Objective: Although tinnitus is one of the most commonly reported symptoms in the general population, patients with bothersome tinnitus are challenged by issues related to accessibility of care and intervention options that lack strong evidence to support their use. Therefore, creative ways of delivering evidence-based interventions are necessary. Internet-based cognitive behavioral therapy (ICBT) demonstrates potential as a means of delivering this support but is not currently available in the United States. This article discusses the adaptation of an ICBT intervention, originally used in Sweden, Germany, and the United Kingdom, for delivery in the United States. The aim of this study was to (a) modify the web platform's features to suit a U.S. population, (b) adapt its functionality to comply with regulatory aspects, and (c) evaluate the credibility and acceptability of the ICBT intervention from the perspective of health care professionals and patients with bothersome tinnitus. Materials/Method:Initially, the iTerapi ePlatform developed in Sweden was adopted for use in the United States. Functional adaptations followed to ensure that the platform's functional and security features complied with both institutional and governmental regulations and that it was suitable for a U.S. population. Following these adaptations, credibility and acceptance of the materials were evaluated by both health care professionals (n = 11) and patients with bothersome tinnitus (n = 8). Results:Software safety and compliance regulatory assessments were met. Health care professionals and patients reported favorable acceptance and satisfaction ratings regarding the content, suitability, presentation, usability, and exercises provided in the ICBT platform. Modifications to the features and functionality of the platform were made according to user feedback. Conclusions:Ensuring that the ePlatform employed the appropriate features and functionalities for the intended population was essential to developing the Internet-based interventions. The favorable user evaluations indicated that the intervention materials were appropriate for the tinnitus population in the United States.

Objectives: Although tinnitus is one of the most commonly-reported symptoms in the general population, patients with bothersome tinnitus are challenged by issues related accessibility of care, and intervention options that lack strong evidence to support their use. Therefore, creative ways of delivering evidence- based interventions are necessary. This presentation focuses on the adaptation of an Internet-based Cognitive Behavioral Therapy (ICBT) intervention, originally used in Sweden and in the UK, for individuals with tinnitus in the United States. Elements of the ICBT program requiring consideration included (a) adaptations to the platform’s features and functionalities, (b) translation into Spanish to extend the reach of the program (c) user acceptability and satisfaction of the program, (d) outcomes from a pilot trial from which it was hypothesized that patients would demonstrate a reduction in tinnitus distress and associated difficulties as measures using standardized self-reported outcome measures, and (e) discussion of the relative merits and appropriateness of the intervention. Design: The iTerapi platform developed in Sweden was adopted for use in the US. The platform required functional and security features modifications to confirm its compliance with both institutional and governmental regulations, and to ensure it was suitable for the US population. Acceptability and suitability of the materials were evaluated by both hearing healthcare professionals (n=11) andindividuals with tinnitus (n=8). A pilot study followed as adults with bothersome tinnitus completed the 8-week program (n=30). Results: Cultural adaptations included word substitutions, adapting counseling examples for a US population, and modifying the spelling of certain words. The materials were then translated into Spanish and cross-checked. Professional review ensured the suitability of the chapters. Literacy level analysis confirmed all chapters were within the guidelines to be below the 6th grade level for readability. Healthcare professionals and individuals with tinnitus reported favorable acceptance and satisfaction ratings regarding the content, suitability, presentation, usability and exercises provided in the ICBT platform. Preliminary analyses of pilot data indicated a reduction in tinnitus distress and associated difficulties (i.e., anxiety, depression, insomnia) and an improvement in quality of life. Conclusions: Ensuring that the ePlatform offers the appropriate features and functionalities for the intended population is an essential part of developing Internet-based intervention. The user evaluations and pilot trial outcomes indicated that clinical trials can be performed to assess the effectiveness of ICBT for tinnitus in the US.

京都大学 / 新制・課程博士 / 博士(医学) / 甲第24131号 / 医博第4871号 / 新制||医||1059(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 阪上 優, 教授 佐藤 俊哉, 教授 小杉 眞司 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

No description available.

Many individuals who are incarcerated have co-occurring substance use disorders that can lead to continued substance use and criminal activity post-release. The insidious and cyclic nature of substance use disorder limits the ability of these individuals fulfill meaningful life roles and engage in an occupationally rich life upon their return to the community. The current field of research examining effective in-prison treatment for those with substance use disorders highlights the need for evidence-based, occupation-focused treatment programs to address substance use disorder in an incarcerated population. After a review of recent literature, it was found that effective substance use treatment programs in correctional settings are occupation-focused, gender-responsive, and trauma-informed; include multiple treatment modalities and an aftercare component; and facilitate the creation of trust-based relationships. The author considered these essential elements while creating The Power to Choose, a 16-session manualized group treatment protocol that is occupation-focused and recovery-oriented. The protocol was reviewed by field experts to determine social validity. Recommendations from experts were implemented into the final version of the group treatment protocol and submitted to the correctional facility for program implementation and evaluation.

