The Efficacy and Effectiveness of Online CBT - Jeroen Ruwaard
The Efficacy and Effectiveness of Online CBT - Jeroen Ruwaard The Efficacy and Effectiveness of Online CBT - Jeroen Ruwaard
116 Chapter 6. Online CBT in Routine Clinical Practice6.2.4 Statistical significance and effect sizeStatistical significance. Table 6.2 shows means and standard deviations of patients’questionnaire scores at each measurement occasion. Table 6.3 shows results ofthe regression analyses of pre-to-post-treatment changes in symptom severity. Eachmeasure of specific and general psychopathology indicated significant (P < .001)reductions in symptom severity, on the short term (at posttest and 6-week follow-up),as well as on the long term (at one-year follow-up).Effect size. Point estimates and 95% confidence intervals of effect sizes are shown inTable 6.3. With regard to the primary outcome measures of specific symptom severity,short-term improvements represented a large pooled standardized effect size of d =1.4 (range: 0.7 ≤ d ≤ 1.9). One year after treatment, these effect sizes were foundto be sustained. With regard to general psychopathology (as measured by the DASStotal score), short-term improvements represented a large pooled effect size of d =1.2 (range: 0.7 ≤ d ≤ 1.6), and these effect sizes also sustained on the long term.6.2.5 Reliable and clinically significant changeResults of the clinical significance analyses are shown in Table 6.4. On the short-term(at post-test and 6-weeks follow-up), reliable improvement was 72% among treatmentcompleters (n = 1046, 71%), and 55% in the full intent-to-treat sample (N = 1500,conservatively assuming no change where scores were unavailable). Recovery (i.e.,reliable improvement from a pretest score above cut-off to a post-treatment scorebelow cut-off) was 51% in the completers analysis and 40% in the intent-to-treatanalysis. Reliable deterioration was 2% or less. Available data of the 1-year follow-up(n = 358), which were almost exclusively provided by treatment completers (99%),revealed an average reliable improvement rate of 78% and a recovery rate of 59%(c.f. Table 6.5).
6.2. Results 117Table 6.4: Clinical significance of short-term changes in primary psychopathology. aTreatment Recovered Improved No change Deterioratedmeasure b Sample c n n % n % n % n %DepressionBDI All 413 177 44% 68 17% 165 39% 3 1%Completer 258 158 61% 58 22% 41 16% 1 0%Dass All 413 189 46% 37 9% 183 44% 4 1%Depression Completer 258 170 66% 29 11% 55 21% 4 2%PanicPDSS-SR All 139 52 37% 14 10% 73 53% 0 0%Completer 87 42 48% 11 13% 34 39% 0 0%Posttraumatic stressIES All 478 190 40% 94 20% 193 40% 1 0%Completer 358 181 51% 93 26% 83 23% 1 0%BurnoutOLBI All 470 134 29% 111 24% 220 47% 5 1%Completer 364 122 34% 104 29% 133 37% 5 1%Dass Stress All 470 205 44% 58 12% 204 43% 3 1%Completer 364 189 52% 53 15% 119 33% 3 1%a Analyses of short-term changes were based on individual difference scores on the primary outcome measures, calculated asthe pretest score minus the mean of the post-test and 6-week follow-up score.b BDI: Beck Depression Inventory, version IA (cut-off: 10; reliable change: 7 scale points); DASS: Depression Anxiety StressScales (DASS Depression cut-off: 12; reliable change:5 scale points; DASS Stress cut-off: 14; reliable change: 7 scale points);IES: the Impact of Event Scale (cut-off: 24; reliable change: 12 scale points); OLBI: Oldenburg Burnout Inventory (cut-off:2.18; reliable change: .37 scale points). PDSS-SR: Panic Disorder Severity Scale - Self report (cut-off: 8; reliable change: 5scale points).c All: all patients (assuming no change where data was missing); Completer: subsample of patients, who completed the fulltreatment and at least one post-treatment assessment.Table 6.5: Clinical significance of changes in primary psychopathology, at one-yearfollow-up.Treatment Recovered Improved No change Deterioratedmeasure a n n % n % n % n %DepressionBDI 131 73 56% 33 25% 25 19% 0 0%Dass Depression 80 70% 19 17% 14 12% 2 2%PanicPDSS-SR 43 28 65% 6 14% 9 21% 0 0%BurnoutOLBI 184 72 42% 52 30% 40 23% 8 5%Dass Stress 95 52% 31 17% 54 29% 4 2%a BDI: Beck Depression Inventory, version IA (cut-off: 10; reliable change: 7 scale points); DASS: Depression Anxiety StressScales (DASS Depression cut-off: 12; reliable change:5 scale points; DASS Stress cut-off: 14; reliable change: 7 scale points);OLBI: Oldenburg Burnout Inventory (cut-off: 2.18; reliable change: .37 scale points). PDSS-SR: Panic Disorder Severity Scale -Self report (cut-off: 8; reliable change: 5 scale points).
