Publications by authors named "Eileen Bendig"

9 Publications

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Feasibility of a Software agent providing a brief Intervention for Self-help to Uplift psychological wellbeing ("SISU"). A single-group pretest-posttest trial investigating the potential of SISU to act as therapeutic agent.

Internet Interv 2021 Apr 24;24:100377. Epub 2021 Feb 24.

Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Lise Meitner Straße 16, 89081 Ulm, Germany.

Background: Software agents are computer-programs that conduct conversations with a human. The present study evaluates the feasibility of the software agent "SISU" aiming to uplift psychological wellbeing. Methods: Within a one-group pretest-posttest trial,  = 30 German-speaking participants were recruited. Assessments took place before (t1), during (t2) and after (t3) the intervention. The ability of SISU to guide participants through the intervention, acceptability, and negative effects were investigated. Data analyses are based on intention-to-treat principles. Linear mixed models will be used to investigate short-term changes over time in mood, depression, anxiety.

Intervention: The intervention consists of two sessions. Each session comprises writing tasks on autobiographical negative life events and an Acceptance- and Commitment Therapy-based exercise respectively. Participants interact with the software agent on two consecutive days for about 30 min each.

Results: All participants completed all sessions within two days. User experience was positive, with all subscales of the user experience questionnaire (UEQ) M > 0.8. Participants experienced their writings as highly self-relevant and personal. However, 57% of the participants reported at least one negative effect attributed to the intervention. Results on linear mixed models indicate an increase in anxiety over time (β = 1.33,  = .001). Qualitative User Feedback revealed that the best thing about SISU was its innovativeness (13%) and anonymity (13%). As worst thing about SISU participants indicated that the conversational style of SISU often felt unnatural (73%).

Conclusion: SISU successfully guided participants through the two-day intervention. Moreover, SISU has the potential to enter the inner world of participants. However, intervention contents have the potential to evoke negative effects in individuals. Expectable short-term symptom deterioration due to writing about negative autobiographical life events could not be prevented by acceptance and commitment therapy-based exercises. Hence, results suggest a revision of intervention contents as well as of the conversational style of SISU. The good adherence rate indicates the useful and acceptable format of SISU as a mental health chatbot. Overall, little is known about the effectiveness of software agents in the context of psychological wellbeing. Results of the present trial underline that the innovative technology bears the potential of SISU to act as therapeutic agent but should not be used with its current intervention content.

Trial-registration: The Trial is registered at the WHO International Clinical Trials Registry Platform via the German Clinical Studies Register (DRKS): DRKS00014933 (date of registration: 20.06.2018). Link: https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00014933.
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http://dx.doi.org/10.1016/j.invent.2021.100377DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8005771PMC
April 2021

Lessons learned from an attempted randomized-controlled feasibility trial on "WIDeCAD" - An internet-based depression treatment for people living with coronary artery disease (CAD).

Internet Interv 2021 Apr 24;24:100375. Epub 2021 Feb 24.

Department of Clinical Psychology and Psychotherapy, University Ulm, Ulm, Germany.

Despite the high prevalence of comorbid depression in people living with coronary artery disease (CAD), uptake of psychological treatment is generally low. This study was designed to investigate the feasibility of an internet-based cognitive-behavioral (iCBT) depression intervention for people with CAD and depressive symptoms.

Methods: People with CAD and depressive symptoms (PHQ-9 ≥ 5) were randomly assigned to the eight modules comprising iCBT ( = 18), or waitlist-control ( = 16). Measures were taken at baseline (t1) and at post-treatment (eight weeks after randomization, t2). Feasibility-related outcomes were recruitment strategy, study attrition, intervention dropout, satisfaction, negative effects as well as the potential of the intervention to affect likely outcomes in a future full-scale trial (depression, anxiety, quality of life, fear of progression). Data analyses were based on intention-to-treat principles. Linear regression models were used to detect between group differences. Linear Mixed Models were used to model potential changes over time.

Results: This trial was terminated prior to a-priori defined sample size has been reached given low recruitment success as well as high intervention dropout (88%) and study attrition (23%). On average, participants in the intervention group completed  = 2.78 ( = 3.23) modules. Participants in the waitlist control group barely started one module ( = 0.82,  = 1.81). The satisfaction with the intervention was low ( = 20.6,  = 0.88). Participants reported no negative effects attributed to the iCBT. Differences between groups with regard to depression, anxiety, fear of progression and quality of life remained non-significant ( > 0.05).

