Publications by authors named "Matthias Domhardt"

18 Publications

  • Page 1 of 1

Mechanisms of change in Internet- and mobile-based interventions for PTSD: a systematic review and meta-analysis.

Eur J Psychotraumatol 2021 Feb 19;12(1):1879551. Epub 2021 Feb 19.

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

: While Internet- and mobile-based interventions (IMIs) are potential options to increase the access to evidence-based therapies for post-traumatic stress disorder (PTSD), comprehensive knowledge on their working mechanisms is still scarce. : We aimed to evaluate studies investigating the efficacy and mechanisms of change in IMIs for adults with PTSD. : In this systematic review and meta-analysis (PROSPERO CRD42019130314), five databases were consulted to identify relevant studies, complemented by forward (i.e. citation search) and backward (i.e. review of reference lists from included studies) searches. Randomized controlled trials (RCTs) investigating the efficacy of IMIs compared to active controls, as well as component and mediation studies were included. Two independent reviewers extracted the data and assessed the risk of bias and requirements for process research. Random-effects meta-analyses on PTSD symptom severity as primary outcome were conducted and further information was synthesized qualitatively. : In total, 33 RCTs were included (N = 5421). The meta-analysis comparing IMIs to non-bonafide active controls yielded a significant standardized mean difference (SMD) of -0.36 (95%CI -0.53 to -0.19) favouring IMIs. Although meta-analytic pooling was not possible for the component and mediation studies, evidence suggests no differential effects regarding PTSD symptom reduction between different levels of support and personalization and between different types of exposure. Moreover, mediation studies revealed significant intervening variable effects for self-efficacy beliefs, perceived physical impairment, social acknowledgement, and trauma disclosure. : Results indicate that IMIs for PTSD are superior to active controls. Furthermore, findings may contribute to the development of new interventions by outlining important directions for future research (e.g. regarding requirements for process research) and highlighting potential mechanisms of change (i.e. self-efficacy, perceived physical impairment, social acknowledgement, and trauma disclosure).
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http://dx.doi.org/10.1080/20008198.2021.1879551DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8128120PMC
February 2021

Involving patients' perspective in the development of an internet- and mobile-based CBT intervention for adolescents with chronic medical conditions: Findings from a qualitative study.

Internet Interv 2021 Apr 16;24:100383. Epub 2021 Mar 16.

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

Objective: A user-centered approach is critical for increasing the adherence to and effectiveness of an internet- and mobile-based intervention program. Therefore, potential future intervention users were involved in the development of an internet- and mobile-based cognitive behavioral therapy program (iCBT) for adolescents and young adults (AYA) with chronic medical conditions and comorbid symptoms of anxiety or depression. We aimed to identify challenges and coping strategies of the intended target group, as well as their needs and preferred intervention characteristics for an iCBT program.

Methods: Twenty AYA (aged 14-20, 60% females) with either type 1 diabetes (55%), juvenile idiopathic arthritis (25%) or cystic fibrosis (20%) were interviewed in condition-specific focus groups (4-11 participants per group) either via videoconferencing or face-to-face. Transcript verbatim data was analyzed using content analysis.

Results: Frequently reported disease-specific burdens were among others fear of disease progression, non-acceptance of disease and stressful incidents related to and aversions against medical therapy. Most frequently reported coping strategies included, seeking social support and accepting the disease. Recommendations for the content of an iCBT for comorbid symptoms of anxiety and depression comprised: dealing with disease-related fears and getting advice on health-promoting lifestyles. iCBT characteristics considered preferable by participants were: providing individual feedback by a real-person; implementation of a feature to monitor treatment progress; youthful and varied content presentation; time per session not exceeding 1 h; non-involvement of parents. A mobile-based reminder feature was considered useful, and individual tailoring and self-determination of iCBT content was considered desirable.

Conclusions: The findings highlight important patient perspectives and age-specific recommendations which can help design more optimal iCBT interventions for AYA with chronic medical conditions.
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http://dx.doi.org/10.1016/j.invent.2021.100383DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8008172PMC
April 2021

More Light? Opportunities and Pitfalls in Digitalized Psychotherapy Process Research.

Front Psychol 2021 19;12:544129. Epub 2021 Mar 19.

