their behaviour such as physical activity and nutrition, is computer tailoring. However, previous
research proposed that computer-tailored interventions should focus more on self-regulation methods
(goal setting, self-monitoring, skills-building activities, email reminders, booster sessions, and interactive
activities). We investigated the acceptability and feasibility of a recently developed dynamic eHealth
nutrition and physical activity programme based on self-regulation.
Methods: Participants (n = 194) completed an online questionnaire about a chosen behaviour (fruit,
vegetables or physical activity) and received a personalized advice. Within the eHealth program “MyPlan”
participants formulated their own action plan by goal setting. Follow-up modules were provided to
evaluate and adapt individual goals. Participants also completed an evaluation questionnaire, with
questions on the quality, user-friendliness and applicability of the program.
Results: Participants rated the program positively on different aspects. There were significant differences
between gender, age groups and social economic status (SES). Women, older and low SES participants
indicated the personalized advice and action plan as more relevant, instructive, interesting and
motivating. Nevertheless, older and low SES participants rated the questions and response options as
less clear and understandable than younger and high SES participants. Low SES participants also found
the advices too long compared to high SES participants.
Conclusions: These results suggest that the eHealth programme is an acceptable and feasible tool for
the promotion of physical activity and healthy nutrition. It remains important to develop easy and
understandable questions and advices.
0075
A Randomised Controlled Trial of a Brief Online Mindfulness-based: Replication and Extension
1 ,2
3 ,2
1
1
1
Kate Cavanagh , Clara Strauss , Alasdair Churchard , Puffin O'Hanlon , Thomas Mundy , Phoebe
1
4 ,2
Votalato , Fergal Jones
1
2
3
University of Sussex, East Sussex, UK, Sussex Mindfulness Centre, East Sussex, UK, Sussex
4
Partnership NHS Foundation Trust, East Sussex, UK, Canterbury Christ Church University, Kent, UK
Purpose: There is growing evidence that mindfulness has positive consequences for psychological and
physical health in both clinical and non-clinical populations. Self-guided mindfulness-based interventions
may be a way to increase access to the benefits of mindfulness. Building on previous research, this study
explored whether two brief, online, mindfulness-based interventions (with and without formal meditation
practice) could increase mindfulness and reduce perceived stress, perseverative thinking and
anxiety/depression symptoms within a student population.
Methods: One hundred and fifty-four students were randomly allocated to a two-week, self-guided, online
mindfulness-based intervention with or without meditation practices, or a wait-list control. Measures of
mindfulness, perceived stress, perseverative thinking and anxiety/depression were administered before
and after the intervention period.
Results: Intention to treat analysis identified significant group by time interactions for mindfulness skills,
perceived stress, perseverative thinking and anxiety/depression symptom severity. Participation in the
mindfulness-based interventions was associated with significant improvements in all measured domains,
with effect sizes in the small to medium range. No significant changes on these measures were found for
the control group. No differences between the intervention conditions were found.
Conclusions: This provides further evidence in support of the feasibility and effectiveness of shorter selfguided mindfulness-based interventions. The limitations and implications of this study for clinical practice
are discussed.
0085
Real-life Implementation of an Online Positive Psychological Intervention
1 ,3
2
2
3
3
Linda Bolier , Francine Schneider , Hein de Vries , Ernst Bohlmeijer , Gerben Westerhof , Brigitte
1
2
Boon , Liesbeth van Osch
1
2
Trimbos Institute (Department of Public Mental Health), Utrecht, The Netherlands, Maastricht University
3
(CAPHRI School for Public Health and Primary Care), Maastricht, The Netherlands, University of Twente
(Department of Psychology, Health and Technology), Enschede, The Netherlands
Purpose
In order to close the mental health gap it might be wise to deliver positive psychological interventions in
addition to problem-based interventions, because many people with subclinical depression or mental
health problems such as stress and anxiety might be more attracted by a well-being approach rather than
a problem-focused approach. Although promising results have been obtained in randomized controlled
trials (RCTs) of online positive psychological interventions (OPPIs), the actual implementation of these
interventions lags behind. In this study, we examined whether the findings of an RCT examining an OPPI
are generalizable to the real-life implementation of the same intervention.
Methods
The effectiveness of Psyfit.nl, an online mental fitness program based on positive psychology, was
examined in an RCT. In the study, 284 mildly depressed participants were included and randomized
across the Psyfit condition and a waiting-list control group. Online measurements were taken at baseline,
2 months, and 6 months after baseline.
In a real-life implementation pre-post study, people who attended an online health monitor of the Regional
Public Health Service received personalized feedback to participate in Psyfit.nl, based on their mental
health score. More than 4.000 people received this advice. Assessments were taken at baseline and 6
months after baseline (n=900).
Results
Participants in the Psyfit condition reported significantly higher levels of wellbeing at 2-month follow-up
and fewer depressive and anxiety symptoms at both 2-month and 6-month follow-up compared to the
waiting-list control group.
Regarding the pre- post study, the first results, use and effects of Psyfit.nl -imbedded in a local health
service, will be presented, compared to the earlier results of the RCT.
Conclusions
The results of this study will give ground for a conclusion whether effects of an OPPI are sustained in a
real-life situation. Moreover, implications and challenges regarding the implementation of OPPIs will be
discussed.
0099
Development and Formative Evaluation of Computerized Trans-Diagnostic DBT Skills Training for
Emotion Dysregulation
Anita Lungu, Maria Vicenta Navarro Haro, Chelsey Wilks, Marsha Linehan
University of Washington, Seattle, WA, USA
Purpose: Many individuals with mental health problems do not receive evidence based treatments
(EBTs) fitting their clinical profile. Affect dysregulation has emerged as a potential transdiagnostic disease
process. Dialectical Behavior Therapy (DBT) has shown high potential to treat emotion dysregulation
trans-diagnoses. Using computerized evidence-based psychotherapy addresses several critical barriers
to EBTs dissemination: the high cost of face-to-face treatment, and the decreased treatment seeking due
to stigma around mental health. Our presentation will focus on Phase 1 of the project which aims to
develop and evaluate a computerized trans-diagnostic DBT skills training intervention (targeting emotion
dysregulation) for mood or anxiety disorders. We also introduce the design of Phase 2 resulting from
integrating the feedback from Phase 1.
Methods: The development and formative evaluation uses an iterative design and combines a qualitative
and quantitative evaluation of the prototype. One or two groups of 5 participants complete the intervention
weekly on site, via a computer. For the qualitative evaluation, participants are interviewed by a researcher
afterwards using a semi-structured interview assessing comprehension, usefulness of intervention
components, engagement with materials, and perceived worth. For the quantitative evaluation,
participants respond to self-report questionnaires of skills use, anxiety, depression, and emotion
dysregulation before starting the intervention, mid-way through the intervention, and at the end of the
intervention. Phase 2 will comprise of a largely open trial.
Results: This is an ongoing study. Results of the Phase 1 will be presented. We hypothesized that
participants will find the intervention usable and feasible. We expect that, after receiving the intervention,
participants will decrease anxiety, depression and emotion dysregulation after the intervention.
Conclusions: If the computerized trans-diagnostic DBT skills training results usable and feasible, a
population in need to learn how to use more effective emotion regulation strategies would be able to
access a low cost evidence based intervention.
0111
Non-use of Internet Interventions for People with a Chronic Health Condition
Thomas FULLER, Nadia Garnefski, Vivian Kraaij
Leiden University, Leiden, The Netherlands
High levels of attrition and poor adherence are well-cited problems affecting the efficacy of Internet
interventions for mental and physical health conditions. Strategies to address these issues have typically
focused on trying to improve the design, content, or accessibility of the intervention or change a
characteristic of the user. Such strategies implicitly assume that there is some kind of deficit in the
intervention or person and that, if “fixed” more people will logically use the intervention. But what if nonuse (including attrition and poor adherence) to online interventions was a product of other factors such as
offline health-related behaviours, conscious decisions to not use the intervention or substitution with
competing technologies?
In the sounding board session I will briefly present a research proposal for a study that aims to generate a
more comprehensive understanding of the non-use of Internet interventions for chronic health conditions.
While the intervention, health condition and study population are yet to be finalised, I will focus on the
general framework for the study. Research methods will include: 1. a systematic review addressing what
is known about the non-use of interventions for chronic health conditions; 2. a systematic review of
existing strategies of for addressing non-use; 3. an observational study of the online and offline health
behaviours people with a chronic health condition offered an internet intervention; 4. follow-up interviews
with non-users. It is anticipated that a fifth study could be designed that uses the findings from studies 1-4
to develop and test theories which may encourage better uptake of Internet interventions.
0112
The Effectiveness of an Internet-based Parent Management Training (PMT) Program Compared to
Another More Advanced Face to Face Parent PMT
Ata Ghaderi, Pia Enebrink
Karolinksa institutet, Stockholm, Sweden
Although several parent management training (PMT) programs seem to be promising in terms of
decreasing child symptomatology and enhanced parenting, not enough is known regarding their relative
impact and long-term outcome in effectiveness trials. The main aim of the present study was to
investigate the effectiveness of a lean and focused Internet-based PMT program called Communication
method (iComet) to a more flexible and advanced, second generation PMT called Family Check-Up
(FCU) in a randomized trial.
A total of 241 families with a child/adolescent aged 10-14 years exhibiting conduct problems were
randomized to iComet or FCU. Primary outcome measure were conduct problems measured by Strength
and Difficulties Questionnaire as well as Disruptive Behavior Disorders rating scale. The attrition rate at
post-treatment was high (40%) and significantly higher within the iComet (47%) than FCU (34%).
At post-treatment, 12 weeks later, parents reported significant improvements on both primary and most of
the secondary outcome measures in both condition, with very few differences between the two programs.
At 1-year follow-up, the improvements were generally maintained, with the FCU condition showing slightly
better outcome than the iComet, although not all families have yet provided data yet.
Although both PMT programs showed similar good effects with moderate effect sizes, the maintenance of
outcome seems to be better in the FCU condition compared to iComet. However, this result is preliminary,
as not all the parents have yet reached the 1-year follow-up assessment. Nevertheless, attrition was
lower in the FCU than in iComet both at post-assessment and at 1-year follow-up until now, and a larger
number of families completed the FCU intervention. The results with respect to reliable change and the
proportion of those reaching clinically significant change at 1-year follow-up will be presented and discuss
to provide a clearer picture of effectiveness of each intervention.
0125
Engagement with the TeenDrivingPlan and Diversity of Teens' Supervised Practice Driving:
Lessons for Internet-based Learner Driver Interventions
1 ,2
1
1
1
3
1 ,2
Flaura Winston , Jessica Mirman , Allison Curry , Melissa Pfeiffer , Michael Elliott , Dennis Durbin
1
2
The Children's Hospital of Philadelphi, Philadelphia, PA, USA, University of Pennsylvania, Philadelphia,
3
PA, USA, University of Michigan, Ann Arbor, PA, USA
Objective: Inexperienced, less-skilled driving characterizes many newly licensed drivers and contributes
to high crash rates. A randomized trial of TeenDrivingPlan (TDP), a new learner driver phase Internetbased intervention, demonstrated effectiveness in improving safety relevant, on-road driving behavior,
primarily through greater driving practice diversity. To inform future learner driver interventions, this
analysis examined TDP use and its association with practice diversity.
Design: Post-hoc analysis of data from teen/parent dyads (n = 107), enrolled early in learner phase and
assigned to treatment arm in randomized trial.
Methods: Inserted software beacons captured TDP use data. Electronic surveys completed by parents
and teens assessed diversity of practice driving and TDP usability ratings TDP at 24 weeks (end of study
period).
Results: Most families (84%) used TDP early in the learner period; however, the number of TDP
sessions in the first week was three times higher among dyads who achieved greater practice diversity
than those with less. By week five, many families still engaged with TDP but differences in TDP use could
not be detected between families with high versus low practice diversity. Usability was not a major issue
for this sample based on largely positive user ratings.
Conclusions: An engaging Internet-based intervention, such as TeenDrivingPlan, can support families in
achieving high practice diversity. Future learner driver interventions should provide important information
early in the learner period when engagement is greatest, encourage continued learning as part of logging
practice drives, and incorporate monitoring software for further personalization to meet family needs.
0129
Diabetes Patient Perceived Usability and Long-Term Acceptance with Ongoing TechnologyFacilitated Depression Monitoring
Shinyi Wu, Magaly Ramirez, Irene Vidyanti, Peyjiuan Lee, Kathleen Ell
University of Southern California, Los Angeles, CA, USA
Purpose: Depression is a significant challenge for diabetes care because of frequent concurrence and
worsened health outcomes. Patients may benefit from ongoing depression symptom monitoring. An
automatic telephonic assessment system (ATA) tethered with internet-based disease management
registry was used in a trial to monitor depression symptoms of low-income minority diabetes
patients. The purpose of this study is to evaluate patient perceived usability and long-term acceptance of
ATA in order to understand its potential as a comorbid depression care management tool.
Methods: During the first 6 months of the trial, patients participated in a diabetes disease management
program (DMP) and received ATA calls. Patients transitioned from DMP to usual care in months 7-12, but
continued receiving calls. Calls stopped after 12 months, although patients were followed up for another
6 months. Structured interviews were conducted at 6, 12, and 18 months with 150, 220, and 150
patients, respectively. Measures were based on Likert scales and average values of multi-item measures
were calculated.
Results: During 6- and 12-month interviews, most patients reported that ATA calls were usually or always
easy to use (86% and 79%, respectively). Over time, fewer patients reported that calls were useful (61%
and 49%), and more patients felt that calls were intrusive (13% and 27%). Patients with major depression
rated lower on usefulness of ATA at 6 months (Rho=-0.21). Patients’ acceptance of ATA as part of
depression care at 6-, 12-, and 18- month interviews changed from 82% to 54% and then to 60%,
respectively. At 18 months, most patients perceived benefits of ATA on awareness of feeling (80%) and
on self-care reminders (77%).
Conclusions: Patients were generally satisfied with ATA usability and accepted technology-facilitated
monitoring of depression symptoms when coupled with a DMP. In the long-term, they realized the
benefits of ongoing technology-facilitated depression monitoring.
0141
Effectiveness and Cost-Effectiveness of Web-based Treatment for Phobic Outpatients On a
Waiting List for Psychotherapy
1
1
1
1
2
Robin Kok , Pim Cuijpers , Annemieke van Straten , Aartjan Beekman , Judith Bosmans
1
Department of Clinical Psychology and the EMGO institute for Health and Care Research, Faculty of
2
Psychology and Education, VU University Amsterdam, Amsterdam, The Netherlands, Department of
Health Sciences and the EMGO institute for Health and Care Research, Faculty of Earth and Life
Sciences, VU University Amsterdam, Amsterdam, The Netherlands
Purpose
Phobic disorders are highly prevalent and constitute a considerable burden for patients and society. As
patients wait for face-to-face psychotherapy for phobic disorders in outpatient clinics, this time can be
used for guided self-help interventions. The aim of this study is to investigate a five week internet-based
guided self-help programme of exposure therapy in terms of clinical effectiveness and impact on speed of
recovery in psychiatric outpatients.
Methods
A randomised controlled trial conducted among 212 Dutch adult patients recruited from waiting lists of
outpatient clinics for face-to-face psychotherapy for phobic disorders. Patients suffering from at least one
DSM-IV classified phobia (social phobia, agoraphobia or specific phobia) are randomly allocated (at a 1:1
ratio) to either a free of cost five-week internet-based guided self-help program followed by face-to-face
psychotherapy, or a control group followed by face-to-face psychotherapy. Clinical and healthcare
consumption self-assessment measurements take place at baseline, post-test (five weeks after baseline)
and at 3, 6, 9 and 12 months after baseline. Face-to-face treatment information was retrieved from the
clinics' electronic healthcare records.
Results
Small but appreciable short-term benefits were observed at post-test. Long-term and cost-effectiveness
data are currently being analysed.
Conclusions
Web-based guided self-help preceding face-to-face psychotherapy in outpatients clinics is feasible,
acceptable, and leads to appreciable benefits for both the patients and the clinics.
0144
E-Mental Health in Practice: An Australian Project Enhancing Uptake of E-Mental Health in Primary
Care
1
2
2
3
3
1
David Kavanagh , Judy Proudfoot , Jonathan Tennant , Julia Reynolds , Kathy Griffiths , Robert King ,
1
1
Jennifer Connolly , Angela White
1
2
3
Queensland University of Technology, Brisbane, Australia, Black Dog Institute, Sydney, Australia, The
Australian National University, Canberra, Australia
Purpose
The Australian Government has invested significant funds in electronic mental health services. To
maximise access and uptake of these services, the three-year e-Mental Health in Practice (eMHPrac)
Project was established to build linkages between e-mental health services and the wider health services
available in the community. eMHPrac aims to build these linkages by providing training and support in emental health to General Practitioners, Allied Health professionals and service providers working with
Indigenous people. The project aims to increase health practitioner awareness of e-mental health
services, build confidence in the e-mental health approach, build skills in using e-mental health, and
increase rates of referral to e-mental health services by primary care providers.
Methods
Cross-sectional online surveys measure practitioner awareness, confidence and attitudes towards emental health in each year of the project. These cross-sections provide snapshots across the sector.
Training in e-mental health is delivered in the second year of the project, with awareness, confidence and
attitudes measured pre- and post-training and again after a period of 6 months of support or supervision
in use of e-mental health. E-mental health service providers obtain source of referral from users and
report this data annually to the eMHPrac team.
Results
This paper presents the results of the first year of cross-sectional surveys and referral data collected
between July 2013 and June 2014. Baseline levels of health professional awareness, confidence and use
of e-mental health are reported, along with baseline proportions of e-mental health service users who
were referred to the service by a health professional.
Conclusions
The implications of the baseline surveys and referral rates for the training and support activities
scheduled for the second year of the project are discussed.
0155
The Effect of Therapist Input on Effectiveness of Internet Therapy for Adolescents with Insomnia
Ed de Bruin, Anne Marie Meijer
University of Amsterdam, Amsterdam, The Netherlands
Purpose
Research has shown that cognitive behavior therapy for insomnia (CBTi) in an ehealth setting is effective
in treating adolescents with insomnia. There are also indications that personalized input from a therapist
during the treatment improves efficacy of internet therapy strongly. Less is known about the variables that
determine the efficacy of therapist input, and its relation to patient variables that could mediate this effect.
Methods
A group of 39 adolescents with diagnosed DSM-IV primary insomnia followed a program of internet CBTi.
During the program the participants registered their sleep times in daily sleep logs. The therapy consisted
of 6 weekly sessions containing exercises of CBTi and personalized feedback from a therapist on
questions from the participants and personalized bedtime-advice based on sleep variables form the sleep
logs. Furthermore the participants had a 20-minute chat session with their sleep therapist after the
second consult.
During the six weeks participants’ sleep variables were measured with nightly actigraphy registration. At
baseline and post-treatment also symptoms of chronic sleep reduction and insomnia were measured.
Therapist input was operationalized with the amount of words of feedback in each consult, the number of
encouraging and supportive comments, the number of empathic and caring comments, and the number
of directive and guiding comments.
Results
Results concerning sleep outcomes at baseline and post-treatment show that the CBTi internet therapy
was effective (ref.). At the conference data will be presented to answer the question whether sleep
improvement based on actigraphy, sleep logs, and symptoms of chronic sleep reduction and insomnia, is
related to therapist feedback. Furthermore, we will explore the influence of SES variables of the
participants on these relations.
Conclusion
Based on the results conclusions will be drawn and discussed concerning the influence of the different
characteristics of therapist feedback on the efficacy of internet CBTi.
0159
Online Self-Reported Psychotic Symptoms and Depression among Young Moroccan-Dutch – A
Web-based Epidemiological Study
1 ,2
1
1 ,3
1
Madelien van de Beek , Lian van der Krieke , Wim Veling , Robert Schoevers
1
University of Groningen, University Medical Center Groningen, Department of psychiatry, Groningen,
2
3
The Netherlands, Dimence, Zwolle, The Netherlands, Maastricht University, Department of Psychiatry
and Neuropsychology, Maastricht, The Netherlands
Purpose
Moroccan-Dutch inhabitants are the second largest immigrant population within the Netherlands. They
are at higher risk to develop psychiatric disorders, but more difficult to reach for researchers and mental
health care workers. However, 70% of these people assembles online (www.marokko.nl). This website is
a forum board, where a wide range of topics are being discussed, including psychiatric problems such as
depression, hearing voices and addiction.
Methods
We developed a new Marokko.nl section devoted to psychiatric problems
(www.ziekofbezeten.marokko.nl, meaning: being ill or being possessed), which provides information
about psychiatric disorders, self-tests for depression and substance use (over 2,000 self-tests have been
filled out since 2012), and email- and chat contact with mental healthcare workers or specially trained
Imams.
This platform has enabled us to collect unique epidemiological data about this population, the so-called
MEDINA-study (Migrants Examined for Determinants of psychopathology through Internet Assessment).
We collected information through an online questionnaire about psychopathology (depressive and
psychotic symptoms) and various social factors (such as discrimination, social defeat and social support).
Results
Until now 267 visitors have completed the online survey (87% female). 77% of these participants have
serious depressive symptoms. Surprisingly, 50% of all female participants report psychotic symptoms,
warranting further follow-up research, since so-far an increased incidence of psychotic disorders has only
been observed among Moroccan-Dutch men.
Conclusions
Internet can serve as a medium to reach otherwise ‘hidden’ populations and can be used for prevention
and research purposes. Since we found high levels of psychopathology in our sample, we are currently
exploring online intervention strategies.
0164
From Concept to Deliverable: How to Turn an Idea into an Internet Intervention
1
1
2
2
Jeremy Gibson , Steve Edge , Mark Begale , Eric Carty-Fickes
1
2
Queensland University of Technology, Brisbane, Qld, Australia, Center for Behavioral Intervention
Technologies, Chicago, IL, USA
It is not uncommon for the development process of Internet interventions to fail to deliver on expectations.
Behavioral intervention technology projects often run over scope, over budget, or simply fail to capture
the expressed goals of the investigators. This paper explores, demonstrates, and provides practical
examples on how to use tested techniques to optimize software development.
This paper will assist researchers to better define the requirements for their interventions and aid them in
communicating these requirements to their software development teams. These concepts will be explored
through both theory and real-life examples.
Throughout the paper a number of tools that can facilitate projects being better configured for success will
be discussed, such as:
• User stories, use cases, and workflow diagrams
• Wireframes, mock-ups, and prototypes
• Test driven development
The paper will help both those who are new to the field of internet interventions as well as those who
already may have some experience in the field.
0167
Exposure-based Therapy via the Internet for Post-Traumatic Stress Symptoms Following
Childbirth - A Randomized Controlled Trial
1
2
2
2
2
Katri Nieminen , Kristin Silfvernagel , Katri Frankenstein , Kamilla Larsson , Loviisa Lundberg , Ulrika
2
1
2 ,3
Persson , Klaas Wijma , Gerhard Andersson
1
Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden,
2
Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden,
3
Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
Purpose
The main purpose of this trial was to investigate the effect of an internet-administered guided self-help
exposure-based therapy for women with post-traumatic stress symptoms as a result of childbirth. The
secondary purpose was to investigate whether sudden gains occurred during treatment and if any sudden
gains predicted treatment outcome.
Methods
A randomized controlled design was used for this trial, where the treatment group (n=28) received an
eight week exposure-based cognitive behavior treatment program, while the control condition (n=28)
consisted of a waiting list.
