The role of therapist support on effectiveness of an internet-based modular self-help intervention for adjustment disorder: a randomized controlled trial.

BACKGROUND: Adjustment disorder is among the most often diagnosed mental health disorders. Still, there is a lack of specific interventions available for adjustment disorder. OBJECTIVES: The aim of this study was to test if an internet-based self-help intervention for adjustment disorder could be effective without therapist involvement. DESIGN: A parallel group randomized controlled trial design was used to test the effectiveness of the Brief Adjustment Disorder Intervention (BADI) - an internet-based intervention for adjustment disorder. METHODS: In total 1077 participants were randomized into two conditions: BADI intervention and BADI intervention with therapist support. The main outcome measures were symptoms of adjustment disorder and well-being. RESULTS: Pre-intervention to post-intervention adjustment disorder effect size for the BADI intervention group was d = 0.64, and for the BADI with therapist support group the effect size was d = 0.53. CONCLUSIONS: The present study supported the effectiveness of the BADI intervention. Our findings also indicated that adding therapist support to the standard BADI intervention did not significantly improve the outcomes.

'It will get even better': preliminary findings from a trauma-focused psychotherapy effectiveness study reveal false positive patients' long-term outcome expectations after the treatment.

BACKGROUND: There is considerable evidence that outcome expectations may predict psychotherapy outcomes. However, little is known about the long-term outcome expectations following the end of the treatment. AIMS: The aim of this study was to evaluate patients' long-term outcome expectations after trauma-focused post-traumatic stress disorder (PTSD) psychotherapy in a single group effectiveness study. METHODS: Twenty participants with various traumatic experiences who completed the Brief Eclectic Psychotherapy for Post-Traumatic Stress Disorder (BEPP) and all the assessments were included into the study. Self-report measures were used to evaluate the therapeutic outcomes: Impact of Event Scale-Revised (IES-R), Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) at pre-treatment, post-treatment, and 6-month follow-up. Subjective Units of Distress Scale was used to measure long-term outcome expectations at post-treatment, asking participants to measure the expected distress in 6 months following the treatment. Assessments at 6-month follow-up were used to estimate the accuracy of patients' expectations of their distress at previous post-treatment assessment. RESULTS: Significant decline of PTSD symptoms at post-treatment with large effect sizes was observed. At post-treatment assessment participants expected significant improvement of their condition in 6 months after the treatment. However, therapeutic effects remained stable at the 6-month follow-up. CONCLUSION: It is concluded that the PTSD patients, even after successful trauma-focused treatment, tend to expect further significant positive changes. However, therapeutic effects were stable half a year after the psychotherapy, and patients tend to have false expectations about further improvement of their condition.

Internet-based modular program BADI for adjustment disorder: protocol of a randomized controlled trial.

BACKGROUND: Adjustment disorder is one of the most common mental health diagnoses. Still it receives relatively little attention from researchers trying to establish best interventions to treat it. With high prevalence of stressful life events, which might be leading to adjustment disorder, and limited resources of mental health service providers, online interventions could be a very practical way of helping people who have these disorders or are in the risk to develop them. The proposed study protocol is aimed to describe a randomized controlled trial of an internet-based modular intervention for adjustment disorder as it is defined in a proposal for the ICD-11. METHODS/DESIGN: This study is a two-armed Randomized Controlled Trial (RCT) to examine the effectiveness of a web-based intervention BADI (Brief Adjustment Disorder Intervention) for adjustment disorder symptoms. BADI has four modules: Relaxation, Time management, Mindfulness and Strengthening relationships. It is based on stress and coping research and integrates evidence-based treatment approaches such as Cognitive Behavioural therapy (CBT), mindfulness and body-mind practices, as well as exercises for enhancing social support. Primary outcome of the study are symptoms of adjustment disorder and well-being. Engagement into the program and motivation for change is a secondary outcome. All participants after completing the baseline assessment are randomly assigned to one of the two groups: either to the one in which participant will instantly gain access to the BADI intervention or a group in which participants will be given access to the BADI program after waiting one month. Participants of BADI can choose exercises of the program flexibly. There is no particular order in which the exercises should be completed. DISCUSSION: Study will provide new insights of modular internet-based interventions efficacy for adjustment disorders. The study will also provide information about the role of motivation and expectancies on engagement in modular internet-based interventions. In case this RCT supports effectiveness of fully automated version of BADI, it could be used very broadly. It could become a cost-effective and accessible intervention for adjustment disorder. TRIAL REGISTRATION: The study was retrospectively registered with the Australian and New Zealand Clinical Trials Registry with the registration number ACTRN12616000883415 . Registered 5 July, 2016.