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

While the evidence on the effectiveness of different psychotherapies is often strong, it is not settled and these therapies work. Knowledge on the causal factors and change mechanisms is of high clinical and public relevance, as it contributes to the empirically informed advancement of psychotherapeutic interventions. Here, digitalized research approaches might possess the potential to generate new insights into human behavior change, contributing to augmented interventions and mental healthcare practices with better treatment outcomes. In this perspective article, we describe recent findings of research into change mechanisms that were only feasible with digital tools and outline important future directions for this rather novel branch of research. Furthermore, we indicate several challenges and pitfalls that are to be solved, in order to advance digitalized psychotherapy process research, both methodologically and technologically.
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http://dx.doi.org/10.3389/fpsyg.2021.544129DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8017120PMC
March 2021

Efficacy of digital health interventions in youth with chronic medical conditions: A meta-analysis.

Internet Interv 2021 Apr 25;24:100373. Epub 2021 Feb 25.

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

Background: Digital health interventions might extend service provisions for youth with chronic medical conditions (CC) and comorbid mental health symptoms. We aimed to comprehensively evaluate the efficacy of Internet- and mobile-based interventions (IMIs) for different psychological and disease-related outcomes in children and adolescents with CC.

Method: Studies were identified by systematic searches in CENTRAL, Embase, MEDLINE/PubMed and PsycINFO, complemented by searches in reference lists of eligible studies and other reviews. We included studies, when they were randomized controlled trials (RCTs) comparing the efficacy of an IMI to control conditions in improving psychological and disease-related outcomes in youth (mean age ≤ 18 years) with CC. Study selection, data extraction and risk of bias assessment were conducted independently by two reviewers. Meta-analyses were performed within a random-effects model, and Hedges' (with 95% confidence intervals) was calculated as effect size measure. Primary outcomes were comorbid mental health symptoms (i.e., depression, anxiety and stress), as well as quality of life and self-efficacy.

Results: A total of 19 randomized controlled trials (2410 patients) were included in this meta-analysis. IMIs were associated with improvements in self-efficacy ( = 0.38; 95% CI, 0.15 to 0.61;  = 0) and combined disease-related outcomes ( = -0.13; 95% CI, -0.25 to -0.01 = 21). Meta-analyses on other outcomes were non-significant, and some pre-planned analyses were not feasible because of a shortage of studies.

Conclusion: The available evidence on IMIs for improving mental and health-related outcomes in youth with CC is limited. Our findings point to a rather small benefit and limited efficacy. Future research is needed, to comprehensively assess the potential of IMIs to extend collaborative care, and to identify factors contributing to improved user-centered interventions with better treatment outcomes.
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http://dx.doi.org/10.1016/j.invent.2021.100373DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7941178PMC
April 2021

Efficacy of digital health interventions in youth with chronic medical conditions: A meta-analysis.

Internet Interv 2021 Apr 25;24:100373. Epub 2021 Feb 25.

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

Background: Digital health interventions might extend service provisions for youth with chronic medical conditions (CC) and comorbid mental health symptoms. We aimed to comprehensively evaluate the efficacy of Internet- and mobile-based interventions (IMIs) for different psychological and disease-related outcomes in children and adolescents with CC.

Method: Studies were identified by systematic searches in CENTRAL, Embase, MEDLINE/PubMed and PsycINFO, complemented by searches in reference lists of eligible studies and other reviews. We included studies, when they were randomized controlled trials (RCTs) comparing the efficacy of an IMI to control conditions in improving psychological and disease-related outcomes in youth (mean age ≤ 18 years) with CC. Study selection, data extraction and risk of bias assessment were conducted independently by two reviewers. Meta-analyses were performed within a random-effects model, and Hedges' (with 95% confidence intervals) was calculated as effect size measure. Primary outcomes were comorbid mental health symptoms (i.e., depression, anxiety and stress), as well as quality of life and self-efficacy.

Results: A total of 19 randomized controlled trials (2410 patients) were included in this meta-analysis. IMIs were associated with improvements in self-efficacy ( = 0.38; 95% CI, 0.15 to 0.61;  = 0) and combined disease-related outcomes ( = -0.13; 95% CI, -0.25 to -0.01 = 21). Meta-analyses on other outcomes were non-significant, and some pre-planned analyses were not feasible because of a shortage of studies.

