One in ten adults in the U.S. report depression, and thirty-eight percent of those receiving treatment are receiving minimally adequate treatment. Studies show that evidence-based Internet interventions are highly effective in treating depression at a low cost. The aim of this study was to reduce symptoms of depression in subjects through the use of a new, electronic Problem Solving Treatment (ePST). Adult participants with moderate to severe depression symptoms were randomly assigned to either treatment or a wait-list condition. The Beck Depression Inventory-II was used as the primary outcome measure. A Repeated Measure Design with one factor in the between (treatment vs control) and one factor in the within (pre, mid-point, and post-treatment) was used in the analysis. Study results showed that participants in the ePST group improved their depression symptoms (from Moderate to Mild levels of depression) after receiving 3 session of ePST, as well as after receiving six session of ePST (from moderate to minimal levels of depression). On the other hand, participants assigned to the control group remained with Moderate levels of depression. / text

Cognitive behaviour therapy is a well-documented first-line treatment for mild to moderate depression. Primary healthcare providers have encountered several barriers when trying to provide CBT in an office-based setting and as such, adoption of this evidence-based treatment has been suboptimal. Primary healthcare nurse practitioners (PHC NPs) have an in-depth knowledge of advanced nursing practice, and are responsible for the assessment, diagnosis and management of patients with acute and chronic conditions, such as depression. PHC NPs are also ideally situated in the health care system to deliver CBT to their patients. The objectives of this project were to develop a format for the delivery of brief CBT methods that was feasible in the PHC setting, increase PHC providers’ confidence to implement CBT and ultimately increase their adoption of CBT

Background: Patients often report that living with a condition such as tinnitus can be debilitating, worrying, and frustrating. Efficient ways to foster management strategies for individuals with tinnitus and promoting tinnitus self-efficacy are needed. Internet-based cognitive behavioral therapy (ICBT) for tinnitus shows promise as an evidence-based intervention in Europe, but is not available in the United States. The aim of this pilot study was to evaluate the feasibility of an ICBT intervention for tinnitus in the United States. Method: This study reports the Phase 1 trial intended to support implementation of a larger randomized clinical trial (RCT) comparing ICBT to a weekly monitoring group. As a pilot study, a single-group pretest–posttest design was used to determine outcome potential, recruitment strategy, retention, and adherence rates of ICBT for tinnitus. The primary outcome was a change in tinnitus distress. Secondary outcome measures included measures of anxiety, depression, insomnia, tinnitus cognitions, hearing-related difficulties, and quality of life. Results: Of the 42 screened participants, nine did not meet the inclusion criteria and six withdrew. There were 27 participants who completed the intervention, with a mean age of 55.48 (± 9.9) years. Feasibility was established, as a large pretest–posttest effect size of d = 1.6 was found for tinnitus severity. Large pretest–posttest effect sizes were also found for tinnitus cognitions and hearing-related effects, and a medium effect was found for insomnia and quality of life. Treatment adherence varied with a retention rate of 85% (n = 23) at post-intervention assessment and 67% (n = 18) for the follow-up assessment. Conclusions: This pilot study supported the feasibility of ICBT for tinnitus in the United States. Ways of improving intervention retention and recruitment rates need to be explored in future ICBT studies. Protocol refinements that were identified will be implemented prior to further RCTs to investigate the efficacy of ICBT for tinnitus in the United States.

No description available.

Clinical psychologists currently struggle to organize information about patients during a cognitive behavioral therapy (CBT) treatment. During a CBT treatment, the patients will have to fill in paper forms between therapy sessions. These forms contain information about how the patients are feeling and the different tasks that they have been assigned as homework. Some problems with the paper forms are that they can easily be forgotten, lost, destroyed, etc. Before this project, Zeeds App could be used instead of the paper forms but the psychologists could not review the homework results from the app. Our solution to this problem is a web portal that is connected to Zeeds App where psychologists can oversee their patient's homework results. Since psychologists can review the answers to the forms before therapy sessions the sessions can be more focused. / Psykologer har för tillfället problem med att organisera information om deras patienter under en kognitiv beteendeterapi. Under en kognitiv beteendeterapi kommer patienten behöva fylla i pappersformulär mellan möten med sin psykolog. Dessa formulär innehåller information om hur patienterna mår och de olika uppgifter som de har fått att utföra som hemläxa. Några problem med dessa pappersformulär är att de är lätt att glömma bort formulären, tappa bort formulären, eller att formulären blir förstörda osv. Innan det här projektet kunde Zeeds App användas istället för pappersformulären men det fanns ingen möjlighet för psykologer att se resultaten från appen. Våran lösning till det här problemet är en webbportal som är kopplad till Zeeds App där psykologer kan se deras patienters resultat för hemläxan. Eftersom psykologer kan se resultaten från hemläxan innan möten kan mötena bli mer fokuserade.

