The Efficacy and Effectiveness of Online CBT - Jeroen Ruwaard

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16 Chapter 2. Online CBT of Work-Related Stressstarted worrying and ruminating spontaneously, they were required to make a shortnote, and to determine the next fixed moment for ruminating. Furthermore they wererequired to focus on their notes and to challenge dysfunctional (black/white) thinking,overgeneralization, catastrophic thinking, self-blaming, and neglect of positive aspects(Beck, 2005). They did this three times a week for 20 minutes.Phase 4. Positive self-verbalization. Participants were taught to focus on theirpositive qualities by using the technique of positive self-verbalization (Lange et al.,1998; Lange, Richard, Kiestra, & van Oostendorp, 1997). They wrote an essay on theirpositive traits and summarized this on a small card. The participants were encouragedto read the summary on the card frequently, and read it aloud.Phase 5. Positive assertiveness/social skills training and behavioural experiments.Participants received a short social skills training. They were encouraged toreflect on the reciprocity of the interactions with their fellow-workers. Subsequently,they received instructions how to experiment with new strategies to improve negativereciprocal behaviours. They were, for instance, taught to communicate wishes in apositive and constructive manner, to give compliments, and to express their interestin the well-being of others. If they questioned the validity of these strategies, thetherapist helped to create behavioural experiments, in which the new approachescould be put to test in a simple and realistic manner.Phase 6. Time management. Participants were made aware how they managedthe demands of both their work and their private life. In the evening, participantsreflected on the activities of the day, after which they planned the activities for the nextday. The participants learned how to set priorities, to reject requests that they foundtoo demanding, to plan time for relaxation and self-reward, and to avoid unrealisticscheduling. They were encouraged to take their time to decide consciously whetherto start an activity immediately, postpone it, or to pass it on to someone else.Phase 7. Future, reintegration and relapse prevention: the toolkit. Participantsreflected on symptoms that might signal relapse. They were encouraged to formulatetheir personal ’relapse prevention toolkit’, using the techniques they had mastered in
2.2. Method 17therapy. They were encouraged to print the toolkit, and place it in a visible place athome as a symbol of what they had mastered. Participants who were partially or fullyon sick leave received suggestions for gradual reintegration.2.2 Method2.2.1 DesignThe comparitive study comprised a waiting-list controlled pre-post trial. Participantswere randomly assigned to two groups. One group started the 7-week treatmentimmediately (experimental group), while the other started it after 7 weeks (waitinglist control group). Three years after the completion of the pretest, a follow-up studywas conducted among the clients of the experimental group who had completed thetherapy to determine the long-term effects of the intervention.2.2.2 ParticipantsRecruitment. A national Dutch quality newspaper published an interview with oneof the authors about Internet-driven therapy. The article announced the current study,and referred interested readers to a website. This site provided psycho-education onwork-related stress, explained the purpose and design of the study, and contained anapplication form.Screening. Respondents were screened by means of self-report questionnaires withrespect to the following exclusion criteria: age < 18 years, heightened risk of dissociationor psychosis, suicidal ideation, drug abuse, use of neuroleptic medication, andconcurrent other treatment. In addition, respondents were required to download,print, and return a signed Informed Consent form. Excluded respondents were referredto other mental health institutions.The participants completed a multiple-choice questionnaire to record age, gender,marital status, education, work contract, work years, working hours, duration ofsymptoms, sick leave status, and perceived causes of stress. In addition, alcoholdependency and drug abuse was registered. To assess the use of neuroleptics, participantsanswered open-ended questions concerning medicine brands and prescribed
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Chapter 7General DiscussionPrevious
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7.1. Key Findings 1277.1.2 The effe
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7.1. Key Findings 129Work−related
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7.2. Strengths and limitations 1317
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7.2. Strengths and limitations 133s
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7.3. Implications for clinical prac
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7.4. Suggestions for future researc
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7.5. Conclusion 139Post-treatment b
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142 Summaryof the introduction prov
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144 Summarythat face-to-face contac
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146 Summarycomplex, routine practic
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SamenvattingIn 1997 ontwikkelden on
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Samenvatting 151startten direct met
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Samenvatting 153up-metingen suggere
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Samenvatting 155ongeveer gelijk zou
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ReferencesAben, I., Verhey, F., Lou
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References 159Bickel, R. (2007). Mu
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References 161apy Research, 1(2), 8
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References 163Hay, P. P., Bacaltchu
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References 165for bulimia nervosa:
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References 167Mond, J. M., Hay, P.
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References 169(2003). The developme
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References 171of change in psycholo
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DankwoordAlleen mijn naam staat op
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Dankwoord 175en Janneke Broeksteeg
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178 Curriculum VitaeLange, A., & Ru
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