Conclusion: The available evidence on IMIs for improving mental and health-related outcomes in youth with CC is limited. Our findings point to a rather small benefit and limited efficacy. Future research is needed, to comprehensively assess the potential of IMIs to extend collaborative care, and to identify factors contributing to improved user-centered interventions with better treatment outcomes.
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http://dx.doi.org/10.1016/j.invent.2021.100373DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7941178PMC
April 2021

Mediators and mechanisms of change in internet- and mobile-based interventions for depression: A systematic review.

Clin Psychol Rev 2021 02 1;83:101953. Epub 2020 Dec 1.

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

The efficacy of Internet- and mobile-based interventions (IMIs) for depression in adults is well established. Yet, comprehensive knowledge on the mediators responsible for therapeutic change in these interventions is pending. Therefore, we conducted the first systematic review on mediators in IMIs for depression, investigating mechanisms of change in interventions with different theoretical backgrounds and delivery modes (PROSPERO CRD42019130301). Two independent reviewers screened references from five databases (i.e., Cochrane Library, Embase, MEDLINE/PubMed, PsycINFO and ICTRP), selected studies for inclusion and extracted data from eligible studies. We included 26 RCTs on mediators in IMIs for depression (6820 participants), rated their risk of bias and adherence to methodological quality criteria for psychotherapy process research. Primary studies examined 64 mediators, with cognitive variables (e.g., perceived control, rumination or interpretation bias) being the largest group of both examined (m = 28) and significant mediators (m = 22); followed by a range of other mediators, including mindfulness, acceptance and behavioral activation. Our findings might contribute to the empirically-informed advancement of interventions and mental health care practices, enabling optimized treatment outcomes for patients with depression. Furthermore, we discuss implications for future research and provide methodological recommendations for forthcoming mediation studies with more pertinent designs, allowing for inferences with higher causal specificity.
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http://dx.doi.org/10.1016/j.cpr.2020.101953DOI Listing
February 2021

Validation of the Mobile Application Rating Scale (MARS).

PLoS One 2020 2;15(11):e0241480. Epub 2020 Nov 2.

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

Background: Mobile health apps (MHA) have the potential to improve health care. The commercial MHA market is rapidly growing, but the content and quality of available MHA are unknown. Instruments for the assessment of the quality and content of MHA are highly needed. The Mobile Application Rating Scale (MARS) is one of the most widely used tools to evaluate the quality of MHA. Only few validation studies investigated its metric quality. No study has evaluated the construct validity and concurrent validity.

Objective: This study evaluates the construct validity, concurrent validity, reliability, and objectivity, of the MARS.

Methods: Data was pooled from 15 international app quality reviews to evaluate the metric properties of the MARS. The MARS measures app quality across four dimensions: engagement, functionality, aesthetics and information quality. Construct validity was evaluated by assessing related competing confirmatory models by confirmatory factor analysis (CFA). Non-centrality (RMSEA), incremental (CFI, TLI) and residual (SRMR) fit indices were used to evaluate the goodness of fit. As a measure of concurrent validity, the correlations to another quality assessment tool (ENLIGHT) were investigated. Reliability was determined using Omega. Objectivity was assessed by intra-class correlation.

Results: In total, MARS ratings from 1,299 MHA covering 15 different health domains were included. Confirmatory factor analysis confirmed a bifactor model with a general factor and a factor for each dimension (RMSEA = 0.074, TLI = 0.922, CFI = 0.940, SRMR = 0.059). Reliability was good to excellent (Omega 0.79 to 0.93). Objectivity was high (ICC = 0.82). MARS correlated with ENLIGHT (ps<.05).

Conclusion: The metric evaluation of the MARS demonstrated its suitability for the quality assessment. As such, the MARS could be used to make the quality of MHA transparent to health care stakeholders and patients. Future studies could extend the present findings by investigating the re-test reliability and predictive validity of the MARS.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0241480PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7605637PMC
December 2020

Validation of the Mobile Application Rating Scale (MARS).

PLoS One 2020 2;15(11):e0241480. Epub 2020 Nov 2.

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

Background: Mobile health apps (MHA) have the potential to improve health care. The commercial MHA market is rapidly growing, but the content and quality of available MHA are unknown. Instruments for the assessment of the quality and content of MHA are highly needed. The Mobile Application Rating Scale (MARS) is one of the most widely used tools to evaluate the quality of MHA. Only few validation studies investigated its metric quality. No study has evaluated the construct validity and concurrent validity.

