The Efficacy and Effectiveness of Online CBT - Jeroen Ruwaard

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20 Chapter 2. Online CBT of Work-Related Stress2.2.4 MeasuresThe primary outcome measure was the Stress subscale from the Depression AnxietyStress Scales (DASS-42: Lovibond & Lovibond, 1995; Dutch version: de Beurs, vanDyck, Marquenie, Lange, & Blonk, 2001). Secondary measures were the Depressionand Anxiety subscales from the DASS and the Emotional Exhaustion subscale of theDutch version of the Maslach Burnout Inventory - General Survey (MBI-GS: Maslach,Jackson, & Leiter, 1996; Dutch version by Schaufeli & van Dierendonck, 2000).DASS. The DASS is a self-report instrument that assesses depressive symptoms,physical anxiety (fear), and mental stress (nervous tension). It contains 42 items,14 per subscale, that relate to the experience of symptoms in the past week. Theitems are measured on a 4-point scale ranging between 0 (”did not apply to me”)to 3 (”applied to me very much, or most of the time”). Higher scores denote lessfavourable conditions.All subscales of the Dutch adaptation are characterized by good internal consistencies(Cronbach’s α between .94 and .97, present sample: .86 to .92). Test-retestreliabilities for the Depression, Anxiety and Stress scale are r = .75, r = .89 and r =.79, respectively (de Beurs et al., 2001) . Clinical cut-off scores of c = 12 and c = 5 fordepression and anxiety are recommended by Nieuwenhuijsen, de Boer, Verbeek, Blonk,and van Dijk (2003). The corresponding percentile score of stress (14) observed in alarge (N = 1771) non-clinical sample in the UK (Crawford & Henry, 2003) was usedas the clinical cut-off in this study.MBI-GS Emotional Exhaustion. The MBI-GS is a self-report questionnaire to assessburnout across professional occupations. The Emotional Exhaustion subscale assessesemotional fatigue, i.e., the feeling of being ”worn-out”. The scale contains five itemsthat are measured on a 7-point scale scored from 0 to 6, where higher scores indicatehigher levels of emotional exhaustion. The internal consistency of the subscale rangesbetween .84 ≤ α ≤ .90 (present sample: α = .84). The 8-month test-retest reliabilityis satisfactory (.58 ≤ r ≤ .85). Well-established clinical cut-off scores are unavailablefor the Exhaustion scale. To indicate burnout, Brenninkmeijer and Van Yperen (2003)recommend a cut-off score of 2.67, which was used in the present study. With this
2.2. Method 21cut-off score, they found a false positive rate of 9.1% and a false negative rate of13.8%.2.2.5 AnalysisIntention-to-treat. The analyses were on an intention-to-treat basis and includedall participants. Dropouts, who did not complete the posttest measurements, wereassumed to have gained nothing. Their pretest scores also served as their posttestscores.Statistical significance. One-way ANCOVA’s (using the pretest scores as a covariate)were conducted to test the difference in means of the two groups at posttest (α = .05).The statistical significance of the within-group pre-post gain scores were assessedusing paired t-tests.The assumptions of ANCOVA were met. The homogeneity of the regression coefficientsin the two groups was confirmed by non-significant interactions between thecovariates (pretest scores) and experimental condition. The distributions of the outcomevariables were approximately normal, and the variance across the experimentalgroups was found to be homogeneous.Effect size. To express the magnitude of the effects, gain scores on the outcomemeasures were standardized to Cohen’s d’s (J. Cohen, 1988), representing the numberof standard deviations separating the two means. Point estimates and 95% confidenceintervals of d were determined both for the within- and the between-group effectsfollowing a procedure described in detail by Robey (2004). In this procedure, betweeneffect sizes are calculated using the pooled standard deviation and confidence intervalsare approximated from the central t-distribution.Clinical relevance. We tested the higher probability of statistically reliable improvementand recovery after treatment compared to the control group with Fisher exacttests, and expressed the difference in this probability between the treatment and thecontrol group in terms of odds ratios (Hillis & Woolson, 2002). We used the ReliableChange Index (RCI) to test the significance of individual improvement (Jacobson &Truax, 1991; α = .05; critical RCI = 1.96; “no change” and “detoriation” were pooled
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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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The Efficacy and Effectiveness of Online CBT - Jeroen Ruwaard

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