Can Between-Session Homework Be Delivered Digitally? A Pilot Randomized Clinical Trial of CBT for Adjustment Disorders.

Adjustment disorder (AjD) is one of the most common disorders in clinical practice, and its symptoms are severe enough to cause great distress and functional impairment. The AjD CBT protocol specifically developed for this disorder has shown positive results when delivered face to face and through virtual reality. Despite existing evidence supporting the benefits of therapeutic homework as part of a psychological intervention, little is known about how to increase homework engagement in psychotherapy. This study examines the feasibility (doability, initial efficacy and acceptability) of a digital support system to deliver homework via the Internet in the treatment of AjD. Participants were randomly assigned to a traditional homework condition or a digital support system condition. Both interventions resulted in statistically significant improvements, with large effect sizes, in all the outcome measures at post-treatment, with no significant differences between groups. At 12-month follow-up, these therapeutic gains were maintained, and an improvement was even observed in both conditions, with no significant differences between groups. Additionally, treatment satisfaction predicted efficacy in both groups separately and when the whole group was considered. This is the first study to explore the feasibility an initial efficacy of delivering a therapeutic homework component for AjD through the Internet.

Exploring the assessment of adjustment disorders: differences between a general and a clinical sample / Explorando la evaluación de los Trastornos Adaptativos: diferencias entre una muestra general y clínica

Background: Adjustment Disorders (AjD) are one of the most prevalent psychological problems in primary and hospital care. It is necessary to have evidence-based instruments to help professionals diagnose and better understand this problem, which has been little studied. This study presents an adaptation of the Inventory of Complicated Grief for the assessment of AjD symptoms, referred to as the Inventory of Stress and Loss (ISL), and explores the differences in the response to stressful situations between general and clinical Spanish populations. Methods: The general sample included 208 participants, and the clinical sample 91 patients with AjD. Results: Results showed that the ISL has high internal consistency. Confirmatory factor analysis showed one single factor, as in the original questionnaire. With respect to concurrent validity, the ISL correlated positively with the STAI-T. Finally, significant differences were found in the total score on the questionnaire between the clinical and general samples, and between men and women in the general sample. Conclusions: Results suggest that the ISL is a simple, useful assessment tool that exhibits good psychometric properties and makes it possible to differentiate normal reactions to a stressful situation from pathological reactions

Antecedentes: los Trastornos Adaptativos (TA) son uno de los problemas psicológicos más prevalentes en atención primaria y hospitalaria. Necesitamos disponer de instrumentos basados en la evidencia que ayuden a los profesionales a diagnosticar y a atender mejor este problema tan poco estudiado. Este estudio presenta la adaptación del Inventario de Duelo Complicado para la evaluación de los síntomas del TA, denominado Inventario de Estrés y Pérdida (IEP), y explora las diferencias en la respuesta a situaciones estresantes entre la población general y clínica española. Métodos: la muestra general incluyó 208 participantes, y la muestra clínica 91 participantes con TA. Resultados: los resultados mostraron que el IEP tiene una alta consistencia interna. El análisis factorial confirmatorio mostró un único factor, como el cuestionario original. En cuanto a la validez convergente, el IEP correlacionó positivamente con el STAI-R. Finalmente, se encontraron diferencias significativas en la puntuación total del cuestionario entre la muestra general y clínica, y entre hombres y mujeres de la muestra general. Conclusiones: los resultados sugieren que el IEP es una herramienta de evaluación simple y útil que muestra buenos resultados psicométricos y hace posible diferenciar las reacciones normales ante un acontecimiento estresante de las patológicas

Exploring the assessment of Adjustment Disorders: Differences between a general and a clinical sample.

BACKGROUND: Adjustment Disorders (AjD) are one of the most prevalent psychological problems in primary and hospital care. It is necessary to have evidence-based instruments to help professionals diagnose and better understand this problem, which has been little studied. This study presents an adaptation of the Inventory of Complicated Grief for the assessment of AjD symptoms, referred to as the Inventory of Stress and Loss (ISL), and explores the differences in the response to stressful situations between general and clinical Spanish populations. METHODS: The general sample included 208 participants, and the clinical sample 91 patients with AjD. RESULTS: Results showed that the ISL has high internal consistency. Confirmatory factor analysis showed one single factor, as in the original questionnaire. With respect to concurrent validity, the ISL correlated positively with the STAI-T. Finally, significant differences were found in the total score on the questionnaire between the clinical and general samples, and between men and women in the general sample. CONCLUSIONS: Results suggest that the ISL is a simple, useful assessment tool that exhibits good psychometric properties and makes it possible to differentiate normal reactions to a stressful situation from pathological reactions.

