lappalainen depression
DESCRIPTION
Raimo Lappalainens and colleagues talk "The impact of an ACT-based Internet Treatment for Depressive symptom"TRANSCRIPT
UNIVERSITY OF JYVÄSKYLÄ
The impact of an ACT-based Internet Treatment for Depressive
symptom
Raimo Lappalainen, Anna Granlund,
Päivi Lappalainen
Department of Psychology
University of Jyväskylä, Finland
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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.
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Aim
We developed a web-based ACT-treatment program (6 weeks) for clients experiencing depressive symptoms, and compared it to a 6 week face-to-face ACT-based treatment
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Method
We had an advertisement in the local newspaper 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
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Criteria for eligibility Depression: 3 questions about depression:
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
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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Therapists
The study was conducted as a part the psychotherapy training given to master’s level students in psychology. In general, the students had no experience or very little experience in carrying out psychological treatment Each therapist was responsible for 2 clients in each group. The mean age of the 18 student therapists was 26.2 years (range 21-34).
All student therapists had received 13 hours training in Acceptance & Commitment Therapy
Used handbooks Supervision 3 hours/week, and student peer-group
meeting weekly
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The web-based treatment program
Included 1 face-to-face sessions at the beginning and 1 at the end (measurements and case formulation) and weekly contact with the therapist (feedback on homework), approx. 40 min/week (20-90 min), the majority of the clients used less than 2 hours/weekly the web intervention
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The web-based treatment program
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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Face-to-face treatment
6 x 60 min during a 6 week period Individual behavioral analysis (case formulation) Value work: description of values, discussion of values
and BA, discussion of commitment to value based actions
Discussions about control and acceptance Experiential exercises, such as mindfulness exercises,
the observer exercise, metaphors Other exercises depending on the problems Homework assignments
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Face-to-Face treatment
The student therapists used altogether 27 exercises and 31 metaphors during the sessions.
The clients completed on average 9.11 exercises (SD=3.69; range 2-15) and heard 6.50 metaphors (SD= 4.09; range 1-13) during the whole treatment (1 assessment + 5 intervention sessions)
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Students confidence of the intervention
The student therapists were moderately confident both with functional analysis (M=6.78; SD= 1.06) and with ACT (M=6.89; SD=0.96) on a scale 0-10, whereas the acceptance of the principles and methods of ACT were rated higher (M= 8.28, SD= 0.83).
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ResultsBDI-II
SCL-90 GHQ Life satisfaction(0-100)
Face-to-Face (n=19) Pre PostF-up 6 mo
23.19.013.3d=1.30
1.050.640.77d=.65
19.410.714.5d=.79
45.656.354.0d=.50
Internet (n=19) Pre PostF-up 6 mo
Between
20.810.38.7* d=1.48(d=.60)
1.110.580.62 d=1.20(d=.35)
22.310.110.5*d=2.17(d=.70)
39.163.467.0*d=1.63(d=.72)
Mittareista: BDI rajat:0–13: ei lainkaan masennusta; 14–19: lievä masennus; 20–28: keskivaikea masennus; 29–63: vakava masennus.SCL-90:, Symptom Check List-90: vertailuryhmänä Espoon kaupungin työntekijät, joiden tulos on 0.60GHQ General Health Questionnaire http://www.thl.fi/toimia/tietokanta/mittariversio/102/
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d=.60
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d=.72
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ResultsAAQ-II KIMS
MindfulnessATQAutomatic Thoughts:How often?
ATQAutomatic Thoughts: How much believe?
WBSIThought Suppression
Face-to-Face (n=19)PrePostF-up
39.049.347.8d=.84
120.5125.4123.3d=18
77.057.662.7d=.72
74.861.558.3d=.83
46.846.444.6d=.17
Internet (n= 19)PrePostF-up
Between
41.247.550.3d=.97(d=.24)
120.0126.0129.3d=.50(d=.32)
74.853.654.1d=.97(d=.43)
70.151.054.3d=.67(d=.19)
49.843.239.5d=.98(d=.40)
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Client’s experiences of the web-intervention
The Compass is great! And the materials are excellent! I have printed out all the texts, exercises and metaphors and I’m going to organize them into a folder. I really appreciate the treatment philosophy: one must take the responsibility and lead one’s life into valued direction. Years of going to therapy and talking about the problems didn’t help me at all but I found this very useful. Thanks for allowing me to participate (225).
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Conclusions
A 6 week Internet-based ACT treatment including 2 (face-to-face) session was as effective as a face-to-face treatment
Indications that an internet-based treatment may have better treatment effect after the active treatment period than a face-to-face treatment
The student delivered ACT-based Internet treatment was well accepted by the clients
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Limitations
Students as therapists Very limited training both in psychotherapy and in ACT All subjects did not have depression diagnoses Relatively small number of subjects Relatively short follow-up time