No description available.

The QUIZIT system has been developed to support adaptive and standard testing, along with automatic grading, record keeping, and test administration using the WWW as a delivery vehicle. We have applied QUIZIT in connection with our NSF-supported Education Infrastructure project on Interactive Learning with a Digital Library in Computer Science to help with evaluation in a master's level course as well as a large freshmen level service course. Preliminary testing in these courses has shown us that QUIZIT is a promising supplement to other forms of evaluation in self-paced education. We also conjecture QUIZIT might be a valuable tool in distance learning environment. / Master of Science

No

緒論 失眠困擾對身心健康有重大的影響，除了藥物取向的治療外，失眠認知行為治療（CBT-I）有足夠的實證研究證據肯定其療效，由於在認知行為治療（CBT）的研究中有證據支持參與者在家中，對治療技術練習與執行的程度與療效有關，因此CBT-I的療效可能也與患者對治療技術的執行程度有關，過去雖然也有少數研究探討CBT-I執行程度與療效的關係，但這些研究缺乏針對CBT-I各個治療技術的執行程度評估，因此本研究欲探討CBT-I中，各項治療技術（睡眠衛生教育、放鬆訓練、刺激控制法、睡眠限制法，及認知重建）的執行程度及執行規律程度，與特定療效指標改善程度的關係。 方法 研究參與者含原發性失眠患者22位，共病其它疾患的失眠患者16位，經篩選階段確認符合收案條件後，在接受為期七週的CBT-I團體治療期間，於第二週起需每日填寫執行程度問卷，同時帶領團體的治療師也於治療第三週起，以治療師執行程度評估量表來評估參與者的執行程度。參與者在治療前後另需分別填寫一週睡眠日誌以及睡眠困擾問卷（Insomnia Severity Inventory；ISI），以睡眠日誌中的SOL、WASO、TST、SE，及ISI得分的前後測改變分數，作為代表療效指標之依變項，預測變項則為參與者自評及治療師所評估的各項治療技術之執行程度分數，治療技術包括：睡眠衛生、放鬆訓練、刺激控制法、睡眠限制法，以及認知重建；並分別以平均數代表執行程度，而以變異數代表執行期間的規律程度。 結果 資料分析以皮爾森相關分析檢驗執行程度與療效間的關聯性，在全部樣本中的結果發現，參與者自評對認知重建的平均數與WASO的改善程度有正相關，以及治療師評估CBT-I的平均數與SOL的改善程度有正相關；而參與者自評放鬆訓練的平均數越低、刺激控制法變異數越高，則ISI的改善程度越好，為不符合預期的結果。在原發性失眠組中發現治療師評估睡眠衛生的平均數與WASO的改善有正相關，治療師評估睡眠限制法的平均數與SOL、TST，以及SE的改善有正相關，而變異數與SOL的改善有負相關，以及治療師評估CBT-I的平均數與SOL的改善有正相關；而不符合預期的結果為，參與者自評執行刺激控制法的變異數與ISI的改善有正相關。最後，在共病組中並沒有發現執行程度與療效之間有顯著相關的結果，而放鬆訓練以及刺激控制法兩項治療技術，也沒有與療效指標有符合預期的顯著相關結果。 結論 對於共病失眠患者而言，治療技術的執行評估與療效間未反映出顯著相關，可能因受限於睡眠生理疾患的干擾，使得療效未如原發性失眠組明顯；而就原發性失眠組而言，睡眠限制法的執行程度是與較多療效指標達到顯著相關的治療技術，顯示睡眠限制法的執行對於改善睡眠症狀有所幫助。本研究較為重大的限制在於，治療技術執行程度評估的評分者間一致性有限，後續研究可進一步發展評估執行程度更適當的方法。 / Introduction Insomnia is a common problem that has a significant impact on patients' physical and mental health. In addition to pharmacological therapy, there are sufficient empirical data to support treatment efficacy of cognitive behavioral therapy for insomnia (CBT-I). A major part of cognitive behavioral therapy is to teach the patients to learn specific cognitive and behavioral techniques that requires to be practiced at home by the patients. Previous studies have reported an association between the degree of adherence to treatment techniques and treatment effects in cognitive behavioral therapy for disorders other than insomnia. Some studies further explored the relationship between treatment adherence and treatment outcome in CBT-I. However, none of the study looked into the adherence to different treatment components on different aspects of treatment outcome. The aim of this study therefore is to explore the relationship between the adherence to different treatment components in CBT-I and the improvement in different sleep parameters. Method Twenty-two patients with primary insomnia and sixteen patients with comorbid insomnia were recruited for this study. During the 6-week period of treatment with CBT-I, they completed a treatment adherence questionnaire daily. The therapists also evaluated the patients’ adherence weekly after treatment sessions. They were required to keep sleep diaries from one week before to one week after the end of the 6-week CBT-I program. They also completed the ISI and sleep diary for one week before and after the treatment. The treatment outcome variables included the ISI score, and sleep onset latency (SOL), wake after sleep onset (WASO), total sleep time (TST) and the sleep efficiency (SE) from sleep diaries. The treatment components evaluated included sleep hygiene, relaxation, stimulus control, sleep restriction and cognitive reconstruction. The predictive variables included the mean for the adherence degrees and the variance for the adherence regularity of the adherence score evaluated by the participants and therapists. Results Pearson correlation was used to examine the associations between the adherence to respective treatment components in CBT-I and the variables of treatment outcome. In the whole sample, the decrease of the WASO correlated significantly with adherence to cognitive reconstruction evaluated by the patients, and the decrease of the SOL correlated significantly with adherence to CBT-I evaluated by the therapists. Nonetheless, the lower adherence to relaxation and the higher variance of adherence to stimulus control, the more improvement of the ISI. In patients with primary insomnia, the decrease of WASO correlated significantly with adherence to sleep hygiene evaluated by the therapists; the decrease of SOL and the increase of TST and SE showed significant correlation with adherence to sleep restriction evaluated by the therapists; the decrease of SOL showed significant negative correlation with the variance of adherence to sleep restriction evaluated by the therapists; the decrease of SOL showed significant positive correlation with the adherence to CBT-I evaluated by the therapists. Opposite to expectation, the decrease of the ISI score correlated significantly with variability of adherence to stimulus control evaluated by the patients. Finally, in patients with comorbid insomnia, the treatment component adherence did not correlate significantly with any outcome variables. The adherence of relaxation and stimulus control did not show significant correlation with outcome variables. Conclusion In patients with comorbid insomnia, treatment effects were not associated with adherence. This may due to the multifactorial nature of comorbid insomnia. Among the treatment components, adherence to sleep restriction seems to be the most predictive factor for good treatment outcome in primary insomnia. One limitation of the present study is its low inter-rater reliability of treatment components adherence evaluation. Therefore, more appropriate methods need to be developed to evaluate the adherence of treatment techniques.