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- Page 133 and 134: Chapter 7General DiscussionPrevious
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- Page 167 and 168: References 159Bickel, R. (2007). Mu
- Page 169 and 170: References 161apy Research, 1(2), 8
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6.2. Results 117Table 6.4: Clinical significance <strong>of</strong> short-term changes in primary psychopathology. aTreatment Recovered Improved No change Deterioratedmeasure b Sample c n n % n % n % n %DepressionBDI All 413 177 44% 68 17% 165 39% 3 1%Completer 258 158 61% 58 22% 41 16% 1 0%Dass All 413 189 46% 37 9% 183 44% 4 1%Depression Completer 258 170 66% 29 11% 55 21% 4 2%PanicPDSS-SR All 139 52 37% 14 10% 73 53% 0 0%Completer 87 42 48% 11 13% 34 39% 0 0%Posttraumatic stressIES All 478 190 40% 94 20% 193 40% 1 0%Completer 358 181 51% 93 26% 83 23% 1 0%BurnoutOLBI All 470 134 29% 111 24% 220 47% 5 1%Completer 364 122 34% 104 29% 133 37% 5 1%Dass Stress All 470 205 44% 58 12% 204 43% 3 1%Completer 364 189 52% 53 15% 119 33% 3 1%a Analyses <strong>of</strong> short-term changes were based on individual difference scores on the primary outcome measures, calculated asthe pretest score minus the mean <strong>of</strong> the post-test <strong>and</strong> 6-week follow-up score.b BDI: Beck Depression Inventory, version IA (cut-<strong>of</strong>f: 10; reliable change: 7 scale points); DASS: Depression Anxiety StressScales (DASS Depression cut-<strong>of</strong>f: 12; reliable change:5 scale points; DASS Stress cut-<strong>of</strong>f: 14; reliable change: 7 scale points);IES: the Impact <strong>of</strong> Event Scale (cut-<strong>of</strong>f: 24; reliable change: 12 scale points); OLBI: Oldenburg Burnout Inventory (cut-<strong>of</strong>f:2.18; reliable change: .37 scale points). PDSS-SR: Panic Disorder Severity Scale - Self report (cut-<strong>of</strong>f: 8; reliable change: 5scale points).c All: all patients (assuming no change where data was missing); Completer: subsample <strong>of</strong> patients, who completed the fulltreatment <strong>and</strong> at least one post-treatment assessment.Table 6.5: Clinical significance <strong>of</strong> changes in primary psychopathology, at one-yearfollow-up.Treatment Recovered Improved No change Deterioratedmeasure a n n % n % n % n %DepressionBDI 131 73 56% 33 25% 25 19% 0 0%Dass Depression 80 70% 19 17% 14 12% 2 2%PanicPDSS-SR 43 28 65% 6 14% 9 21% 0 0%BurnoutOLBI 184 72 42% 52 30% 40 23% 8 5%Dass Stress 95 52% 31 17% 54 29% 4 2%a BDI: Beck Depression Inventory, version IA (cut-<strong>of</strong>f: 10; reliable change: 7 scale points); DASS: Depression Anxiety StressScales (DASS Depression cut-<strong>of</strong>f: 12; reliable change:5 scale points; DASS Stress cut-<strong>of</strong>f: 14; reliable change: 7 scale points);OLBI: Oldenburg Burnout Inventory (cut-<strong>of</strong>f: 2.18; reliable change: .37 scale points). PDSS-SR: Panic Disorder Severity Scale -Self report (cut-<strong>of</strong>f: 8; reliable change: 5 scale points).
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