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OBJECTIVES: Little evidence exists on costs or cost-effectiveness of online interventions for caregivers of people living with dementia. We aimed to assess cost-effectiveness of online cognitive behavioral therapy (CBT) for dementia caregivers with mild-to-moderate depression/anxiety, with or without telephone support, relative to a psychoeducational control treatment. DESIGN: Cost-effectiveness study of data from 3-armed randomized controlled trial comparing computerized CBT (cCBT) or telephone-supported cCBT (cCBT+Telephone) to modular online educational program on dementia (Psychoeducation). SETTING AND PARTICIPANTS: UK-resident adult dementia caregivers with mild-to-moderate anxiety/depression. COST-EFFECTIVENESS ANALYSIS: We calculated health and social care costs, from participant-reported data collected at baseline, 12, 26 weeks, costs of intervention delivery. We examined 3 outcomes: cost of one-point reduction in General Health Questionnaire-12 (GHQ-12) rating at 26-weeks, cost of prevented "caseness" on GHQ-12 at 26 weeks, and cost per quality-adjusted life year (QALY) based on Short Form-6 Dimensions (SF-6D) over 26 weeks. RESULTS: Data from 176 participants (44 cCBT, 91 cCBT+Telephone, 41 Psychoeducation) were analyzed. Costs did not differ between cCBT and Psychoeducation; costs were £125 higher in cCBT+Telephone. Control and intervention groups did not differ on GHQ-12. Caseness was lower in cCBT+Telephone than Psychoeducation; cost of preventing a case was £610, and probability of cost-effectiveness on this outcome reached 98.5% at willingness to pay (WTP) of £12,900. Mean QALY did not differ between cCBT+Telephone and Psychoeducation. QALY gain in cCBT was 0.01 (95% CI 0.001, 0.021). Cost per QALY was £8130. Although base case probability of cost-effectiveness of cCBT was 93% at WTP-per-QALY of £27,600, sensitivity analyses suggested cCBT+Telephone was the more cost-effective. CONCLUSIONS AND IMPLICATIONS: We report preliminary evidence for adopting telephone-supported online CBT. This may be cost-effective in preventing a case of mental health disorder if, absent a societally accepted WTP threshold for this outcome, payers are willing to pay £12,900. Future research should investigate whether supported/unsupported online CBT improves health-related quality of life.

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Digital technologies are increasingly used in health-care delivery and are being introduced into work to prevent unintentional injury, violence, and suicide to reduce mortality. To understand the potential of digital health interventions (DHIs) to prevent and reduce these problems, we conduct a meta-analysis and provide an overview of their effectiveness and characteristics related to the effects. We searched electronic databases and reference lists of relevant reviews to identify randomized controlled trials (RCTs) published in or before March 2020 evaluating DHIs on injury, violence, or suicide reduction. Based on the 34 RCT studies included in the meta-analysis, the overall random effect size was 0.21, and the effect sizes for reducing suicidal ideation, interpersonal violence, and unintentional injury were 0.17, 0.24, and 0.31, respectively, which can be regarded as comparable to the effect sizes of traditional face-to-face interventions. However, there was considerable heterogeneity between the studies. In conclusion, DHIs have great potential to reduce unintentional injury, violence, and suicide. Future research should explore DHIs' successful components to facilitate future implementation and wider access.

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BACKGROUND: Recent studies show that computer-based training enhances cognition in schizophrenia; furthermore, socialization has also been found to improve cognitive functions. It is generally believed that non-social cognitive remediation using computer exercises would be a pre-requisite for therapeutic benefits from social cognitive training. However, it is also possible that social interaction by itself enhances non-social cognitive functions; this possibility has scarcely been explored in schizophrenia patients. This pilot study examined the effects of computer-based neurocognitive training, along with social interaction either with a peer (PSI) or without one (N-PSI). We hypothesized that PSI will enhance cognitive performance during computerized exercises in schizophrenia, as compared with N-PSI. METHODS: Sixteen adult participants diagnosed with schizophrenia or schizoaffective disorder participating in an ongoing trial of Cognitive Enhancement Therapy completed several computerized neurocognitive remediation training sessions (the Orientation Remedial Module©, or ORM), either with a peer or without a peer. RESULTS: We observed a significant interaction between the effect of PSI and performance on the different cognitive exercises (p<0.05). More precisely, when patients performed the session with PSI, they demonstrated better cognitive performances than with N-PSI in the ORM exercise that provides training in processing speed, alertness, and reaction time (the standard Attention Reaction Conditioner, or ARC) (p<0.01, corrected). PSI did not significantly affect other cognitive domains such as target detection and spatial attention. CONCLUSION: Our findings suggest that PSI could improve cognitive performance, such as processing speed, during computerized cognitive training in schizophrenia. Additional studies investigating the effect of PSI during cognitive remediation are needed to further evaluate this hypothesis.