Objective: This study evaluates the construct validity, concurrent validity, reliability, and objectivity, of the MARS.

Methods: Data was pooled from 15 international app quality reviews to evaluate the metric properties of the MARS. The MARS measures app quality across four dimensions: engagement, functionality, aesthetics and information quality. Construct validity was evaluated by assessing related competing confirmatory models by confirmatory factor analysis (CFA). Non-centrality (RMSEA), incremental (CFI, TLI) and residual (SRMR) fit indices were used to evaluate the goodness of fit. As a measure of concurrent validity, the correlations to another quality assessment tool (ENLIGHT) were investigated. Reliability was determined using Omega. Objectivity was assessed by intra-class correlation.

Results: In total, MARS ratings from 1,299 MHA covering 15 different health domains were included. Confirmatory factor analysis confirmed a bifactor model with a general factor and a factor for each dimension (RMSEA = 0.074, TLI = 0.922, CFI = 0.940, SRMR = 0.059). Reliability was good to excellent (Omega 0.79 to 0.93). Objectivity was high (ICC = 0.82). MARS correlated with ENLIGHT (ps<.05).

Conclusion: The metric evaluation of the MARS demonstrated its suitability for the quality assessment. As such, the MARS could be used to make the quality of MHA transparent to health care stakeholders and patients. Future studies could extend the present findings by investigating the re-test reliability and predictive validity of the MARS.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0241480PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7605637PMC
December 2020

Are Internet- and mobile-based interventions effective in adults with diagnosed panic disorder and/or agoraphobia? A systematic review and meta-analysis.

J Affect Disord 2020 11 15;276:169-182. Epub 2020 Jul 15.

Department of Clinical Psychology and Psychotherapy, Ulm University, Albert-Einstein-Allee-47, 89081 Ulm, Germany.

Background: There is no meta-analysis that specifically evaluates the effectiveness of Internet- and mobile-based interventions (IMIs) in adults with diagnosed panic disorder and/or agoraphobia (PD/A) so far. The current meta-analysis aims to fill this gap (PROSPERO CRD 42016034016).

Methods: Systematic literature searches in six databases for randomised and controlled clinical trials investigating IMIs in adults, who met diagnostic criteria for PD/A. Study selection and data extraction were conducted independently by two reviewers. Random-effects meta-analyses, pre-planned subgroup and sensitivity analyses were conducted when appropriate. Primary outcomes were PD and A symptom severity. In addition, adherence, response, remission, quality of life, anxiety and depression symptom severity were examined.

Results: A total of 16 trials (1015 patients), with 21 comparisons (9 IMI vs. waitlist; 7 IMI vs. IMI; 5 IMI vs. active treatment condition), were included. IMIs revealed beneficial effects on panic (Hedges' g range -2.61 to -0.25) and agoraphobia symptom severity when compared to waitlist (pooled g = -1.15, [95%-CI = -1.56; -0.74]). Studies comparing IMIs to active controls (i.e., face-to-face CBT and applied relaxation) did not find significant differences for reductions in panic (g = -0.02, [95%-CI = -0.25; 0.21]) and agoraphobia symptom severity (g = -0.10, [95%-CI = -0.39; 0.19]). Furthermore, IMIs were superior to waitlist controls regarding anxiety and depression symptom severity and quality of life.

Limitations: Tests for publication bias were not feasible due to the limited number of trials per comparison, and the risk of bias assessment indicated some methodological shortcomings.

Conclusions: Findings from this meta-analytic review provide support for the effectiveness of IMIs in patients with verified PD/A. However, before IMIs can be included in treatment guidelines for PD/A, future high quality research is needed that substantiates and extends the evidence base, especially in regard to intervention safety.
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http://dx.doi.org/10.1016/j.jad.2020.06.059DOI Listing
November 2020

Efficacy and Moderators of Internet-Based Interventions in Adults with Subthreshold Depression: An Individual Participant Data Meta-Analysis of Randomized Controlled Trials.

Psychother Psychosom 2021 16;90(2):94-106. Epub 2020 Jun 16.