Results
The results showed that post-traumatic symptoms decreased as a result of the treatment, with large
within-group effects as measured by both the Traumatic Event Scale (TES) (d=1.33) and Impact of Event
Scale-Revised (IES-R) (d=1.3). The difference between the groups was only significant as measured by
the IES-R and the between group effect was large (d = 0.97). For other outcome measures, the Beck
Depression Inventory-II (BDI-II), Beck Anxiety Inventory (BAI) and the Quality of Life Inventory (QOLI) the
between group differences were not significant, however the treatment group had improved significantly
between pre-and post-measurements. Of the participants in the treatment group 17.9 percent
experienced at least one sudden gain on TES and 21.4 percent had at least one sudden gain on the
Patient Health Questionnaire-9 Item (PHQ-9). Sudden gains in depressive symptoms were shown to have
significant effect on the main outcome measure (TES) for posttraumatic stress symptoms.
Conclusions
The results are promising and show that the treatment reduces post-traumatic symptoms following a
traumatic childbirth and indicates a decrease in depressive and anxiety symptoms and an improvement in
quality of life. The trial also shows that sudden gains occur during treatment and that sudden gains in
depression may be of importance for symptom improvement in the treatment for said group.
0169
IntelliCare: Using Artificial Intelligence to Tailor Mobile Interventions
Stephen Schueller, Chris Karr, Susan Kaiser
Northwestern University, Chicago, IL, USA
Purpose: Mobile applications to treat mental health disorders are currently developed as a one-size-fitsall method, thus they lack sufficient personalization to meet individual patient needs. The ultimate goal of
the IntelliCare project is to 1) create a suite of "mini-apps" that target specific behavioral strategies to
reduce depressive and anxiety symptoms, 2) create a recommender system that uses adaptive machine
learning to suggest mini-apps most likely to be used by and useful for the individual patient at any point
during treatment, and 3) evaluate the efficacy of the recommender system. This presentation will
describe the first phase of this project, the development and early evaluation of the mini-apps.
Methods: 12 "mini-apps" have been developed that target specific behavioral strategies, including
behavioral activation, thought restructuring, rumination, goal setting, gratitude, living one's values, social
support, coping, relaxation, physical activity, and insomnia. User interactions also vary across the miniapps and include didactic lessons, notifications and reminders, text-based logging, photo journals,
geolocation, audio, and non-financial incentives. A "conductor-app" manages the interventions and app
assignments. These applications have been placed on the Google Play store, and usability testing has
begun.
Results: The mini-apps, along with results from initial usability evaluations will be presented.
Conclusions: The next phase will be to deploy the IntelliCare suite to develop the data required to drive
the recommender system. The IntelliCare recommender engine will learn from group and individual data
obtained from baseline patient characteristics, use data (e.g., length of time using a treatment
component), embedded sensors in the phone (e.g., GPS), and the user's self-reports (e.g., "like" and
usefulness ratings of treatment components, symptoms) to provide a highly tailored, patient-specific
treatment experience. The broader implications of the use of data and machine learning techniques to
provide more targeted interventions will be discussed.
0172
Serious Gaming in the Prevention of Posttraumatic Stress Disorder (PTSD); Preliminary Results of
a Study on the Effects of “Tetris"
Marit Sijbrandij
VU University, Amsterdam, The Netherlands
Background: After trauma exposure, posttraumatic stress disorder (PTSD) may develop in a minority of
individuals. Intrusions, i.e., involuntary anxiety-provoking images and thoughts related to the trauma
predict PTSD's onset and maintenance. Two promising strategies have been proposed to prevent
trauma-related intrusions: playing the computer game "Tetris" and imagery rescripting. Tetris presumably
taxes the working memory during memory consolidation, which competes with trauma memory storage.
During imagery rescripting, the memory of the trauma is retrieved, and participants imagine different
responses to and outcomes of the original memory. It is yet unclear what strategy is more effective in
reducing intrusions, Tetris or imagery rescripting.
Methods: Sixty participants were randomly allocated to one of three conditions: 1. Tetris (N=20), imagery
rescripting (N=20) and control (N=20). All participants watched an aversive film and then received a 5-min
intervention (Tetris or imagery rescripting) or no intervention (control). In the Tetris condition, participants
were asked to retrieve the most aversive film image and play Tetris. In the imagery rescripting condition,
participants were asked to retrieve the most aversive image of the film and construct an alternative,
positive ending. Main outcome was the number of intrusive memories of the film during the week after the
film.
Results: One-way ANOVA indicated a significant difference between the conditions (F(2,57)=3,20,
p<.05). Post-hoc t-tests showed that the Tetris group reported fewer intrusions of the film than the control
group (t(22,93)=-2.27; p<.05) and the imagery rescripting group (t(27,05)=-2,72; p<.05), whereas no
difference was found in intrusions between imagery rescripting and control (t(38)=-0.27; p=.79).
Conclusion: This experimental study suggest that playing the computer game Tetris during memory
consolidation may reduce the incidence of intrusions after watching a trauma film. Future studies in
trauma samples may test whether Tetris or similar working-memory taxing games are effective in
preventing PTSD.
0174
A Web-based Multiple Behavior Change Intervention: Reach, Use, Preferences, Effectiveness and
Cost-Effectiveness
Daniela Schulz, Francine Schneider, Stef Kremers, Math Candel, Silvia Evers, Hein de Vries
Maastricht University, Maastricht, The Netherlands
Purpose: Interventions that focus on multiple behaviors can have a greater impact on public health than
single-behavior interventions. However, such interventions are more extensive and may be too
demanding for a person. Therefore, this study aimed to describe preferences for changing certain
behaviors and to assess reach, effects and cost-effectiveness of a sequential and simultaneous
computer-tailored intervention on multiple lifestyle behaviors.
Methods: An RCT was conducted with three conditions: a sequential, a simultaneous and a control
condition. Respondents (N=5,055), recruited via an Adult Health Monitor of different Regional Health
Authorities in The Netherlands, received feedback indicating whether they complied with the Dutch
guidelines for physical activity, vegetable consumption, fruit consumption, alcohol intake, and smoking.
Participants in the sequential and simultaneous condition received tailored motivational feedback to
change unhealthy behaviors one at a time (sequential) or all at the same time (simultaneous).
Results: The intervention was positively evaluated, and no significant differences between the conditions
were found regarding the appreciation of the intervention. Health promoting behaviors were selected
more often than addictive behaviors. Both tailoring strategies were found to be effective in improving
lifestyle: at 12 months, the sequential intervention was most effective whereas the simultaneous condition
was most effective after 24 months. Our economic evaluation also revealed that the simultaneous
condition was most cost-effective.
Conclusions: Although the study suffered from high drop-out rates, our results show promising effects of
implementing a web-based tailored lifestyle intervention on a large scale. Positive results were found
regarding reach, appreciation, effectiveness and cost-effectiveness. Further studies should concentrate
on prolonged and sustained use of this kind of intervention.
0175
The Role of Support in Internet-based Treatment for Symptoms of Depression and Anxiety: A
Randomized Controlled Trial
1 ,2
1 ,2
1 ,2
1 ,2
1 ,2
Annet Kleiboer , Tara Donker , Annemieke Van Straten , Heleen Riper , Pim Cuijpers
1
2
VU University Amsterdam, Amsterdam, The Netherlands, EMGO+, Amsterdam, The Netherlands
Purpose
There is no doubt about the effectiveness of Internet-based interventions for symptoms of anxiety and
depression. Meta-analytic evidence indicates that these interventions should be delivered with
professional guidance to reach optimal effects. However, it is not clear what level of support is needed.
This study examined the role of support in Internet-based treatment for symptoms of anxiety and
depression in a randomised controlled trial.
Methods
Adults with mild to moderate anxiety or depression were recruited from the general population and
randomised to: (1) Internet-based treatment without support (n=107), (2) Internet-based treatment with
support on request (n=108), (3) Internet-based treatment with weekly support (n=106), (4) non-directive
chat or email exchange with a coach (n=110), (5) waiting-list control receiving online psycho-education
(n=106). The intervention was a brief problem-solving treatment consisting of 5 lessons delivered over 6
weeks. The primary outcomes, symptoms of anxiety (HADS) and depression (CES-D), were measured 6
weeks after baseline. We also examined differences in treatment adherence and the therapeutic alliance.
Analyses were based on the intention-to-treat principle and missing data (22%) was handled by multiple
imputation.
Results
Treatment adherence (completing at least 3 lessons) was highest in the condition that received nonspecific chat or email support (87%) followed by the condition that received the Internet-based
intervention with weekly support (55%), support on request (53%), and without support (35%).
Participants that received the Internet-based intervention with weekly support, but none of the other
conditions, showed significantly better improvements than the control group for depression. Symptoms of
anxiety were reduced in all conditions, but the differences between the conditions were small.
Conclusion
The results of this study underscore the importance of professional support in Internet-based treatment
for depression, but also indicate that support alone is not sufficient. More research is needed to examine
the role of support in anxiety.
0178
Automated, Internet-based Pain Coping Skills Training to Manage Osteoarthritis Pain: A
Randomized Controlled Trial
1
2
2
2
1
1
Christine Rini , Laura Porter , Tamara Somers , Daphne McKee , Robert DeVellis , Jamie Stiller , Carol
1
3
1
4
2
2
Patterson , Gary Winkel , Joanne Jordan , Meredith Smith , David Caldwell , Francis Keefe
1
2
University of North Carolina at Chapel Hill, Chapel Hill, NC, USA, Duke University Medical Center,
3
4
Durham, NC, USA, Icahn School of Medicine at Mount Sinai, New York, NY, USA, EMD Serono, Inc.,
Rockland, MA, USA
Purpose: Pain coping skills training (PCST) is an empirically-supported, cognitive behavioral pain selfmanagement intervention for osteoarthritis (OA) pain. It is traditionally delivered in person over 10-12
weeks by specially trained clinical psychologists-an approach that limits its reach. To address this
problem, we developed an automated, 8-week Internet-based PCST program (PainCOACH) designed to
mimic therapeutic features of in-person PCST and evaluated its promise, feasibility, and acceptability in
an early-scale randomized controlled trial.
Methods: Participants (91 women and 22 men, average age 67, 29% African American and 69% nonHispanic White, with clinically-confirmed hip/knee OA and significant OA pain) were randomized to an
assessment only control group or a group that used PainCOACH at home. Validated measures of pain
and other outcomes were administered at pre-intervention baseline, midway through the 8-10 week
intervention period, and immediately post-intervention.
Results: Mixed linear models showed a significant reduction in pain from pre- to post-intervention in
women who used PainCOACH compared to control group women (p=.03). Self-efficacy for pain selfmanagement increased significantly from pre- to post-intervention for PainCOACH participants compared
to controls (p=.023). Feasibility was high: 87% of eligible participants were randomized and 97%
completed the post-intervention follow-up. Acceptability was excellent: 91% of PainCOACH participants
completed the entire 8-week program and user feedback was highly positive.
Conclusions: Findings supported the promise, feasibility, and acceptability of automated Internet-based
PCST for people with OA pain. Some null findings (e.g., for pain-related interference with functioning,
negative affect) may have been due to low levels of impairment in the sample. Increases in self-efficacy
were promising given its important role in benefits of behavioral interventions. The findings were
especially notable given our sample's older age and racial diversity. Next steps will be to use findings to
refine PainCOACH for evaluation in a larger trial to be conducted in a clinical setting.
0182
PAXonline: A Randomized Controlled Trial Comparing the Efficacy of an Internet-Based Cognitive
Behavior Intervention, Delivered with or without Assistance from a Therapist, to Waiting-list in
Romanian Adults with Panic Disorder
1 ,2
1 ,2
1 ,2
Amalia Ciuca , Mircea Miclea , Liviu G. Crisan
1
2
Babes-Bolyai University, School of Psychology and Educational Sciences, Cluj-Napoca, Romania, The
Romanian Association for Online Counselling and Psychotherapy, Cluj-Napoca, Romania
Purpose
In Romania, 76.4% of the persons with mental health disorders don't have access to any form of
treatment; only about 11.5% receive psychological or psychiatric help (Florescu et al., 2009).
Despite the promising results the field of iCBT is facing new challenges and there are several aspects
that need to be addressed in order to increase the uptake of Internet-based treatments and implement
them into regular healthcare.
Relying on the comparative analysis of existent iCBT systems and guided by important principles in
designing an efficient e-mental health solution we created the multi-user platform PAXonline for the
prevention and treatment of anxiety disorders.
Objectives
The main objective of this ongoing study is to test the efficacy of PAXonline, an internet based cognitivebehavioral therapy program, in the treatment of Panic Disorder. Other important aims are identifying the
mechanisms of change and patient characteristics for whom this type of therapy is most suited and has
the best results.
Methods
The participants are selected based on established eligibility criteria and then randomly assigned in three
groups: independent use of internet treatment, internet treatment with specialist support (online sessions
and e-mails), and the waiting-list control group.
Instruments
Panic Disorder Severity Rating Scale - Self Report, Agoraphobic Cognitions Questionnaire, Body
Sensations Questionnaire (primary outcomes); Psychiatric Diagnostic and Screening Questionnaire,
Patient Health Questionnaire-9, Work and Social Adjustment Scale, Working Alliance Inventory Short
Revised, Credibility/ Expectancy Questionnaire, Body vigilance scale, Panic Attack Cognition
Questionnaire, Medical Outcomes Study Social Support Scale, adherence and compliance measures.
The primary analyses to be made will be intention to treat, but there will be also additional analysis just for
the treatment completers.
Results
We expect that the guided intervention program will result in superior outcomes to the unguided
intervention program. Both treatment groups are presumed to be superior to the wait-list control.
0183
Fit for eMental Health: An Instrument to Assess Readiness for Blended Care Treatment
1
1
2
1
Jobke Wentzel , Britta Semlianoi , Rosalie van der Vaart , Lisette van Gemert-Pijnen
1
2
University of Twente, Enschede, The Netherlands, Leiden University, Leiden, The Netherlands
Purpose
Blended care enables therapists to meet high demands for personalized care and self-management.
However, it remains difficult to determine the right online-face to face ratio. Therapists need support to
find the optimal ratio and in assessing patient readiness to start blended treatment. In this study, we
describe the development of an instrument to facilitate this support, aimed primarily at depression.
Methods
To determine the content and shape of the instrument: 1) A literature study was done to identify
facilitators and barriers for treatment effect and adherence in eMental health interventions. 2) Interviews
with therapists (n=14) were held to identify practice-based determinants for successful blended treatment.
In these interview sessions, instrument concepts were tested via mock-ups. 3) Two focus groups (n=6 per
group) are scheduled (July 2014) to concretize and prioritize the gathered determinants, via a group-wise
card sort task.
Results
The literature study showed that patient motivation, skills, personality, and practical issues (e.g., internet
access) are associated with online treatment outcomes. The (preliminary) interview data confirm these
results and show additional determinants, both patient-related (e.g., mistrust, expectations) and therapistfactors (ethical considerations, wish for control). Mock-up evaluations show a variety of preferences
regarding timing, medium, and target group (patient/therapist) of the instrument. Focus group results (in
progress) including the concept instrument will be presented at the conference.
Conclusions
We identified a range of determinants for proper blended care. However, in clinical practice it is found that
these barriers can be overcome. The preliminary interview data indicate that the most important predictor
for successful blended treatment and ratio may be effective patient-therapist communication, to manage
goals and expectations. Our results thus far show, that a screening instrument for blended care should be
an assessment or discussion aid, that guides blended eligibility and acceptability, and stimulates patienttherapist communication before and during treatment, possibly via scenarios and checklists.
0185
Post and 6 Month Post Results of a US National Trial of an Internet Intervention for Insomnia
(SHUTi)
1
1
1
1
1
Lee Ritterband , Frances Thorndike , Holly Lord , Christina Frederick , Linda Gonder-Frederick , Karen
1
1
2
Ingersoll , Mark Quigg , Charles Morin
1
2
University of Virginia, Charlottesville, VA, USA, Université Laval, Québec, Canada
Purpose: Cognitive-behavioral therapy for insomnia (CBT-I) has been found to be an extremely effective
treatment for insomnia. However, access to this treatment is significantly limited by lack of available
clinicians skilled in providing it. A fully automated web-based program, called SHUTi (Sleep Healthy
Using the Internet) has been developed to overcome this obstacle. Findings from pilot trials using SHUTi
have been promising. Currently, SHUTi is being evaluated in a larger national trial based in the US
funded by the NIMH (R01MH086758) with a more active comparison condition and longer-term followup. Methods: All participants have been recruited and enrolled for this trial and have reached the six
month post period. 304 participants have been randomized to SHUTi or an online Patient Education
comparison condition. Results: On average, participants have had insomnia for 11.21 years and report
difficulties sleeping 5.62 nights per week (Sleep Onset Latency (SOL)>30 minutes approximately 4
nights/week; Wake After Sleep Onset (WASO)>30 minute approximately 5 nights/week). Although 6month post analyses will be available on the full data set by the time of the presentation, at this time,
preliminary pre to post findings show that those who received SHUTi had significant improvements
compared to participants randomized to a patient education website on the Insomnia Severity Index (ISI;
F(1,233)=43.64, p<.001), Wake After Sleep Onset (WASO; F(1,216)=7.88, p=.005), Sleep Onset Latency
(SOL: F(1,216)=6.37, p=.012), and Sleep Efficiency (SE: F(1,218=15.16, p<.001). Conclusions: The
findings presented will provide further evidence that interactive, tailored, web-based self-help approaches
to addressing insomnia may have longer term impact and may offer an efficacious means to reducing the
public health burden of insomnia. Of note, this talk will present the largest data set from an online CBT
for insomnia trial, providing greater power to ultimately answer questions beyond efficacy in primary
outcomes.
0193
An Online Emotional Therapy System (TEO) to Deliver Homework Assignments in the Treatment
of Adjustment Disorders versus the Traditional Method
1
1 ,2
1
1
1
1 ,2
Mar Molés , Soledad Quero , Sara Nebot , Carla Soler , Daniel Campos , Cristina Botella
1
2
Universitat Jaume I, Castellón, Spain, CIBER de Fisiopatología de la Obesidad y Nutrición
(CIBEROBN), Castellón, Spain
Purpose
Adjustment Disorder (AD) is a very prevalent problem. We have developed a CBT program for AD that
uses virtual reality and includes strategies from Positive Psychology. Subsequently, we also developed
an Online Emotional Therapy System (TEO) to deliver homework assignments over the Internet. This
work presents preliminary data obtained with this component compared to the traditional method.
Methods
The sample included 24 patients with AD (19 women; 5 men). The mean age was 29.83 (SD=10.48).
They were allocated to 2 conditions: homework assignments using TEO (N= 13) and homework
assignments in the traditional way (reading materials and session audio record) (N= 11). Before and after
each homework session positive and negative emotions were assessed. Participants also reported the
change in their mood state and self-efficacy referred to the negative event, after each homework session.
Finally, they valued their satisfaction and utility with the 2 homework methods.
Results
An increase of positive emotions and a decrease of negative ones occurred in the majority of homework
sessions in both conditions (reaching statistical significance in some sessions). Also, there was a positive
change in the mood state and self-efficacy in all sessions in both conditions, improving significantly along
sessions in some cases. Moreover, all participants were satisfied and considered useful all homework
sessions. Although a tendency to higher satisfaction and utility was observed with TEO system, it did not
reach statistical significance.
Conclusions
Although this study is still in progress, preliminary data show that both homework methods improved
clinical relevant variables in AD. Also, TEO was well accepted, which implies to overcome a barrier since
the patients are not used to use ICTs to practice their homework. In addition, TEO permits a higher
control on the part of the therapist and so allowing reinforcing the patients for practicing their homework.
0194
Characteristics of Use of Internet-based Treatment Programs and Its Relationship to the Efficacy
and Acceptance of These Programs
1
1
1
2
Antonio Riera López del Amo , Adriana Mira , Juana Bretón-López , Rosa María Baños , Ignacio
1
1
Miralles , Cristina Botella
1
2
Universitat Jaume I de Castellón, Castellón de la Plana, Spain, Universitat de València, Valencia, Spain
Purpose
The use of the Internet to provide psychological treatment has shown to be a powerful tool due to its
potential capacity to reach more patients in need of treatment. Several meta-analyses support the
efficacy of these self-help CBT Internet-based treatments. However, there are only a few studies trying to
determine whether there is a relationship between therapeutic success, attrition rates, and satisfaction
with the treatment, and the way this kind of programs are used.
"Smiling is Fun" is an Internet-based program for the prevention and treatment of depression. It is a
multimedia, interactive, self-help program, which allows the individual to learn and practice adaptive ways
to cope with depression and daily problems. It includes eight treatment modules based on behavioral
activation and other specific strategies based on positive psychology. It also includes an activity report to
register patients' daily behaviours. The objective of this work is to study the relationship between the
characteristics of use of "Smiling is Fun" and its efficacy and efficiency.
Method
116 participants met the inclusion criteria and did the intervention program. Variables such as the number
of days using the program, frequency of use, number of completed modules, commitment with activity
report measured by the number of activities reported, and time spent connected in each session, are
taken under consideration and related to efficacy and efficiency measures.
Results and Conclusions
At the moment we are proceeding with the analysis of data. Preliminary results show positive
relationships between the use of the tools provided by the program and the results of the intervention.
This kind of studies can increase our knowledge about whether or not there are styles or usage patterns
that can lead to an optimum outcome of Internet-based treatments. They also can provide useful
guidelines regarding the design and development of these programs.
0195
The Importance of Support (Automated or Human) on an Internet-based Intervention for
Depression
1
1 ,3
1 ,3
1
Adriana Mira , Juana Bretón-López , Cristina Botella , Antonio Riera López del Amo , Azucena
1 ,3
2 ,3
García-Palacios , Rosa María Baños
1
2
3
Universitat Jaume I, Castellón, Spain, Universitat de València, Valencia, Spain, Ciber de Fisiopatología
de la Obesidad y Nutrición (CIBERON), Castellón, Spain
Purpose
Internet-based treatments with human support produce greater effect sizes and less dropout rates than
Internet-based programs without any human support. The majority of studies talk about support when it is
administered by a person (therapist or researcher) but these studies do not take into account the support
which may be provided automatically by the system through the ICTs (automated e-mails or SMS). The
objective of the present work it is to study the role of human and ICT support in an Internet-based
program for depression.
Method
We have developed an Internet-based program (Smiling is Fun) for the prevention and treatment of
depression, and have carried out a randomized controlled trial with three experimental conditions: 1)
Intervention program with human support: two briefly weekly support calls (without clinical content)
(n=44), 2) Intervention program without human support (n=36), 3) Waiting list control condition (n=44).
The intervention program gives automatic support to the users of both intervention conditions (SMS,
feedback or reminder emails). The participants had depressive symptoms and were suffering stressful
events that interfere in their lives. All participants fulfilled measures about anxiety, depression, perceived
stress, quality of life, and positive and negative affect at pre-treatment, post-treatment, and follow ups (3,
6, 12 months).
Results
The results show that the participants in both intervention groups improved significantly compared to the
waiting list control group in their symptoms of depression, anxiety, perceived stress and negative affect
and without significant differences between them. The improvements obtained remained at follow-ups.
Conclusions
The support of ICTs may be useful in this type of self-applied treatments to offer feedback, reinforce and
motivate, and it generates the same sort of benefits provided by human support. Therefore, support by
ICTs could be an important strategy and further studies are needed as it could benefit blended and selfapplied treatments.