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PURPOSE: The knowledge-based approach to substance use and HIV prevention, commonly used in Central Asia, does not equip at-risk adolescents with risk reduction skills. This pilot study aims to adapt and test the feasibility and estimate the effect size parameters of a skill-based and family-focused intervention for at-risk adolescents from communities affected by heroin trade and use in Kazakhstan, located on the major drug trafficking route from Afghanistan. METHODS: This National Institute on Drug Abuse-funded pilot trial used a mixed-methods approach and included 181 adolescents (ages 14-17) that reported at least one risk factor (e.g., substance-using family members or friends and parental criminal history). In addition to the school-based health education program, intervention-arm adolescent-caregiver dyads received three computerized pilot sessions focusing on risk reduction self-efficacy, resistance to peer pressure, and strengthening of family relationships. Adolescents completed baseline, 3- and 6-month Audio Computer-Assisted Self-Interview surveys in Russian and treatment group adolescents (n = 12) also participated in postintervention focus groups. RESULTS: Small size effects were observed for youth-level theoretical mediators associated with lower substance use. Compared to the control group, intervention-arm adolescents showed improvement in personal and social competencies such as assertiveness (Cohen's d = .21) and self-esteem (d = .22) at 3 months and increased engagement in prosocial activities at 6 months (d = .41). Adolescents from the intervention group also reported improved self-control skills helping alleviate emotional distress (an increase in anger and tension management d = .30 at 3 months and a reduction in temper d = -.27 at 6 months) along with a lower likelihood of binge drinking at 6 months (odds ratio = .18, p = .023). CONCLUSIONS: In middle-income countries like Kazakhstan, an intervention that utilizes interactive technologies and combines an empirically tested skills-based approach with family involvement may be an engaging, acceptable, and culturally appropriate tool for preventing substance use among at-risk youth.

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BACKGROUND: The suicide rate in the Unites States continues to increase suggesting novel intervention strategies are needed. Anxiety sensitivity (AS), or a fear of anxiety-related sensations, is a suicide risk factor that can be ameliorated via a single-session, computerized intervention called the Cognitive Anxiety Sensitivity Treatment (CAST). Results from randomized controlled trials have demonstrated that reductions in suicidal ideation (SI) due to CAST were mediated by AS reductions. However, a more detailed analysis of the mechanisms of SI reduction due to AS interventions is needed to further our understanding of theoretical models of AS and suicide, and to refine AS treatments. METHODS: Participants (N = 74) with co-occurring anxiety pathology and SI were randomized to a single-session computerized treatment (CAST + cognitive bias modification) or a control intervention. Assessments were conducted immediately post treatment, and at 1 month and 4 month follow-ups. RESULTS: Chained mediation models revealed significant reductions in SI (month 4 follow-up) through AS (post-treatment) and subsequently anxiety symptoms (month 1 follow-up), but not depressive symptoms. There were no direct mediation effects through either AS or anxiety or depressive symptoms. LIMITATIONS: Limitations include self-report assessment of symptoms, a sample of only individuals with a diagnosed anxiety pathology, and exploratory nature of anxiety/depression dimension analyses. CONCLUSIONS: Results of the current study help clarify the mechanistic pathways of SI reduction due to an AS intervention, and suggest future work attempting to increase the efficacy of AS interventions should consider the potentially important role of downstream mechanisms that follow AS reduction.