Conclusion: This trial failed to recruit a sufficient number of participants. Future work should explore potential pitfalls with regards to the reach and persuasiveness of internet interventions for people living with CAD. The study gives important indications for future studies with regard to the need for new ideas to reach and treat people with CAD and depression.
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http://dx.doi.org/10.1016/j.invent.2021.100375DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7941156PMC
April 2021

Study protocol of a randomised controlled trial on SISU, a software agent providing a brief self-help intervention for adults with low psychological well-being.

BMJ Open 2021 02 8;11(2):e041573. Epub 2021 Feb 8.

Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany.

Introduction: Only a minority of people living with mental health problems are getting professional help. As digitalisation moves on, the possibility of providing internet/mobile-based interventions (IMIs) arises. One type of IMIs are fully automated conversational software agents (chatbots). Software agents are computer programs that can hold conversations with a human by mimicking a human conversational style. Software agents could deliver low-threshold and cost-effective interventions aiming at promoting psychological well-being in a large number of individuals. The aim of this trial is to evaluate the clinical effectiveness and acceptance of the brief software agent-based IMI SISU in comparison with a waitlist control group.

Methods And Analysis: Within a two-group randomised controlled trial, a total of 120 adult participants living with low well-being (Well-being Scale/WHO-5) will be recruited in Germany, Austria and Switzerland. SISU is based on therapeutic writing and acceptance and commitment therapy-based principles. The brief intervention consists of three modules. Participants work through the intervention on 3 consecutive days. Assessment takes place before (t1), during (t2) and after (t3) the interaction with SISU, as well as 4 weeks after randomisation (t4). Primary outcome is psychological well-being (WHO-5). Secondary outcomes are emotional well-being (Flourishing Scale), psychological flexibility (Acceptance and Action Questionnaire-II), quality of life (Assessment of Quality of Life -8D), satisfaction with the intervention (Client Satisfaction Questionnaire-8) and side effects (Inventory for the assessment of negative effectsof psychotherapy). Examined mediators and moderators are sociodemographic variables, personality (Big Five Inventory-10), emotion regulation (Emotion Regulation Questionnaire), alexithymia (Toronto Alexithymia Scale-20), centrality of events (Centrality of Events Scale), treatment expectancies (Credibility Expectancy Questionnaire) and technology alliance (Inventory of Technology Alliance-Online Therapy). Data analysis will be based on intention-to-treat principles. SISU guides participants through a 3-day intervention.

Ethics And Dissemination: This trial has been approved by the ethics committee of the Ulm University (No. 448/18, 18.02.2019). Results will be submitted for publication in a peer-reviewed journal and presented at conferences.

Trial Registration: The trial is registered at the WHO International Clinical Trials Registry Platform via the German Clinical Trials Register (DRKS): DRKS00016799 (date of registration: 25 April 2019). In case of important protocol modifications, trial registration will be updated. This is protocol version number 1.
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http://dx.doi.org/10.1136/bmjopen-2020-041573DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7871683PMC
February 2021

Associations of depression and diabetes distress with self-management behavior and glycemic control.

Health Psychol 2021 Feb 30;40(2):113-124. Epub 2020 Nov 30.

Research Institute of the Diabetes Academy Mergentheim, Diabetes Center Mergentheim.

Objective: To analyze the independent associations of depression and diabetes distress with self-management and glycemic outcome in Type I (T1DM) and Type 2 diabetes (T2DM).

Method: Six hundred six people with T1DM or T2DM participated in a cross-sectional survey including measures of depression (PHQ-9), diabetes distress (PAID-5), self-management behavior (DSMQ), and glycemic outcome (HbA1c). Structural equation modeling was performed to analyze the independent linear associations (standardized coefficients) between these variables.

Results: In those with T1DM (n = 339), both depressive symptoms and diabetes distress were associated with lower self-management (-0.34, p < .001, and -0.16, p = .007, respectively) and thereover (indirectly) with higher HbA1c (0.20, p < .001, and 0.10, p = .016, respectively); direct associations with HbA1c were not observed. In those with T2DM (n = 267), only depressive symptoms were associated with lower self-management (-0.41, p < .001) and thus (indirectly) with higher HbA1c (0.17, p < .001). Diabetes distress, by contrast, was directly associated with higher HbA1c (0.20, p = .003) but not with self-management.

Conclusions: The results are consistent with the hypothesis that depression is linked to less optimal diabetes self-management, thus leading to less optimal glycemic outcome. The associations were relatively consistent across diabetes types. Diabetes distress was additionally associated with higher glycemic levels, suggesting that people with both depression and diabetes distress might have the least optimal outcome. The conclusions are limited by the cross-sectional study design, self-report assessment of behavior, and potential bias arising from questionnaire measures. Further research is needed to support these findings. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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http://dx.doi.org/10.1037/hea0001037DOI Listing
February 2021

Digital interventions in adult mental healthcare settings: recent evidence and future directions.