Department of Medical Psychology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands,

Introduction: Evidence on effects of Internet-based interventions to treat subthreshold depression (sD) and prevent the onset of major depression (MDD) is inconsistent.

Objective: We conducted an individual participant data meta-analysis to determine differences between intervention and control groups (IG, CG) in depressive symptom severity (DSS), treatment response, close to symptom-free status, symptom deterioration and MDD onset as well as moderators of intervention outcomes.

Methods: Randomized controlled trials were identified through systematic searches via PubMed, PsycINFO, Embase and Cochrane Library. Multilevel regression analyses were used to examine efficacy and moderators.

Results: Seven trials (2,186 participants) were included. The IG was superior in DSS at all measurement points (posttreatment: 6-12 weeks; Hedges' g = 0.39 [95% CI: 0.25-0.53]; follow-up 1: 3-6 months; g = 0.30 [95% CI: 0.15-0.45]; follow-up 2: 12 months, g = 0.27 [95% CI: 0.07-0.47], compared with the CG. Significantly more participants in the IG than in the CG reached response and close to symptom-free status at all measurement points. A significant difference in symptom deterioration between the groups was found at the posttreatment assessment and follow-up 2. Incidence rates for MDD onset within 12 months were lower in the IG (19%) than in the CG (26%). Higher initial DSS and older age were identified as moderators of intervention effect on DSS.

Conclusions: Our findings provide evidence for Internet-based interventions to be a suitable low-threshold intervention to treat individuals with sD and to reduce the incidence of MDD. This might be particularly true for older people with a substantial symptom burden.
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http://dx.doi.org/10.1159/000507819DOI Listing
June 2020

Effectiveness and cost-effectiveness of guided Internet- and mobile-based CBT for adolescents and young adults with chronic somatic conditions and comorbid depression and anxiety symptoms (youthCOACH): study protocol for a multicentre randomized controlled trial.

Trials 2020 Mar 12;21(1):253. Epub 2020 Mar 12.

Department of Clinical Psychology and Psychotherapy, Faculty of Engineering, Computer Science and Psychology, Institute of Psychology and Education, Ulm University, Albert-Einstein-Allee 47, 89081, Ulm, Germany.

Background: Adolescents and young adults (AYA) with chronic somatic conditions have an increased risk of comorbid depression and anxiety symptoms. Internet- and mobile-based cognitive behavioural therapy (iCBT) might be one possibility to extend the access to evidence-based treatments. Studies suggest that guided iCBT can reduce anxiety and depression symptoms in AYA. However, little is known about the effectiveness of iCBT for AYA with chronic somatic conditions and comorbid symptoms of anxiety and/or depression in routine care. Evidence on the (cost-)effectiveness of iCBT is essential for its implementation in health care.

Objectives And Methods: This multicentre two-armed randomized controlled trial (RCT) aims to evaluate the (cost-) effectiveness of guided iCBT (youthCOACH) in addition to treatment as usual (TAU) compared to enhanced treatment as usual (TAU+) in AYA aged 12-21 years with one of three chronic somatic conditions (type 1 diabetes, cystic fibrosis, or juvenile idiopathic arthritis). AYA with one of the chronic somatic conditions and elevated symptoms of anxiety or depression (Patient Health Questionnaire [PHQ-9] and/or Generalized Anxiety Disorder [GAD-7] Screener score ≥ 7) will be eligible for inclusion. We will recruit 212 patients (2 × n = 106) in routine care through three German patient registries. Assessments will take place at baseline and at 6 weeks, 3 months, 6 months, and 12 months post-randomization. The primary outcome will be combined depression and anxiety symptom severity as measured with the PHQ Anxiety and Depression Scale. Secondary outcomes will include health-related quality of life, coping strategies, self-efficacy, stress-related personal growth, social support, behavioural activation, adjustment and trauma-related symptoms, automatic thoughts, intervention satisfaction, working alliance, and Internet usage. The cost-effectiveness will be determined, and potential moderators and mediators of intervention effects will be explored.

Discussion: iCBT might implicate novel ways to increase the access to evidence-based interventions in this specific population. The distinct focus on effectiveness and cost-effectiveness of youthCOACH in patients with chronic somatic conditions, as well as intervention safety, will most likely provide important new insights in the field of paediatric e-mental health. A particular strength of the present study is its implementation directly into routine collaborative health care. As such, this study will provide important insights for health care policy and stakeholders and indicate how iCBT can be integrated into existing health care systems.

