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Remote delivery of psychological interventions: Impact and acceptability of preventive strategies to improve risk factors associated with coronary heart disease
Uppsala universitet, Humanistisk-samhällsvetenskapliga vetenskapsområdet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
2018 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Abstract [en]

Depression, anxiety and excessive weight are public health concerns that have been associated with an increased risk and worse prognosis of coronary heart disease. Remote delivery of psychological interventions may be an effective preventive strategy to improve these lifestyle-related risk factors as treatment may be delivered to many people at a low cost and reduce stigma related to seeking help. The general contribution of this thesis is to investigate the impact and indicators of treatment acceptability in contexts where this type of delivery may improve access to psychological interventions. The aim of Study I was to investigate whether stigma predicts the intention to seek help via the Internet compared to face to face among undergraduate students (N=267) and primary care patients (N=195). The results indicate that Internet-based interventions may improve intentions to seek help among individuals who are reluctant to seek psychological treatment face to face due to stigma. In Study II, the effect of a guided Internet-based Cognitive Behavior Therapy (iCBT) and Treatment-As-Usual (TAU) was compared to TAU only to reduce symptoms of depression and anxiety among patients with a recent myocardial infarction (N=239) in a randomized controlled trial. The results indicate no difference in symptoms of depression and anxiety between the groups. Study III describe treatment activity among participants allocated to the iCBT intervention in Study II (N=117). Furthermore, user experiences were explored using a semi-structured interview with 21 of these participants. The results indicate overall low treatment activity and different preferences regarding the web-based portal, treatment program and therapist communication. The aim of Study IV was to evaluate the impact and investigate indicators of treatment acceptability of a guided Acceptance and Commitment Therapy (ACT) self-help intervention to improve value attainment related to health and reduce experiential avoidance among individuals with overweight or obesity using a multiple baseline design (N=13). The results indicate that theACT intervention may be an acceptable intervention to improve value attainment related to health and decrease experiential avoidance. In conclusion, the studies in this thesis illustrate several challenges related to the willingness to seek and engage in Internet-based interventions. Furthermore, the results indicate varying responses to the remote delivery of ACT. The principal findings are discussed in relation to methodological limitations. Possible strategies to improve the take-up rates, adherence and treatment satisfaction are suggested as well as areas of future research.

Ort, förlag, år, upplaga, sidor
Uppsala: Acta Universitatis Upsaliensis, 2018. , s. 75
Serie
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Social Sciences, ISSN 1652-9030 ; 156
Nyckelord [en]
Depression, anxiety, overweight, obesity, technology-assisted interventions, Cognitive Behavioral Therapy, Acceptance and Commitment Therapy
Nationell ämneskategori
Samhällsvetenskap
Forskningsämne
Psykologi
Identifikatorer
URN: urn:nbn:se:uu:diva-354028ISBN: 978-91-513-0373-4 (tryckt)OAI: oai:DiVA.org:uu-354028DiVA, id: diva2:1220322
Disputation
2018-09-14, Blåsenhus, Betty Pettersson-salen (14:031), Campus Blåsenhus, von Kreamers allé 1A och 1C, Uppsala, 09:15 (Svenska)
Opponent
Handledare
Tillgänglig från: 2018-08-22 Skapad: 2018-06-18 Senast uppdaterad: 2018-08-28
Delarbeten
1. Self-stigma and the intention to seek psychological help online compared to face-to-face
Öppna denna publikation i ny flik eller fönster >>Self-stigma and the intention to seek psychological help online compared to face-to-face
2018 (Engelska)Ingår i: Journal of Clinical Psychology, ISSN 0021-9762, E-ISSN 1097-4679, Vol. 74, nr 7, s. 1207-1218Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Objectives: The present study aims to investigate the impact of helpseeking self-stigma on the preference and intention to seek psychologicaltreatment delivered online compared to face-to-face.

Design: This study uses survey data from two Swedish samples.Sample 1 consists of 267 students (78.7% women) with a mean ageof 24.5 (SD = 6.1). Sample 2 consists of 195 primary care patients(56.9% women) with a mean age of 45.3 (SD = 17.7).

