The Efficacy and Effectiveness of Online CBT - Jeroen Ruwaard

Recommendations

Info

100 Chapter 5. Online CBT of Bulimic SymptomsTable 5.4: Online CBT vs. control conditions (bibliotherapy and a waiting-list): ratesof reliable clinically significant change (RCSC; EDE-Q/BAT) and abstinence (bingeeating/purging), at posttest and 1-year follow-up (intention-to-treat analysis).Measure a Pretest Posttest Follow-upgroup n RCSC OR (CI .95 ) p c RCSC OR (CI .95 ) p cEDE-Qonline CBT 33 42% 4.5 (1.5 - 13.9) .01 42% 1.3 (.4 - 4.3) .99bibliotherapy 31 16% 32%waiting-list 34 12%BATonline CBT 32 22% 3.0 (.7 - 13.4) .51 25% 1.0 (.3 - 4.0) .99bibliotherapy 29 14% 24%waiting-list 31 3%Binge eatingonline CBT 35 37% 3.5 (1.2 - 10.4) .07 40% 1.3 (.4 - 3.8) .99bibliotherapy 35 14% 34%waiting-list 35 14%Purgingonline CBT 28 39% 7.2 (1.8 - 35.4) .02 39% 1.4 (.4 - 5.2) .99bibliotherapy 26 8% 30%waiting-list 24 8%a EDE-Q: Eating Disorder Examination-Questionnaire; BAT: Body Attitude Test. Behavioral items of the EDE-Q self-report wereused to assess one month frequencies of binge eating and purging (defined as the sum of the frequencies of self-inducedvomiting and laxative misuse).b n = number of participants with clinical symptom levels at pretest: EDE-Q: > 2.3; BAT: > 36; binge eating and purging:frequency > 0.c P-values reflect the results of a Fisher’s Exact test of the differences between the online CBT group and the control conditions(at posttest: the combined bibliotherapy group and the waiting-list group; at follow-up: the bibliotherapy group). P-valueswere Holm-Bonferroni adjusted to correct for multiple testing.d Follow-up data of the waiting-list group are not shown because follow-up measurements in this group were administered at alater time.(Andersson & Cuijpers, 2009; Cuijpers et al., 2009). The self-help book and the onlinetreatment comprised similar therapeutic principles and strategies. Yet, at posttest,effects of online CBT group were significantly better than those of bibliotherapy, whilethe effects of bibliotherapy were not significantly different from those of the waitinglist.In addition, participants in the bibliotherapy group were more likely to drop outof the study or seek additional treatment. Formal cost-effectiveness studies are neededto further inform us on the relative benefits of guided and unguided interventions.
5.4. Discussion 101Our results imply that face-to-face sessions are an optional ingredient of onlineCBT. Past trials of internet-based CBT for bulimic symptoms included face-to-facesessions (Ljotsson et al., 2007; Sánchez-Ortiz et al., 2010; Fernandez-Aranda et al.,2009; Nevonen et al., 2007; Robinson & Serfaty, 2008), which limits conclusionsabout the effects of online treatment per se, and may restrict the results of these trialsto those clients who are not deterred by face-to-face contact. These limitations donot apply to this trial, since the study did not involve any face-to-face contact. Ourresults suggest that face-to-face sessions may be an optional ingredient of online CBT.In the study of Sánchez-Ortiz and colleagues, face-to-face contact was replaced withtelephone contact when participants preferred not to meet face to face (Sánchez-Ortizet al., 2010). If existing online programs, which currently require face-to-face sessions,are adapted along similar lines, the uptake of these programs might increase.In the online CBT group, improvements at post-test remained stable up to one-yearafter treatment. However, in the bibliotherapy group, participants strongly improvedafter the end of treatment, which resulted in non-significant differences betweenthe two experimental conditions at follow-up. Since the bibliotherapy did not haveeffects at post-test, it is likely that bibliotherapy had