Extant treatments for borderline personality disorder (BPD) are time-intensive, consist of multiple components, and are informed by different theoretical perspectives. Comprehensive evaluation of the driving mechanism(s) maintaining BPD is warranted to maximize cost-effectiveness and efficiency of treatment. Focusing on impaired interpersonal functioning in BPD, a hallmark characteristic of the disorder, may provide a useful microcosm for evaluating different approaches to understanding what drives the full expression of the disorder. This study evaluated two brief, theoretically distinct interventions for BPD and their effects on interpersonal conflict using single case experimental design. Patients (N = 8; 6 female, mean age 27.00, range 19–55) were randomized to receive an intervention either informed by emotion dysregulation theory or attachment theory. Patients reported their frequency of daily interpersonal conflicts using ecological momentary assessment and completed weekly questionnaires including measurement of theoretically-consistent mechanisms and global BPD symptoms. It was hypothesized that patients would demonstrate a significant response (50% decrease in daily interpersonal conflicts) during either intervention compared to baseline. It was also hypothesized that patients would evidence decreases in the purported mechanism of whichever intervention they received. Regarding change in interpersonal conflicts, three participants responded after the first module (two in the attachment security intervention, one in the emotion regulation intervention), three were partial responders (two in attachment security, one in emotion regulation), and two were classified as non-responders (both in emotion regulation). Furthermore, there were decreasing trends in both mechanisms for the majority of patients who received the corresponding interventions. Interestingly, there were decreasing trends in the alternate mechanism even when patients did not receive the corresponding intervention. No significant differences between conditions were observed related to interpersonal conflict or mechanisms. Notably, there were decreases in global BPD symptoms across both conditions. Results indicate that interpersonal conflict specifically and BPD symptoms can improve in brief interventions informed by different theories. This study suggests that multiple mechanisms may be driving BPD symptomatology and/or mechanisms may be more similar than previously stated in the literature, and points to the importance of idiographic evaluation in BPD research and treatment.

Background: Digital mental health interventions (DMHI) hold promise for addressing mental health needs on a large scale. Among these interventions, Internet-based Cognitive Behavioral Therapy (iCBT) has proven effective in tackling various mental health issues. However, the effectiveness of these interventions is hindered by a lack of sustained user engagement. A lack of knowledge on what specific iCBT content is the most engaging and the absence of a standardized approach to measure engagement hampers progress in this area. Aim: To conduct an evaluation of engagement based on usage data to learn which and what kind of iCBT content from a self-tailored blended iCBT application is the most engaging in order to inform strategies and enhance efforts to improve the overall effectiveness of the intervention. Methods: An observational, quantitative study of real-world usage data was conducted to evaluate engagement levels across various iCBT modules available in the app. Four engagement metrics were obtained from the users´ usage data: Adherence Rate, Rate of Max. Progress, Return Rate, and Average Time Spent to create rank and compare engagement levels across the iCBT modules. Results: The results included data from the 1st of January to the 30th of April of 2023 for 138 iCBT modules. The mean engagement score for all iCBT modules was 56.41±9.85, with a median of 57.30 and a range of 67.97. The most engaging iCBT modules were “Thought traps and questioning thoughts” (81.4), “A model for social anxiety” (80.5), and “Safety Behaviors” (78.1). The most engaging iCBT module classifications were “Social phobia” (92.10), “Depressive disorder” (80.70), and “Post-traumatic stress disorder” (80.40). Conclusions: Based on real-world usage data of patients, it was possible to determine the extent to which users engaged with different iCBT modules comprehensively. The findings shed light on the strengths and weaknesses of the iCBT modules regarding engagement levels. The quantitative evaluation of “in the wild” patient usage data proved useful for assessing engagement levels of specific content within the app.

京都大学 / 新制・論文博士 / 博士(医学) / 乙第13571号 / 論医博第2297号 / 新制||医||1069(附属図書館) / (主査)教授 川上 浩司, 教授 渡邉 大, 教授 村井 俊哉 / 学位規則第4条第2項該当 / Doctor of Medical Science / Kyoto University / DFAM

College life is a unique experience in the life of many young adults that presents many challenges for which they might not be prepared, including living away from home and adapting to a new social and academic environment. In particular, these experiences may be particularly adverse for students with social phobia and may be predictors of academic and social problems, and may even predict dropout. The purpose of the present research is to identify possible connections between socially phobic tendencies and the social, emotional, and overall well-being of college students. Social phobia itself is an unnecessary and overwhelming fear of being scrutinized by others (National Institute of Mental Health 2009). By implementing the use of four psychological tests: the Social Phobia and Anxiety Inventory, Positive and Negative Affect Schedule, College Affiliation Questionnaire, and Life Orientation Test, this research sought to investigate the correlations existing between college students' self-reports on these measures through the use of the UCF Sona system. Students' personal characteristics and demographics were also examined correlationally along with their self-reports on all four measures. A total of 165 participants were used in this study. After gathering descriptive statistics from each test and their demographics, correlations were run between the four tests and then between demographic information and tests. The results showed social phobia having a positive correlation with negative affect and a negative relationship with positive affect. In turn, negative emotion was correlated with a lowered overall life orientation and a more pessimistic mindset. No strong correlations were identified between psychological tests and student characteristics as was previously thought. Overall, there are definite indicators that social anxiety has a negative impact on one's quality of life and emotions, however, more research needs to be done with more diverse sampling and different methodology to see if there is a link between particular student characteristics and prevalence rates of social anxiety within those characteristic subsets.

This study uses data from HopeWorks, a Christian, faith-based vocational program inside the Shelby County Division of Corrections in Memphis, Tennessee, to examine factors affecting reentry success. Specifically, this research examines how spirituality - using measures that assess both spirituality (measured at the end of the program) and change in spirituality (measured as the difference between pre- and post-program measures of spirituality) - affects released offenders' reengagement with the program, ability to obtain employment, and ability to refrain from reoffending.