Trial Registration: German Clinical Trials Register (DRKS), DRKS00017161. Registered on 17 September 2019.
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http://dx.doi.org/10.1186/s13063-019-4041-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7069009PMC
March 2020

Intervention components, mediators, and mechanisms of change of Internet- and mobile-based interventions for post-traumatic stress disorder: protocol for a systematic review and meta-analysis.

Syst Rev 2019 11 7;8(1):265. Epub 2019 Nov 7.

Department of Clinical Psychology and Psychotherapy, University of Ulm, Albert-Einstein-Allee-47, 89081, Ulm, Germany.

Background: While Internet- and mobile-based interventions (IMIs) might possess the potential to increase access to evidence-based therapies for post-traumatic stress disorder (PTSD), comprehensive knowledge on active intervention components and change mechanisms underlying their efficacy is largely pending so far. The proposed systematic review and meta-analysis will systematically review the current status of research on the efficacy of IMIs for adult PTSD compared to active control conditions and identify active intervention components and mediators responsible for therapeutic change.

Methods: A systematic literature search (PsycINFO, Medline/PubMed, Embase, CENTRAL, ICTRP, and Web of Science) will be conducted using keywords targeting "PTSD" and "Internet- and mobile-based interventions". Two independent researchers will retrieve studies eligible for inclusion and extract and evaluate data (design, population, outcomes, sample size, duration of intervention and follow-up, drop-out rate). Risk of bias will be assessed, and results will be synthesized qualitatively and evaluated meta-analytically when possible.

Discussion: The results of this systematic review and meta-analysis might further contribute to the development of IMIs for PTSD by highlighting intervention components and mediators associated with their efficacy. Knowledge about the active ingredients might ultimately lead to more effective interventions and treatment packages, with implications for clinical practice and dissemination of these rather novel interventions.

Systematic Review Registration: PROSPERO (CRD42019130314).
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http://dx.doi.org/10.1186/s13643-019-1190-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6836517PMC
November 2019

Acceptance and commitment therapy for chronic pain: protocol of a systematic review and individual participant data meta-analysis.

Syst Rev 2019 06 14;8(1):140. Epub 2019 Jun 14.

Department of Psychology, University of Uppsala, Uppsala, Sweden.

Background: Acceptance and commitment therapy (ACT) can be effective in treating chronic pain. Despite evidence supporting the effectiveness of ACT, uncertainties remain regarding which subgroups in the chronic pain population are likely to benefit most and least. This protocol describes the application for two meta-analytic approaches, one at the level of individual participant data and the other at the level of aggregated data, from randomized controlled trials of ACT for chronic pain (ACT-CP-MA).

Methods: We will systematically conduct literature searches in CENTRAL, MEDLINE, EMBASE, PsycINFO, and trial registers. Two reviewers will independently select studies for inclusion and data extraction. ACT-CP-MA will include randomized controlled trials with ACT for chronic pain compared to control conditions for adults (≥ 18 years) with chronic pain (> 3 months). We will invite the authors of all eligible trials to share individual participant data. Outcomes will include standardized measures of pain interference, pain intensity, depression, anxiety, health-related quality of life, participants' rating of overall improvement, and ACT-related process variables. Using the Cochrane Collaboration's tool and GRADE, reviewers will independently check for risk of bias, quality of evidence, and strength of recommendations. In the individual participant data meta-analysis, we will use a one-step approach where participants are clustered with studies and data from all studies are modeled simultaneously. For analyses, we will use mixed-effects models. Additionally, we will employ a meta-analysis with aggregate data and compare the results of both meta-analyses.

Discussion: This collaborative meta-analysis of individual participant data from randomized controlled trials of ACT for chronic pain versus control conditions will demonstrate how the known benefits of ACT for chronic pain vary across different subtypes of the chronic pain population. The results of the meta-analyses will be based on a comprehensive search of multiple databases and will help to inform future clinical trials and decision-making on the use of ACT in chronic pain and improve the quality, design, and reporting of future trials in this field.

Systematic Review Registration: PROSPERO CRD42019120901.
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http://dx.doi.org/10.1186/s13643-019-1044-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6570828PMC
June 2019

Internet- and mobile-based interventions for anxiety disorders: A meta-analytic review of intervention components.