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BACKGROUND AND AIMS: Cannabis is the most widely consumed illicit drug. Although it is too early to confirm the impact of legalization, the use of cannabis appears to be on the rise in some countries due to its authorization for medical/recreational purposes. Among different types of therapeutic approaches to reduce cannabis use, computerized interventions are becoming a new treatment option. To assess their efficacy, a systematic review and meta-analysis was conducted. METHODS: A systematic review and meta-analysis was performed employing randomized controlled clinical trials indexed in MEDLINE and PsycINFO. The principal outcome measure was cannabis use, and the secondary one was the use of other substances during interventions. A subgroup analysis was conducted by length of follow-up, number of sessions, age group, type of analysis, and type of control condition. RESULTS: The meta-analysis included nine studies with 2963 participants. Computerized interventions resulted in significant reductions in the use of cannabis (standardized mean difference [SMD]: -0.19; 95% CI: -0.26, -0.11) and other substances (SMD: -0.27; 95% CI: -0.46, -0.08). CONCLUSIONS: Computerized interventions examined in the present study reduced the frequency of cannabis and other substance use. Limitations included the recalculation of dichotomous and continuous data as SMD and the lower number of studies included in the secondary outcome. Computerized interventions could be a viable option to reduce cannabis use.

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BACKGROUND: Despite the large body of literature demonstrating the effectiveness of cognitive behavioral treatments for agoraphobia, many patients remain untreated because of various barriers to treatment. Web-based and mobile-based interventions targeting agoraphobia may provide a solution to this problem, but there is a lack of research investigating the efficacy of such interventions. OBJECTIVE: The objective of our study was to evaluate for the first time the effectiveness of a self-guided mobile-based intervention primarily targeting agoraphobic symptoms, with respect to a generic mobile app targeting anxiety. METHODS: A Web-based randomized controlled trial (RCT) compared a novel mobile app designed to target agoraphobia (called Agoraphobia Free) with a mobile app designed to help with symptoms of anxiety in general (called Stress Free). Both interventions were based on established cognitive behavioral principles. We recruited participants (N=170) who self-identified as having agoraphobia and assessed them online at baseline, midpoint, and end point (posttreatment) over a period of 12 weeks. The primary outcome was symptom severity measured by the Panic and Agoraphobia Scale. RESULTS: Both groups had statistically significant improvements in symptom severity over time (difference -5.97, 95% CI -8.49 to -3.44, P<.001 for Agoraphobia Free and -6.35, 95% CI -8.82 to -3.87, P<.001 for Stress Free), but there were no significant between-group differences on the primary outcome (difference 0.38, 95% CI -1.96 to 3.20, P=.64). CONCLUSIONS: This is, to our knowledge, the first RCT to provide evidence that people who identify as having agoraphobia may equally benefit from a diagnosis-specific and a transdiagnostic mobile-based intervention. We also discuss clinical and research implications for the development and dissemination of mobile mental health apps. TRIAL REGISTRATION: International Standard Randomized Controlled Trial Number (ISRCTN): 98453199; http://www.isrctn.com /ISRCTN98453199 (Archived by WebCite at http://www.webcitation.org/6uR5vsdZw).

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Computer-delivered, brief interventions (CDBIs) have been an increasingly popular way to treat alcohol use disorders; however, very few studies have examined which characteristics of CDBIs maximize intervention effectiveness. The literature has consistently demonstrated that therapist empathy is associated with reduced substance use in in-person therapy; however, it is unclear whether this principle applies to CDBIs. Therefore, the study aimed to examine whether the presence of an empathic narrator increased intentions to reduce heavy drinking in a CDBI. Results suggest that the presence of empathy increases motivation to reduce drinking, and makes participants feel more supported and less criticized.