Results: The number of participants who preferred online treatmentwas higher if seeking psychological help for a perceived stigmatized problem compared to mental health problems in general. The oddsratios for choosing treatment online over face-to-face were 6.41,95% CI [4.05, 10.14] in Sample 1 and 11.19, 95% CI [5.29, 23.67]in Sample 2. In addition, findings suggest that higher levels of helpseeking self-stigma predicted higher intention to seek treatmentonline compared to face-to-face.

Conclusions: Our results suggest that online interventions may facilitatehelp-seeking among individuals deterred by stigma.

Nyckelord
E-mental health, help-seeking, Internet based intentions, mental health services, online therapy
Nationell ämneskategori
Psykologi
Identifikatorer
urn:nbn:se:uu:diva-343472 (URN)10.1002/jclp.22583 (DOI)000435275800010 ()29315545 (PubMedID)
Tillgänglig från: 2018-02-27 Skapad: 2018-02-27 Senast uppdaterad: 2018-08-29Bibliografiskt granskad
2. Internet-based Cognitive Behavior Therapy for Symptoms of Depression and Anxiety among Patients with a Recent Myocardial Infarction: The U-CARE Heart Randomized Trial
Öppna denna publikation i ny flik eller fönster >>Internet-based Cognitive Behavior Therapy for Symptoms of Depression and Anxiety among Patients with a Recent Myocardial Infarction: The U-CARE Heart Randomized Trial
Visa övriga...
2018 (Engelska)Ingår i: Journal of Medical Internet Research, ISSN 1438-8871, E-ISSN 1438-8871, Vol. 20, nr 3, artikel-id e88Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Background: Symptoms of depression and anxiety are common after a myocardial infarction (MI). Internet-based cognitivebehavioral therapy (iCBT) has shown good results in other patient groups.

Objective: The aim of this study was to evaluate the effectiveness of an iCBT treatment to reduce self-reported symptoms ofdepression and anxiety among patients with a recent MI.

Methods: In total, 3928 patients were screened for eligibility in 25 Swedish hospitals. Of these, 239 patients (33.5%, 80/239women, mean age 60 years) with a recent MI and symptoms of depression or anxiety were randomly allocated to a therapist-guided,14-week iCBT treatment (n=117), or treatment as usual (TAU; n=122). The iCBT treatment was designed for post-MI patients.The primary outcome was the total score of the Hospital Anxiety and Depression Scale (HADS) 14 weeks post baseline, assessedover the internet. Treatment effect was evaluated according to the intention-to-treat principle, with multiple imputations. For themain analysis, a pooled treatment effect was estimated, controlling for age, sex, and baseline HADS.

Results: There was a reduction in HADS scores over time in the total study sample (mean delta=−5.1, P<.001) but no differencebetween the study groups at follow-up (beta=−0.47, 95% CI −1.95 to 1.00, P=.53). Treatment adherence was low. A total of46.2% (54/117) of the iCBT group did not complete the introductory module.

Conclusions: iCBT treatment for an MI population did not result in lower levels of symptoms of depression or anxiety comparedwith TAU. Low treatment adherence might have influenced the result.

Trial Registration: ClinicalTrials.gov NCT01504191; https://clinicaltrials.gov/ct2/show/NCT01504191 (Archived at Webciteat http://www.webcitation.org/6xWWSEQ22)

Nationell ämneskategori
Psykologi Kardiologi
Forskningsämne
Medicinsk vetenskap
Identifikatorer
urn:nbn:se:uu:diva-336209 (URN)10.2196/jmir.9710 (DOI)000428245500002 ()25873137 (PubMedID)
Forskningsfinansiär
Vetenskapsrådet, dnr 2009-1093Hjärt-Lungfonden, dnr E 148/11Forte, Forskningsrådet för hälsa, arbetsliv och välfärd, dnr 2014-4947Vårdalstiftelsen, dnr 2014-0114
Tillgänglig från: 2017-12-13 Skapad: 2017-12-13 Senast uppdaterad: 2018-07-24Bibliografiskt granskad
3. Treatment Activity, User Satisfaction, and Experienced Usability of Internet-Based Cognitive Behavioral Therapy for Adults With Depression and Anxiety After a Myocardial Infarction: Mixed-Methods Study
Öppna denna publikation i ny flik eller fönster >>Treatment Activity, User Satisfaction, and Experienced Usability of Internet-Based Cognitive Behavioral Therapy for Adults With Depression and Anxiety After a Myocardial Infarction: Mixed-Methods Study
Visa övriga...
2018 (Engelska)Ingår i: Journal of Medical Internet Research, ISSN 1438-8871, E-ISSN 1438-8871, Vol. 20, nr 3, artikel-id e87Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