0201
Laying the Groundwork to Ensure a Sustainable Pediatric Sleep Internet Intervention
1 ,2
1
1
1
1 ,2
Penny Corkum , Aimee Coulombe , Katelynn Boerner , Tamara Speth , Christine Chambers , Roger
3
4
5
6
7
7
Godbout , Reut Gruber , Wendy Hall , Graham Reid , Robyn Stremler , Shelly Weiss , Manisha
8
Witmans
1
2
Dalhousie University, Halifax, Nova Scotia, Canada, IWK Health Centre, Halifax, Nova Scotia, Canada,
3
4
University of Montreal, Montreal, Quebec, Canada, McGill University, Montreal, Quebec, Canada,
5
6
University of British Columbia, Vancouver, British Columbia, Canada, Western University, London,
7
8
Ontario, Canada, University of Toronto, Toronto, Canada, Thompson Rivers University, Kamloops,
British Columbia, Canada
Purpose: Despite its high prevalence, consequences on functioning, and evidence for treatment efficacy,
pediatric insomnia is rarely adequately addressed in non-sleep speciality settings. A primary reason for
this translational knowledge gap is that few non-specialist health professionals have the capacity or
opportunity to deliver these interventions. Internet interventions would seem an ideal way to increase
access to treatment, while recognizing health care constraints. We are currently developing Better Nights,
Better Days (BNBD), a web-based intervention to treat pediatric insomnia. The paper will overview the
steps we conducted to ensure the sustainability of BNBD, including the results of three studies: the first
identifying general barriers/facilitators for non-sleep specialist health professionals in their delivery of
sleep interventions; the second examining health care providers' specific barriers/facilitators to web-based
pediatric sleep interventions; and the third evaluating parents' and health care providers' perspectives of
the usability of a beta-version of BNBD.
Methods: Web-based surveys were used in all studies. Responses were analyzed using a qualitative +
quantitative approach, with the data being coded according to a model of behaviour change for internet
interventions (Ritterband et al., 2009). Participants included 124 front-line Canadian health professionals
(Study 1), 175 health professionals (Study 2), and 25 parents and 34 sleep and health professionals
(Study 3).
Results: Study 1 found that knowledge, training and education were the most frequently reported
barriers/facilitators to implementing evidence-based sleep interventions. Study 2 found that time/training,
environment, user-characteristics, website-characteristics and support were all important factors to
address when creating an internet intervention to address insomnia in children. Study 3 highlighted the
importance of support being integrated into the internet intervention.
Conclusions: This series of studies provides evidence to direct the development of BNBD, as well as
providing a model of internet intervention development which focuses on sustainability from the early
stages of development.
0204
Internet Interventions for Interpersonal Violence
1 ,2
Gerhard Andersson
1
2
Linköping University, Linköping, Sweden, Karolinska Institute, Stockholm, Sweden
Gerhard Andersson, PhD on behalf of the Mira, Iris and Ivin research groups
Interpersonal violence continues to be a problem in society and there is a need for effective and costeffective treatments for both offenders and victims. The aim of this presentation is to summarize a series
of studies conducted in Sweden as part of an assignment from the Department of Health and Social
Welfare. The first study was a totally automated single session website intervention aimed at victims of
interpersonal violence and based on motivational interviewing (N=253). We used the a Change
Questionnaire (based on MI) and asked for self-efficacy for change and importance of that change prepost completing the interactive website. Results showed small but statistically significant improvements
(d=0.20 for change and d=0.11 for importance). The second study was a randomized controlled trial
including 64 persons with a previous experience of being in a violent relationship. They were randomized
to either 8 weeks of guided ICBT or to a control group. Results showed large between group effects for
measures of trauma (d = 0.83) and a moderate effect on depression (d = 0.67). The third study was
aimed at people experiencing difficulties regulating anger, aggression and disruptive behavior in intimate
relationships. Sixty-five participants were included and randomized to either treatment (n = 32) or a
control condition (n = 33). The treatment lasted for 8 weeks. Results showed significant reductions on all
outcome measures, current psychological and physical violence and aggression, compared to the control
group. There were also effects on relationship satisfaction, as well as depression and anxiety symptoms.
Effect sizes were in the moderate to large range. Overall, the present studies suggest that internet
delivered prevention and treatment can serve as useful tools in the management of interpersonal
violence.
0212
Comparing Outcome and Adherence Data of an Internet Intervention for Insomnia Across Multiple
Studies and Settings
1
1
1
1
Frances Thorndike , Lee Ritterband , Holly Lord , Linda Gonder-Frederick , Charles Morin
1
2
University of Virginia, Charlottesville, VA, USA, Université Laval, Québec, Canada
2
Purpose: Little is known about how outcome and adherence data from research trials translate into realworld outcomes when Internet interventions are disseminated more broadly. To help make sense of this
translational process, outcome and process data using the same insomnia intervention will be compared
across six settings. Methods: These settings include two RCTs with a single face-to-face assessment
(N=22 and N=14); one RCT with a single phone assessment (N=151); program evaluation conducted by
an Employee Assistance Plan (N=29); a national health television program providing access to its viewers
(N=39); and a commercial entity providing access for a fee (N=500). In these six scenarios, the
intervention is identical: a 6-week fully automated Internet intervention for adult insomnia (SHUTi: Sleep
Healthy Using the Internet); however, the time periods for ‘outcome' measurement are not identical
across the settings [e.g., the RCTs collected outcomes at Pre and Post (a set 63 day interval) and nonresearch settings collected data as it was available from start to end of intervention use (as few as 35
days)]. Results: Data on the primary sleep variables of insomnia severity, sleep onset latency (length of
time to fall asleep), and wake after sleep onset (time awake during the night) will be presented, showing
the change from the last reported week of sleep diaries to the first reported week of diaries. Intervention
usage data (e.g., % who completed each of the assigned cores) will also be presented for each of the
different settings. Conclusion: These comparisons will provide useful information on the relationship
between RCT data and real-world use.
0219
Effects of a Web-Based Intervention Aiming at Changes in Secondary Traumatic Stress and
Secondary Traumatic Growth
1 ,2
1
1
1
Roman Cieslak , Katarzyna Zukowska , Ewelina Smoktunowicz , Martyna Kowalska , Anna Rogala
1
2
University of Social Sciences and Humanities, Warsaw, Poland, University of Colorado, Colorado
Springs, USA
1
Purpose. The study investigated the effectiveness of a web-based intervention, ‘The Helpers’ Stress’,
designed to reduce work-related secondary traumatic stress and enhancing secondary traumatic growth.
It was hypothesized that changes in those outcomes would be induced through self-efficacy and social
support enhancing techniques.
Background. Human services professionals working with traumatized clients are at risk of developing
secondary traumatic stress due to work-related exposure. Empirical evidence points to the role of selfefficacy and social support as key resources facilitating recovery after indirect exposure to trauma.
Methods. Participants (N = 253) were randomly assigned to one of three conditions: (1) the control
condition, using educational materials referring to dealing with secondary trauma and work stress, (2) the
intervention group participating in interactive cognitive and behavioral activities focusing on social support
enhancement, and (3) the intervention condition, with interactive cognitive and behavioral activities
prompting self-efficacy. The primary outcomes included secondary traumatic stress and posttraumatic
growth, with social support and secondary trauma self-efficacy constituting the measured mediators.
Participants completed the assessment before the intervention (Time 1), at post-intervention (Time 2),
and at 4 weeks after Time 2 assessment (Time 3).
Results. The analysis showed significant differences in the levels of perceived social support across
time, observed in all conditions. Across the measurement points, participants in all conditions reported an
increase in levels of self-efficacy, a decrease in levels of secondary traumatic stress, and an increase of
levels of posttraumatic growth. The results of mediation analysis indicated that the effects of group
assignment (social support versus control condition at T1) on posttraumatic growth (T3) were mediated by
social support (T2). Further, the effects of group assignment (self-efficacy versus control condition) on
posttraumatic growth (T3) and secondary traumatic stress (T3) were mediated by self-efficacy (T2).
0222
Efficacy of a Web-based Intervention with Mobile Phone Support to Treat Depressive Symptoms in
Adults with Diabetes Mellitus Type 1 and Type 2: A Randomized Controlled Trial
1
1
1 ,2
1 ,3
4
1 ,5
Stephanie Nobis , Dirk Lehr , David Daniel Ebert , Matthias Berking , Frank Snoek , Heleen Riper
1
Division of Online Health Training, Innovation Incubator, Leuphana University Lüneburg, Lüneburg,
2
Germany, Department of Clinical Psychology and Psychotherapy, Philipps-University Marburg, Marburg,
3
Germany, Department of Clinical Psychology and Psychotherapy, University Erlangen-Nürnberg,
4
Erlangen, Germany, Department of Medical Psychology, VU University Medical Centre, Amsterdam, The
5
Netherlands, Institute for Health and Care Research (EMGO), VU University Medical Centre,
Amsterdam, The Netherlands
Purpose: Depression is common in diabetes and linked to a wide range of adverse outcomes. In metaanalyses it has been shown that web-based interventions are effective to treat mental disorders, like
depression. However, there are only few web-based studies available that addressed the specific needs
of people with a chronic somatic disease and comorbid depression. The primary purpose of this study
was to evaluate the efficacy of a web-based intervention to reduce depression in adults with diabetes
mellitus type 1 and type 2.
Methods: We performed a randomized controlled trial. 260 participants with diabetes and elevated
depressive symptoms (Center for Epidemiological Studies depression Scale (CES-D≥23)) were
randomized to the GET.ON Mood Enhancer Diabetes self-help intervention with support of a trainer
(n=130) or to a brief psychoeducation control group (n=130). The primary outcome was depressive
symptoms (assessed with the CES-D). Secondary outcomes included diabetes-specific emotional
distress and self-management behavior. Diagnostic interviews were conducted at baseline. Data were
collected at baseline and at post-treatment (2-months). To evaluate the difference between intervention
and control group at post treatment, we employed analyses of covariance (ANCOVA).
Results: The intervention demonstrated a significantly greater improvement on depressive symptoms
compared to the control group based on intention-to-treat (p˂0.001, d = 0.89) and per-protocol-analyses
(p˂0.001, d = 1.00). The intervention group also displayed significantly higher improvements in reducing
diabetes-specific emotional distress (p˂0.001, d = 0.58; ITT).
Conclusion: A low threshold guided web-based intervention is effective in reducing depressive
symptoms and in reducing diabetes-specific emotional distress in adults with diabetes mellitus type 1 and
type 2. Results on the stability of these effects after 6 month will be available until October and will be
presented at the conference.
0234
Web-based Mental Health Check-ups for Children and Adolescents: The Specific Case of
DETECTA-WEB in Spain
Jose A. Piqueras, Mariola Garcia-Olcina, Maria Rivera-Riquelme, Tiscar Rodriguez-Jimenez, Mireia
Orgiles, Jose P. Espada
Universidad Miguel Hernandez Elche, Elche, Alicante/Comunidad Valenciana, Spain
Purpose
The first objective of present workshop was to analyze the reliability, validity, feasibility and utility of
previous Web-based check-ups and screening programs in school setting to identify most common
mental disorders in children and adolescents. Then, we show the main characteristics and properties of
the Spanish school-based program named DETECTA-WEB. Finally, we try to display how to develop an
equivalent program in other countries based on our experience between 2010 and 2013.
Methods
The study involved about 1.500 students, attending elementary and secondary education and High
School, aged 8 to 18 years, recruited from public and private institutions from the southeast of Spain.
Results
Results provide a screening program based on a short and quick web questionnaire -consequently
efficient in terms of time and cost-, to identify the major emotional disorders in childhood and
adolescence, with the following utilities: (i) classification and assignment of potential users to the
appropriate public mental health services in terms of suffered disorders, (ii) decision making by parents to
prevent the development, maintenance and aggravation of some common mental disorders whose onset
occurs predominantly in youth and (iii) be easily extrapolated for its use to other educational and health
settings as well as to other countries and cultures.
Conclusions
Thus, the on-line school-based DETECT-WEB program seems to be a valid, useful, and feasible program
for the early detection of anxious-depressive symptoms in Spanish children and adolescent.
0236
Challenging the 1% Rule: An Observational Study of Online Community Engagement in Users of a
Digital Sleep Improvement Programme
2 ,1
2
2
2
Sophie Bostock , Peter Hames , Brandon Paluzzi , Rosie Gollancz , Colin Espie
1
2
University of Oxford, Oxford, UK, Sleepio Ltd, London, UK
1
Purpose
Empirical evidence suggests that the ‘1% rule’ applies to participatory patterns within digital health
communities. This principal states that 90% of actors are passive (‘lurkers’), 9% contribute sparingly and
the top 1% create the majority of content (‘superusers’). We hypothesised that design features could
widen active participation in an online community for poor sleepers, and challenge the 1% rule.
Methods
We describe user-activity data extracted from Sleepio, an evidence-based digital sleep improvement
programme. Sleepio consists of 6 core weekly online sessions, based on cognitive behavioural therapy.
Members can access an optional online community with three participatory forum types: weekly expertled sessions, peer-to-peer discussions and personal walls. ‘Graduates’, who have completed all 6 core
sessions, can continue to access the community, and can volunteer to post welcome messages on new
members’ walls.
Results
Analysis was based on 56,222 posts by Sleepio members who viewed >1 community page (56% female,
mean age 45). Superusers (top 1%) accounted for 69% posts; the next active 9% contributed 26% and
the least active 90% contributed 5% posts. This overall frequency distribution is consistent with the 1%
rule.
37% of actors were actively engaged (made 1+ post), versus <25% in similar health networks. 18.2% of
actors posted across several forum types but each type also attracted unique actors: wall posts (+12.8%),
peer discussions (+4.3%), expert-led sessions (+2.0%). Poorer sleep at sign-up was correlated with more
posts. 76.5% of posts were made by users after they had graduated. When analysis was limited to posts
made pre-graduation, superusers accounted for 26% of posts.
Conclusions
Although the 1% rule is a useful benchmark for online communities, design features in the Sleepio
community appear to promote higher levels of active participation. Results suggest that online
communities can help to extend engagement in behavioural interventions beyond completion of
structured content.
0238
A National Survey of the Infrastructure and IT Policies Required to Deliver Computerised
Cognitive Behavioural Therapy in the English NHS
1 ,2
1
1
2
Christopher Williams , Holly Andrewes , Carrie-Anne McClay , David Kenicer
1
2
University of Glasgow, Glasgow, Scotland, UK, NHS Greater Glasgow and Clyde, Glasgow, Scotland,
UK
Purpose: This study aimed to identify if patients have adequate access to Computerised Cognitive
Behavioural Therapy (cCBT) programmes in all mental health trusts across England.
Methods: The primary researcher contacted a targeted sample of information technology (IT) leads in
each mental health trust in England to complete the survey. Telephone, email and postal mail were used
to contact an IT lead or nominated expert from each mental health trust.
Results: 48 of the 56 IT experts from each mental health trust in England responded. The experts who
were chosen had sufficient knowledge of the infrastructure, technology, policies and regulations to
answer all survey questions.
Results: 77% of trusts provided computers for direct patient use, with computers in all except one trust
meeting the specifications to access cCBT. However, 24% of trusts acknowledged that the number of
computers provided was insufficient to provide a trust-wide service. 71% stated that the bandwidth
available was adequate to provide access to cCBT sites, yet for many trusts, internet speed was identified
as unpredictable and variable between locations. IT policies in only 56% of the trusts allowed National
Health Service (NHS) staff to directly support patients as they complete cCBT courses via emails to the
patients' personal email account. Only 37% allowed support via internet video calls, and only 9% allowed
support via instant messaging services.
Conclusions: Patient access to cCBT in English NHS mental health trusts is limited by the inadequate
number of computers provided to patients, unpredictable bandwidth speed and inconsistent IT policies,
which restrict patients from receiving the support needed to maximise the success of this therapy. English
NHS mental health trusts need to alter IT policy and improve resources to reduce the waiting time for
psychological resources required for patients seeking this evidence-based therapy.
0240
Blended Learning- Developing and Delivering Book Based Classes for Depression and Anxiety
Online and Via Face to Face Classes
1 ,2
2
Christopher Williams , Ann McCreath
1
2
University of Glasgow, Glasgow, Scotland, UK, Five Areas Limited, Glasgow, Scotland, UK
Purpose: People like to learn in different ways. Some like online modalities, others prefer to read, and
still others like to learn with others in classroom settings. The Living Life to the Full Classes (LLTTF) are a
series of 8 classes covering common problems encountered during times of depression and anxiety.
Content is available for class based face to face delivery- as well as online via www.llttf.com which
receives over 28 million hits a year. This workshop will describe the development of this same set of
blended materials, and will provide an overview of how resources are introduced and supported in clinical
services. The approach takes a different approach to most online packages. Instead of seeing the online
offering as cCBT, instead online modules are viewed as blended learning support for bibliotherapy based
resources. As such the model fits that of a guided/supported self-help model and utilises content based
on a cognitive behaviour therapy model. Two randomised controlled trials of the face to face classes have
so far confirmed effectiveness of content.
Methods: interactive workshop with didactic teaching, small group tasks and discussion
Results: the outcome data from two RCTs will be summarised, as well as practical learning points for use
in practice
Conclusions: CCBT does not have to look like traditional cCBT packages. Instead book-based content
can be successfully supplemented by online support modules and resources including automated emails.
The key is accessible and usable resources that address issues of relevance to the user
0242
Blending Mobile and Web Technologies to Improve Outcomes in Diabetes
2 ,1
3
1
3
1 ,4
Shelagh Mulvaney , Lindsay Satterwhite Mayberry , Xian Ho , Cecilia Quintero , Kevin Johnson ,
3 ,1
Chandra Osborn
1
2
Vanderbilt University Medical Center, Department of Biomedical Informatics, USA, Vanderbilt University
3
Medical Center, School of Nursing, USA, Vanderbilt University Medical Center, Department of Medicine,
4
USA, Vanderbilt University Medical Center, Department of Pediatrics, USA
Purpose
Research suggests that individually targeted, tailored, and/or adaptive approaches to intervention design
provide engaging and efficacious behavior change programs. This presentation will describe research
design, user-centered design, and results from two research projects. Projects blended data collection
methods, communication technologies, and content based on group or individual characteristics to
improve outcomes for adolescents or adults with diabetes.
Methods
Using matched historical controls, Study 1 focused on social learning and communication strategies to
improve self-management and glycemic control (HbA1c) in adolescents age 13-17 with type 1 diabetes
(n=46) over 3 months by blending web-based and text messaging components. Individually tailored text
messages, based on barriers to self-management, were generated through website participation. Also
utilizing historical controls, Study 2 focused on communication strategies in low-income adults with type 2
diabetes (n=240). Over 3-months interactive voice response telephone calls and text messages were
tailored to individual preferences for communications as well as barriers to self-management. Automated
phone calls provided self-management feedback based on participants’ responses to daily text
messages.
Results
Study 1 indicated high engagement with messaging, high satisfaction, and impact on HbA1c
(p=.006). There was less engagement with the web-based component. Reported reasons for this
included log-in fatigue and a lack of social connections through the website. In Study 2, there also was a
high level of engagement but controlling for age, insulin status, and socioeconomic status, there was no
impact on HbA1c. In that study, there may have been impactful socio-economic factors at play that were
not the target of the intervention, such as access to medications.
Conclusions
Blending technologies and communication modalities to match the individual, developmental, and
psychosocial characteristics for each population and condition can result in patient engagement and
program efficacy. Behavioral targets amenable to messaging and feedback may be over shadowed by
socioeconomic factors.
0244
Mobile HIV Risk Assessment and Prevention Involving Drug and Sexual Behaviors: The RAPID
Project
1
1
2
Douglas W. Billings , Samantha L. Leaf , Sabrina L. Smiley
1
2
ISA Associates, Alexandria, Virginia, USA, Howard University, Washington, D.C., USA
Purpose
The reality of community practice often dictates that substance abuse treatment providers do not have the
time to provide HIV prevention services. To overcome this, we developed a computer-based assessment
and education tool that provides feedback to client populations about their risk behaviors, and links that
feedback to behavior change messages. This intervention is fully narrated and delivered on a
touchscreen mobile device.
Methods
Recruitment at a substance abuse treatment referral center is ongoing through June, 2014. At this time,
118 participants have been recruited. In order to be eligible, individuals must be between 18 and 49 years
old and report in the past 3 months either intravenous drug use, sex with multiple partners, or unprotected
sex with a partner who is not monogamous, who uses IV drugs, or who is HIV positive.
Participants are randomly assigned to either the experimental condition or to a control condition
consisting of general STD information delivered on the same touch-screen computers. Both experiences
take approximately 1.5 hours to complete. Follow-ups occur 3-months later.
Results
The sample is predominantly African American (90%) and economically disadvantaged (e.g., over 1/3
have not finished high school). Seventy percent report polysubstance use in the past month. Of the 61
female participants, 50 reported vaginal sex in the past month with only 39% of these sex acts condomprotected. Almost half of these women reported getting paid for sex. Of the 57 male participants, 46
reported vaginal or anal sex with only 38% of these sex acts condom-protected.
Conclusions
All follow-ups will be collected by September allowing us to present full behavior change data. The
primary DVs include safer injection practices and condom frequency. Our hope is that by developing a
mobile-based HIV behavioral intervention for high-risk populations, we can deliver high impact prevention
that is cost-effective and scalable.
0246
Challenging the “90-9-1 Principle” in an Internet Support Group for Mood and Anxiety Disorders in
Primary Care
Bruce Rollman, Bea Herbeck Belnap, Kaleab Abebe, Jordan Karp, Emily Rosenberger, Charlene Xie,
Michael Spring, Armando Rotondi
University of Pittsburgh, Pittsburgh, PA, USA
Purpose: Internet support groups (ISGs) that enable patients with similar conditions to exchange
information and emotional support are a widely-available self-help resource. However, 1% of ISG
members typically provide most content with the next 9% providing the balance, and almost no
contributions from other members (“90-9-1 Principle”). We investigated the 90-9-1 Principle in a
moderated ISG created for an ongoing NIH-funded trial determining whether an ISG linked to patients’
routine source of primary care can improve treatment outcomes for mood and anxiety disorders.
Methods: Physicians from 26 Pittsburgh-area primary care practices referred patients aged 18-75 to our
trial in response to an electronic medical record system-generated prompt. Consenting patients who
scored PHQ-9 and/or GAD-7 ≥10 and had Internet access were randomized to one of three groups,
including one with password access to our ISG. We encouraged patients to login via email notification of
new content, and the ability to earn status indicators for participation to recognize their contributions (e.g.,
“badges”). We analyzed server logs and categorized the top 1% of posters as “superusers,” the next 9%
as “top contributors,” and the rest as either “contributors” (provided 1+ posts), “observers” (logged-in,
never commented), or “never log-ins.”
Results: Between 8/1/12-12/31/13, we randomized 505 patients including 215 to ISG access (mean age:
41, female: 81%, mean PHQ-9 and GAD-7 scores: 13.7 and 12.7, respectively). Participants created
1,167 posts, and 49% posted at least once (mean: 5.4, median: 3). Superusers averaged 62
posts/person (10% of total posts); top contributors 20 posts/person (33%); and contributors 2.7
posts/person (56%; 39% of members), but 27% were observers and 24% never logged-in.