An adaptive virtual reality system for the treatment of adjustment disorder and complicated grief: 1-year follow-up efficacy data.

Adjustment disorder (AD) and complicated grief (CG) are serious mental conditions that have a high prevalence and are associated with significant impairments in social and work functioning. Recently, these categories have been better specified in the new ICD-11 proposal. Empirical research on the efficacy of treatments for these problems is scarce. This study aims to offer long-term efficacy data from a between-groups controlled study that compares two treatment conditions (AD-protocol applied in a traditional way: N = 18 and the same protocol supported by virtual reality (VR); VR-protocol applied in a traditional way: N = 18) and a waiting list (WL) control group (N = 18). Both treatment conditions resulted in statistically significant improvements on both primary and secondary outcome measures, with large effect sizes, and this improvement did not occur in the WL. These changes were maintained in both treatment conditions in the medium (6-month) and long-term (12-month follow-up). Larger effect sizes were achieved in the VR condition in the long term. Furthermore, clinically significant change estimations on the primary outcome measures showed an advantage for the VR condition This is the first controlled study to compare a traditional face-to-face protocol for the treatment of stress-related disorders with the same protocol supported by VR and a WL control group.

An internet-based intervention for adjustment disorder (TAO): study protocol for a randomized controlled trial.

BACKGROUND: Adjustment Disorder (AjD) is a common and disabling mental health problem. The lack of research on this disorder has led to the absence of evidence-based interventions for its treatment. Moreover, because the available data indicate that a high percentage of people with mental illness are not treated, it is necessary to develop new ways to provide psychological assistance. The present study describes a Randomized Controlled Trial (RCT) aimed at assessing the effectiveness and acceptance of a linear internet-delivered cognitive-behavioral therapy (ICBT) intervention for AjD. METHODS: A two-armed RCT was designed to compare an intervention group to a waiting list control group. Participants from the intervention group will receive TAO, an internet-based program for AjD composed of seven modules. TAO combines CBT and Positive Psychology strategies in order to provide patients with complete support, reducing their clinical symptoms and enhancing their capacity to overcome everyday adversity. Participants will also receive short weekly telephone support. Participants in the control group will be assessed before and after a seven-week waiting period, and then they will be offered the same intervention. Participants will be randomly assigned to one of the 2 groups. Measurements will be taken at five different moments: baseline, post-intervention, and three follow-up periods (3-, 6- and 12-month). BDI-II and BAI will be used as primary outcome measures. Secondary outcomes will be symptoms of AjD, posttraumatic growth, positive and negative affect, and quality of life. DISCUSSION: The development of ICBT programs like TAO responds to a need for evidence-based interventions that can reach most of the people who need them, reducing the burden and cost of mental disorders. More specifically, TAO targets AjD and will entail a step forward in the treatment of this prevalent but under-researched disorder. Finally, it should be noted that this is the first RCT focusing on an internet-based intervention for AjD in the Spanish population. TRIAL REGISTRATION: ClinicalTrial.gov: NCT02758418 . Trial registration date 2 May 2016.

An online emotional regulation system to deliver homework assignments for treating adjustment disorders.

Adjustment Disorders (AD) is a very common mental health problem in primary care. Only general treatment guidelines are available for its treatment. Our research team has developed a cognitive-behavioural treatment (CBT) supported by Virtual reality (EMMA system) that has shown its utility in the treatment of AD. EMMA is a VR adaptive display that adapts its presentation to the patient' therapeutic needs. So far, researchers have been centered on how to use the Information and Communication Technologies to deliver treatment within the therapeutic context. TEO is a completely open Online Emotional Therapy web-based system that allows creating personalized therapeutic material. The patient can access this material over the Internet. Preliminary data about the acceptability of TEO system in a case study has already been obtained. The aim of the present work is to describe the session protocol regarding the homework assignments component in the treatment of AD designed in TEO system. Also, data about preferences and efficacy of TEO system versus traditional homework assignments implementation in a single case study with AD are presented. A web-based system of this kind increases the possibilities for therapy.