Depress Anxiety 2019 03 19;36(3):213-224. Epub 2018 Nov 19.

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

Background: Although the efficacy of Internet- and mobile-based interventions (IMIs) for anxiety is established, little is known about the intervention components responsible for therapeutic change. We conducted the first comprehensive meta-analytic review of intervention components of IMIs for adult anxiety disorders.

Methods: Randomized controlled trials (RCTs) comparing IMIs for anxiety disorders to active online control groups, or IMIs to dismantled variations of the same intervention (± specific components) were identified by a systematic literature search in six databases. Outcomes were validated observer-rated or self-report measures for anxiety symptom severity and treatment adherence (number of completed modules and completer rate). This meta-analytic review is registered with PROSPERO (CRD42017068268).

Results: We extracted the data of 34 RCTs (with 3,724 participants) and rated the risk of bias independently by two reviewers. Random-effects meta-analyses were performed on 19 comparisons of intervention components (i.a., different psychotherapeutic orientations, disorder-specific vs. transdiagnostic approaches, guidance factors). IMIs had a large effect when compared to active online controls on symptom severity (standardized mean difference [SMD] of -1.67 [95% CI: -2.93, -0.42]; P = 0.009). Thereby, guided IMIs were superior to unguided interventions on symptom severity (SMD of -0.39 [95% CI: -0.59, -0.18]; P = 0.0002) and adherence (SMD of 0.38 [95% CI: 0.10, 0.66]; P = 0.007).

Conclusions: Overall, the results of this meta-analysis lend further support to the efficacy of IMIs for anxiety, pointing to their potential to augment service supplies. Still, future research is needed to determine which ingredients are essential, as this meta-analytic review found no evidence for incremental effects of several single intervention components apart from guidance.
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http://dx.doi.org/10.1002/da.22860DOI Listing
March 2019

Motivational Interviewing as a tool to enhance access to mental health treatment in adolescents with chronic medical conditions and need for psychological support (COACH-MI): study protocol for a clusterrandomised controlled trial.

Trials 2018 Nov 14;19(1):629. Epub 2018 Nov 14.

Department of General Paediatrics, Neonatology and Paediatric Cardiology, University Children's Hospital, Medical Faculty, Moorenstr. 5, Düsseldorf, 40225, Germany.

Background: This cluster-randomised monocentric controlled trial focuses on improving the uptake symptoms of mental health care in adolescents with chronic medical conditions who have been identified by screening to have depression or anxiety. The study aims to determine the efficacy of motivational interviewing (MI) delivered by trained physicians to increase 12- to 20-year-old adolescents' utilisation of psychological health care for symptoms of anxiety or depression.

Methods/design: In this single-centre approach, n = 1,000 adolescents will be screened (using PHQ-9 and GAD-7), and adolescents with results indicative of anxiety or depressive symptoms (n = 162) will be advised to seek psychological health care in clusters from treating physicians in specialised outpatient departments. Participants who screen positive will receive either two sessions of MI or treatment as usual (TAU; regarded as the typical daily clinical practice), which is focused on recommending them to seek psychological health care for further evaluation. MI efficacy will be compared to the current TAU as the control condition. The primary outcome is the utilisation rate of psychological health care after counselling by an MI-trained physician vs. an untrained physician. Additionally, reasons for not claiming psychological support and changes in disease-related parameters will be evaluated in a 6-month follow-up session.

Discussion: This trial will evaluate the feasibility of MI as a way to improve the utilisation of mental health-care services by adolescents who need further support other than that provided by standard care for chronic diseases. Physicians offering MI to adolescents may serve as a model for optimising health-care management in daily clinical practice, which may improve adolescents' long-term well-being by improving adherence to medical treatment and preventing negative lifelong consequences into adulthood.

Trial Registration: German Trials Register (DRKS), DRKS00014043 . Registered on 26 April 2018. Düsseldorf University study ID: 2017114504.
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http://dx.doi.org/10.1186/s13063-018-2997-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6236943PMC
November 2018

Internet- and Mobile-Based Interventions for Mental and Somatic Conditions in Children and Adolescents.

Z Kinder Jugendpsychiatr Psychother 2020 Jan 13;48(1):33-46. Epub 2018 Nov 13.