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O objetivo deste trabalho foi avaliar a usabilidade, funcionalidade e efeitos iniciais de uma intervenção psicoeducacional computadorizada sobre Transtorno Obsessivo-Compulsivo (TOC), através de um ensaio com usuários. A intervenção consistiu em um programa composto por três módulos contendo textos informativos, vídeos e três quizzes com 10 perguntas cada. Participaram 21 sujeitos entre 19 e 55 anos. Os instrumentos utilizados foram o Yale-Brown Obsessive-Compulsive Scale(Y-BOCS), escalas subjetivas para avaliação da intensidade dos sintomas de TOC, escalas subjetivas de humor e de ansiedade, questões de usabilidade e log do programa. Os participantes levaram em média oito dias para completar o programa e o tempo médio de uso totalizou 2 horas e 14 minutos. Apenas uma questão dos quizzes teve frequência de acertos abaixo de 70%. O nível médio de satisfação foi de 8,33 no primeiro módulo, 8,71 no segundo e 9,00 no terceiro. Houve diminuição nos escores obsessivos da Y-BOCS e diferença estatisticamente significativa na escala subjetiva de sintomas do TOC entre os módulos 1 e 2, e 1 e 3. O programa obteve um bom nível de satisfação dos usuários e apresenta potencial efeito na redução de sintomas percebidos. Entende-se que o desenvolvimento do programa contribui em termos teóricos e práticos para o atual momento da psicologia e sua interface com a tecnologia.(AU).

This study aimed at evaluating usability, functionality and initial effects of a computerized psychoeducational intervention directed at Obsessive-Compulsive Disorder (OCD), through a usability trial with users. Twenty-one users ranging from 19 to 55 years old took part in the study. Measures were Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), subjective scales to assess OCD symptoms intensity, mood and anxiety, usability questions, and the system log. Participants took an average of eight days to complete the intervention, and the average time of software usage was 2 hours and 14 minutes. Only one quiz question showed less than 70% correct answers. Mean level of satisfaction was 8.33 for the first module, 8.71 for the second and 9.00 for the third. There was a decrease in Y-BOCS obsessive scores, and a statistically significant difference was found on the scale of OCD symptoms intensity, between modules 1 and 2, and 1 and 3. The software reached a good level of satisfaction among users and shows potential in reduction of perceived symptoms. It is argued that, as a template, the program can contribute both practically and theoretically for novel applications in the interface of psychotherapy and technology.(AU).

El objetivo de este estudio fue evaluar la usabilidad, funcionalidad y efectos iniciales de una intervención psicoeducativa computarizada sobre el Trastorno obsesivo-compulsivo (TOC), a través de un experimento con usuarios. Participaron 21 sujetos con edades entre 19 y 55 años. Los instrumentos utilizados fueron lo Yale-Brown Obsessive-Compulsive Scale(Y-BOCS), escalas subjetivas para evaluar la gravedad de los síntomas del TOC, el estado de ánimo y la ansiedad, preguntas de usabilidad y el registro del programa. Los participantes tomaron un promedio de ocho días para completar el programa, y el tiempo de uso promedio fue de dos horas y 14 minutos. Sólo una cuestión de los quizzes tuvo un promedio de respuestas correctas abajo del 70%. El nivel medio de satisfacción fue 8.33 en el primer módulo, 8.71 en el segundo y 9.00 en el tercero. Hubo una reducción en la subescala de síntomas obsesivos del Y-BOCS y una diferencia estadísticamente significativa en la escala subjetiva de los síntomas del TOC entre los módulos 1 y 2, y 1 y 3. El programa logró un buen nivel de satisfacción entre los usuarios y presenta potencial para la reducción de los síntomas percibidos. Se entiende que el desarrollo del programa contribuye en términos teóricos y prácticos para el momento actual de la psicología y su interfaz con la tecnología.(AU).