Conclusion: While our observations support the “90-9-1 Principle” for posts/person, we found broader
ISG participation than typically reported. We will present additional data characterizing trial participants
and strategies we use to promote engagement with our ISG.
0248
Efficacy of Minimal Guided and Unguided Internet-based Treatment for Work-Related Stress
Results of Two Randomized Controlled Trials
1
1
1
1
David Ebert , Dirk Lehr , Heleen Riper , Matthias Berking
1
2
Division Health Trainings Online Leuphana University, Lueneburg, Germany, Philipps University,
Marburg, Germany
Purpose: Internet-based guided self-help interventions for work-related stress have shown to be
effective. However, results for unguided interventions are conflicting. Once developed, costs of such
interventions are substantially linked to guidance time. Thus, evaluating whether interventions with no or
less intensive guidance may still be effective appears promising. This presentation will present results of
two randomized controlled trials evaluating an unguided and a minimal guided version of a web-based
intervention for work-related stress (GET.ON-Stress).
Methods: Two RCTs have been conducted only varying in the extend of guidance. Employees (n=528)
with heightened levels of perceived stress (PSS≥22) were recruited by a large health insurance company.
In study 1, a minimal guided version (up to 1h) and in study 2, an unguided version of GET.ON Stress
have been compared to a 6-month waiting-list control group. Primary outcome was perceived stress.
Assessments took place at baseline, post-test and 6 months.
Results: Between group effect sizes for stress were found at post-test (d=0.80) and at 6-months (d=0.92)
for the minimal guided program version. Complete data for the unguided version will be available at the
date of the conference.
Discussion: The present studies further enhance the evidence-base for internet-based interventions for
work-related stress. Effect sizes for the minimal guided version of GET.ON-Stress were as large as for a
more intensive guided version (up to 4h per participant) of the same program found in a previous trial
applying the same study design (d = 0.85 post-test; 0.99 at 6 months). Preliminary analyses of the
unguided version are also promising. However, comparing effect sizes of different guidance versions
across several trials does not allow to draw a reliable conclusion about whether or not different guidance
intensities lead to similar effects. Future studies should thus compare (cost)-effectiveness of (minimal)
guided and unguided internet-based stress management in a single trial.
0249
Association between Craving in Food-Related Virtual Environments and Food Craving as a Trait
Marta Ferrer-Garcia, Jose Guitierrez-Maldonado
University of Barcelona, Barcelona, Spain
This study provides preliminary data on the validation of a cue-exposure therapy software based on
virtual reality (VR) for the treatment of binge eating behavior. In vivo cue-exposure therapy has proved
useful for the treatment of bingeing in patients with bulimia nervosa. However, in vivo exposure shows
logistical drawbacks that make it necessary to explore alternative means of exposure. The objective of
this study is to assess the capability of VR scenarios simulating food-related situations to elicit food
craving in a non-clinical sample.
Thirty eight healthy college students (30 females and 8 males) participated in the study. They were all
exposed to ten different foods in four non-immersive VR environments (Kitchen, dining room, café, and
bedroom). After 30 seconds of exposure to each food in each environment, participants were asked to
rate from 0 to 100 craving experienced in the situation. Participants also completed the Eating Attitudes
Test-3 (EDI-3) and the Food Craving Questionnaire Trait and State (FCQ-T/S), and rated from 0 to 10 the
usability, quality and realism of the software.
Correlation analyses showed a statistically significant association between mean craving experienced in
the VR environments and FCQ-T (r=0.330, p=0.043) and FCQ-S (r=0.369, p=0.023) scores. However,
only the scale of Asceticism in the EDI-3 was significantly correlated with craving experienced in the VR
situations (r=0.374, p=0.021). This was probably due to the fact that the sample consisted of students
without eating disorders. Participants rated positively the usability (M=8.96, SD=1.03), quality (M=7.58,
SD=0.98) and realism (M=7.06, SD=1.15) of the software.
Results show that VR could be a useful technology for cue-exposure therapy as it is capable of eliciting
food craving, especially in those participants showing high levels of food craving both as a trait and as a
state. Moreover, the software is considered easy to manage and realistic by users.
0257
An Adaptive Item Selection Method for Curtailment
Niels Smiths
VU University Amsterdam, Amsterdam, The Netherlands
Health questionnaires are often built up from sets of questions which are totaled to obtain a sum score;
often, this score is subsequently used to classify respondents. An important consideration in designing
questionnaires is to minimize respondent burden. Finkelman et al. (2012) introduced curtailment as an
efficient method of questionnaire administration aimed at classification into categories, such as ‘at risk'
and ‘not at risk'. Curtailment uses a prediction model for forecasting observed class membership; the
strategy is to stop testing when not yet administered items are unlikely to change the respondent's
classification. The item administration of curtailment is static, i.e., is equal for all respondents, and
dynamic item selection could increase efficiency. The current paper uses a method for adaptive item
selection which stems from Data Mining (Hastie et al., 2009). The item selection method will be studied
using several real data sets. Benefits and limitations of this new methodology are discussed.
0262
E-Health for Personality Disorders? An Implementation Study!
David Koppers, Henricus Van
NPI, Amsterdam, The Netherlands
Purpose
Several studies show that the effectiveness of e-health interventions for a broad scope of Axis I disorders
as depression, substance abuse, anxious- and eating disorders is comparable with regular face to face
interventions.
In the Netherlands some blended treatments for personality disorders were developed focused on
specific symptoms, like emotion regulation or impulsivity, but until now not on the personality structure. In
addition, studies on its effectiveness are very scarce.
Therefore in the objective of this presentation is to show how blended modules could be implemented in
regular psychotherapeutic treatments for personality disorders.
Methods
In this quasi experimental cohort study the implementation, feasibility and effectiveness of Blended
Schemafocused therapy (BSFT) and Blended Affectphobiatherapy (BAPhT) are compared. Both
treatment modules focus on B- and C-cluster personality disorders. The BSFT consists of 11 face to face
and 17 self-management online sessions. The BAPhT has 20 face to face and 15 online sessions. These
modules are compared with full face to face Schemafocused Therapy and Affect Phobia Therapy as
regularly delivered.
All patients are referred by their General Practitioner for personality treatment of personality disorder and
normally have received earlier treatment in Mental Health.
Results
By measuring effectiveness both at a symptomatic and a structural level we intend to demonstrate
potential differential effects between treatments. In addition, process factors are measured during therapy
in order to compare working alliance issues between blended and face to face forms.
Conclusion
Personality disorders are known for their difficultness to treat and still underrepresented in e-health
studies. In this presentation we will demonstrate a model to implement blended forms in
psychotherapeutic treatment for personality disorders and test its feasibility and effectiveness.
0044
User Views of Web Design Features to Enhance Accessibility of Materials Promoting Physical
Activity for Diabetes Self-Management
1
1
1
2
2
2
Lucy Yardley , Alison Rowsell , Ingrid Muller , Dean Schillinger , Courtney Lyles , Lina Tieu , Peter
3
3
3
3
4
4
Schwarz , Henna Riemenschneider , Caroline Lang , Gabriele Mueller , Jürgen Pelikan , Florian Röthlin ,
4
5
5
5
Kristin Ganahl , Gerardine Doyle , Sarah Gibney , Emily Carroll , On behalf of the Diabetes Literacy
6
Consortium
1
2
3
University of Southampton, Southampton, UK, University of California, San Francisco, USA, University
4
of Dresden, Dresden, Germany, Ludwig Boltzmann Institute for Health Promotion Research, Vienna,
5
6
Austria, University College Dublin, Dublin, Ireland, University Catholique de Louvain, Louvain-la-Neuve,
Belgium
Purpose
In view of concern that users of internet interventions are often more highly educated, we were interested
in the potential to make web-based materials and tools more accessible and engaging to those with lower
levels of health literacy by: tailoring the material to the particular needs, abilities and perspective of the
user; employing engaging audio-visual presentation and quiz formats; and providing simple interactive
tools to support self-management tasks (e.g. guidance for choosing and planning lifestyle changes). The
aim of this study was to carry out qualitative research into user views of a web-based intervention
incorporating these features, prior to carrying out a large-scale international trial of the website.
Methods
As a test case for the acceptability and effectiveness of the interactive web-based format, we developed
an intervention to encourage people with diabetes to undertake physical activity. We first agreed on the
content and format of the intervention with our international partners, and developed the website in
English. We then carried out interviews and in-depth ‘think aloud’ studies with 35 British people with
diabetes purposively sampled for varying age, gender and levels of health literacy, iteratively modifying
the website content to improve usability and acceptability. We then modified the website for use in
Germany, Austria, Ireland and the USA and carried out 8 further interviews and think aloud studies in
each of these countries.
Results
The interactive features of the website proved engaging and popular with most participants, including
those with higher and lower levels of health literacy, and those with shorter and longer time since
diagnosis of diabetes.
Conclusions
Interactive website formats are acceptable and comprehensible for people with all levels of health
literacy. This paper illustrates how LifeGuide software for web-based intervention development can
facilitate translation and sharing of web-based interventions across different countries.
0045
Collaborative Development of an Unguided Intervention for Emotional Distress
1
2
1
1
1
Adam Geraghty , Ricardo Munoz , Lucy Yardley , Paul Little , Michael Moore
1
2
University of Southampton, Southampton, UK, Palo Alto University, California, USA
Purpose
Emotional distress may be associated with or distinct from psychological disorders such as depression
and generalised anxiety. Nevertheless, emotional distress can be associated with substantial functional
impairment, increased risk of major depression, increased damaging health behaviours and can lead to
sleep disturbance. The aim of this study was to develop an internet intervention for emotional distress
designed to be used primarily without guidance.
Methods
In this project, we worked closely with patients to develop an internet intervention where the therapeutic
content and the structure was designed to be used without support. Simple reinforcing techniques were
drawn from evidence-based treatments including Cognitive Behaviour Therapy (CBT) and MindfulnessBased Stress Reduction (MBSR). LifeGuide software was used to build an intervention that encourages
individuals/patients to use the intervention modules as and when they feel the need or are symptomatic
(experiencing distress; e.g. sadness, worry, loneliness) rather than following a weekly session-based
structure. Twenty primary care patients who had visited their GP experiencing distress took part in
usability testing and qualitative piloting of the intervention content. The intervention ‘Healthy Paths
through Stress’ will be tested in a large public health trial in the North East of England from September December 2014.
Results
Qualitative piloting confirmed that the intervention was broadly acceptable, comprehensible and
engaging, but provided valuable feedback about how to improve the user experience.
Conclusions
By working closely with the target user group, the team was able to identify and quickly correct features of
the website content and format that required improvement. The LifeGuide system facilitated the
development progress by providing functionality that allowed members of the research team and users to
comment in detail on prototype and modified versions of the webpages, and supported rapid, easy
modification of the intervention.
0048
Efficacy of a Text Message-based Smoking Cessation Intervention for Young People: A Cluster
Randomized Controlled Trial
Severin Haug
Swiss Research Institute for Public Health and Addiction at Zurich University, Zurich, Switzerland
Purpose: To test the efficacy of an individually tailored, fully automated mobile phone text messagingbased intervention for smoking cessation in young people.
Methods: A 2-arm cluster randomized controlled trial, using school class as the randomization unit, was
conducted to test the efficacy of the text messaging intervention compared to an assessment-only control
group. Students who smoked were proactively recruited via online screening in vocational school classes.
Text messages, tailored to demographic and smoking-related variables, were sent to the participants of
the intervention group at least 3 times per week over a period of 3 months. A follow-up assessment was
performed 6 months after study inclusion.
Results: A total of 2638 students in 178 vocational school classes in Switzerland participated in the
online screening. Overall, 1012 persons met the inclusion criteria for study participation, and 755 persons
(74.6%) participated in the study. Of the 372 program participants, 9 (2.4%) unsubscribed from the
program during the intervention period. Six-month follow-up data were obtained for 559 study participants
(74.0%). The 7-day smoking abstinence rate at follow-up was 12.5% in the intervention group and 9.6%
in the control group (P=.92). No differences between the study groups were observed in 4-week point
prevalence abstinence rates. The decrease in the mean number of cigarettes smoked per day from
baseline to follow-up was higher in the intervention group than in the control group (P=.002). No
differences between the groups were observed in stage of change (P=.82) and quit attempts (P=.38).
Conclusions: This study demonstrated the potential of a text message-based intervention to reach a
high proportion of young smokers with low education levels. The intervention did not have statistically
significant short-term effects on smoking cessation; however, it resulted in statistically significant lower
cigarette consumption.
0060
Serious Games: Benefits and Application Areas for Psychotherapy
Christiane Eichenberg, Markus Schott
Sigmund Freud University, Department of Psychology, Vienna, Vienna, Austria
Although the term ‘serious games’ was coined in 1970, it is now being used in the context of the
treatment of mental or psychosomatic illness and behavioural interventions. Serious games, as now
defined, are computer game which focus on learning experiences or behaviour change as well as
entertainment: real-life situations are simulated or gaming principles are used, with the aim of acquiring
certain types of behaviour, activities or information.
Purpose: The objective of this paper is to provide an overview of this new field of practice and research.
We will offer a range of contemporary examples of serious games with a focus on
games for psychotherapy for childhood and adolescents (e.g. for those with anxiety disorders,
depression).
Methods: A systematic literature review of serious games and mental disorders was undertaken using
psychological and medical databases. Effectiveness studies, acceptance studies and pilot investigation
were included.
Results: Results from evaluations and pilot projects have shown that serious games can usefully
integrated in psychotherapy, especially for adolescents. Examples of contemporary models and
indications about the possible integration into psychotherapeutic processes - both for cognitive-behavioral
and psychodynamic therapies - will be given.
Conclusion: Serious games are a promising tool for psychotherapy although many research questions
remain to be answered.
0064
The ibobbly Suicide Prevention App: Results from a Pilot Randomised Controlled Trial
1
1
2 ,1
1
3
Fiona Shand , Helen Christensen , Joseph Tighe , Rebecca Ridani , Jane Burns
1
2
3
Black Dog Institute, Sydney, Australia, Alive & Kicking Goals!, Broome, Australia, Young and Well
Cooperative Research Centre, Melbourne, Australia
Purpose
Aboriginal and Torres Strait Islander people aged 15 to 34 are three to four times more likely to die by
suicide than their non-Indigenous peers. ibobbly was designed in collaboration with young Indigenous
Australians to reduce suicidal thinking. This paper describes the early results of a pilot randomised
controlled trial in the Kimberley, a remote part of Western Australia.
Method
Participants were randomised to use ibobbly for six weeks, or to a six week waitlist control condition.
Participants were assessed at baseline and follow up for depression, psychological distress, suicidality,
and impulsivity. Their health service utilisation was measured at baseline. Qualitative interviews are
being conducted to inform the redesign of ibobbly and to explore attitudes to help seeking.
Results and Conclusions
At baseline, participants demonstrated severe levels of psychological distress and moderately severe
depression. Around two-thirds had experienced suicidal thoughts in the two weeks prior to their first
assessment. Preliminary analysis shows that using ibobbly has resulted in decreases in depression,
psychological distress, and suicidality. Health service utilisation at baseline, despite high levels of
psychological distress, was more frequently for physical injuries than for psychological problems. The
app was strongly endorsed by participants and by Aboriginal health workers. A therapeutic app to reduce
suicidality amongst young Aboriginal and Torres Strait Islander people is feasible and potentially effective.
A larger national trial is commencing in 2015.
0065
Targeted Dissemination of an E-mental Health Intervention
1 ,2
1 ,2
Janine Clarke , Judy Proudfoot
1
2
Black Dog Institute, Sydney, Australia, UNSW Australia, Sydney, Australia
Purpose: Effective dissemination is essential for wide take-up of e-mental health interventions, and is
facilitated by identification and engagement with key target groups. As part of the ongoing evaluation and
dissemination of the Black Dog Institute’s (Sydney, Australia) myCompass program, we were interested in
learning whether the intervention was feasible, acceptable and clinically efficacious in people with Type 1
and Type 2 diabetes, groups at particularly high risk of experiencing common mental health problems.
Methodology: A single-group, pre-post design was used. 91 people with Type 1 or Type 2 diabetes
were recruited via advertisements placed on social media (Facebook, Twitter and blogs) by diabetes
organizations and the Black Dog Institute. Before and after a 7-week intervention period, and again 3
months later, participants completed a range of standardized symptom measures of general and
diabetes-specific distress, and reported on their diabetes self-care and glycemic control.
Results: Key findings will be discussed and include significant improvement in symptoms of depression,
anxiety and diabetes-related distress at post-intervention, with gains maintained at 3-month follow-up.
Conclusion: myCompass shows promise as an intervention for common mental health problems in
people with diabetes. Contrasting with diabetes-specific approaches to depression treatment,
myCompass is a public health program capable of targeting depressive symptoms across a range of
physical disorders. A dissemination strategy targeting groups at high risk of common mental health
problems reflects growing recognition of the number of Australians experiencing multi-morbidity, and for
whom psychological intervention is critical for reducing the societal and personal burden of disease.
0066
The Y-Worri Project: An Evaluation of the E-Couch Anxiety and Worry Program in Schools.
1
2
1
3
1
Alison Calear , Helen Christensen , Philip Batterham , Andrew Mackinnon , Kathleen Griffiths
1
2
The Australian National University, Canberra, ACT, Australia, University of New South Wales, Sydney,
3
NSW, Australia, University of Melbourne, Melbourne, VIC, Australia
Purpose: (i) To evaluate the acceptability and effectiveness of the Internet-based e-couch Anxiety and
Worry program in reducing and preventing symptoms of anxiety in an adolescent school-based
population, and (ii) to assess the utility of two methods of implementing an anxiety prevention program in
schools to identify the most effective dissemination method to increase the implementation of mental
health prevention programs in schools.
Methods: 30 schools from across Australia participated in the trial (N = 1,936), with each school
randomly allocated to one of two intervention conditions (e-couch teacher-delivered or e-couch health
service supported) or to the wait-list control condition. All students were invited to complete a preintervention, post-intervention, 6- and 12-month follow-up questionnaire. Students in the intervention
conditions undertook the e-couch Anxiety and Worry program during one class period a week for six
weeks. Students in the e-couch teacher-delivered condition were supervised by their classroom teacher
during the completion of the program. Students in the e-couch health service supported condition were
guided in the completion of the program by a youth worker from headspace: Australia’s national youth
mental health foundation.
Results: Preliminary results from the Y-Worri project will be presented, including intervention effects on
generalised anxiety, social anxiety, anxiety sensitivity, and mental well-being. Differential effects for the
two implementation methods will also be explored. Student satisfaction ratings indicated acceptability of
the program, although feedback and adherence rates suggested briefer interventions with less text may
be preferred.
Conclusions: If found to be effective, the e-couch Anxiety and Worry program could be offered to
schools to prevent and reduce symptoms of anxiety in students. Implications for school-based delivery
approaches and methods for increasing engagement will be discussed.
0068
e-TC: Development and Pilot Testing of a Web-based Intervention to Reduce Anxiety and
Depression in Survivors of Testicular Cancer
1 ,2
1 ,2
2 ,3
2 ,4
1 ,2
5 ,6
Louise Heiniger , Phyllis Butow , Ian Olver , Peter Grimison , Allan 'Ben' Smith , Britt Klein ,
7 ,8
9
1 ,2
1 ,2
2 ,7
2 ,10
Addie Wootten , Jo Abbott , Melanie Price , Margaret McJannett , Ben Tran , Martin Stockler ,
2 ,11
Howard Gurney
1
2
The University of Sydney, Sydney, New South Wales, Australia, The Australian and New Zealand
3
Urogenital and Prostate Cancer Trials Group, Sydney, New South Wales, Australia, Cancer Council
4
Australia, Sydney, New South Wales, Australia, Chris O'Brien Lifehouse, Sydney, New South Wales,
5
6
Australia, Federation University, Ballarat, Victoria, Australia, The Australian National University,
7
Canberra, Australian Capital Territory, Australia, Royal Melbourne Hospital, Melbourne, Victoria,
8
9
Australia, Australian Prostate Cancer Research, East Melbourne, Victoria, Australia, Swinburne
10
University of Technology, Hawthorn, Victoria, Australia, Concord Hospital, Concord, New South Wales,
11
Australia, Westmead Hospital, Westmead, New South Wales, Australia
Purpose: Despite a good prognosis, many testicular cancer survivors report anxiety, depression and
unmet needs in the longer term. Many barriers to seeking support, such as stigma, inconvenience and
cost, may be overcome using online interventions, which have been effectively utilised in other settings
and patient groups. The purpose of this study is to develop and pilot test ‘e-TC', a tailored, online
psychosocial intervention targeting anxiety and depression in testicular cancer survivors.
Methods: e-TC incorporates evidence-based clinical therapies, psychosocial interventions for cancer
patients and survivors, and expert advice, with the user's experience tailored to their relationship status. A
panel of expert advisers, including consumers and clinicians, was involved in an iterative feedback
process throughout development. The pilot study will assess feasibility of, and satisfaction with, e-TC in
40 TC survivors who completed active treatment 6months-5years ago. Participants will use e-TC for up to
10 weeks and provide feedback on the utility, comprehensiveness, relevance, simplicity and length of
each module and the intervention as a whole. At baseline, participants will complete demographic and
disease-related questions, the QLQ-TC26 (quality of life), Distress and Impact thermometers (DIT), the
Hospital Anxiety and Depression Scale (HADS), the Fear of Recurrence Scale (FRS), the Duke Social
Support scale (DSS), and the Casun unmet needs scale (CASUN). The DIT and HADS will be repeated
throughout the intervention. Post-intervention, participants will complete the QLQ-TC26, HADS, FRS and
CASUN.
Results: Preliminary feedback from consumers and clinicians about the quality and usefulness of e-TC
has been overwhelmingly positive. A detailed overview of e-TC, up-to-date pilot study data and
intervention feedback will be reported.
Conclusions: e-TC is an innovative way to make psychosocial support for men with testicular cancer more
accessible and to increase the treatment options for managing anxiety and depression associated with
testicular cancer.
0082
Impact of Telephone Prompts on the Adherence to an Internet-based Aftercare Program for
Women with Severe and Chronic Bulimia Nervosa
Ina Beintner, Corinna Jacobi
Technische Universität Dresden, Dresden, Germany
Purpose: Poor adherence is a common challenge in self-directed mental health interventions.
Accordingly, we faced poor adherence in a randomized controlled trial evaluating an internet-based
aftercare program for women with severe and chronic bulimia nervosa following inpatient treatment.
Methods: Based on research findings that support the utility of telephone prompts to increase adherence,
regular short telephone prompts were implemented into the study protocol halfway through the trial
period. Women were attempted to contact bimonthly by a research assistant. Telephone calls took less
than five minutes and did not include any symptom-related counselling. Of the 126 women in the
intervention group, 63 were attempted to contact (telephone prompt group) based on their time of
enrolment in the study.
Results: Most of those women (67%) were reached once or twice during the intervention period.
However, adherence in the telephone prompt group was significantly higher than in the group of women
who were not attempted to prompt. Two prompts were associated with 25% more overall intervention
participation.
Conclusions: Our findings suggest that telephone prompts can positively affect adherence to an
Internet-based aftercare intervention directed at patients with bulimia nervosa.