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

This meta-review integrates the current meta-analysis literature on the efficacy of internet- and mobile-based interventions (IMIs) for mental disorders and somatic diseases in children and adolescents. Further, it summarizes the moderators of treatment effects in this age group. Using a systematic literature search of PsycINFO and MEDLINE/PubMed, we identified eight meta-analyses ( = 8,417) that met all inclusion criteria. Current meta-analytical evidence of IMIs exists for depression (range of standardized mean differences, SMDs = .16 to .76; 95 % CI: -.12 to 1.12; k = 3 meta-analyses), anxiety (SMDs = .30 to 1.4; 95 % CI: -.53 to 2.44; = 5) and chronic pain (SMD = .41; 95 % CI: .07 to .74; = 1) with predominantly nonactive control conditions (waiting-list; placebo). The effect size for IMIs across mental disorders reported in one meta-analysis is SMD = 1.27 (95 % CI: .96 to 1.59; = 1), the effect size of IMIs for different somatic conditions is SMD = .49 (95 % CI: .33 to .64; = 1). Moderators of treatment effects are age ( = 3), symptom severity ( = 1), and source of outcome assessment ( = 1). Quality ratings with the AMSTAR-2-checklist indicate acceptable methodological rigor of meta-analyses included. Taken together, this meta-review suggests that IMIs are efficacious in some health conditions in youths, with evidence existing primarily for depression and anxiety so far. The findings point to the potential of IMIs to augment evidence based mental healthcare for children and adolescents.
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http://dx.doi.org/10.1024/1422-4917/a000625DOI Listing
January 2020

Psychotherapy of adjustment disorders: Current state and future directions.

World J Biol Psychiatry 2018 ;19(sup1):S21-S35

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

Objectives: This narrative review article provides an overview of current psychotherapeutic approaches specific for adjustment disorders (ADs) and outlines future directions for theoretically-based treatments for this common mental disorder within a framework of stepped care.

Methods: Studies on psychological interventions for ADs were retrieved by using an electronic database search within PubMed and PsycINFO, as well as by scanning the reference lists of relevant articles and previous reviews.

Results: The evidence base for psychotherapies specifically targeting the symptoms of AD is currently rather weak, but is evolving given several ongoing trials. Psychological interventions range from self-help approaches, relaxation techniques, e-mental-health interventions, behavioural activation to talking therapies such as psychodynamic and cognitive behavioural therapy.

Conclusions: The innovations in DSM-5 and upcoming ICD-11, conceptualising AD as a stress-response syndrome, will hopefully stimulate more research in regard to specific psychotherapeutic interventions for AD. Low intensive psychological interventions such as e-mental-health interventions for ADs may be a promising approach to address the high mental health care needs associated with AD and the limited mental health care resources in most countries around the world.
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http://dx.doi.org/10.1080/15622975.2018.1467041DOI Listing
November 2018

Resilience in Survivors of Child Sexual Abuse: A Systematic Review of the Literature.

Trauma Violence Abuse 2015 Oct 10;16(4):476-93. Epub 2014 Nov 10.

Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, Ulm, Germany.

Objective: This review article summarizes empirical research on resilience in survivors of child sexual abuse (CSA) and discusses protective factors that are associated with adaptive functioning in spite of sexual victimization.

Methods: A literature search to identify studies published up to November 2013 was performed within the databases PsycINFO, MEDLINE/PubMed, Web of Science, and PSYNDEXplus. Additional relevant studies were retrieved using a snowball technique. A total of 37 articles met the inclusion criteria and were included in the final sample.

Results: In the studies included in this review, the percentage of CSA survivors who were found to have a normal level of functioning despite a history of sexual abuse ranged from 10% to 53%. The protective factors that had the best empirical support were found to be education, interpersonal and emotional competence, control beliefs, active coping, optimism, social attachment, external attribution of blame, and most importantly, support from the family and the wider social environment.

Conclusions: Preventive and clinical interventions for survivors of CSA should utilize psychoeducation and cognitive strategies that are adapted to the developmental level of the victim and that seek to enhance social support from significant others. Future research should focus on longitudinal research designs considering resilience rather as a dynamic process with multiple dimensions in a social and developmental context.
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http://dx.doi.org/10.1177/1524838014557288DOI Listing
October 2015