BACKGROUND:

Knowledge about user experiences may lead to insights about how to improve treatment activity in Internet-based cognitive behavioral therapy (iCBT) to reduce symptoms of depression and anxiety among people with a somatic disease. There is a need for studies conducted alongside randomized trials, to explore treatment activity and user experiences related to such interventions, especially among people with older age who are recruited in routine care.

OBJECTIVE:

The aim of the study was to explore treatment activity, user satisfaction, and usability experiences among patients allocated to treatment in the U-CARE Heart study, a randomized clinical trial of an iCBT intervention for treatment of depression and anxiety following a recent myocardial infarction.

METHODS:

This was a mixed methods study where quantitative and qualitative approaches were used. Patients were recruited consecutively from 25 cardiac clinics in Sweden. The study included 117 patients allocated to 14 weeks of an iCBT intervention in the U-CARE Heart study. Quantitative data about treatment activity and therapist communication were collected through logged user patterns, which were analyzed with descriptive statistics. Qualitative data with regard to positive and negative experiences, and suggestions for improvements concerning the intervention, were collected through semistructured interviews with 21 patients in the treatment arm after follow-up. The interviews were analyzed with qualitative manifest content analysis.

RESULTS:

Treatment activity was low with regard to number of completed modules (mean 0.76, SD 0.93, range 0-5) and completed assignments (mean 3.09, SD 4.05, range 0-29). Most of the participants initiated the introduction module (113/117, 96.6%), and about half (63/117, 53.9%) of all participants completed the introductory module, but only 18 (15.4%, 18/117) continued to work with any of the remaining 10 modules, and each of the remaining modules was completed by 7 or less of the participants. On average, patients sent less than 2 internal messages to their therapist during the intervention (mean 1.42, SD 2.56, range 0-16). Interviews revealed different preferences with regard to the internet-based portal, the content of the treatment program, and the therapist communication. Aspects related to the personal situation and required skills included unpleasant emotions evoked by the intervention, lack of time, and technical difficulties.

CONCLUSIONS:

Patients with a recent myocardial infarction and symptoms of depression and anxiety showed low treatment activity in this guided iCBT intervention with regard to completed modules, completed assignments, and internal messages sent to their therapist. The findings call attention to the need for researchers to carefully consider the preferences, personal situation, and technical skills of the end users during the development of these interventions. The study indicates several challenges that need to be addressed to improve treatment activity, user satisfaction, and usability in internet-based interventions in this population.

Nyckelord
adherence; attrition; cognitive behavioral therapy; computer-assisted therapy; internet; mental health; myocardial infarction
Nationell ämneskategori
Psykologi Kardiologi
Identifikatorer
urn:nbn:se:uu:diva-347341 (URN)10.2196/jmir.9690 (DOI)000428245500001 ()29549067 (PubMedID)
Forskningsfinansiär
Vetenskapsrådet, dnr 2009-1093Hjärt-LungfondenForte, Forskningsrådet för hälsa, arbetsliv och välfärd, dnr 2014-4947Vårdalstiftelsen, dnr 2014-0114
Tillgänglig från: 2018-03-29 Skapad: 2018-03-29 Senast uppdaterad: 2018-07-23Bibliografiskt granskad
4. Acceptance and Commitment Therapy to Promote Value Attainment Among Individuals with Overweight: a Multiple Baseline Evaluation
Öppna denna publikation i ny flik eller fönster >>Acceptance and Commitment Therapy to Promote Value Attainment Among Individuals with Overweight: a Multiple Baseline Evaluation
(Engelska)Ingår i: Journal of Contextual Behavioral Science, ISSN 2212-1447Artikel i tidskrift (Refereegranskat) Submitted
Nationell ämneskategori
Samhällsvetenskap
Forskningsämne
Psykologi
Identifikatorer
urn:nbn:se:uu:diva-354027 (URN)
Tillgänglig från: 2018-06-18 Skapad: 2018-06-18 Senast uppdaterad: 2018-06-18

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