Curr Opin Psychiatry 2020 07;33(4):422-431

Department of Clinical Psychology and Psychotherapy, University of Ulm, Ulm, Germany.

Purpose Of Review: Internet and mobile-based interventions (IMI) can be used as online delivered forms of psychotherapeutic mental health treatments. These interventions can be an effective as well as time and cost-efficient treatment with the potential to scale up mental healthcare. In this review, we map implementation possibilities into routine mental healthcare settings and provide the most recent evidence.

Recent Findings: Fourteen articles on digital mental healthcare approaches published in the last 18 months were included. Despite the limited number, the studies provide evidence for the effectiveness of IMI in treating inpatients and outpatients with various disorders in different mental healthcare settings. IMI were investigated as stand-alone interventions, in combination with other treatment forms (blended-care), or as aftercare.

Summary: Although there is encouraging evidence for the effectiveness of IMI in mental healthcare settings, several limitations have to be considered. The small number of studies conducted within the healthcare system, especially with inpatient samples, calls for more collaboration between researchers and clinical practitioners to unravel barriers and develop efficient protocols for the integration into routine care. Nonetheless, IMI are a promising tool for the endeavour of closing the treatment gap and should, therefore, be further explored in varying settings.
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http://dx.doi.org/10.1097/YCO.0000000000000614DOI Listing
July 2020

Digital interventions in adult mental healthcare settings: recent evidence and future directions.

Curr Opin Psychiatry 2020 07;33(4):422-431

Department of Clinical Psychology and Psychotherapy, University of Ulm, Ulm, Germany.

Purpose Of Review: Internet and mobile-based interventions (IMI) can be used as online delivered forms of psychotherapeutic mental health treatments. These interventions can be an effective as well as time and cost-efficient treatment with the potential to scale up mental healthcare. In this review, we map implementation possibilities into routine mental healthcare settings and provide the most recent evidence.

Recent Findings: Fourteen articles on digital mental healthcare approaches published in the last 18 months were included. Despite the limited number, the studies provide evidence for the effectiveness of IMI in treating inpatients and outpatients with various disorders in different mental healthcare settings. IMI were investigated as stand-alone interventions, in combination with other treatment forms (blended-care), or as aftercare.

Summary: Although there is encouraging evidence for the effectiveness of IMI in mental healthcare settings, several limitations have to be considered. The small number of studies conducted within the healthcare system, especially with inpatient samples, calls for more collaboration between researchers and clinical practitioners to unravel barriers and develop efficient protocols for the integration into routine care. Nonetheless, IMI are a promising tool for the endeavour of closing the treatment gap and should, therefore, be further explored in varying settings.
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http://dx.doi.org/10.1097/YCO.0000000000000614DOI Listing
July 2020

My Sadness - Our Happiness: Writing About Positive, Negative, and Neutral Autobiographical Life Events Reveals Linguistic Markers of Self-Positivity and Individual Well-Being.

Front Psychol 2018 8;9:2522. Epub 2019 Jan 8.

Institute of Psychology and Education, University Psychotherapeutic Outpatient Clinic, Ulm University, Ulm, Germany.

Narratives of autobiographical events contain rich information about an individual's private experience, his/her deepest thoughts, feelings, and emotions. The present study investigates linguistic markers of emotion expression and subjective well-being in adults during one session of positive, negative, and neutral expressive writing. Participants ( = 28 healthy participants, = 7 adults with depressive symptoms), all native speakers of German were instructed to write expressively about personally relevant autobiographical life events of negative, positive, and neutral content. Quantitative text analysis was performed to determine the amount of emotional words, first person pronouns (singular vs. plural), and cognitive function words used in positive, negative, and neutral narratives and to examine the potency of these classes of words as linguistic markers of positivity/negativity, self-reference, and cognitive reappraisal. Additionally, the relationship between expressive writing and subjective well-being was explored by assessing changes in self-reported psychosomatic symptoms and in bodily and emotional awareness immediately after positive, negative, and neutral writing. Regarding healthy participants, negative narratives contained significantly more negative emotional words than positive or neutral narratives. However, negative narratives also contained more positive emotional words compared to negative emotional words in positive narratives. Moreover, negative narratives contained more cognitive function words than positive narratives, suggesting that healthy participants tried to reappraise negative experiences while writing about negative personal life events. Positive narratives were characterized by an increased use of positive words and of pronouns of the first person plural ("we"), supporting a positivity bias and an extension of self-reference from first person singular to plural (we-reference) during positive expressive writing. Similarly, writing about neutral events was characterized by a positivity bias. Although based on descriptive analysis only, preferential use of positive words and cognitive function words in negative narratives was absent in participants reporting depressive symptoms. Positive, negative, and neutral expressive writing was accompanied by differential changes in bodily sensations, emotional awareness, and self-reported psychosomatic symptoms in all participants. The findings are discussed with respect to previous research, a self-positivity bias, and a universal positivity bias in language use highlighting the relevance of these biases as markers of subjective well-being.
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http://dx.doi.org/10.3389/fpsyg.2018.02522DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6331680PMC
January 2019

