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Titov N.,University of New South Wales | Titov N.,Clinical Research Unit for Anxiety and Depression CRUfAD
Current Opinion in Psychiatry | Year: 2011

Purpose of Review: The rapidly growing number of published research papers attests to the increasing interest in Internet-delivered psychotherapy (iPT). The present article reviews the current status of iPT for the treatment of adults with symptoms of depression. Recent Findings: Randomized controlled trials have confirmed the efficacy of guided iPT in treating people with diagnosed or elevated symptoms of depression with equivalent results obtained by programs based on cognitive behavioural or problem solving models. With guidance, effect sizes are comparable to those obtained in face-to-face psychotherapy and low-intensity interventions are as effective as those with higher levels of therapist contact. On current evidence, entirely self-guided programs appear to have fewer benefits, but deliver tangible benefits to completers. Summary: Recent studies indicate the utility of iPT. Large-scale trials are needed to evaluate optimal strategies for disseminating iPT. Future studies should independently replicate findings and efforts are required to educate patients and health professionals about iPT. © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. Source

Anderson T.M.,University of New South Wales | Anderson T.M.,Clinical Research Unit for Anxiety and Depression CRUfAD | Knight R.G.,University of Otago
Journal of Clinical and Experimental Neuropsychology | Year: 2010

The objective of this study was to compare the coordinative function of the central executive of working memory in matched groups of controls and persons with traumatic brain injury (TBI) with long-term impairments in functioning, using a dual-task paradigm. The dual-task procedure required participants to complete digit span and tracing tasks separately and then together to produce a change index that reflects loss of productivity on the dual trial. A TBI group and a matched group of controls were compared on this task and on ratings of social competency and neuropsychological tests. The two groups were found to differ in social competence, in the number of dysexecutive symptoms, and on dual-task performance, but not on any other measures of cognitive ability. Poor performance on the dual task was found only in persons with initial very severe TBI. There was no evidence that the group difference on the dual task was the consequence of increased task difficulty level, distribution of attention, or other within-task biases. Performance on the dual task was correlated with dysexecutive symptoms and social competency (in particular interpersonal and cognitive competence), but not with other tests of executive functioning. The findings suggest that deficits in the coordinative function persist in long-term survivors of TBI after other deficits in executive functioning may have resolved and are associated with lower ratings of current interpersonal competence. © 2010 Psyhology Press, an imprint of the Taylor & Francis Group, an Informa business. Source

Andrews G.,University of New South Wales | Williams A.D.,Clinical Research Unit for Anxiety and Depression CRUfAD
Clinical Psychology Review | Year: 2015

Depression is a global health problem but only a minority of people with depression receive even minimally adequate treatment. Internet delivered automated cognitive behaviour therapy (iCBT) which is easily distributed and in which fidelity is guaranteed could be one solution to the problem of increasing coverage. In this review of iCBT for Major Depressive Disorder in adults, we address the concerns of clinicians in utilizing this technology by reviewing the research evidence with reference to efficacy and effectiveness and presenting a model for dissemination and uptake of iCBT into practice. This review includes studies of participants who would meet criteria for major depressive disorder who were supported as they learnt and implemented changes in thoughts, emotions and behaviours by using cognitive behaviour principles. We conclude that this form of treatment is effective and acceptable to both patients and clinicians. © 2014 Elsevier Ltd. Source

Mewton L.,University of New South Wales | Mewton L.,Clinical Research Unit for Anxiety and Depression CRUfAD | Andrews G.,University of New South Wales | Andrews G.,Clinical Research Unit for Anxiety and Depression CRUfAD
Journal of Affective Disorders | Year: 2014

Background Depression is a major risk factor for suicide. Given the strong association between depression and suicide, treatment for depression should be a fundamental component of suicide prevention. Currently it is not. This study aims to demonstrate the usefulness of internet-delivered cognitive behavioural therapy (iCBT) for depression as a means of reducing suicide ideation.Methods: The sample comprised 484 patients who were prescribed iCBT for depression by their primary care physician. The outcomes of interest were major depression, as indexed by the PHQ-8, and suicidal ideation as measured by question 9 of the PHQ-9. Marginal models were used to appropriately analyse available data without biasing parameter estimates.Results: Following iCBT for depression, suicidal ideation and depression decreased in parallel over time. The prevalence of suicidal ideation reduced from 50% at baseline to 27% after treatment, whilst the prevalence of major depression reduced from 70% to 30%. Depression scores and suicidal ideation decreased after treatment regardless of demographic or clinical variables of interest. Limitations This is a naturalistic study; randomisation and scientific control were not possible.Conclusions: The current study demonstrates the usefulness of iCBT for depression as a means of reducing suicidal ideation which can be implemented on a large scale without enacting major structural change at the societal level. These findings need to be replicated in randomised controlled trials. © 2014 Elsevier B.V. All rights reserved. Source

Mewton L.,University of New South Wales | Wong N.,Clinical Research Unit for Anxiety and Depression CRUfAD | Andrews G.,University of New South Wales | Andrews G.,Clinical Research Unit for Anxiety and Depression CRUfAD
Depression and Anxiety | Year: 2012

Background Clinical trials have demonstrated the efficacy of internet cognitive behavioral therapy (iCBT) in the treatment of generalized anxiety disorder (GAD). The current study aims to determine whether these efficacy findings, established under controlled research conditions, translate into effectiveness in practice. Methods The sample comprised 588 patients who completed at least one iCBT lesson for GAD through CRUfAD clinic (www.crufadclinic.org). This six-lesson course became available to primary care physicians to prescribe in 2009. Routine data collection included demographics, GAD symptomatology (GAD-7), psychological distress (K-10), and disability (WHODAS). Results All six lessons were completed by 324/588 (55.1%) patients. When compared with completers, noncompleters tended to be younger and based in rural locations. Prior to discontinuing the course, noncompleters demonstrated statistically significant reductions in psychological distress. For those who completed the course, effect sizes on all outcome measures were medium to large and over 60% of moderate-to-severe GAD cases met criteria for remission upon treatment completion. Conclusions The current study indicates that computerized CBT for GAD is effective in generating positive, clinically significant outcomes among typical patients treated under the usual conditions in primary care. Future research should focus on reducing treatment discontinuation among younger people and those based in rural locations. © 2012 Wiley Periodicals, Inc. Source

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