The Efficacy and Effectiveness of Online CBT - Jeroen Ruwaard
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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

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10.07.2015 Views

46 Chapter 3. Online CBT of DepressionAppliedn = 231Withdrew n = 8033 did not start47 incomplete screeningPre-testn = 151Excluded n = 9724 prevailing pts20 suicidal ideation15 severe depression14 dissociation13 panic disorder5 no depression4 psychosis2 drug abuseRandomised (1:2)n = 54Waiting-list Control n = 18Web-based CBT n = 3633 completed3 discontinued11-week Follow-up n = 162 uncontactablePost-treatment Follow-up n = 333 unmotivatedAnalyzed n = 18Analyzed n = 36Web-based CBT n = 1614 completed2 discontinuedPost-treatment Follow-up n = 142 unmotivated18 Months Follow-up n = 1218 Months Follow-up n = 27Analyzed n = 12Analyzed n = 27Figure 3.1: Flowchart of study participation.

3.3. Results 472002). First, we used the Reliable Change Index (RCI) to test the significance ofindividual change (Jacobson & Truax, 1991; ’no change’ and ’deterioration’ werepooled into a single ’unimproved’ category). Next, recovery was defined as reliablechange from a pretest score above the (published) clinical cut-off to a posttest scorebelow the cut-off. Therefore, participants scoring below cut-off at pretest wereexcluded from the recovery analysis.Follow-up. Pre-treatment to follow-up data of those who participated in the followupwere analyzed using repeated measures analysis of variance (ANOVA) with time ofmeasurement as a 3-level within-subject factor (pretest/posttest/follow-up). Differencesbetween the means at the times of measurement were tested for significanceusing simple contrasts and p-value adjustments to control the false discovery ratewithin each measure.Mediating variables. To assess the strength of outcome predictors, we examined thecorrelation of several predictor variables with the change scores of the BDI-IA (pretestposttest;pretest-follow-up). Additionally, the predictors were examined throughmultiple regression analyses.3.3 Results3.3.1 RCTEnrollment and screening. In response to the newspaper article, 231 respondentsapplied for treatment, of whom 80 (34%) subsequently withdrew. Of the 151 participantswho completed the screening, 97 (64%) were excluded, and 54 (36%) wereincluded (cf. Figure 3.1). As shown in Table 3.1, excluded respondents scored lessfavourably on the BDI-IA [t(148) = 5.8, P < .001] and the other outcome measures,in accordance with the exclusion protocol. In addition, excluded respondents wereyounger [t(149) = 3.3, P =.001] and less educated [χ 2 (1, n = 143) = 4.9, P =.03].Sample. The included sample (N = 54) comprised 37 women (69%) and 17 men(31%). On average, they were middle-aged (M = 42, SD = 10, range: 18 - 71),

46 Chapter 3. <strong>Online</strong> <strong>CBT</strong> <strong>of</strong> DepressionAppliedn = 231Withdrew n = 8033 did not start47 incomplete screeningPre-testn = 151Excluded n = 9724 prevailing pts20 suicidal ideation15 severe depression14 dissociation13 panic disorder5 no depression4 psychosis2 drug abuseR<strong>and</strong>omised (1:2)n = 54Waiting-list Control n = 18Web-based <strong>CBT</strong> n = 3633 completed3 discontinued11-week Follow-up n = 162 uncontactablePost-treatment Follow-up n = 333 unmotivatedAnalyzed n = 18Analyzed n = 36Web-based <strong>CBT</strong> n = 1614 completed2 discontinuedPost-treatment Follow-up n = 142 unmotivated18 Months Follow-up n = 1218 Months Follow-up n = 27Analyzed n = 12Analyzed n = 27Figure 3.1: Flowchart <strong>of</strong> study participation.

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