Efficacy of a guided internet-based intervention (iSOMA) for somatic symptoms and related distress in university students: study protocol of a randomised controlled trial.

BMJ Open 2018 12 31;8(12):e024929. Epub 2018 Dec 31.

Department of Clinical Psychology, Psychotherapy and Experimental Psychopathology, Institute of Psychology, University of Mainz, Mainz, Germany.

Introduction: Persistent and distressing somatic symptoms are common in younger age cohorts such as university students. However, the majority does not receive adequate psychosocial care. Internet-based and mobile-based interventions may represent low threshold and effective extensions to reduce somatic and associated mental symptom severity. The planned study aims to investigate the feasibility and efficacy of an internet-based intervention in reducing somatic and psychological symptoms in an international population of university students with somatic symptom burden.

Methods And Analysis: This parallel two-armed randomised controlled trial evaluates an 8-week guided intervention, including web-based consecutive modules based on cognitive behavioural therapy (CBT) principles against a waitlist control group. Guidance will be provided by trained psychologists with weekly written supportive feedback. As part of the 'Studicare' project, the present study aims to recruit n=154 university students indicating somatic symptom burden at baseline in German-speaking universities. Self-report assessments will take place at baseline and after intervention completion (8, 16 weeks after randomisation). The primary outcome will be the severity of somatic symptoms and associated mental distress. Secondary outcomes include depression, (health) anxiety, disability, intervention satisfaction and adherence.

Ethics And Dissemination: Ethics approval has been granted. Results from this study will be published in peer-reviewed journals and presented at international conferences.

Trial Registration Number: DRKS00014375; Pre-results.
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http://dx.doi.org/10.1136/bmjopen-2018-024929DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6318514PMC
December 2018

Internet- Based Interventions in Chronic Somatic Disease.

Dtsch Arztebl Int 2018 11;115(40):659-665

Institute of Psychology and Education, Department of Clinical Psychology and Psychotherapy, Universityof Ulm, Ulm, Germany; Department for Psychology, Clinical Psychology and Psychotherapy, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; Department of Medical Psychology, VU University Medical Center and Academic Medical Center, Amsterdam, Netherlands; Department of Behavioural Sciences and Learning, Linköpings University, Linköping and Departmentof Clinical Neuroscience, Karolinska Institut, Stockholm, Sweden.

Background: Clinical guidelines recommend psychosocial care as an integral part of medical treatment, but access is often limited. Technology-based approaches provide an attractive opportunity to optimize health outcomes and quality of life in people with chronic somatic diseases e.g. by means of Internet- and mobile-based interventions (IMIs). The present article provides an overview on the basics of IMIs, applications and their evidence base for people living with chronic somatic diseases.

Methods: We conducted a selective literature search in the PubMed and Cochrane databases. Reviews which included randomized controlled trials investigating psychological IMIs were discussed pertaining to their relevance for the population described.

Results: IMIs lead to a change in unfavorable behavior connected to chronic somatic diseases. IMIs can foster protective factors like balanced physical activity or risk factors like smoking or alcohol consumption. However, studies reveal small effect sizes of d=0.25 for physical activity and an averaged effect size of d=0.20 for smoking and alcohol consumption. Additionally, IMIs can be used for the (co-)treatment of chronic somatic diseases, for instance to increase disease-specific selfefficacy in patients with diabetes (d=0.23). Studies included in meta-analyses are often highly heterogenous and are investigated in research contexts with limited health care services relevance.

Conclusion: IMIs are potentially effective when aiming at lifestyle changes and supporting medical treatment in people with chronic somatic diseases. However, results are still heterogenous and the evidence base is limited regarding specific settings, compounding the discussion of possible ways of implementing IMIs into our healthcare systems.
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http://dx.doi.org/10.3238/arztebl.2018.0659DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6234467PMC
November 2018