0083
Early Detection and Intervention of Anorexia Nervosa: Discouraging (?) Results of a Randomized
Controlled Efficacy Trial
1
1
1
1
2
2
Corinna Jacobi , Ulrike Völker , Katharina Möbius , Robert Richter , Megan Jones , James Lock , C. Barr
2
Taylor
1
2
Technische Universität Dresden, Dresden, Germany, Stanford School of Medicine, Stanford, USA
Purpose: Internet-based preventive interventions reduce risk and incidence of bulimic and binge eating
disorders among young high-risk women. However, their specific effects on core symptoms of anorexia
nervosa (AN) are rather weak. The Internet-based program "Parents Act Now - P@N" for early
intervention and indicated prevention of AN was developed to target parents of girls at risk for AN. The
primary objective of this trial was to evaluate the efficacy of P@N in reducing risk status and core
symptoms of AN.
Methods: 1) Screening and identification of high-risk adolescents (11-17yrs.) by selected risk factors and
early symptoms of AN. 2) Randomized controlled trial comparing P@N with an assessment-only control
condition. Assessments at pre-, post-intervention (six weeks later), 6- and 12-month-follow-up.
Results: Between 10/2010 and 12/2012, 12,377 screens were handed out in 86 German schools; 3,939
girls filled out the screen and 473 (12%) were identified as at risk for AN. 65 families were randomized to
the P@N or control condition, 43 participated in post-assessments, 25 in 12-month FUs. Moderate
positive effects were found on few subscales of eating pathology (Restraint, Bulimia).
Conclusions: Indicated prevention for AN targeting parents does not seem very promising. Parental
motivation to participate and adherence to the program was low. Drop-out rates were high which limits the
conclusions to be drawn from the effects of intervention.
0086
Usage of a Web- and App-based Weight Management Intervention within a Workplace Context
1
1
1
2
3
1
Leanne Morrison , Laura Dennison , Charlie Hargood , Scott Lloyd , Dawn Phillips , Danius Michaelides ,
1
1
1
1
1
1
Sharon Lin , Tamsin Briggs , Peter Smith , Mark Weal , Paul Little , Lucy Yardley
1
2
University of Southampton, Southampton, UK, Redcar and Cleveland Borough Council, Redcar, UK,
3
Durham County Council, Durham, UK
Purpose: This study examines usage of an online weight management programme (POWeR) and
supplementary Android application (POWeR Tracker) within a workplace setting. It will also showcase
how the LifeGuide and UBhave intervention authoring tools can be used to modify existing interventions,
disseminate interventions on a large scale, and conduct in-depth analyses of intervention usage.
Methods: POWeR has been disseminated to 29 workplaces across the North East of the UK, each with
between 8 to 23,000 employees. Dissemination will continue throughout the summer of 2014. Usage of
both the website and app is automatically logged. Self-report data on positive workplace norms for weight
management, healthy eating, and physical activity are collected at baseline. Self-reported weight loss is
collected at 8-week follow-up.
Results: To date, 721 participants have registered of which 97% (n = 700) completed baseline, 79% (n =
566) have reached 8-week follow-up, and 25% (n=58) were Android Smartphone owners and
downloaded POWeR Tracker. Of participants who have reached follow up, 12% (n = 68) completed the
first three core sessions of the website. A greater proportion of participants who downloaded the app
completed the core web sessions (34%) compared to participants who did not download the app (10%),
X2(1, n = 566) = 23.53, p < .001. Neither completion of core web sessions nor app download was
associated with self-reported workplace norms for weight management, healthy eating, or physical
activity. Novel visualisation software developed by the UBhave project (www.ubhave.org) will be used to
provide a more fine-grained analysis of how participants have used specific components of the app and
website.
Conclusion: Preliminary analyses suggest that a supplementary app can encourage greater usage of an
online weight management programme. The workplace context does not appear to influence intervention
usage. Novel visualisation software can facilitate in-depth analyses of intervention usage.
0087
Improvement of Self-Help and Blended Care Therapies for Depression by Utilizing Predictive
Models Developed with Artificial Intelligence Techniques
1
1
1
1
1
2
Reinier Kop , Mark Hoogendoorn , Michel Klein , Pim Cuijpers , Heleen Riper , Matthias Berking
1
2
VU University Amsterdam, Amsterdam, The Netherlands, University of Erlangen-Nürnberg, Erlangen,
Germany
Purpose
To increase the impact of self-help or blended care treatments, Artificial Intelligence techniques can be
exploited to allow computers to reason about the current and future state of a patient and decide on
personalized interventions that are tailored towards individual patient needs.
Methods
Based on relevant psychological theories, dynamic computational models have been developed that
describe how different factors influence the mood of a person. These models can be used to predict the
course of a depression and the effect of therapeutic interventions and comprise of ample parameters (e.g.
coping skills). Machine learning has been used to personalize the parameters of the model. Several
techniques have been deployed by using: (1) parameters of the most similar previously seen patient; (2)
generic parameters for all patients, and (3) parameters that best fit the patient measurements during the
first therapeutic week. A data set about 109 depressed patients that underwent emotion regulation
training via a mobile phone application has been used to compare the different approaches. Each patient
regularly filled in measures of agreement with a list of 122 statements during the first and sixth week.
Results
An implementation of the dynamic model has been developed, including the machine learning
techniques. The results show that using data of past patients helps to find appropriate parameter settings
for the prediction of future depressive states.
Conclusion
Artificial Intelligence techniques can provide input for (partly) automated interventions by predicting the
course of the depression. Tailoring of these models to individual patients using machine learning is
possible if EMA data is available.
0092
Predictors of Adherence to a Web-based Stress-Management Intervention
1
1
1 ,2
1 ,3
1 ,3
1
Anna-Carlotta Zarski , Dirk Lehr , Matthias Berking , Heleen Riper , Pim Cuijpers , Elena Heber ,
1 ,4
David Ebert
1
2
Leuphana University Lüneburg, Lüneburg, Germany, Friedrich-Alexander-University Erlangen-Nürnberg,
3
4
Nürnberg, Germany, VU University Amsterdam, Amsterdam, The Netherlands, Philipps University
Marburg, Marburg, Germany
Purpose: GET.ON-Stress is a web-based stress-management intervention designed to improve stress
related mental and emotional problems in employees with an elevated stress level. Based on problem
solving and emotion regulation in theoretical accordance to the transactional stress model of Lazarus, the
programme has proven effective in reducing health strains associated with stress including depression
and anxiety. But as in other online-based interventions, low adherence to the treatment-programme is a
major concern. Non-adherent participants, who drop out of the intervention, receive incomplete treatment,
which is less efficacious. Identifying predictors of adherence provides the possibility to adapt future
online-based stress-management programmes especially for the needs of non-adherent subgroups and
enhance their effectiveness. The goal of the current study is to identify predictors of adherence to an
online cognitive-behavioural stress-management intervention (GET.ON Stress) that target work-related
stress in employees.
Methods: Three randomized controlled trials evaluating the efficacy of GET-ON-Stress under varying
conditions concerning treatment guidance have been conducted (guided self-help vs. waitlist-control,
feedback on demand vs. waitlist-control, unguided self-help vs. waitlist control). For this secondary
analyses, the data-sets of the three randomized controlled trials will be combined in order to examine
predictors of adherence (N = 792). A hierarchical multiple linear regression will be conducted on the
combined sample. Adherence is defined by the number of modules completed in the programme. That
comprises seven sessions each of a duration of approximately 45 – 60 minutes and one booster session
available four weeks after completing the training. Predictor variables included demographic, treatment
guidance, participant- (e.g. emotional self-regulation) and symptom-related factors (e.g. perceived stress,
symptoms of anxiety and depression).
Results: Research in progress.
Conclusions: Research in progress.
0094
Wellbeing After Cancer: A Feasibility Trial of a Transdiagnostic Internet-Delivered Cognitive
Behaviour Therapy Program for Cancer Survivors
1
1
2
2
Nicole Alberts , Heather Hadjistavropoulos , Blake Dear , Nick Titov
1
2
Department of Psychology, University of Regina, Regina, Saskatchewan, Canada, The Centre for
Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
Purpose: Increased attention has been drawn to the challenges faced by cancer survivors following
treatment completion. Although most survivors tend to adjust well to these challenges over time, a subset
of individuals experience clinical levels of anxiety and depression. The present study evaluates the
effectiveness and acceptability of a new Internet-delivered cognitive behavioural therapy (CBT) protocol,
Wellbeing After Cancer, designed to treat anxiety and depression among recent cancer survivors.
Methods: The protocol comprised 5 online lessons delivered over 8 weeks and is based on an
established ICBT treatment course (the Wellbeing Course; Dear et al., 2011). Eighteen individuals who
completed primary cancer treatment within the past 18 months received CBT-based online lessons,
homework assignments, once weekly contact from a therapist via e-mail or phone, and automated emails.
Post-treatment interviews were conducted in order to gain further insight into participants’ experiences
with the program.
Results: Seventy-eight percent of participants completed the lessons within the 8-week program. Posttreatment data was collected from 18/18 (100%) participants. Participants improved significantly on the
primary outcome measures, the Patient Health Questionnaire 9 Item (PHQ-9) and Generalized Anxiety
Disorder 7 Item (GAD-7), with within-groups effect sizes (Cohen’s d) at post-treatment of 0.71, and 0.90,
respectively. The program was also rated as highly acceptable with all 18 participants reporting it was
worth their time and they would recommend it to a friend. Participant feedback on the program provided
further support for its acceptability, with participants identifying several strengths of the program.
Conclusions: These results provide preliminary support for the acceptability and effectiveness of ICBT
interventions for cancer survivors following treatment completion. Further research is needed to
determine efficacy of the program.
0098
Reaching Out to Women with Postpartum Depression: An Efficacy Trial of a Therapist-Guided
Internet-Delivered Therapy for Postpartum Depression
Nicole Pugh, Heather Hadjistavropoulos
University of Regina, Regina, SK, Canada
Purpose: Postpartum depression (PPD) is an undertreated condition that impacts up to 15% of women
following childbirth. Treatment barriers for PPD include stigma associated with receiving mental health
treatment, along with childcare difficulties, transportation challenges, and time and financial constraints.
Women with PPD who feel stigmatized by having depression and seeking face-to-face therapy may find
Internet Cognitive Behavior Therapy (ICBT) a particularly attractive treatment option. While there is
strong evidence to suggest that therapist-guided Internet-delivered CBT is an efficacious form of
treatment, research has not investigated ICBT for PPD.
Methods: The current study examined the efficacy of therapist-guided ICBT for the treatment of PPD.
Using a randomized control design, women (n = 50) scoring above 10 on the Edinburgh Postnatal
Depression Scale were randomly assigned to either therapist-guided ICBT or a waiting-list control (WLC)
condition. The efficacy of the treatment was investigated at baseline and at 7- and 14-week follow-up.
Treatment satisfaction and therapeutic alliance were explored at post-treatment. Additionally, qualitative
information was collected regarding the strengths and challenges of ICBT.
Results: Results of a longitudinal mixed model analysis indicated that symptoms of PPD decreased more
quickly for participants in the therapist-guided ICBT group compared to those in the WLC group and these
results were clinically significant, reliable, and maintained at follow-up. Results further suggested that
therapist-guided ICBT participants demonstrated a greater reduction in symptoms of postnatal anxiety,
general stress, parental distress, and an increase in psychological and environmental quality of life when
compared to the WLC participants. Satisfaction with the overall program and therapist alliance was
excellent. Qualitative feedback was consistent with the value of ICBT given internalized stigma.
Conclusion: Therapist-guided ICBT appears to be an efficacious and highly desirable form of treatment
for PPD. Future research directions, highlighting how ICBT may address concerns regarding stigma, are
discussed.
0100
Out and Online: Development, User Profile and Usability of an Online Intervention to Improve
Mental Health and Reduce Internalised Homophobia in Same-Sex Attracted Young Adults
1
2 ,4
2
2
3
1
Jo Abbott , Britt Klein , Mari Molloy , Suzanne McLaren , David Austin , Denny Meyer
1
2
Swinburne University of Technology, Hawthorn, Victoria, Australia, Federation University Australia,
3
4
Ballarat, Victoria, Australia, Deakin University, Burwood, Victoria, Australia, The Australian National
University, Canberra, Australian Capital Territory, Australia
Purpose: Same-sex attracted young adults (SSAYA) have been found to experience higher rates of
mental health problems and face greater barriers accessing specialist mental health care services
compared to heterosexual young adults. In addition, the mental health of SSAYA and their help-seeking
behaviour may be influenced by internalised homophobia which is defined as the extent to which a samesex attracted individual has internalised society's negative view of homosexuality. Internet-based mental
health interventions have the potential to make treatment more accessible and engaging for SSAYA.
Methods: This paper details the development, user feedback and profile of users of an online mental
health program tailored to treat multiple mental health symptoms in SSAYA. An 8 module program (Out &
Online) has been developed, informed through focus groups with same-sex attracted young adults, and
expert review. Usability testing of the program is being conducted with consumers, followed by a
randomised controlled trial.
Results: Focus groups were conducted with 17 SSAYA from regional and metropolitan Melbourne,
Australia. This informed the development of an 8-module online program tailored for a user's mental
health symptoms and gender. Based on results of an online screening assessment, users receive a
program with general treatment content and content for up to 3 mental health symptoms they have been
experiencing. In this paper results of usability testing are presented, along with data on the profile of
people logging on to use the program, including the extent to which they experience internalised
homophobia and their attitudes towards seeking help.
Conclusions: This innovative tailored program targeting multiple symptoms, and acknowledging the
salience of gender and sexual orientation, may serve as a model for how other online interventions may
be tailored to be more personalised for individual users. It has the potential to reduce internalised
homophobia and enhance the mental health outcomes of SSAYA.
0102
Designing Apps for Acceptability and Interactivity
1 ,2
1 ,2
1 ,2
3 ,2
Helen Christensen , Fiona Shand , Rebecca Ridani , Joe Tighe
1
2
3
University of NSW, Sydney, NSW, Australia, Black Dog Institute, Sydney, NSW, Australia, Alive and
Kicking Goals, Broome, WA, Australia
Purpose
To describe the principals involved in developing an interactive app for suicide prevention in indigenous
communities. To understand how and why the app proved to be acceptable and effective. To describe
the focus group reactions to the prototype app to improve new application.
Methods
We reviewed the principles that were used to develop a prototype and its successor. We reviewed
feedback from participants and from focus groups. We examined outcome data from the randomised
controlled trial. We reviewed feedback about the initial prototype for new development.
Results
We review the aspects of the app that were found useful/ improved interactivity in the context of
consumer perspectives, use of indigenous voice, and adult education learning.
Conclusion
Further qualitative research is required to understand how to develop the next app prototype.
0103
A Review of the Internalised-Stigma Literature and Considerations for Internet-Based Intervention
Development
Bronte McLeod, Neil Thomas, Jo Abbott
Swinburne University of Technology, Hawthorn, Victoria, Australia
Purpose: To present a review of the literature regarding current conceptualisations of internalised-stigma
across a number of mental and physical health areas. These conceptualisations will inform the
development of interventions that specifically target this construct. The online applicability of these
interventions will be considered.
Methods: This paper will discuss the relevance of the internalised-stigma construct for vulnerable
populations including men with prostate cancer, same-sex attracted individuals, women with post-partum
depression and persons with severe mental illness. While there is considerable literature exploring
community-stigma interventions, there is limited research outlining strategies aimed at challenging selfstigmatising beliefs. Consideration of the community-stigma and peer-support literature highlights the
potential for technological interventions in mitigating the presence and severity of internalised-stigma.
Results: Internalised-stigma can contribute to poor mental and physical health outcomes including
depression, diminished hope and self-esteem and enhanced illness-related symptoms. Moreover, a
reduction in occupational and social functioning can limit accessibility to mental health-related services
and lead to withdrawal from the community. The social-cognitive model of community-stigma posits that
contact with individuals who experience physical or mental health issues challenges stereotype
legitimacy, thereby reducing stereotype endorsement and social distancing. In order to counteract the
social withdrawal and sense of alienation experienced by stigmatised individuals, interventions targeting
contact strategies through an online medium may prove effective as they promote anonymity and
empowerment.
Conclusions: To date, there is a paucity of literature outlining intervention strategies aimed at
challenging self-stigmatising beliefs. Future research directions, highlighting the potential for online
intervention delivery, are discussed.
0104
Does Your Smartphone Know Your Mood? Preliminary Findings with Unobtrusive Ecological
Momentary Assessment
Jeroen Ruwaard, Joost Asselbergs
Vrije Universiteit, Amsterdam, The Netherlands
Purpose
To develop e-health applications that are responsive to current patient needs, researchers increasingly
turn to Ecological Momentary Assessment (EMA), the in-the-moment sampling of behaviour and
experiences in the natural environment. Prompted EMA, however, requires a careful balance between
respondent burden and sampling frequency, which limits the amount of data it can provide to treatment
personalization algorithms. In this study, we explore the feasibility of unobtrusive EMA, by examining
whether mood fluctuations can be predicted from coarse indicators of social interaction and daily activity
that can be continuously monitored on common smartphones.
Methods
In two uncontrolled studies, N = 111 healthy participants installed two Android apps, implementing A)
prompted EMA of mood (5 times per day), B) continuous unobtrusive EMA (e.g., of phone call duration,
social media activity, accelerometer data; see http://funf.org), and C) repeated assessment of depressive
symptoms (HADS/CES-D). Study 1 (n = 31) ran for 6 weeks and Study 2 (n = 80) ran for 3 weeks.
Merged data of A, B en C are input to regression model selection procedures that are designed to identify
variable subsets that are predictive of prompted EMA mood scores. Through these procedures, we
assess the predictive value of the unobtrusive variables, over and above obvious predictors such as
mood history and recent depression scores.
Results
May 2014, N = 103 participants had contributed over 84.000 unobtrusive EMA log-files, amounting to
36Gb of raw data. Preliminary analyses suggest that unobtrusive measures can make small but
significant contributions to predictive models of mood, especially when model selection procedures are
free to develop personalized models for individual users. Final results will be presented at the conference.
Conclusion
Unobtrusive EMA provides a feasible new method to study dynamic relations between behaviour,
emotions and the social environment, and may be a key element of adaptive treatment architectures.
0105
Developing an Online Psychological Support Intervention for Partners of Men with Prostate
Cancer
1 ,2
3
4
5 ,6
2 ,7
7 ,8
Addie Wootten , Jo Abbott , David Austin , Britt Klein , Anthony Costello , Declan Murphy , Debra
3
Osborne
1
2
Australian Prostate Cancer Research, East Melbourne, Victoria, Australia, Royal Melbourne Hospital,
3
4
Parkville, Victoria, Australia, Swinburne University of Technology, Hawthorn, Victoria, Australia, Deakin
5
6
University, Burwood, Victoria, Australia, Federation University Australia, Ballarat, Victoria, Australia, The
7
Australian National University, Canberra, Australian Capital Territory, Australia, Epworth Prostate Centre,
8
Richmond, Victoria, Australia, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
Purpose:
To establish the psychosocial support needs of partners of men with prostate cancer and use this
information to develop an internet based support program for these partners.
Methods:
Six focus groups were conducted to explore the psychosocial needs of partners of men with prostate
cancer as well as a systematic review of previously published psychosocial interventions to support
partners or couples. An online psychological intervention was then developed and pilot tested. The
experience of depression and anxiety of participants utilising the developed online intervention was
assessed utilizing the GAD-7 and the PHQ-9. Relationship function was assessed using the Kansas
Marital Satisfaction Scale (KMS). Emotional wellbeing was assessed using the Mental Health Continuum
Short Form (MHC-SF).
Results:
Twenty-seven partners participated in the phase one focus groups. Themes identified included the
emotional impact on the partner, the way in which communication difficulties impacted emotionally and on
the quality of the relationship and the need for support in managing the impact of prostate cancer on the
intimate relationship. The systematic review revealed very few psycho-social interventions to support
partners. Twelve partners have pilot tested the online intervention. Mean age was 60 years (range 48-73).
Baseline mental health indicated that 58% were flourishing, while 42% had moderate wellbeing scores.
Depression scores indicated that 42% mild depression and 8% moderate depression while 17% were
experiencing mild anxiety and 8% severe anxiety. Participant feedback indicated that navigation and
accessibility was good, engagement and user experience was good and the content was appropriate.
Conclusions:
This online psychological intervention for partners of men with prostate cancer could provide a way in
which support can be delivered to the majority of these partners despite geographic location.
Development challenges and lessons learnt from this project will be explored in terms of supporting
people affected by cancer, and their families.
0106
The Promise of Big Data for Mental Health Care
1 ,2
1 ,3
Johannes H Smit , Heleen Riper
1
2
GGZ Ingeest, Amsterdam, The Netherlands, VU Medical Center/ department of Psychiatry, Amsterdam,
3
The Netherlands, Vrije Universiteit / Department of Clinical Psychogology, Amsterdam, The Netherlands
Purpose
In mental health treatments, only a small fraction of information on a patient is currently used. But
especially in disorders as depression temporal daily mood fluctuations are known to be present and they
play a major role in the development of more severe conditions of the disease. At present we do not know
much about the etiology of this process and how it relates to the unique characteristics of a patient in
terms of -for example- personality traits or the genetic constitution and vulnerability. However, in the last
decade an explosion of patient data, as a by-product of the digital revolution has emerged. Genetic data,
medical records, patients reports on clinical outcome, user generated data on social media and data
gathered by mobile devices are quickly becoming available on a patient level. These 5 combined data
sources are categorized under the term Big Data and -without doubt- Big Data has an enormous potential
to benefit mental health care. The aim of the presented study is to explore the 5 components of Big Data
in relation to depression treatment and -in particular- how they can be used in Ecological Momentary
Study designs.
Methods
We systematically investigated the literature on different components of Big Data for mental health care in
particular depression treatment both online and offline.
Results
Preliminary results show that only by combining data sources (Big Data) we will be able to obtain more
knowledge on the etiology of mood fluctuations d the development of more severe conditions of
depression.
Conclusions
Big Data targeted at mental health care will build a bridge between available information and personalized
mental health care treatments and interventions. Big Data has the capacity to transform and revolutionize
the way we approach mental health care and especially by means of Ecological Momentary Study
designs.
0109
MasterMind: Mastering the Implementation and Up-scaling of Cognitive Behavioural Internet
Interventions in Routine Practice
1
3 ,1
1 ,2
1 ,2
Christiaan Vis , Jan Smit , Pim Cuijpers , Heleen Riper
1
2
VU University Amsterdam, Amsterdam, The Netherlands, Leuphana University Lüneburg, Lüneburg,
3
Germany, GGZ inGeest, Amsterdam, The Netherlands
Purpose: Cognitive behavioural Internet interventions for depression are proven to be (cost) effective.
Additionally, these interventions are ideally suited to enlarge healthcare services’ reach and access.
However, up scaling into routine practice is lagging behind. The European MasterMind project aims at
implementing and up scaling of cCBT in routine practice and targets to reach 5,230 patients and 118
professionals in routine care in 12 different European regions.
Methods: For MasterMind, the Model for ASessment of Telemedicine (MAST) will be used for structuring
the multidisciplinary and multilevel evaluation. In total, seven highly interrelated domains will be
assessed: 1) client and care profiles, 2) safety, 3) clinical and 4) cost-effectiveness, 5) patient and
professional perspectives, 6) organisational aspects and the broader 7) social, legal and ethical issues.
Transferability will be assessed in two steps in which first experienced regions will implement cCBT in
routine practice. The lessons learned from this first implementation wave will be employed by less
experienced regions in a second wave.
