Internet-based cognitive behavioural therapy for depression and anxiety among Arabic-speaking individuals in Sweden: a pilot randomized controlled trial.

Arabic-speaking immigrants and refugees constitute one of the largest immigrant groups in Sweden. Previous research on Arabic-speaking immigrants indicates elevated levels of psychological disorders, including depression and anxiety. The aim of the present pilot study was to examine the efficacy of an internet-delivered cognitive behavioural treatment (ICBT) in an Arabic-speaking immigrant population. The intervention was individually tailored based on self-described problems and consisted of nine modules targeting areas such as depression, anxiety and insomnia. In total, 59 individuals were included and randomized to either an 8-week treatment or wait-list control. Self-reported symptoms of depression on the PHQ-9 were used as primary outcome measure. Secondary outcome measures of anxiety, stress, insomnia, quality of life and post-traumatic stress were also used. In the intention-to-treat analysis, depressive symptoms were significantly reduced compared to the wait-list control group with a between-group effect at post-treatment of Cohen's d = 0.85 [0.29, 1.41]. We also found significant between-group effects for symptoms of insomnia and stress, but not for anxiety, post-traumatic stress or quality of life measures. The results indicate that ICBT is a promising treatment approach for treating symptoms of depression, insomnia and stress, in an Arabic-speaking immigrant population. Further studies with larger samples are warranted.

Development of an Internet-Based Cognitive Behavioral Therapy Self-Help Program for Arabic-Speaking Immigrants: Mixed-Methods Study.

BACKGROUND: Recent years have seen an increase in Arabic-speaking immigrants in Sweden and other European countries, with research showing this group to suffer from elevated levels of various forms of psychological disorders. There is a lack of treatment options for immigrants with mild to moderate mental health problems, with barriers including lack of accessible services and concerns that problems will not be understood by health care providers. OBJECTIVE: This study aims to describe the process of developing a transdiagnostic internet-based cognitive behavioral therapy self-help program in Arabic for mild to moderate symptoms of common psychological problems such as anxiety, depression, and insomnia. METHODS: The iterative development process, including feedback from 105 pilot users as well as 2 focus groups, is described. RESULTS: Overall, the modules were rated as acceptable by the pilot users, with overall ratings ranging from 3 to 4 points on average for the respective modules on a 5-point Likert scale. Feedback from the 2 focus groups was overall positive with regard to the content and structure of the program but also included suggestions for improving the Arabic translation as well as the usability of the material. CONCLUSIONS: An internet-based self-help program that is deemed acceptable by an Arabic-speaking audience can be successfully developed, thus providing increased access to psychological help for an at-risk population. However, further research regarding the efficacy of this type of intervention is warranted.

Randomised controlled non-inferiority trial with 3-year follow-up of internet-delivered versus face-to-face group cognitive behavioural therapy for depression.

BACKGROUND: Guided internet-delivered cognitive behaviour therapy (ICBT) has been found to be effective in the treatment of mild to moderate depression, but there have been no direct comparisons with the more established group-based CBT with a long-term follow-up. METHOD: Participants with mild to moderate depression were recruited from the general population and randomized to either guided ICBT (n=33) or to live group treatment (n=36). Measures were completed before and after the intervention to assess depression, anxiety, and quality of life. Follow-ups were conducted at one-year and three-year after the treatment had ended. RESULTS: Data were analysed on an intention-to-treat basis using linear mixed-effects regression analysis. Results on the self-rated version of the Montgomery-Åsberg Depression Scale showed significant improvements in both groups across time indicating non-inferiority of guided ICBT, and there was even a tendency for the guided ICBT group to be superior to group-based CBT at three year follow-up. Within-group effect sizes for the ICBT condition at post-treatment showed a Cohen's d=1.46, with a similar large effect at 3-year follow-up, d=1.78. For the group CBT the corresponding within-group effects were d=0.99 and d=1.34, respectively. LIMITATIONS: The study was small with two active treatments and there was no placebo or credible control condition. CONCLUSIONS: Guided ICBT is at least as effective as group-based CBT and long-term effects can be sustained up to 3 years after treatment.

Less positive or more negative? Future-directed thinking in mild to moderate depression.

Depressed patients have been found to generate fewer anticipated positive future events, but most previous studies have included patients who have either been severely depressed or expressed suicidal thoughts and intents or both. The aim of this study was to compare positive and negative future-directed thinking in persons with mild to moderate depression who did not express suicidal thoughts or intents (n = 20) with a matched group of nondepressed persons (n = 20). The two groups completed the Future-Thinking Task (FTT), in which they were asked to generate positive and negative anticipated future events for three upcoming time periods (1 week, 1 year, and 5-10 years). In the present version of the FTT, both quantitative and qualitative aspects were included (i.e. subjective likelihood and emotional valence). Results showed that depressed persons reported lower scores regarding anticipated future positive events but they did not differ in terms of future negative events. The results are consistent with previous research and further strengthen the notion that reduced anticipation of future positive events is a defining characteristic of depression, even in the absence of suicidal ideation.

Future thinking in tinnitus patients.

OBJECTIVE: The purpose of the study was to investigate future thinking in a group of tinnitus patients. It was predicted that participants in the tinnitus group would report fewer positive future events. METHODS: A cross-sectional design was used. Two groups of participants completed the test session: tinnitus patients (n=20) and healthy controls (n=20) without tinnitus. Participants completed measures of anticipation of future positive and negative experiences, anxiety and depression. In addition, participants with tinnitus completed a test of tinnitus annoyance. RESULTS: Tinnitus participants generated a greater number of negative future events compared to the controls. There was no difference between the groups on positive future events or on self-reported anxiety, but the tinnitus group scored higher on a depression measure. Controlling for depression scores removed the group difference. CONCLUSIONS: While the groups differed on future thinking, the difference concerned negative events, which suggests that anxious information processing might be important in explaining tinnitus annoyance. Levels of depressive symptoms should, however, be considered.