university of jyvÄskylÄ developing act-based web treatment for depression päivi lappalainen, anna...
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UNIVERSITY OF JYVÄSKYLÄ
Developing ACT-based Web Treatment for Depression
Päivi Lappalainen, Anna Granlund, Sari Siltanen,
Raimo Lappalainen
Department of Psychology
University of Jyväskylä, Finland
UNIVERSITY OF JYVÄSKYLÄ
Introduction
Depression is common, affecting about 121 million people worldwide
Depression is among the leading causes of disability worldwide.
Fewer than 25 % of those affected have access to effective treatments
There is a need to develop alternative approaches to help clients with depression.
UNIVERSITY OF JYVÄSKYLÄ
We developed a web-based treatment program (6 weeks) for clients experiencing depressive symptoms, and compared it to a 6 week face-to-face ACT-based treatment
Preliminary results: 6 months follow-up in October 2011
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The web-based treatment program
included 1 face-to-face session at the beginning (measurements) and weekly contact with the therapist (feedback on homework), approx. 40 (20-90 min).
consisted of 6 modules (one module per week), mostly text (information, exercises, homework) pictures and a few taped exercises
Each module included homework each week which the clients completed and placed in their own folder in the treatment platform
The modules were based on the core processes of ACT: Values, value-based actions, acceptance, cognitive fusion, contact with the present moment and self-as-context
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Criteria for eligibility Depression: 3 questions about depression (scale 0-10):
1) Have you experienced depressed mood most of the day, nearly every day (e.g., feels sad or irritable) without knowing why
2) Have you had periods with markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day
3) Have you had periods of several days, when you have felt so depressed that nothing can make you feel better
No simultaneous attendance in another treatment Basic computer skills and access to the Internet
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Procedure
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Research questions
Is a (mainly) web-based short intervention as efficient as a face-to-face treatment when treating mood disorders?
Do the clients accept a web-based short treatment?
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Method
We had an advertisement in the local newspaper in February 2011 seeking clients experiencing depressive symptoms
60 persons contacted the clinic and were interviewed in the telephone
38 participants were randomized to either a 6 week face-to-face or a 6 week Internet based ACT-treatment program
The treatment was delivered by 18 psychology students with no previous experience of ACT
Each student therapist had one face-to-face and one net client
UNIVERSITY OF JYVÄSKYLÄParticipant Characteristics:
Face-to-Face (n=19) Internet (n=19)
Sex Female Male
13 (68.4 %)6 (31.6 %)
13 (68.4 %)6 (31.6 %)
Age (M, SD) 46.95 (12.26) 42.26 (16.04)
Education 9 years 12 years University
1 (5.3 %)9 (47.4 %)9 (47.4 %)
3 (15.8 %)7 (36.8 %)9 (47.4 %)
Working/studying Yes No
8 (42.1 %)11 (57.9 %9
9 (47.4 %)10 (52.6 %)
Diagnosis Yes No Other than depression
8 (42.1 %)10 (52.6 %)1 (5.3 %)
10 (52.6 %)8 (42.1 %)1 (5.3 %)
Depression medication Yes No
6 (31.6 %)13 (68.4 %)
7 (36.8 %)12 (63.2 %)
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Time used in the web treatment program
30 min-1 hour/week 36.8 % (7 clients)
1-2 hours/week 42,1 % (8 clients)
2-3 hours/week 5.1 % (1 client)
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Results
BDI IIDepression
SCL-90Symptom Checklist
GHQGeneral Health Q
Life Satisfaction
Face-to-Face (n=18)PrePost
23.39.2
1.050.64
19.410.2
45.456.6
Internet (n= 19)PrePost
20.710.3
1.110.58
22.411.4
39.1*63.4
General self evaluated life satisfaction increased more in the internet group (significant interaction effect) On other variables: Similar changes during the time in both treatments
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ResultsAAQ-II KIMS
MindfulnessATQAutomatic Thoughts:How often?
ATQAutomatic Thoughts: How much believe?
WBSIThought Suppression
Face-to-Face (n=18)PrePost
38.548.9
120.8125.9
77.456.9
75.761.7
47.446.9
Internet (n= 19)PrePost
41.247.5
120.0126.0
74.053.6
68.649.8
49.843.2
Significant changes during the treatment in both groupsExcept for Internet group in KIMS (p = 0.09)
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Subjective Client Experiences
Face-to-face (n=18) Internet (n=19)
Satisfaction 8.8 (max 10) 8.4 (max 10)
Change in well-being 7.7 (max 10) 7.5 (max 10)
Better mood 13 (72.2 %) 15 (78.9%)
Less Anxiety 7 (38.9 %) 9 (47.4%)
More energy 6 (33.3 %) 6 (31.6%)
Less stress 3 (16.7 %) 6 (31.6%)
Increased physical activity (exercise)
2 (11.1%) 7 (36.8%)
Better health 2 (11.1%) 1 (5.3%)
Has learned new skills 12 (66.7%) 13 (68.4%)
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Experiences
Face-to-face (n=18) Internet (n=19)
Ideal lenght of treatment 19.3 weeks 9 weeks
I would recommend this kind of treatment
9.06 8.16
I need more help 5.89 4.84
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Conclusions
A 6 week Internet-based ACT treatment including 1 (face-to-face) session was as effective as a face-to-face treatment
The student delivered ACT-based Internet treatment was well accepted by the clients
There were some indications that after a brief ACT-intervention, the ideal lenght of the treatment was reported to be shorter in the Internet group
Our study supports the idea that the Internet-based ACT treatment is well suited for training psychologists