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Robinson E.,Clinical Research Unit for Anxiety and Depression
PloS one | Year: 2010

Internet-based cognitive behavioural therapy (iCBT) for generalized anxiety disorder (GAD) has been shown to be effective when guided by a clinician. The present study sought to replicate this finding, and determine whether support from a technician is as effective as guidance from a clinician. Randomized controlled non-inferiority trial comparing three groups: Clinician-assisted vs. technician-assisted vs. delayed treatment. Community-based volunteers applied to the VirtualClinic (www.virtualclinic.org.au) research program and 150 participants with GAD were randomized. Participants in the clinician- and technician-assisted groups received access to an iCBT program for GAD comprising six online lessons, weekly homework assignments, and weekly supportive contact over a treatment period of 10 weeks. Participants in the clinician-assisted group also received access to a moderated online discussion forum. The main outcome measures were the Penn State Worry Questionnaire (PSWQ) and the Generalized Anxiety Disorder-7 Item (GAD-7). Completion rates were high, and both treatment groups reduced scores on the PSWQ (p<0.001) and GAD-7 (p<0.001) compared to the delayed treatment group, but did not differ from each other. Within group effect sizes on the PSWQ were 1.16 and 1.07 for the clinician- and technician-assisted groups, respectively, and on the GAD-7 were 1.55 and 1.73, respectively. At 3 month follow-up participants in both treatment groups had sustained the gains made at post-treatment. Participants in the clinician-assisted group had made further gains on the PSWQ. Approximately 81 minutes of clinician time and 75 minutes of technician time were required per participant during the 10 week treatment program. Both clinician- and technician-assisted treatment resulted in large effect sizes and clinically significant improvements comparable to those associated with face-to-face treatment, while a delayed treatment/control group did not improve. These results provide support for large scale trials to determine the clinical effectiveness and acceptability of technician-assisted iCBT programs for GAD. This form of treatment has potential to increase the capacity of existing mental health services. Australian New Zealand Clinical Trials Registry ACTRN12609000563268. Source

Large M.M.,University of New South Wales | Nielssen O.B.,University of New South Wales | Nielssen O.B.,Clinical Research Unit for Anxiety and Depression
Medical Journal of Australia | Year: 2010

Objective: To examine the changes in rates of methods of suicide in Australian states and territories between 1988 and 2007. Design and setting: Meta-analysis of suicide mortality rates and suicide methods (hanging, shooting, gassing, poisoning, jumping from a height, drowning, use of a sharp implement) for males and females in Australian states and territories in the decades 1988-1997 and 1998-2007. Main outcome measures: Changes in use of suicide methods from 1988 to 2007; changes in the overall suicide rates and in rates for each method of suicide in Australian states and territories between 1988-1997 and 1998-2007. Results: There was a decline in rates of shooting, gassing, poisoning and drowning in males and a decline in shooting, gassing, jumping from a heiight and drowning among females, but an increase in hanging by both males and females in the decade 1998-2007 when the compared to 1988-1997. There was significant variation in the rates of and trends in methods of suicide between the states and territories of Australia between 1988-1997 and 1998-2007. Conclusions: The decline in rates of suicide in most parts of Australia coincides with a reduction in the availability of lethal methods. Consideration should be given to further measures to limit the availability of lethal methods of suicide. Source

Andrews G.,Clinical Research Unit for Anxiety and Depression | Andrews G.,University of New South Wales
British Journal of Psychiatry | Year: 2010

A recent study found that people with depression identified In the community recovered equally well given unsupported computerised cognitive-behavioural therapy (CBT), general practitioner treatment or a combination of the two, even If they did not comply. The results are different from those reported elsewhere. Could natural remission explain the finding? Source

McEvoy P.M.,Center for Clinical Interventions | McEvoy P.M.,University of Western Australia | Mahoney A.E.J.,Clinical Research Unit for Anxiety and Depression | Moulds M.L.,University of New South Wales
Journal of Anxiety Disorders | Year: 2010

Accumulating evidence suggests that repetitive negative thinking (RNT) is a transdiagnostic phenomenon. However, various forms of RNT such as worry, rumination, and post-event processing have been assessed using separate measures and have almost exclusively been examined within the anxiety, depression, and social phobia literatures, respectively. A single transdiagnostic measure of RNT would facilitate the identification of transdiagnostic maintaining factors of RNT, and would be more efficient than administering separate measures for each disorder. Items from three existing measures of RNT were modified to remove diagnosis-specific content and administered to a sample of undergraduate students (N=284). Exploratory factor analysis yielded two factors labeled Repetitive Negative Thinking and Absence of Repetitive Thinking (ART). The RNT scale demonstrated high internal reliability and was associated with anxiety, depression, anger, shame, and general distress. Moreover, the RNT scale was associated with constructs that are theoretically related to engagement in RNT, including positive and negative metacognitions, cognitive avoidance, thought suppression, and thought control strategies. The ART scale had little predictive utility. Theoretical and clinical implications are discussed. © 2010 Elsevier Ltd. Source

Wims E.,Clinical Research Unit for Anxiety and Depression | Titov N.,University of New South Wales | Andrews G.,University of New South Wales | Choi I.,University of New South Wales
Australian and New Zealand Journal of Psychiatry | Year: 2010

Objective: To determine the efficacy of an Internet-based clinician-assisted cognitive behavioural treatment program (the Panic program) for panic disorder (with or without agoraphobia). Method: Fifty-nine individuals meeting diagnostic criteria for panic disorder with agoraphobia were randomly assigned to a treatment group or to a waitlist control group. Treatment group participants completed the Panic program, comprising six on-line lessons, weekly homework assignments, received weekly email contact from a psychiatry registrar, and contributed to a moderated online discussion forum with other participants. An intention-to-treat model was used for data analyses. Results: Twenty-three (79%) of treatment group participants completed all lessons within the 8-week program, and post-treatment data were collected from 22/29 treatment group and 22/25 waitlist group participants. Compared to the control group, treatment group participants reported significantly reduced symptoms of panic as measured by the Panic Disorder Severity Scale, Body Sensation Questionnaire, and Agoraphobic Cognitions Questionnaires. Significant reductions were also reported on measures of disability and depression. The mean within- and between-group effect size (Cohen's d) on the Panic Disorder Severity Scale was 0.93 and 0.59, respectively, and effects were sustained at 1-month follow-up. Mean therapist time per participant was 75 minutes for the program. Conclusions: These results replicate those from the open trial of the Panic Program indicating the efficacy of the Internet-based clinician-assisted cognitive behavioural treatment program for panic disorder with agoraphobia. © 2010 The Royal Australian and New Zealand College of Psychiatrists. Source

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