Results: MasterMind provides insight in the factors that play a role in the implementation and up scaling
of cCBT in a variety of real political, social, economic and clinical contexts. It provides insight in
perspectives of involved stakeholders and results in concrete recommendations for implementing cCBT
for depression in different contexts.
Discussion: Issues of dissemination and implementation are gaining priority in research and funding
agendas. Items for discussion are:
1. Is evidence-based implementation realistic?
2. Or, is a radical shift in the research paradigm needed: routine practice driven research?
0116
Suggested Steps for Providing Evidence-based Digital Interventions Across the World to People
with No Access to Health Care Providers
1 ,2
Ricardo F. Muñoz
1
Institute for International Internet Interventions for Health (i4Health), Palo Alto University, Palo Alto,
2
California, USA, University of California, San Francisco/San Francisco General Hospital, San Francisco,
California, USA
Purpose: One of the greatest advantages of Internet and other digital interventions is the ability to reach
large numbers of people who have no access to face-to-face providers. This can best be done by using
self-help automated websites or mobile applications. Digital applications used as adjuncts to live therapy
or in a guided context are consumable, that is, require the time of live providers to conduct the therapy
sessions or provide individual guidance to users. Thus, there is a limit to how many individuals they can
serve. Self-help automated interventions, once programmed and evaluated, are theoretically available to
any person anywhere in the world who wants to use them, at whatever time and place they find
convenient. This makes it feasible to reach as many people as want to use them and even to make the
interventions available at no cost to the users because the marginal cost (the cost of providing the
intervention to one more person) eventually approaches zero. This presentation will suggest a set of
steps from face-to-face interventions, to pilot studies, to randomized trials, and eventually to participant
preference trials, which can be left up indefinitely to benefit users interested in the intervention, and which
can continue to evaluate the effectiveness of the intervention.
Methods: Review of a proof-of-concept research program focused on smoking cessation, ranging from
pilot studies to worldwide randomized trials to worldwide participant preference trials.
Results: Effectiveness of worldwide participant preference trials appear to be at least as good as those
found in randomized controlled trials.
Conclusion: The presented framework for moving from pilot studies, to randomized trials, to participant
preference trials open to anyone in the world has promise as a way to reach individuals interested in
health interventions anywhere in the world.
0117
Data Mining Applications in EMI - Challenges and Recent Applications
Burkhardt Funk
Leuphana Universität Lüneburg, Lüneburg, Germany
Statistical methods from data mining have been successfully applied in many research fields. This talk
provides an introductory overview to data mining and explores its applicability and potential benefits in the
E-Mental Health domain. Main questions are: (i) How could data mining support ecological momentary
assessment and interventions? (ii) What are the challenges when applying data mining methods? (iii)
What are selected methods and toolsets that are ready-to-use?
The talk will touch upon the data mining process, especially feature extraction/selection as well as model
building and evaluation. Recent applications and current trends will be presented.
0120
Serious Gaming Aspects of SPARX cCBT
1
1 ,2
1
3
1
Sally Merry , Theresa Fleming , Mathijs Lucassen , Matthew Shepherd , Karolina Stasiak
1
2
Department of Psychological Medicine, University of Auckland, Auckland, New Zealand, Department of
3
Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand, School of
Counselling, Human Services and Social Work, University of Auckland, Auckland, New Zealand
Purpose
We will describe and critique the gaming strategies and e-learning techniques used to develop an
effective and engaging e-therapy.
Methods
We worked with groups of young people, a computer games developer, a learning technologist, cognitive
behavioural therapists and youth mental health clinicians to develop the intervention. We created an
immersive interface with both an egocentric and an exocentric view of a fantasy world [1]. Within this
interface we created a story line in which the avatar progresses through a series of modules, each placed
in a province in the fantasy world. The aim of the avatar in the story is to save a world infested with
GNATS (Gloomy, Negative, Automatic, Thoughts) and to transform them into SPARX (Smart, Positive,
Active, Realistic, X-factor thoughts). As the story unfolds, the avatar is faced with a series of challenges of
increasing complexity and difficulty, and is rewarded at the end of each module with a power gem that
builds towards restoring the Circle of Power in the land. We had clear learning outcomes and used
number of techniques to ensure adequate learning of cognitive behavioural and other techniques to
manage low mood.
Results
SPARX has been shown to be effective with high levels of engagement by young people [2].
Conclusions
Combining e-learning theory and techniques used by computer games developers is a promising
approach in the development of e-therapies for young people.
1.
Dede, C., Planning for neomillenial learning styles. Educause Quarterly, 2005(1): p. 7-12.
2.
Merry, S.N., et al., The effectiveness of SPARX, a computerised self help intervention for
adolescents seeking help for depression: randomised controlled non-inferiority trial. BMJ, 2012. 344: p.
e2598.
0121
My Road Ahead: Preliminary RCT Results from an Online Psychological Support Program for Men
with Prostate Cancer
1 ,2
4
4
5
6
7
Addie Wootten , Jo Abbott , Denny Meyer , David Austin , Britt Klein , Declan Murphy , Anthony
1 ,3
5
5
Costello , Katherine Chisholm , Marita McCabe
1
2
Royal Melbourne Hospital, Parkville, VIC, Australia, Epworth Prostate Centre, Richmond, VIC, Australia,
3
4
Australian Prostate Cancer Research, East Melbourne, VIC, Australia, Swinburne University of
5
6
Technology, Hawthorn, VIC, Australia, Deakin University, Burwood, VIC, Australia, Federation
7
University, Ballarat, VIC, Australia, Peter MacCallum Cancer Centre, East Melbourne, Australia
Purpose:
This study aimed to develop and assess the efficacy of a unique online psychological intervention in
reducing psychological distress and improving quality of life.
Methods:
My Road Ahead is an online CBT-based self-directed intervention delivered over 6 modules. Participants
were randomly assigned to one of three (3) intervention arms. Group 1: online intervention, group 2:
online intervention plus access to the moderated forum; Group 3: moderated forum only. Participants
completed the DASS-21, the Prostate Cancer-Related Quality of Life scale, the IIEF, the Dyadic Sexual
Communication Scale-short form, the Communication Pattern Questionnaire - Short and the Kansas
Martial Satisfaction Survey.
Results:
This paper presents preliminary results from 142 participants who were randomly assigned to the three
groups. The majority of men had undergone a radical prostatectomy (88%). Psychological distress levels
at baseline were equal across groups and relatively low and no significant effect of group was. However,
participants who received access to the program plus the forum showed a significant reduction in
psychological distress. Significant group differences were found for participants' sexual confidence
(F(2,79) = 3.267, p=.043, partial 2=.076), with those participants who had access to the program plus
the forum showing significant improvement in sexual confidence.
Conclusions:
This is the first randomised controlled trial to assess the efficacy of a self-directed online psychological
intervention for men with prostate cancer that we are aware of. These preliminary results indicate that the
intervention in combination with access to a moderated forum provides an effective intervention in
improving sexual confidence and some promise in reducing psychological distress. The anonymity of the
online medium could also provide a forum for men to access appropriate support without fear of stigma
that still surrounds psychological or emotional distress in the wider community.
0122
Application of mHealth for Online and Offline Social Connectedness
Mark Erik Larsen, Tjeerd Boonstra, Helen Christensen
Black Dog Institute, Sydney, New South Wales, Australia
Purpose
Social connectedness is a key factor in mental health and well-being, and in today's digital age
encompasses both online and offline interactions. The ubiquity of mobile phones and their utility as data
collection platforms has been well established, and we report on the use of such a platform to integrate a
set of measures of online and offline social connectedness and emotional status.
Methods
Data are collected passively through the Purple Robot platform on a user's own Android handset, or a
custom app on their iPhone. Users are invited to use the app to login to their Facebook or Twitter
accounts, allowing a mapping of their online social networks. Sentiment analysis is also applied to content
posted through these networks, allowing a time-varying evaluation of an individual’s emotional status. If
enabled, local communication protocols are employed to form an evolving map of near-by devices and
handsets, providing an indication of the user's proximity to other individuals as a marker of their offline
connectedness.
Results & Conclusions
Results from a pilot study involving a sample intervention conducted with volunteer staff and students at a
research organisation will be presented. Changes in network topology (size and density) and expressed
sentiment following the intervention will be presented. The implementation challenges and multi-platform
data quality issues will be discussed, along with future barriers to translation into a wider intervention.
0123
Exploring the Role of an Online Psychological Support Program for Men with Prostate Cancer in
Overcoming Barriers to Access Appropriate Support for Mental and Sexual Problems
2 ,3
4
5
7 ,4
6
1 ,3
Addie Wootten , Jo Abbott , David Austin , Britt Klein , Declan Murphy , Anthony Costello ,
5
5
Katherine Chisholm , Marita McCabe
1
2
Royal Melbourne Hospital, Parkville, VIC, Australia, Epworth Prostate Centre, Richmond, VIC, Australia,
3
4
Australian Prostate Cancer Research, East Melbourne, VIC, Australia, Swinburne University of
5
6
Technology, Hawthorn, VIC, Australia, Deakin University, Burwood, VIC, Australia, Peter MacCallum
7
Cancer Centre, East Melbourne, VIC, Australia, Federation University, Ballarat, VIC, Australia
Purpose:
This study aimed to explore the potential for the use of an online psychological intervention, My Road
Ahead, in overcoming issues of stigma in accessing psychological and sexual support in the context of
prostate cancer.
Methods:
My Road Ahead is an online CBT-based self-directed intervention delivered over 6 modules. The program
focuses on identification and management of emotional problems, interpersonal and communication
challenges and sexual function and intimacy as well as self-esteem, identity and masculinity. My road
ahead contains a range of psycho-education, interactive exercises and videos as well as optional offline
exercises to complete with their partner. The program also has a forum where participants can share
experiences with other participants if they wish to.
Results:
This paper presents preliminary results from 142 participants. Mean age of participants was 62 years
(range 42-82). The majority of men had undergone a radical prostatectomy (88%). Sixteen percent of
participants reported that they had participated in the program because it was anonymous and 17%
because it was a self-help option rather than a face to face intervention. Only 21% of participants involved
their partner in the optional exercises and qualitative responses as to why they had not engaged their
partners indicated a common theme of fear of being misunderstood, feeling unable to communicate
problems, or lack of closeness within the relationship. Forum discussions also focused on the lack of
healthcare professionals support in managing sexual difficulties post treatment and the resultant impact
on help-seeking behaviour.
Conclusions:
This online self-directed psychological intervention for men following treatment for localised prostate
cancer shows promise in overcoming some of the stigma associated with the experiences of prostate
cancer
0127
Global Health Promotion and Social Media
Helen Christensen
Black Dog Institute, Sydney, Australia
Purpose
The last decades have witnessed the development of e-health interventions for chronic conditions such
as anxiety, depression, diabetes and obesity. The last 25 years has seen the growth of computer assisted
CBT, the development of interactive web programs, mobile phone enabled programs, and
apps. Alongside these developments, health systems research and knowledge has grown with the aim of
implementing these programs into clinical practice, promoting their use by consumers, and disseminating
them globally. The last decade has seen a new idea emerging, namely, that social media is an
opportunity to influence health attitudes and behaviour in a way previously not thought possible. This
paper briefly examines some new research in this area, and explores the potential of this medium in the
area of health promotion.
Methods
Literature review, observational studies, validation studies.
Results
Once validated, social media may be the preferred method for disseminating information to promote help
seeking and to reduce stigma. It may be useful in detecting and in intervening for suicide risk, and may
assist in surveillance of acute psychological crisis.
Conclusion
Methodologies to study social media are evolving. Social online networks may assist in changing health
behaviours.
0128
The myCompass Project: Translating and Disseminating a Self-guided Public Health Program Via
Mobile Devices and the Internet
1
1 ,2
1 ,2
Judy Proudfoot , Alexis Whitton , Janine Clarke
1
2
Black Dog Institute, Sydney, NSW, Australia, University of New South Wales, Sydney, NSW, Australia
Purpose: Unmet need, barriers to treatment access and increasing healthcare costs are common
concerns for health departments. Evidence-based automated public health interventions can relieve some
of the pressure. This presentation describes an example of research translation and the various stages
that one eHealth program has undergone in a translational process.
Method: ‘myCompass' is a fully-automated, interactive, stand-alone mobile phone and internet-delivered
program for the treatment of mild-to-moderate symptoms of depression, anxiety and stress. Users can
access the program through any internet-enabled device, including smart phones, tablets, laptops and
desktop computers. The program comprises brief psychotherapeutic modules, symptom tracking, mental
health information, quick tips, motivational messages and diary. Stages in the translational process of
myCompass include identification of a need, research to assess the need, collaborative development of
the program underpinned by evidence, evaluation of impact using the RE-AIM model.
Results: Data from myCompass research studies and other sources will be presented to illustrate
different translational stages, including assessment of need, evaluation of program effectiveness and
usage, and dissemination.
Conclusion: The myCompass program may be seen an example of research translation.
0131
Depressed and Suicidal Statements on Twitter: An Exploration of Context and Response
1
2
3
3
1
Bridianne O'Dea , Phillip Batterham , David Milne , Cecile Paris , Helen Christensen
1
2
Black Dog Institute, Sydney, NSW, Australia, Centre for Mental Health Research, Australian National
3
University, Canberra, ACT, Australia, Commonwealth Scientific and Industrial Research Organisation
(CSIRO, Sydney, NSW, Australia
Background: Twitter has become a primary vehicle for information diffusion in the current century. It has
significantly increased our capacity to communicate with others, share information, connect experiences
and form opinions. It provides us with an overwhelming ability to learn things at a speedier pace and
allows us to participate in meaningful interactions that was previously not possible. Research has found
that Twitter is used to express an array of thoughts, feelings, and behaviours. Using sentiment analysis
and principles of social network analysis, the spread of certain emotions has been examined as well as
the use of Twitter in response to certain events. This gives valuable insight into the real-time thoughts and
actions of Twitter users and how particular sentiments are more likely to spread than others. While
popular commentary has noted that Twitter is used to cyber-bully and harass others, the nature of this
use and such responses is mostly unknown.
Aim: This study presents an overview of current methodologies used to examine mental health status
using Twitter. We then proceed to outline our current investigation: the use of Twitter for the expression of
depression and suicidal ideation. This study aims to examine the number of depressed and suicidal
tweets as well as the context for such tweets and other users' responses to these tweets.
Methods: Using computerised sentiment analysis and data mining software, we collected tweets posted
from May 2014. We then classified responses using a coding scheme.
Results: Preliminary findings indicate that Twitter is used to express depressed thoughts and suicidal
ideation. Moreover, that the large majority of responses from other Twitter users appear to be positive
and supportive.
Conclusions: This ongoing study presents some of the methodological issues in using social media for
population monitoring of suicide and depression and postulates future applications in this area.
0132
A Dedicated Website to Facilitate Help-Seeking for Young People with Mental Health Problems:
Preliminary Results from a Pilot RCT
1
2
2
1 ,3
Sylvia Kauer , Julie Grey , Kerrie Buhagair , Lena Sanci
1
2
University of Melbourne, Melbourne, Australia, ReachOut.com by Inspire Foundation, Sydney, Australia,
3
Young and Well Cooperative Research Centre, Melbourne, Australia
Purpose: Mental ill-health continues to be a major public health challenge, particularly for adolescents.
Whilst one in four young people experience mental disorders, only 35% seek professional help.
Readiness and access to appropriate care from primary care and specialists remain a major barrier.
Young people regularly turn online for mental health information and support, which offer innovative
avenues for young people. Nevertheless, our recently published systematic review demonstrates that the
impact of online programs on help-seeking is rarely evaluated.
Aims: This pilot RCT aims to evaluate an dedicated online intervention to facilitate help-seeking and
improve access to appropriate care for young people with mental health concerns, comparing these helpseeking outcomes with usual search strategies.
Methods: Developed from the theoretical bases of the theory of planned behaviour and participatory
action health methodology, the impact of Link on help-seeking was examined using a pragmatic pilot RCT
design based on SPIRIT guidelines with 60 18–25 year olds randomised to: (1) the intervention website,
Link, or (2) the control condition (usual search strategies both on and offline). Baseline, 1 week and 1
month follow up surveys were completed.
Results & Conclusions: This pilot study will be completed in August 2014 with the preliminary findings
presented for the first time at ISRII. Structural equation modelling will compare young people’s attitudes,
intentions and help-seeking behaviours between the study arms and explore whether a dedicated website
increases help-seeking compared to usual strategies.
Conclusions: The potential impact this dedicated website has to direct young people to the most
appropriate services for their needs, ensuring that face-to-face care is received for those with severe
symptoms whilst lower intensity online services are provided to others will be discussed.
0134
Recharge App: Development and Evaluation of a Mobile Phone App Intervention Targeting the
Regulation of the Sleep/Wake Cycle in a Group of Young Males.
1 ,2
1 ,2
3
4
4
Kathryn McCabe , Tracey Davenport , Kitty Rahilly , Derek Chambers , Fenella Murphy , Jane Burns
,5
1
, Ian Hickie
1
2
The University of Sydney, NSW, Australia, Young and Well Cooperative Research Centre, VIC,
3
4
Australia, ReachOut.com by Inspire Foundation, NSW, Australia, Inspire Ireland Foundation, Cork,
5
Ireland, University of Melbourne, VIC, Australia
2
Purpose: Disruption of the sleep/wake cycle is characteristic of a range of mental health conditions
and affects multiple biological systems that regulate mood, digestion and cardiac function. Techniques
targeting sleep/wake cycle regulation are a common therapeutic tool used by clinicians to treat conditions
such as depression. The primary aim of this project was to improve mental health and wellbeing of young
males (aged 16-24 years) by delivering a mobile phone app intervention promoting the development of
healthy sleep/wake practices. Method: Initial phases of the project utilised participatory design
methodologies to actively engage young men in the concept formulation, design and pilot testing phases
of the study. Results: The mobile phone-based intervention included measurable and action-oriented
tasks targeting early morning routine, increasing physical activity and morning light exposure. We
describe the feasibility testing process used to assess user engagement with the app and the protocol for
the randomised controlled trial (RCT) to evaluate the efficacy of the intervention. Conclusions: Appbased technologies provide exciting opportunities for mental health intervention, especially interventions
targeted toward young people.
0135
Privacy and Trust Issues in the Development of a Mental Health Virtual Clinic for University
Students
Amelia Gulliver, Kylie Bennett, Anthony Bennett, Julia Reynolds, Kathleen Griffiths, Louise Farrer
Centre for Mental Health Research, The Australian National University, Canberra, Australia
Purpose: Traditional university based mental health services tend to be delivered face-to-face, which
may be more time consuming and less cost-effective than distal interventions, and contribute to a high
clinical load in the tertiary setting. Therefore, there is a need for the development of a university based
online service that has the capacity to circumvent these issues, and more effectively and efficiently
address student mental health in universities. The issues of privacy and trust have emerged as critical
concepts in the development of this online service. However, little research is available on the personal
information that participants are comfortable providing and whether it presents a barrier to accessing
online services.
Methods: Two stages of data collection were conducted. The first stage consisted of four 1.5-hour focus
groups conducted with university students (n = 19; 10 female, 9 male) to determine their views on online
help-seeking for mental health problems, and their ideas about components of the virtual clinic and how
they could function. The second stage comprised three 1-hour prototype development sessions
conducted with university students (n = 6; 3 male, 3 female) using participatory design methods to
engage participants in the development and refinement of a service model for the virtual clinic and
determine their views on privacy and trust issues.
Results: The students raised a number of issues related to privacy and trust in relation to the
development of the university virtual clinic. The major topics related to credibility and trust of online
services, the university's access to their personal information and what information would be asked, the
stigma associated with registering for the service, and privacy concerns related to online forums as part of
the virtual clinic.
Conclusions: The results suggest that privacy and trust are key considerations in the development of
online services for university students.
0136
The Attitudes and Behaviours of University Staff Regarding Online Mental Health Interventions:
Implications for the Development of a Virtual Clinic for University Students
1 ,2
1
1
1
Louise Farrer , Amelia Gulliver , Kathleen Griffiths , Kylie Bennett
1
2
Centre for Mental Health Research, ANU, Canberra, Australia, Young and Well Cooperative Research
Centre, Melbourne, Australia
Purpose
University students report using the internet for help with mental health problems and indicate willingness
to use online mental health services. University teaching and research supervision staff are often asked
to connect students who need mental health support with appropriate care. However, little is known about
the attitudes and behaviours of staff with regard to online mental health resources. Information from this
important stakeholder group is relevant to the development and dissemination of online mental health
interventions within a university setting.
Methods
An anonymous online survey was sent via e-mail to staff involved in teaching and/or supervising students
at a large Australian university. The survey measured the following: demographic information, internet
usage and purpose, attitudes about the value and utility of web-based resources, and
willingness/concerns about recommending online mental health resources to students.
Results
238 university lecturers, tutors and research supervisors completed the survey. Approximately two-thirds
of respondents had used the internet previously for accessing information about symptoms or health care
providers. The majority of respondents considered online services to be helpful for accessing information
and facilitating or complementing face-to-face care. However, only 20% believed that online services are
a credible treatment option and 4.3% believed that they offer the same quality of care as face-to-face
services. Among their primary concerns about recommending online mental health resources to students
were that online resources are untrustworthy, ‘second-best', and encourage ‘self-diagnosis'.
Conclusions
Results of the survey suggest that many university staff members are sceptical about the quality and
effectiveness of online mental health interventions. This may affect their willingness to recommend them
to students. Strategies to increase awareness of effective online programs and how they can be utilised
by students, as well as opportunities to enable staff to input into the development of new online
interventions may be beneficial.
0137
Online Peer-to-Peer Support for Adolescents and Young Adults with Mental Health Problems: A
Systematic Review.
Kathina Ali, Louise Farrer, Amelia Gulliver, Kathleen M Griffiths
Centre for Mental Health Research, The Australian National University, Canberra, ACT, Australia
Purpose: Adolescence and early adulthood are critical periods of life for the development of emotional
and psychological problems and mental disorders. Online peer-to-peer support has proven to be a
popular medium to communicate online and improve mental health by providing social support. Previous
systematic reviews have targeted internet support groups for adults with mental health problems,
including depression. However, there have been no systematic reviews examining the effectiveness of
peer-to-peer support in improving the mental health of adolescents and young adults.
Methods: The PubMed, PsycInfo and Cochrane databases were searched using keywords and MeSH
terms. Retrieved abstracts (n = 3934) were double screened and coded. Studies were included if they (1)
investigated an online peer-to-peer interaction, (2) the interaction discussed topics related to mental
health, (3) the sample included adolescents (aged 12-17 years) or young adults (aged 18-25 years), and
(4) the paper was in English. Studies were excluded if the peer-to-peer interaction focused primarily on
physical health conditions (e.g. cancer, diabetes).
Results: Findings from this systematic review will be presented and implications for policy and practice
will be discussed.
Conclusion: This systematic review will identify and synthesise the current state of the evidence for
online peer-to-peer support for adolescents and young adults with mental health problems. The findings
of the review will be used to inform the development of peer-support tools delivered within a virtual clinic
for university students.
0148
The Global Dissemination of Psychological Treatments: Strategies and Methods
Christopher G Fairburn
Oxford University, Oxford, UK
Effective psychological treatments have been developed for a range of mental problems, most notably
anxiety disorders, eating disorders and depression. Treatments effects are large and well
maintained. The challenge is to make these treatments available to all those who would benefit from
them. This requires converting them into "programme-led" interventions suitable for delivery on a global
scale (Fairburn and Patel, 2014). The evaluation of the resulting interventions requires interdisciplinary
research involving the combination of public health research strategies and those needed to substantiate
the impact of any treatment.