Objectives. To examine the clinical effectiveness of guided self-help (GSH) for anxiety and depression in routine clinical practice, and the role of self-efficacy, therapeutic alliance and socio-economic status in influencing that effectiveness. Design. A within-subjects repeated measures design in which participants served as their own controls by completing questionnaires across a control period prior to GSH intervention, then again at post-intervention and 3- and 6-month follow-up. Methods. GSH participants completed outcome measures for mental health (HADS) and work/social functioning (WSAS). Factors explored by regression as possible predictors of effectiveness were self-efficacy, therapeutic alliance and socioeconomic status. Results. Sixty people completed GSH, with analyses indicating effectiveness of GSH in significantly improving mental health and social functioning at post-treatment and 3-month follow-up, but not at 6-month follow-up. Effectiveness was also indicated under intent-to-treat conditions (n = 97) with medium effect sizes (≈ 0.6) for each outcome measure at post-treatment. Improvement in mental health was predicted by lower self-efficacy and greater therapeutic alliance. Completers of the intervention had significantly higher socio-economic status than non-completers. Conclusions. The current study has suggested effectiveness of GSH in routine clinical practice across different primary care services at post-treatment, but with less evidence of this at follow-up. Effectiveness has been highlighted to be influenced by self-efficacy and therapeutic alliance, suggesting the importance of considering non-specific factors when patients access GSH in primary care. This study underlines the need for further research exploring longer-term clinical effectiveness and examining for whom GSH works in order to constructively inform future evidence-based practice.