Contacted 63; 20 did not fulfill the criteria (6 were not depressed; 4 had another treatment at the same time, 8 persons couldn’t commit into weekly treatment, one didn’t have basic knowledge of using the computer, one could not be reached
Mittareista: AAQ-2, ACCEPTANCE AND ACTION-2 mittaa psykologista joustavuutta ja välttämistä; skaala 0-70, normaaliarvot n. 45 ylöspäin Bond, F. W., Hayes, S. C., Baer, R. A., Carpenter, K. M., Guenole, N., Orcutt, H. K., Waltz, T., & Zettle, R. D. (in press). Preliminary psychometric properties of the Acceptance and Action Questionniare - II: A revised measure of psychological flexibility and experiential avoidance. Behavior Therapy . KIMS: mittaa tietoisuustaitoja (mitä korkeampi arvo, sitä parempi) ATQ: Automatic Thoughts-mittari mittaa masentuneilla yleisten automaattisten (negat.) ajatusten esiintyvyyttä ja sitä, kuinka paljon henkilö uskoo niihin (mitä alhaisempi arvo, sitä parempi) WBSI: White Bear Suppression Inventory: mittaa ajatusten tukahduttamista (mitä alhaisempi arvo, sitä parempi) Wegner, D. M. & Zanakos, S. (1994). Chronic thought suppression. Journal of Personality, 62, 615-640.
UNIVERSITY OF JYVÄSKYLÄ The impact of an ACT-based Internet Treatment for Depressive symptom Raimo Lappalainen, Anna Granlund, Pä ivi Lappalainen Department of Psychology University of Jyvä skylä , Finland
UNIVERSITY OF JYVÄSKYLÄ 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.
UNIVERSITY OF JYVÄSKYLÄ 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
UNIVERSITY OF JYVÄSKYLÄ 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
UNIVERSITY OF JYVÄSKYLÄ 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
UNIVERSITY OF JYVÄSKYLÄ Participant Characteristics: Face-to-Face Internet (n=19) (n=19)Sex Female 13 (68.4 %) 13 (68.4 %) Male 6 (31.6 %) 6 (31.6 %)Age (M, SD) 46.95 (12.26) 42.26 (16.04)Education 9 years 1 (5.3 %) 3 (15.8 %) 12 years 9 (47.4 %) 7 (36.8 %) University 9 (47.4 %) 9 (47.4 %) Working/studying Yes 8 (42.1 %) 9 (47.4 %) No 11 (57.9 %9 10 (52.6 %)Diagnosis Yes 8 (42.1 %) 10 (52.6 %) No 10 (52.6 %) 8 (42.1 %) Other than depression 1 (5.3 %) 1 (5.3 %)Depression medication Yes 6 (31.6 %) 7 (36.8 %) No 13 (68.4 %) 12 (63.2 %)
UNIVERSITY OF JYVÄSKYLÄ 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
UNIVERSITY OF JYVÄSKYLÄ 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
UNIVERSITY OF JYVÄSKYLÄ 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
UNIVERSITY OF JYVÄSKYLÄ 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
UNIVERSITY OF JYVÄSKYLÄ 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)
UNIVERSITY OF JYVÄSKYLÄ 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).
UNIVERSITY OF JYVÄSKYLÄ Results BDI-II SCL-90 GHQ Life satisfaction (0-100)Face-to-Face(n=19) Pre 23.1 1.05 19.4 45.6 Post 9.0 0.64 10.7 56.3F-up 6 mo 13.3 0.77 14.5 54.0 d=1.30 d=.65 d=.79 d=.50Internet(n=19) Pre 20.8 1.11 22.3 39.1 Post 10.3 0.58 10.1 63.4F-up 6 mo 8.7* 0.62 10.5* 67.0* d=1.48 d=1.20 d=2.17 d=1.63Between (d=.60) (d=.35) (d=.70) (d=.72)Mittareista:BDI rajat:0–13: ei lainkaan masennusta; 14–19: lievä masennus; 20–28: keskivaikea masennus; 29–63: vakavamasennus.SCL-90:, Symptom Check List-90: vertailuryhmä nä Espoon kaupungin työ ntekijä t, joiden tulos on 0.60GHQ General Health Questionnaire http://www.thl.fi/toimia/tietokanta/mittariversio/102/
UNIVERSITY OF JYVÄSKYLÄ 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).
UNIVERSITY OF JYVÄSKYLÄ 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
UNIVERSITY OF JYVÄSKYLÄ 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