Fairburn CG, Patel V. The global dissemination of psychological treatments: a roadmap for research and
practice. American Journal of Psychiatry 2014; 171: 495-498.
0150
The MobileCoach – An Open Source Solution for Behavioral Change Interventions
1 ,2
3
4
Andreas Filler , Severin Haug , Tobias Kowatsch
1
2
Health-IS Lab, 8092 Zurich, Switzerland, Trier University of Applied Sciences, Environmental Campus
3
Birkenfeld, 55761 Birkenfeld, Germany, Swiss Research Institute for Public Health and Addiction, 8031
4
Zurich, Switzerland, Institute of Technology Management, University of St. Gallen, 9000 St. Gallen,
Switzerland
Purpose: The MobileCoach (MC) project aims to build a fully automated behavior change intervention
that aims to improve health behavior. Due to its modularity and open source approach, the MC lays a
fruitful ground for researchers and applications in several domains of health behavior change such as
smoking cessation, alcohol abuse, nutrition, physical activity or mental diseases.
Methods: Building on the foundations of automata theory, the MC follows the concepts of a state
machine that uses intervention rules for state transitions, which can be referred to as a fully automated
expert system. Here, the state is an aggregate of all relevant attributes related to the intervention
progress of a participant whereas state transitions triggered by intervention rules lead to a change in
these attributes. In particular, each participant of the intervention group is assigned to a particular
intervention state based on her answers during a baseline assessment. In response to this assessment, a
web-based feedback is generated individually by the system for each participant. Then, depending on a
participant’s regular feedback (e.g. by text messages), intervention rules trigger state transitions and the
tailoring of subsequent feedback messages (e.g. text messages).
Results: The MC allows health professionals to create behavioral interventions without any technical
programming skills such as a baseline assessment survey, tailored feedback messages or intervention
rules. First empirical results of two MC-based interventions (for smoking cessation and the reduction of
problem drinking) are presented.
Conclusions: The MobileCoach is a fully automated behavioral intervention system that will be made
public as open source project by the end of 2014.
0153
The YouTurn Program - Using Principles from Behavioral Economics and an Online Tool to
Support Smoking Cessation
1
2
1
Flavius Kehr , Matthias Frieden , Tobias Kowatsch
1
2
Institute of Technology Management, University of St. Gallen, 9000 St. Gallen, Switzerland, YouTurn,
8055 Zürich, Switzerland
Purpose: Health Information System Services (HISS) have the potential to improve well-being of
employees, which in turn leads to a reduction of days of sickness absence and an increase in individual
and organizational performance. However, low participation rates indicate a need to better understand
incentives that motivate employees not only to join but also to stick to HISS-supported health promotion
programs. Two concepts from behavioral economics, namely reinforcing value and delay discounting,
may help to improve our understanding in this regard. Emanating from these concepts, the paper
introduces YouTurn, an online smoking cessation program tailored to employees, where participants can
bet real money on their success, but also lose money in case of failure. Results of a preliminary
evaluation of the YouTurn program are presented.
Methods: An online survey with 249 employees was conducted to explore the willingness to participate in
the program, the willingness to invest real money on cessation success, and the perceived risks related to
losing the money in case of failure. Moreover, features and preferences with regard to the design of the
YouTurn online tool were assessed.
Results: In general, employees who smoked showed a high willingness to participate in the program.
They indicated that both monetary incentives as well as the risk to lose money were perceived as
motivators, while a regression analysis revealed only monetary incentives to significantly impact
willingness to participate. Employees willing to smoke indicated a high preference for smartphones as
technological platform for YouTurn. Feedback on own earnings and progress throughout the program
were rated as particularly important.
Conclusions: Results indicate that principles from behavioral economics and monetary incentives, as
contemplated in the YouTurn program, may offer a valuable and unique way to support smoking
cessation at the workplace.
0154
Fielding Primary Care Internet-based Interventions to Prevent Adolescent Depression: The Tale of
Two Derivatives
1
1
2
1
1
Monika Marko-Holguin , Benjamin Van Voorhees , Tracy Gladstone , Daniela DeFrino , Lauren Anker ,
1
1
Eduard Reimer , Nikhil Nandakumar
1
2
University of Illinois at Chicago, Chicago, Illinois, USA, Wellesley College for Women, Boston,
Massachusetts, USA
Purpose: Primary Care-Internet-based depression interventions were developed to target adolescents
aged 13-18 at risk for depression. In fielding two versions of the CATCH-IT (Competent Adulthood
Transition with Cognitive-behavioral and Interpersonal Training) intervention, there became apparent
strengths and weaknesses, which we explore in this discussion.
Methods: We trialled two variants of CATCH-IT, one targeting all adolescents 13-18 (CATCH-IT 3) and
one targeting 13-17 year old Black and Latino adolescents (CURB, Chicago Urban Resiliency Building).
For CATCH-IT 3, we utilized "Synchronization of the Senses" theory, which includes self-diary peer
videos, stories and design elements to create a fused experience. For CURB, we used the PEN-3
Cultural Framework, including peer videos and urban themed stories. We fielded the interventions in two
large multi-site, randomized controlled trials. CURB was halted midway due to low recruitment and
engagement and revised into a focus group study to address these challenges.
Results: We have enrolled N=147/expected 400 and 85 in the CATCH-IT 3 and CURB studies
respectively. CATCH-IT 3 participants noted the stories and self-diary peer videos and rewards for
participation as most attractive components. CURB focus groups revealed community center outreach as
the best method of recruitment. A smartphone app was overwhelmingly affirmed as the next generation of
CURB, including the instantaneous feedback on coping skills and exercises using Natural Language
Processing (NLP) and direct contact with a mental health professional for guidance. The findings also
unfolded a clear ethnic group differentiation for preferred formats
Conclusions: Difficulties in fielding CURB appear to be multi-systemic. Despite valid and well-supported
suggestions and opinions of adolescents, it is still unclear how these potential changes will impact
efficacy of this e-program given previously validated models have followed similar structure as that of
CATCH-IT 3.
0161
From Peer Support to Video Modelling to Undermine Self-Stigma: MI Recovery and Development
of the Self-Management and Recovery Technology (SMART) System
1
2
3
1
1
1
Neil Thomas , John Farhall , Cassy Nunan , Fiona Foley , Nuwan Leitan , Michael Kyrios
1
2
Swinburne University, Melbourne, Victoria, Australia, La Trobe University, Melbourne, Victoria, Australia,
3
Mental Illness Fellowship of Victoria, Melbourne, Victoria, Australia
Purpose: Transformation of identity is a key component process identified in adaptation to and personal
recovery from severe mental illness. Mental health service user accounts suggest that this involves
overcoming internalised views of self, involving self-stigma and internalised passive patient roles.
Methods: Collaboration with mental health service users has led to the development of the MI Recovery
program which targets self-stigma. Initial work with a face-to-face peer-facilitated course has been used to
inform the development of online resource, the Self-Management and Recovery Technology (SMART)
program in collaboration with the National eTherapy Centre at Swinburne University. This has been
developed to be suited to incorporation into routine practice of mental health workers using a tablet
computer. Stereotypes about mental illness are challenged through the use of videos featuring peers
modelling positive stories of recovery in combination with therapeutic material to reconstruct self-identity.
Results: In a baseline controlled trial, internalised stigma related to mental illness reduced significantly in
people receiving the face-to-face version, relative to a stable baseline. Gains were maintained at followup. Findings from pilot of the online version will be presented.
Conclusions: Implications for the role of video modelling in reducing self-stigma will be discussed.
0162
Short-term Results of a Web-based Multiple-session Attentional Bias Modification Training for
Smokers
1
1
2
3
3
Iman Elfeddali , Hein de Vries , Catherine Bolman , Thomas Pronk , Reinout Wiers
1
School for Public Health and Primary Care (Caphri)/Maastricht University, Maastricht, The Netherlands,
2
3
Open University of the Netherlands, Heerlen, The Netherlands, University of Amsterdam, Amsterdam,
The Netherlands
Aims This study aimed to assess the efficacy of a multiple-session attentional bias modification (ABM)
training in modifying these implicit cognitive biases and fostering six months continued smoking
abstinence. Differential effects of the training were assessed for light-moderate and heavy smokers.
Methods Participants (daily smokers aged 18-65 years) were randomized to receive either six sessions
of ABM- or placebo-training. Pre- and post-tests consisted of assessments of smoking-related cognitions,
attentional bias (visual probe task) and approach bias (manikin-task). The main outcome was continued
abstinence, six months after baseline.
Results The ABM-training had a significant positive effect on continued abstinence, in heavy smokers
only (complete case analyses: OR = 0.18; P = 0.04; CI = 0.04-0.90; conservative analyses: OR = 0.26;
P= 0.05; CI= 0.07-1.01). In heavy smokers, the training resulted in small effects with regard to attentional
bias and no effects on approach bias. The training had no effect for light to moderate smokers.
Conclusions Providing multiple sessions of attentional bias modification training via the Internet has the
potential to foster continued smoking abstinence in heavy smokers who make a quit-attempt.
0179
Treatment of Depression via the Internet in Sweden
1 ,2
Gerhard Andersson
1
2
Linköping University, Linköping, Sweden, Karolinska Institute, Stockholm, Sweden
Mood disorders are highly prevalent and costly for society as well. For mood disorders most Swedish
trials have focused on major depression with trials on guided ICBT, psychodynamic treatment,
acceptance and commitment therapy, and physical activity. There are also trials on Smartphone-delivered
behavioural activation and blended treatments. Overall, the results show that guided internet treatment is
as effective as face-to-face therapy for major depression and one trial suggests that relapse can be
prevented.
0180
Happy@Work: (Cost-) Effectiveness of a Preventive Web-based Guided Self-help Course for
Employees with Depressive Symptoms
1 ,4
1 ,4
2
3 ,4
1 ,4
Anna Geraedts , Annet Kleiboer , Noortje Wiezer , Willem van Mechelen , Pim Cuijpers
1
2
3
Vrije University, Amsterdam, The Netherlands, TNO, Hoofddorp, The Netherlands, Vrije University
4
Medical Center, Amsterdam, The Netherlands, EMGO Institute for Health and Care Research,
Amsterdam, The Netherlands
Purpose
Depressive disorders are highly prevalent in the working population and are associated with excessive
costs for society and companies. Research has shown that depressive symptoms can be treated
effectively via web-based guided self-help. However, a web-based guided self-help intervention for
depressive symptoms that incorporates work-related problems has not yet been developed. Such an
intervention could be valuable and cost efficient because it might not only reduce depressive symptoms
but also absenteeism and presenteeism. Therefore, we developed a web-based guided self-help course
for employees with depressive symptoms who are not on sick-leave.
Methods
This study is a 2-arm randomized controlled trial comparing a web-based guided self-help course with
care-as-usual. We recruited employees from different companies in the Netherlands. The main inclusion
criterion was elevated depressive symptoms. The intervention consisted of 6 lessons and coaching was
provided via the website. Self-report questionnaires on depressive symptoms (CES-D), anxiety (HADS),
burnout (MBI) and work performance (HPQ) were completed at baseline, post-treatment, 6 months and
12 months. A total of 231 employees were randomized to either the intervention group (n=116) or careas-usual (n=115). The economic evaluation was performed from both the societal and employers'
perspective.
Results
Both the intervention and the CAU group showed significant improvements on depressive symptoms at 8
weeks, which sustained over time. Post-treatment significant effects were found in favor of the
intervention group for anxiety symptoms and exhaustion, but the effects were not significant over time.
The economic evaluation showed that the intervention is promising in terms of cost-effectiveness but the
results depend on the willingness to pay for improvement in depressive symptoms.
Conclusions
This study showed that a web-based guided self-help course for employees with depressive symptoms is
not more effective in reducing depressive symptoms among employees than care-as-usual. The
probability of cost-effectiveness depends on the willingness to pay.
0181
15 Years of Internet Interventions Research: ANXIETY
Per Carlbring
Department of Psychology, Stockholm, Sweden
Sweden conduced its first randomized controlled trial on an anxiety disorder in the year 1999. Since then
numerous trials and programs have been developed including problems such as panic disorder, social
anxiety disorder, generalized anxiety disorder, severe health anxiety, post-traumatic stress disorder,
obsessive compulsive disorder, specific phobia, and mixed anxiety-depression. Moreover, there are
studies on specific problems such as procrastination. With the exception of cognitive bias modification
training most studies show effects in line with face-to-face cognitive behavior therapy. In addition to
cognitive behavior therapy there are Swedish trials on mindfulness-based internet treatment,
interpersonal psychotherapy, and psychodynamic internet treatment. This presentation will take the
listener on a journey from the past, via the present and a place where the bright future can be seen.
0184
Web-based Stress-Management Training for Employees: Results of a Randomized Controlled Trial
1
1 ,2
1
1 ,3
1 ,4
Elena Heber , David Daniel Ebert , Dirk Lehr , Matthias Berking , Heleen Riper
1
Division of Online Health Training, Innovation Incubator, Leuphana University, Lueneburg, Germany,
2
Department of Clinical Psychology and Psychotherapy, Philipps-University, Marburg, Germany,
3
Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-University, Erlangen4
Nuremberg, Germany, Department of Clinical Psychology, VU University, Amsterdam, The Netherlands
Purpose: Work-related stress is highly prevalent in employees and is associated with adverse
consequences for health. Furthermore, it can cause excessive costs on a societal level due to
absenteeism and presenteeism. The evidence on web-based interventions for stress is limited and
available studies lead to conflicting results. This study investigated the efficacy and cost-effectiveness of
a newly developed guided web-based stress management intervention based on problem solving and
emotion regulation for employees.
Method: A randomized controlled trial design was applied. Recruitment took place via mass media and a
major health insurance company. Individuals with an increased suicidal risk or previously diagnosed
dissociative or psychotic symptoms were excluded. A total of 264 employees above 18 years (PSS ≥22)
was randomized to an intervention or 6-month waitlist control group. Primary outcome was perceived
stress (Perceived Stress Scale, PSS-10). Assessments took place at baseline, seven weeks, and six
months.
Results: Based on intention-to-treat-analyses, significant large between group effect sizes for stress were
found at post-test (Cohen's d=.85) and 6-month follow-up (d=.99). Similar improvements were found for
depression. Economic analyses are currently conducted and will be available shortly.
Conclusion: This study showed that a web-based intervention was effective in reducing stress in
employees. A large-scale application as a preventative stress-management tool for employees is
conceivable and could potentially reduce the burden of stress-related health problems.
0202
Using Technology to Improve Eating Disorders Treatment
1
2
3
1
3
2
Andrea Kass , Megan Jones , Dawn Eichen , Michelle St. Paul , Elizabeth Bollinger , Danielle Ryu ,
4
4
2
1 ,3
2
Jenine Saekow , Elise Gibbs , Mickey Trockel , Denise Wilfley , C. Barr Taylor
1
2
Washington University in St. Louis, St. Louis, Missouri, USA, Stanford University School of Medicine,
3
4
Palo Alto, California, USA, Washington University School of Medicine, St. Louis, Missouri, USA, PGSPStanford PsyD Consortium, Palo Alto, California, USA
Purpose: Eating disorders (EDs) are common and serious problems on college campuses and programs
are need that can provide easily accessible, relatively low cost prevention and treatment programs.
Healthy Body Image (HBI) program is a comprehensive, internet-based/mobile platform which uses an
evidence-based screen to identify and offer tailored evidence-based interventions. We are now
conducting the first national implementation of HBI, while simultaneously evaluating the newest
intervention in our suite of platforms, Student Bodies - Eating Disorders (SB-ED), on improved access,
costs, and outcomes of mental health care for EDs compared to usual care. Methods: SB-ED is an online,
guided self-help intervention to improve ED symptomatology. Thirty universities across the United States
are being randomized to receive HBI with or without SB-ED. Adaptive designs allow for intervention
tailoring based on users' symptom and adherence tracking, to increase user experience and engagement.
Results: Year 1 implementation efforts focused on recruiting and randomizing universities, engaging
local campus partners, customizing implementation to local sites, and running the first cohort of users
through the platform. Platform adaptations have been identified based on data from the first cohort of
users; roll-out of platform updates (i.e., "HBI 2.0") is planned for the upcoming fall academic semester.
Thus far, over 1000 students have been screened, 45% of whom are at low risk for an ED, 29% at high
risk for an ED, 20% have an ED and are eligible for online intervention, and 4% need referral.
Conclusions: Lessons learned from Year 1 implementation and plans for Year 2 implementation will be
discussed. Evaluation of evolving technologies represents a novel direction for study implementation. If
successful, SB-ED and the online platform will be an attractive solution for college campuses to address
the treatment needs of individuals with eating disorders, with high capacity for widespread dissemination
using minimal person-based resources.
0209
Log In and Breathe Out: Effectiveness of an Internet-based Recovery Training for Better Sleep in
Stressed Employees - Results from a Randomized Controlled Trial.
1
1
1
1
1 ,2
Hanne Thiart , Dirk Lehr , David Ebert , Matthias Berking , Heleen Riper
1
2
Leuphana University, Lueneburg, Germany, VU University, Amsterdam,, The Netherlands
Studies suggest that recovery from work and the ability to recreate one`s resources is a key factor
relevant for maintaining and restoring health. Especially, restorative sleep is of major importance for
successful recovery from work-stress. Insomnia complaints often result from cognitive arousal and
deficient cognitive detachment from work. Insomnia is also associated with a lack of positive recreational
activities that facilitate cognitive detachment and reduce work-related rumination.
Therefore, GET.ON Recovery was developed and aimed to target (a) sleep, (b) cognitive detachment and
(c) recreational activities. GET.ON Recovery is an online training combining techniques from cognitive
behavioral therapy for insomnia, behavioral activation and techniques to reduce rumination and to foster
cognitive detachment from work-related problems. The aim of the present study was to evaluate the
efficacy of this guided online training for employees affected by insomnia.
Methods: In a two-arm randomized controlled trial (N=128), the effects of a guided online training were
compared to a waitlist-control condition. Teachers with high insomnia complaints (Insomnia Severity
Index≥15) and work-related rumination (Irritation≥15) were included. Primary outcome: insomnia severity.
Health was assessed at baseline, after 8 weeks and at 6-months follow-up. Secondary outcomes
included sleep efficiency, recuperation in sleep, work-related rumination, worrying and expert-rated
incidence of Primary Insomnia, Major Depressive Disorder and General Anxiety Disorder.
Results: Compared to the waitlist-control, insomnia severity of the GET.ON Recovery group decreased
significantly stronger (d=1.45) with Numbers-needed-to-Treat of NNT<2 for reliable change and NNT<4
for reduction in expert-rated diagnosis of primary insomnia. The improvements were maintained at 6
months follow up.
Discussion: The recovery training was effective in reducing sleep problems, fostering mental
detachment from work and recreational behavior in stressed employees. Results suggest that the online
trainings reach employees that were not attracted by existing occupational health interventions.
0221
What about the Costs. Are Internet Interventions for Stressed Employee's Attractive Measures for
Employer's to Reduce the Costs of Presenteeism and Absenteeism?
1
1
1
4
1
1
3
Dirk Lehr , David Ebert , Stephanie Nobis , Filip Smit , Hanne Thiart , Elena Heber , Matthias Berking ,
2
Heleen Riper
1
2
3
Leuphana University, Lueneburg, Germany, VU University, Amsterdam, The Netherlands, Friedrich4
Alexander-University, Erlangen-Nuremberg, Germany, Trimbos-Instituut, Utrecht, The Netherlands
Stress-related health problems are related to substantial socio-economic costs. Reduced productivity at
the work place due to presenteeism or absenteeism is of importance from an employer's perspective. It
has been argued that internet interventions have the potential to save such costs. Especially employers
are often encouraged to invest in internet interventions as investing in employees' health is assumed to
save cost. However, in the field of Occupational E-Mental Health evidence for such beneficial effects is
rather weak. The aim of the present studies was to investigate the effects of two internet interventions for
stressed employees with regard to the costs of presenteeism and absenteeism and potential savings.
Methods: Presenteeism and absenteeism were assessed in two randomized controlled trials comparing
an intervention and a waiting-list control condition. Interventions: (1) stress-management training for
employees (N=264), (2) online recovery training for employees with increased symptoms of insomnia and
a lack of mental detachment from work (N=128). The costs for presenteeism and absenteeism for the last
3 month were measured at baseline and at 6-months follow-up. We employed the Trimbos/iMTA
questionnaire for costs associated with Psychiatric Illness (TiC-P) to measure direct and indirect costs.
Results: Preliminary analyses indicated that costs due to presenteeism and absenteeism decreased in
intervention and control groups. However, the decrease was larger in both interventions groups.
Depending on the method calculating presenteeism the additional effect was 150-350 Euros per
participant.
Conclusion: From an employer's perspective internet interventions for stressed employees might be a
promising measure save costs related to presenteeism and absenteeism. Furthermore, a full economic
analysis (cost-effectiveness and cost-utility analysis) for the recovery training will be conducted from a
societal perspective will conducted till October and be presented at the conference. Using the incremental
cost-effectiveness ratio (ICER), we will show the differences in the costs and benefits between the two
groups.
0227
A Randomized Controlled Trial of a Guided and Individualized, Web-based, Stress Management
Program for Stressed Managers
1
1
1
2
3
Robert Persson Asplund , Jesper Dagöö , Gerhard Andersson , Per Carlbring , Brjánn Ljótsson
1
2
3
Linköping University, Linköping, Sweden, Stockholm University, Stockholm, Sweden, Karolinska
Institute, Stockholm, Sweden
Occupational-stress is a common health issue and it causes significant problems for many individuals and
rehabilitation of stress is costly to society. Occupational-stress appears to be especially frequent among
low and mid-level managers. Research has shown that web-based behavioral health programs are
effective for treating anxiety, depression and other health related issues. Stress management training has
empirical support, but little data exists on its efficacy with stressed managers when delivered via the
internet. In light of these observations we are currently conducting a randomized controlled trial of a
guided and individualized, web-based, stress management program (iSTRESS) for stressed managers.
Methods: The participants are recruited by self-referral through advertisement in national newspapers
and on the internet. The main inclusion criterion was stress as a primary diagnosis. Participants with
comorbid diagnosis (anxiety, depression, insomnia) were also included as long as the stress diagnosis
was considered primary. We aim to include a total of 100 participants and randomize them into two
groups, iSTRESS or an attention control-group that will discuss stress-related topics in a web-based and
moderated forum. Both programs will last for eight weeks and all participants will received a weekly mail
contact with a psychologist. Participants will be evaluated on self-report measures, for stress (PSS),
burnout, depression, anxiety and insomnia. We will also measure health-economic aspects like
absenteeism.
Results: Analyses will be based on both study completers and intention to treat. Final pre-post
treatment results will be available at the conference. Preliminary result from a previous small sample
pilot trail on the iSTRESS-program showed promising results on measures of stress at postassessment (7 points improvement on Perceived-Stress-Scale, pre=25).
Conclusions: To our knowledge this is the first controlled trail examining the efficacy of a web-based
stress management program for managers. Final pre-post and 3 month follow-up treatment results will be
available for presentation at the ISRII 2014 conference.