an indirect delayed effect; thebibliotherapy might have stimulated participants to seek additional treatment at alater stage. The fact that 31% of the participants in the bibliotherapy group startedadditional treatment before post-test, supports this reasoning. Our results suggest thatbibliotherapy increases the probability of recovery by promoting positive attitudestowards treatment in a considerable portion of patients.5.4.1 LimitationsFirst, results of the long-term follow-up should be interpreted with caution. Studyattrition at follow-up was high. Participants, who experienced a more favourable longtermoutcome, may have been more inclined to respond to the follow-up invitations.Also, no data were available with regard to additional treatment between post-testand the long-term follow-up. This is a serious omission, since these data could haveprovided more support for our post-hoc hypothesis about the effect of additionaltreatment at follow-up.
Page 1:
The Efficacy andEffectiveness ofOnl
Page 4 and 5:
The studies in this thesis were sup
Page 6 and 7:
Promotiecommissie:Promotores: Prof.
Page 8 and 9:
6 Online CBT in Routine Clinical Pr
Page 10 and 11:
2 Chapter 1. General Introductionps
Page 12 and 13:
4 Chapter 1. General Introductiongr
Page 14 and 15:
6 Chapter 1. General Introduction1.
Page 16 and 17:
8 Chapter 1. General Introductiontr
Page 18 and 19:
Ruwaard, J., Lange, A., Bouwman, M.
Page 20 and 21:
12 Chapter 2. Online CBT of Work-Re
Page 22 and 23:
Page 24 and 25:
Page 26 and 27:
Page 28 and 29:
Page 30 and 31:
Page 32 and 33:
Page 34 and 35:
Page 36 and 37:
Page 38 and 39:
Page 40 and 41:
Page 42 and 43:
Ruwaard, J., Schrieken, B., Schrijv
Page 44 and 45:
36 Chapter 3. Online CBT of Depress
Page 46 and 47:
Page 48 and 49:
Page 50 and 51:
Page 52 and 53:
Page 54 and 55:
Page 56 and 57:
Page 58 and 59: 50 Chapter 3. Online CBT of Depress
Page 68 and 69: Ruwaard, J., Broeksteeg, J., Schrie
Page 70 and 71: 62 Chapter 4. Online CBT of Panic S
Page 92 and 93: Ruwaard, J., Lange, A., Broeksteeg,
Page 94 and 95: 86 Chapter 5. Online CBT of Bulimic
Page 110 and 111: 102 Chapter 5. Online CBT of Bulimi
Page 112 and 113: Ruwaard, J., Lange, A., Schrieken,
Page 114 and 115: 106 Chapter 6. Online CBT in Routin
Page 133 and 134: Chapter 7General DiscussionPrevious
Page 135 and 136: 7.1. Key Findings 1277.1.2 The effe
Page 137 and 138: 7.1. Key Findings 129Work−related
Page 139 and 140: 7.2. Strengths and limitations 1317
Page 141 and 142: 7.2. Strengths and limitations 133s
Page 143 and 144: 7.3. Implications for clinical prac
Page 145 and 146: 7.4. Suggestions for future researc
Page 147: 7.5. Conclusion 139Post-treatment b
Page 150 and 151: 142 Summaryof the introduction prov
Page 152 and 153: 144 Summarythat face-to-face contac
Page 154 and 155: 146 Summarycomplex, routine practic
Page 157 and 158: SamenvattingIn 1997 ontwikkelden on
Page 159 and 160:
Samenvatting 151startten direct met
Page 161 and 162:
Samenvatting 153up-metingen suggere
Page 163 and 164:
Samenvatting 155ongeveer gelijk zou
Page 165 and 166:
ReferencesAben, I., Verhey, F., Lou
Page 167 and 168:
References 159Bickel, R. (2007). Mu
Page 169 and 170:
References 161apy Research, 1(2), 8
Page 171 and 172:
References 163Hay, P. P., Bacaltchu
Page 173 and 174:
References 165for bulimia nervosa:
Page 175 and 176:
References 167Mond, J. M., Hay, P.
Page 177 and 178:
References 169(2003). The developme
Page 179 and 180:
References 171of change in psycholo
Page 181 and 182:
DankwoordAlleen mijn naam staat op
Page 183:
Dankwoord 175en Janneke Broeksteeg
Page 186 and 187:
178 Curriculum VitaeLange, A., & Ru
show all

The Efficacy and Effectiveness of Online CBT - Jeroen Ruwaard

Create successful ePaper yourself

Delete template?

Save as template?