To Örebro University

Therapist-guided internet-based cognitive behavioural therapy (iCBT) has improved access to treatment for depression and anxiety, but scalability is limited by reliance on trained therapists. This feasibility trial evaluated a tailored digital self-help intervention for adults with depressive and anxiety symptoms, delivered with or without clinician guidance. In total, 124 participants in Sweden with at least mild depressive or anxiety symptoms were recruited through social media and randomized (1:1) to an eight-week program with (n = 63) or without (n = 61) clinician guidance. All participants completed telephone assessments before and after the intervention. The primary aim was to assess feasibility of both versions, while considering outcome advantages of guidance and reduced clinician time with self-help. Feasibility outcomes included adherence, credibility, satisfaction, and adverse events. The intervention was perceived as credible, with high satisfaction and engagement: most participants used the program weekly, and two thirds completed at least three of five modules. Outcomes were similar across groups, though participants with guidance reported higher satisfaction. Clinician time averaged 36 minutes for self-help participants and 66 minutes for those receiving guidance. Both groups showed large symptom reductions (Cohen's d = 1.05-1.10), supporting feasibility and motivating future trials comparing self-help and clinician-guided delivery.

INTRODUCTION: Therapist-guided internet interventions have increased access to care for a range of psychiatric and somatic conditions during the last decades. However, there is still a need for more easily accessible self-care interventions to improve treatment dissemination further. Brief digital self-care interventions, i.e. self-help interventions without therapist-guidance that are given together with a clinical assessment interview, reduce both patient burden and clinical resources.

METHODS: A new individually tailored self-care intervention for anxiety and low mood has been developed and will be tested in a pilot study. The study is a single-blind randomized controlled trial with parallel arms design. Participants are randomized to one of two groups: with or without weekly support from a therapist during the intervention. The intervention is eight weeks long and consists of less text and less number of exercises compared to the more comprehensive therapist-guided internet interventions used in Swedish routine care. A telephone interview evaluating the intervention will take place at the end of the eight weeks. The goal is to recruit 160 participants.

RESULTS AND CONCLUSIONS: The design of the self-care intervention and preliminary efficacy data from the trial will be presented. Data on participant characteristics, adherence and choice of tailored problem area will also be shown. If successful, self-care interventions can further increase accessibility to care for people suffering with low mood and anxiety. Future studies aim to adapt the level of support by a clinician based on participant response to the self-care intervention, i.e. offering more support to participants that have a predicted negative outcome of the intervention.

Background: Research show that internet-based CBT (iCBT) is an effective treatment for depression. However, little is known about how length of treatment text material affect outcomes. Accessibility to treatment would improve if treatment could be presented with less text, especially for patients with ADHD symptoms and lower reading speed.Objective: The aim of this study was to test the hypothesis that a Condensed treatment would be non-inferior to a Full-length treatment. We further hypothesized that a Condensed treatment would be extra helpful for participants with a low reading speed and more ADHD symptoms.

Method: A single-blind randomised controlled trial was conducted (N = 267) comparing two versions of guided iCBT for depression; Full-length (60 000 words) and Condensed (30 000 words). Estimated between-group effect sizes and their confidence intervals were compared to a pre-determined non-inferiority margin (Cohen’s d = 0.4). Moderation analyses of reading speed and ADHD symptoms were conducted, as well as comparisons of treatment engagement and knowledge acquisition.

Results: The Condensed version of iCBT was non-inferior at endpoint for depressive symptoms, anxiety symptoms, and quality of life compared to the Full-length version. There was a significant interaction effect between reading speed and treatment version. No significant differences between the treatment versions were found on measures of treatment engagement or knowledge acquisition.

Conclusion: A condensed version of iCBT for depression can be used with non-inferior results. A condensed treatment might be extra helpful for patients with lower reading speed. Given a high degree of missing data, these results need to be replicated.

BACKGROUND: Research shows that internet-based cognitive behavioural therapy (iCBT) is an effective treatment for depression. However, little is known about how the length of the text material in iCBT affects outcomes.

OBJECTIVE: The aim of this study was to test whether a condensed iCBT version for depression would be non-inferior to the existing full-text version in reducing depressive symptoms at post-treatment. We also wanted to test non-inferiority for secondary outcomes and explore reading speed and ADHD symptoms as potential moderators.

METHOD: A single-blind randomized controlled trial was conducted (N = 267) comparing two versions of guided iCBT for depression; full-text (around 60,000 words) and condensed (around 30,000 words, with the option to listen to the text). Estimated between-group effect sizes and their confidence intervals for depression, anxiety and quality of life, were compared to a pre-determined non-inferiority margin (ES = 0.4). Moderation analyses of reading speed and ADHD symptoms were conducted.

RESULTS: The condensed version of iCBT was non-inferior to the full-text version on post-treatment measures for depressive symptoms (95 % CI = -0.42-0.24), anxiety symptoms (95 % CI = -0.24-0.32), and quality of life (95 % CI = -0.09-0.49). Non-inferiority was inconclusive for depressive symptoms at the one-year follow-up (95 % CI = -0.60-0.47). There was no significant moderation effects of reading speed (p = 0.06) or ADHD symptoms (p = 0.11) on depressive symptoms.

CONCLUSION: These results indicate that a condensed version of iCBT for depression is as effective at treating depression as the full-text version. By shortening texts, iCBT may be made available to more people. Due to unequal dropout rates between the groups, these results are preliminary and need to be replicated.

Objectives: Male pelvic pain is a common yet poorly understood condition, strongly influencing quality of life of those affected. Research on psychological and sexual factors is lacking, specifically on younger men in family-forming ages. This study aims to explore psychological and sexual factors related to pelvic pain in younger men (<40 years) through a cross-sectional design.

Methods: Participants were recruited via social media, and completed a digital survey regarding sexual health and psychological distress (n=2,647). Men with varying levels of pelvic pain were compared on levels of psychological distress and self-reported sexual health.

Results: Men with pelvic pain (n=369) reported significantly higher levels of catastrophizing, anxiety and premature ejaculation compared to men without pelvic pain. Furthermore, men with higher pain intensity reported significantly higher levels of catastrophizing, anxiety and depressive symptoms compared to men experiencing lower pain intensity. Hierarchical regression analysis revealed catastrophizing and depressive symptoms as significantly predictors of pain intensity.

Conclusions: These findings underscore the role of psychological factors in male pelvic pain, and points to the need for integrating a psychological understanding for further treatment development.