0233
Quantifying the Self, the Other and the Community for Depression Treatment
1 ,5
1
2
4
3
1
Heleen Riper , Jeroen Ruwaard , Jan Smit , Pepijn Van der Ven , Gerhard Andersson , Pim Cuijpers
1
2
VU University Amsterdam, Amsterdam, The Netherlands, GGZ inGeest, Amsterdam, The Netherlands,
3
4
5
Linkoping University, Linkoping, Sweden, University of Limerick, Limerick, Ireland, Leuphana University,
Luneburg, Germany
Depressive disorders are of a heterogeneous nature and patients differ substantially with regard to
symptom dimensions, clinical factors and their depression trajectories. These characteristics can be
captured only partly by single time point assessments retrospectively. Assessments of day-to-day and
within-day fluctuations of mood may be essential next steps in the further understanding of depressive
disorders and individual patient needs (‘personalisation’). These insights have been recently revealed by
concepts such as the ‘quantified self’. Mobile health enables this real life time monitoring (Ecological
Momentary Assessment, EMA) and (guided and unguided) intervening (Ecological Momentary
Intervention, EMI) of depression, independent of time (and location of patients or professionals. EMA/EMI
offer thereby a wealth of opportunities to follow the user’s disease or treatment progress over time,
predict treatment outcome or prompt for real time interventions. Monitoring of mood and activities is an
important component of Cognitive Behavioural Therapy (CBT).
Mobile EMA methods enable for
·
monitoring in real time as opposed to retrospective-recall strategies that may be influenced by
memory bias and
·
the monitoring of other variables assessed through incorporated sensors such as GPS, motion
detectors and sounds recordings.
These real-time mobile EMA methods in turn may enrich and enhance the validity of traditional EMA selfreports such as pen and paper diaries.
An example of mobile EMA/EMI approach was developed and evaluated in the European
ICT4Depression project that was funded by the Seventh Framework Programme. In this presentation we
will use the results of this project to explore and discuss a beyond state-of-the-art framework for the
monitoring, prevention and treatment of depression by means of EMA and EMI. Concepts and methods
that enable the capturing of the ‘quantified other’ and the ‘quantified community’ within the context of
depression will be discussed (Riper et al. 2014).
0241
A Technology Enhanced, Community-based, Middle School Healthy Weight Regulation Program:
StayingFit Communities
1
1
3
2
3
1
Myra Altman , Jacqueline Hayes , Madeline Jansen , Jennifer Lesser , Danielle Ryu , Andrea Kass ,
2
3
1
Katherine Taylor , C. Barr Taylor , Denise Wilfley
1
2
Washington University in St. Louis, St. Louis, MO, USA, PGSP-Stanford PsyD Consortium, Palo Alto,
3
CA, USA, Stanford School of Medicine, Stanford, CA, USA
Purpose: School-based interventions for childhood obesity exist; however, they have largely shown no
effect on weight status, possibly due to lack of targeted intervention. Utilizing internet-based interventions
enables an individualized approach that is easily disseminated. The purpose of the present study is to, 1)
evaluate the efficacy of a targeted online intervention –StayingFit- in achieving healthy weight regulation,
and improvements in obesity-related behaviors and psychosocial outcomes in middle school children, and
2) sustainability of these changes through the use of personalized web and mobile application-based
coaching and novel partnerships with a healthcare system. Methods: StayingFit is a 16-week online
healthy lifestyle intervention. Children are assessed and tracked into three separate targeted programs
based on presenting weight status: healthy weight, at-risk for overweight, and overweight. Children who
are obese are referred to in-person treatment with a behavioral health consultant at a collaborating
healthcare system. Upon completing the online program students graduate into StayingFit Communities
and continue to maintain healthy behaviors through personalized online coaching (via social media,
email, and text message) and continued self-monitoring (web and mobile application-based). Results:
542 students were included in the cluster randomized controlled trial (281 intervention group, 261
control). Of the intervention students, 273 (50%) were sorted into the healthy weight group, 54 (10%) to
the at-risk for overweight group, and 215 (40%) to the overweight group. 64 children were screened as
obese and referred for in-person treatment. Students will complete the program in May, 2014 and will
participate in Staying Fit Communities through August, 2014, at which point all data will be available for
analysis and presentation. Conclusions: StayingFit Communities is a novel approach to childhood
obesity prevention and treatment. By combining a targeted internet-based intervention with sustained
contact through web and mobile platforms, we hope to achieve and maintain behavior changes and
health improvements.
0250
Internet-based Interventions in the Public Health System in Spain: Randomized Clinical Trials in
Progress
4
2
3
1
Javier García Campayo , Gonzalo Haro , Julio Domenech , Rosa Baños
1
2
3
University of Valencia, Valencia, Spain, Universitat Jaume I, Castellón de la Plana, Spain, Hospital
4
Arnau de Vilanova de Valencia, Valencia, Spain, Universidad de Zaragoza, Zaragoza, Spain
The Internet-based intervention field is growing all over the world. One of the main objectives of these
interventions is to improve mental health care in public systems, helping to reduce financial costs and
waiting lists, among other issues. The focus of this symposium is to describe the state of this field in
Spain. Several clinical trials that are being carried out in the public mental health system in our country
will be discussed. The Primary Care Prevention and Health Promotion Research Network (RedIAPP) is
configured by several research groups and its mission is to generate knowledge that will benefit primary
care, particularly on the efficacy, effectiveness and efficiency. In this context two multisite randomized
clinical trials are being conducted in four Spanish regions (Baleares, Andalucía, Aragón y Valencia) to
test the efficacy and efficiency of internet-based interventions in the treatment of depression in primary
care. Another clinical trial is being conducted in specialized care (mental health) testing a transdiagnostic
internet-based intervention for the treatment of emotional disorders (anxiety and depression). This trial is
being conducted at Hospital Provincial de Castellón. This field is also progressing in the health
psychology field. Concretely, a randomized controlled trial is being carried out in the rehabilitation
medicine unit at Hospital Arnau de Vilanova (Valencia) testing the efficacy of a blended internet-based
intervention for the psychological treatment of chronic low back pain.
0252
Advances in Augmented Reality for the Treatment of Animal Phobias
1
1
1
1
1
1
J Bretón-López , M. A. Pérez-Ara , M Wrzesien , B Serrano , Rosa Banos , E Del Rio , Cristina Botella
1
2
Universitat Jaume I, Castellón de la Plana, Spain, University of Valencia, Valencia, Spain
1
Introduction
Empirically supported treatments, including in vivo exposure therapy, have shown to be efficacious in
treating specific phobias. However, researchers have yet to assess its overall effectiveness regarding
important aspects such as treatment motivation and adherence. Information and Communication
Technologies (ICTs) such Augmented Reality (AR) have demonstrated their effectiveness for conducting
the exposure technique in phobia treatment. AR is a technology that allows for a digitally enhanced view
of the real world and adds layers of digital information directly on top of items in the world around us. The
main aspect in AR is that the virtual elements add relevant and helpful information to the real scene. The
purpose of this work is to present the main results obtained using different AR systems for the treatment
of animal phobia.
Method
We used two AR systems developed by our group for applying the exposure technique and the Öst
guidelines to perform the one session treatment. The main characteristics of these AR systems and
several studies carried out to test their effectiveness are described. Also, the core results in assessment
periods obtained in these studies are presented.
Results
Results showed that these AR systems were effective at treating animal phobias. The participants
improved significantly in several outcome measures after treatment. Furthermore, the treatment gains
were maintained at follow-up periods. In addition, the systems obtained appropriate results regarding
effectiveness, with a high satisfaction by the participants with the treatment received.
Conclusions
The results show that the virtual animals were capable of activating the participants' anxiety, and that
subsequently this anxiety decreased as the time of exposure progressed. The acceptance of the
participants of these AR systems shows that they can be a relevant alternative in order to reduce the high
percentage of rejections of in vivo exposure technique, and increase the motivation and adherence to the
treatment.
0253
Development of VR-based Software for Binge Eating Behavior Treatment: Preliminary Data
Marta Ferrer-Garcia, Jose Guitierrez-Maldonado
University of Barcelona, Barcelona, Spain
This presentation provides information about the first steps in the development of a virtual reality based
software for binge eating behavior treatment. Binge eating behavior is a key feature of both BN and BED.
Previous studies have proposed that cue-exposure therapy (CET) may be an effective intervention for
bingeing. However, in vivo food exposure conducted in the therapist's office presents logistical problems
and lacks ecological validity. Virtual reality (VR), which allows the displaying of food cues in a contextual
setting, may increase ecological validity and facilitate the availability of proximal and contextual cues.
Therefore, the addition of VR cue-exposure treatment to cognitive-behavioral programs is proposed as an
effective procedure for reducing binge eating episodes in BN and BED patients.
To develop a new intervention program which adds VR-exposure treatment to cognitive-behavioral
therapy the following objectives were proposed: first, to determine which situations and which specific
stimuli provoke craving for food in patients with BN and BED, in order to develop proper VR environments
for CET; second, to assess whether VR environments, which contain the aforementioned stimuli, are able
to provoke psychological and physiological responses similar to those produced in real situations; third, to
check whether repeated exposure to these virtual environments reduces reactivity (food craving) to these
stimuli; four, to adapt VR exposure to a cue-exposure treatment program for BN and BED; and finally, to
verify the effectiveness of the intervention.
To date, studies focused on the first two steps of this research have already been conducted. Information
obtained by means an ad hoc questionnaire developed on the basis of the literature in order to assess the
level of binge craving across different areas related to binge eating was used to develop a VR application
for CET. The software consists of four VR environments (kitchen, dining-room, bedroom, and
bakery/cafe) and 30 different palatable foods which can be combined in order to construct an exposure
hierarchy adapted to the specific needs of each patient. The therapeutic aim of this application is to
extinguish conditioned food craving response and facilitate the generalization of craving extinction.
Preliminary data about the validity of the VR-based application for CET have been obtained. Further
research with a clinical sample is currently being conducted and detailed information regarding the
software and updated data will be presented.
0254
Application of Cue Exposure Treatment through Virtual Reality for Cigarette Craving
1
1
1
Irene Pericot-Valverde , Olaya García-Rodríguez , Roberto Secades-Villa , Jose Guitierrez-Maldonado
1
2
University of Oviedo, Asturias, Spain, University of Barcelona, Barcelona, Spain
2
Introduction.
Cigarette craving is an important factor in the maintenance of smoking behavior and a barrier to quit. Cue
exposure treatment (CET) consists of controlled and repeated exposure to smoking-related cues, in order
to reduce craving responses. Previous studies have shown that exposure through virtual reality (VR)
seems to be a more efficient strategy to present cues than other procedures. The goal of this research
was to determine the effectiveness of a VR-CET for reducing smoking craving.
Method.
This research was carried out in 2 phases. Phase 1: We assessed the validity of 7 virtual environments
with smoking-related cues for producing craving in smokers1. The relation between several individual
variables and craving responses was also analized2. Phase 2: We assessed the effect of systematic cue
exposure through virtual reality on background and cue-induced craving in treatment seeking smokers
and whether participants' characteristics moderated craving reductions3.
Results.
Phase 1 confirmed the validity of the virtual environments to produce craving in smokers. We found that
the sense of presence was the best predictor of craving. Phase 2: VR-CET effectively reduced
background craving and cue-induced craving as a result of prolonged exposure sessions. Examination of
individual differences showed that higher scores in both impulsivity and depressive symptoms leaded to
greater reductions in cigarette craving.
Conclusions.
Our results demonstrate that VR-CET is an effective and feasible intervention to reduce cigarette craving
for treatment-seeking smokers. A combination of CET through VR with psychological treatments may
improve current treatments for smoking cessation.
References.
1. García-Rodríguez, O., Pericot-Valverde, I., Gutiérrez-Maldonado, J., Ferrer-García, M., & SecadesVilla, R. (2012). Validation of smoking-related virtual environments for cue exposure therapy. Addictive
Behaviors, 37(6), 703-708.
2. Ferrer-García, M., García-Rodríguez, O., Pericot-Valverde, I., Yoon, J. H., Secades-Villa, R., &
Gutiérrez-Maldonado, J. (2012). Predictors of smoking craving during Virtual reality exposure. Presence:
Teleoperators and Virtual Environments, 21(4), 423-434.
3. Pericot-Valverde, I., Secades-Villa, R., Gutiérrez-Maldonado, J., & García-Rodríguez, O. (in press).
Effects of systematic cue exposure through virtual reality on cigarette craving. Nicotine & Tobacco
Research.
0256
mHealth for the Management of Chronic Pain in Youth. The Case of Fibroline
Jordi Miró, Rocio de la Vega, Roman Roset
Universitat Rovira i Virgili, Catalonia, Spain
The objectives of our presentation are to: (1) introduce Fibroline, its development and characteristics, and
(2) report on their usability and acceptability properties. Fibroline is an App aimed towards preventing or
reducing pain and other negative common symptoms in fibromyalgia (JFS) and chronic widespread pain
(CWP) in adolescents and young adults. It is a Smartphone self-administered cognitive behavioral
treatment (CBT) protocol.
(1) Purposes and functionality of Fibroline
The treatment is condensed in 9 weeks, and to be administered in full through the Smartphone. The
treatment content: educational material, tasks, etc. is unlocked while the user progresses through the
treatment (i.e, a new activity/information is not available until the previous one has not been fully
finished/attended to). The App itself guides the user through the process. With patient consent, a health
professional will be able to see the patient's performance data.
An important feature of Fibroline is the "Evolution" section: the user will be able to see a chart with his/her
progress on the different domains covered in the treatment package (e.g., pain, sleep, anxiety, etc).
Users will be able to associate their improvements with their performance on the treatment tasks.
(2) Usability and acceptability testing
Usability has been defined as the effectiveness, efficiency and satisfaction with which specific users can
achieve a specific set of tasks in a particular environment. The objectives for Fibroline were to analyze
whether the app was (1) easy to learn, (2) error-free, and (3) liked by the user.
A qualitative usability testing approach with a semi-structured interview has been conducted. The design
is based on the concept of a ‘‘hermeneutical circle'' which is an iterative process of implementing a
design, learning and understanding from discussion and feedback, and making subsequent design
refinements. Results from this process will be provided to attendees to the symposium.
0258
RESTORE: An Online Intervention to Support Self-Management of Cancer-Related Fatigue, an
Exploratory Randomised Controlled Trial
Chloe Grimmett
University of Southampton, Southhampton, UK
Background: One of the most frequently reported and distressing symptoms experienced after cancer
treatment is fatigue. RESTORE is a novel online resource designed to enhance self-efficacy to manage
cancer-related fatigue following primary cancer treatment. The purpose of this exploratory trial was to test
proof of concept and inform the design of an effectiveness trial.
Methods: Informed by the MRC guidance on developing and evaluating complex interventions,
RESTORE was developed in partnership with survivors, Macmillan partners, clinicians and academic
experts. The intervention consists of five weekly sessions with components and activities informed by
self-efficacy theory. Proof of concept was assessed in a multi-centre parallel-group two-armed (1:1)
exploratory randomised controlled trial with qualitative process evaluation. Participants (≥18 years; ≤5
years post treatment for non-metastatic disease; reporting moderate to severe fatigue) were randomly
assigned to RESTORE or a fatigue leaflet. Self-efficacy to manage fatigue was measured at baseline
(T0), 6 (T1) and 12 (T2) weeks. Other measures included: quality of life; depression; and fatigue. Data
were analysed using mixed-effects linear regression and directed content analysis. Trial registration
number ISRCTN67521059.
Results: 163 people participated in the trial and 19 in the process evaluation. The intervention was found
to be feasible, acceptable and established proof of concept. There was a trend for higher fatigue selfefficacy at T1 (p = 0.09) in the intervention group compared with controls. A number of refinements to
RESTORE and the methods used are required before testing the effectiveness of RESTORE in a large
trial.
Conclusion: Findings suggest that RESTORE is feasible and acceptable, and has potential to improve
self-efficacy to self-manage fatigue following primary cancer treatment. On completion of refinements an
effectiveness trial is warranted.
0259
Cognitive Behavioural Intervention Supported by ICTs for Managing Chronic Low Back Pain
Julio Doménech
Universitat Jaume I, Castellón de la Plana, Spain
Psychological treatments have been successful in treating chronic low back pain (CLBP). However, the
effect sizes are still modest and it is important to improve treatment adherence and self-management. A
way to progress in this goal is by using information and communication technologies (ICTs).
Hospital Arnau de Vilanova de Valencia and Labpsitec (Universitat Jaume I, Universidad de Valencia) are
conducting a research project exploring the efficacy and efficiency of a cognitive-behavioral program
(CBT) for CLBP using a blended approach: six weekly face-to face group sessions supported by an
Internet-based protocol for homework and for the follow-up periods.
We developed the internet-based intervention and we are now conducting a randomized controlled trial.
The objective of this trial is to investigate the short- and long-term efficacy of the CBT) for CLBP using or
not ICTs. A secondary objective of this trial is to evaluate the influence of relevant variables on treatment
response. Possible barriers in the implementation of CBT with and without ICT will also be investigated.
One hundred and eighty CLBP participants from specialized care will be randomly assigned to three
conditions: Control group (CG), CBT, and CBT supported by ICTs (CBT + ICT). Participants belonging to
the three conditions will receive a conventional rehabilitation program (back school). The CBT group
program will last six sessions. The CBT + ICT group will use the internet to practice the therapeutic
strategies between sessions and in the follow-ups at their homes. Primary outcome variables will be selfreported disability and pain intensity. Assessment will be carried out in five moments: pretreatment, posttreatment and 3-, 6-, and 12-month follow-ups. The influence of catastrophizing, fear-avoidance beliefs,
anxiety and depression in response to treatment in the primary outcomes will also be analysed. This
study will show data of the possible benefits of using ICTs in the improvement of CBT for treating CLBP in
a public setting
0260
A Transdiagnostic Online Program for the Treatment of Emotional Disorders
Gonzalo Haro
University of Valencia, Valencia, Spain
Emotional disorders (anxiety disorders and depression) are the most prevalent mental disorders with
lifetime prevalence of atojn 29% and with high rates of comorbidity (Kessler et al., 2005). If not suitably
treated, they have a chronic evolution producing a high impairment in important life areas like work and
social life. Although we have cognitive-behavioral (CBT) evidence-based treatments for these disorders,
there is still some barriers regarding dissemination and implementation that makes difficult for patients to
receive such treatments.
New perspectives in psychological treatments are trying to overcome these barriers. One is the
transdiagnostic approach that offers intervention protocols that can be used for a wide variety of
emotional disorders. Another approach is the use of ICT like internet-based interventions to reach a wider
number of people who could benefit for CBT.
Hospital Provincial de Castellón and Labpsitec (Universitat Jaume I and Universidad de Valencia) are
conducting a joint project with the aim of developing and testing an internet-based protocol for the
treatment of emotional disorders in specialized care.
The research team has developed the transdiagnostic Internet-based intervention and we are now testing
its efficacy and effectiveness in a randomized controlled trial.
One hundred and forty patients meeting DSM-5 criteria for a emotional disorder will be randomly
assigned to one of three conditions: Internet-based transdiagnostic intervention, treatment as usual
(psychological treatment delivered at the mental health unit) and waiting list.
This study will show data of the possible benefits of using ICTs to deliver a transdiagnostic CBT
intervention for treating emotional disorders in a specialized public care setting.
0263
A Panel Discussion on Dissemination and Commercialization of eHealth/Internet Interventions
1
2
3
4
5
6 ,7
Kevin Patrick , Jain Praduman , George Reynolds , Mark Willems , Simon Wilson , Lee Ritterband
1
2
3
UCSD, San Diego, CA, USA, Vignet, Fairfax, VA, USA, Health Decision Technologies, Oakland, CA,
4
5
6
USA, MindDistrict, Amsterdam, The Netherlands, Big White Wall, London, UK, University of Virginia,
7
Charlottesville, VA, USA, BeHealth Solutions, Charlottesville, VA, USA
Few would argue that there is compelling evidence for the feasibility and efficacy of Internet interventions
generally. Studies continue to be conducted further establishing the science of eHealth programs in a
growing number of areas, populations, and intervention types. Deconstruction studies are now being
conducted to understand the active ingredients of these programs allowing for greater refinement and
even better outcomes. However, a major problem has emerged - how to make empirically validated
interventions available once the research funding ends. Dissemination of effective eHealth programs is
the next major undertaking in the field. Without dissemination, the research that has been conducted is
meaningless. But moving interventions into the ‘real world' is not straight-forward and there are enormous
hurdles to overcome in doing so. These hurdles vary given a number of issues including the type of
intervention, diverse laws and differing levels of government involvement and support across countries,
and people's willingness and interest of adoption. One particularly sensitive topic that many researchers
and academics have struggled with is the idea of commercialization. Attitudes surrounding this issue
appear to be shifting with a greater appreciation and, perhaps, acceptance that this may be one of the
more viable paths for disseminating. However, with commercialization, additional concerns emerge which
must be addressed, including issues of ethics, data integrity, biases, and conflicts of interest.
This panel will focus on many of the key issues in disseminating Internet interventions, particularly
through commercialization. The panelists for this session have all been working to disseminate eHealth
programs and will share many of their lessons learned. There will also be an opportunity for questions
from the audience to be raised and discussed. Panelists include Mark Willems, CEO of minddistrict
(www.mindistrict.com); Jain Praduman "PJ", CEO of Vignet (www.vignetcorp.com); George Reynolds,
President and CEO of Health Decision Technologies (www.healthdecisiontechnologies.com); Simon
Wilson, Clinical Director at Big White Wall (www.bigwhitewall.com); and Kevin Patrick, Professor at
University of California at San Diego and co-founder of Santech (www.santechhealth.com). The session
will be chaired by Lee Ritterband, Professor at University of Virginia and co-founder of BeHealth Solutions
(www.behealthsolutions.com).
0173
Fostering Widespread Up Take of ehealth Components in Services for Mental Health and
Wellbeing: Discussion of Key Requirements, Challenges and Solutions
1
2
3
4
1
David Kavanagh , Judy Proudfoot , Gerhard Andersson , Nick Titov , Angela White
1
2
Queensland University of Technology, Brisbane, Queensland, Australia, Black Dog Institute, Sydney,
3
4
New South Wales, Australia, Linköping University, Linköping, Sweden, Macquarie University, Sydney,
New South Wales, Australia
PURPOSE: Deepen the appreciation of factors that promote routine use of ehealth in services for mental
health and wellbeing
E-mental health programs and services have now been used by large numbers of people, and
effectiveness studies show effect sizes that are substantial and comparable to those from efficacy
trials. However, acceptance and use by practitioners and the general community remain sub-optimal in
many instances. Examples of successful service integration and research on dissemination of other
innovations may identify critical elements for effective translation to routine care.
Panel members briefly summarise results of their effectiveness studies, of national roll-out of an online
clinic (MindSpot), and use of Internet-based CBT in standard clinical services in Sweden. Preliminary
research on Australia-wide integration into general practices, private Psychology services and remote
Indigenous settings from the e-Mental Health in Practice project is also described.
Panel discussion examines features of programs, IT resourcing, service policies and procedures,
marketing, training and supervision which promote uptake, and ways these features may be enhanced. It
explores challenges that have been encountered with budgets and funding models, hardware,
connectivity and culturally diverse contexts, and discusses potential solutions.
Throughout the discussion, reference is made to available research and to gaps in existing knowledge.
Members engage with the audience and co-panellists to identify innovative strategies to optimise reach
and personal impact in differing national and social contexts, through seamless integration with existing
and emerging services.

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