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O objetivo deste trabalho foi avaliar a usabilidade, funcionalidade e efeitos iniciais de uma intervenção psicoeducacional computadorizada sobre Transtorno Obsessivo-Compulsivo (TOC), através de um ensaio com usuários. A intervenção consistiu em um programa composto por três módulos contendo textos informativos, vídeos e três quizzes com 10 perguntas cada. Participaram 21 sujeitos entre 19 e 55 anos. Os instrumentos utilizados foram o Yale-Brown Obsessive-Compulsive Scale(Y-BOCS), escalas subjetivas para avaliação da intensidade dos sintomas de TOC, escalas subjetivas de humor e de ansiedade, questões de usabilidade e log do programa. Os participantes levaram em média oito dias para completar o programa e o tempo médio de uso totalizou 2 horas e 14 minutos. Apenas uma questão dos quizzes teve frequência de acertos abaixo de 70%. O nível médio de satisfação foi de 8,33 no primeiro módulo, 8,71 no segundo e 9,00 no terceiro. Houve diminuição nos escores obsessivos da Y-BOCS e diferença estatisticamente significativa na escala subjetiva de sintomas do TOC entre os módulos 1 e 2, e 1 e 3. O programa obteve um bom nível de satisfação dos usuários e apresenta potencial efeito na redução de sintomas percebidos. Entende-se que o desenvolvimento do programa contribui em termos teóricos e práticos para o atual momento da psicologia e sua interface com a tecnologia.

This study aimed at evaluating usability, functionality and initial effects of a computerized psychoeducational intervention directed at Obsessive-Compulsive Disorder (OCD), through a usability trial with users. Twenty-one users ranging from 19 to 55 years old took part in the study. Measures were Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), subjective scales to assess OCD symptoms intensity, mood and anxiety, usability questions, and the system log. Participants took an average of eight days to complete the intervention, and the average time of software usage was 2 hours and 14 minutes. Only one quiz question showed less than 70% correct answers. Mean level of satisfaction was 8.33 for the first module, 8.71 for the second and 9.00 for the third. There was a decrease in Y-BOCS obsessive scores, and a statistically significant difference was found on the scale of OCD symptoms intensity, between modules 1 and 2, and 1 and 3. The software reached a good level of satisfaction among users and shows potential in reduction of perceived symptoms. It is argued that, as a template, the program can contribute both practically and theoretically for novel applications in the interface of psychotherapy and technology.

El objetivo de este estudio fue evaluar la usabilidad, funcionalidad y efectos iniciales de una intervención psicoeducativa computarizada sobre el Trastorno obsesivo-compulsivo (TOC), a través de un experimento con usuarios. Participaron 21 sujetos con edades entre 19 y 55 años. Los instrumentos utilizados fueron lo Yale-Brown Obsessive-Compulsive Scale(Y-BOCS), escalas subjetivas para evaluar la gravedad de los síntomas del TOC, el estado de ánimo y la ansiedad, preguntas de usabilidad y el registro del programa. Los participantes tomaron un promedio de ocho días para completar el programa, y el tiempo de uso promedio fue de dos horas y 14 minutos. Sólo una cuestión de los quizzes tuvo un promedio de respuestas correctas abajo del 70%. El nivel medio de satisfacción fue 8.33 en el primer módulo, 8.71 en el segundo y 9.00 en el tercero. Hubo una reducción en la subescala de síntomas obsesivos del Y-BOCS y una diferencia estadísticamente significativa en la escala subjetiva de los síntomas del TOC entre los módulos 1 y 2, y 1 y 3. El programa logró un buen nivel de satisfacción entre los usuarios y presenta potencial para la reducción de los síntomas percibidos. Se entiende que el desarrollo del programa contribuye en términos teóricos y prácticos para el momento actual de la psicología y su interfaz con la tecnología.

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Cognitive bias modification paradigms training positive mental imagery and interpretation (imagery CBM-I) hold promise for treatment innovation in depression. However, depression is a global health problem and interventions need to translate across settings and cultures. The current pilot study investigated the impact of 1 week of daily imagery CBM-I in treatment-seeking individuals with major depression in outpatient psychiatry clinics in Iran. Further, it tested the importance of instructions to imagine the positive training materials. Finally, we examined the effects of this training on imagery vividness. Thirty-nine participants were randomly allocated to imagery CBM-I, a non-imagery control program, or a no treatment control group. Imagery CBM-I led to greater improvements in depressive symptoms, interpretive bias, and imagery vividness than either control condition at post-treatment (n = 13 per group), and improvements were maintained at 2-week follow-up (n = 8 per group). This pilot study provides first preliminary evidence that imagery CBM-I could provide positive clinical outcomes in an Iranian psychiatric setting, and further that the imagery component of the training may play a crucial role.