Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: Online and blended (face-to-face plus online) interventions for common mental health disorders are gaining in significance. However, many licensed psychotherapists still have guarded attitudes towards technology-aided formats, hindering dissemination efforts. Objective: This study provides a first therapist-centered evaluation of online and blended therapy and aims at identifying commonalities and differences in attitudes towards both formats. It further tests the impact of a short video clip on expressed attitudes. Methods: In total, 95 Austrian psychotherapists were contacted and surveyed via their listed occupational e-mail address. An eight-minute informational video clip was followed by two randomized survey blocks, assessing therapists’ attitudes towards online and blended therapy. Results: The sample resembled all assessed properties of Austrian psychotherapists (age, theoretical orientation, and region). Therapists did not hold a uniform overall preference. Instead, both intervention approaches’ advantages were perceived equally neutral (t(94)= 1.89, p= .063; d= 0.11), whereas online interventions were associated with more disadvantages and risks (t(94)= 9.86, p<.001; d= 0.81). The short informational clip did not excerpt any detectable effect on therapist views (r(95)= -.109 , p= 0.295). Personal use of modern technologies had a medium effect on given ratings and cognitive behavioral therapists tended to have more open-minded views than other therapists. Conclusions: This study is the first to directly compare attitudes towards online and blended therapy on a fine-grained level. Positive expectations play a pivotal role in the dissemination of new technologies, but unexperienced therapists seem to lack knowledge on how to benefit from technology-aided treatments. In order to speed up implementation, this aspects need to be addressed in the development of new interventions. Further, the preference of blended treatments over online interventions seems to relate to avoidance of risks. While this study is likely to represent therapist attitudes in countries with less advanced eHealth services, therapists’ attitudes in more developed countries might present differently.

Disordered gambling is a public health concern associated with detrimental consequences for affected individuals and social costs. Currently, opioid antagonists are considered the first-line treatments to reduce symptoms of uncontrolled gambling. Only recently, glutamatergic agents and combined pharmacological and psychological treatments have been examined appearing promising options for the management of gambling disorder. A multilevel literature search yielded 34 studies including open-label and placebo-controlled trials totaling 1340 participants to provide a comprehensive evaluation of the short- and long-term efficacies of pharmacological and combined treatments. Pharmacological treatments were associated with large and medium pre-post reductions in global severity, frequency, and financial loss (Hedges’s g: 1.35, 1.22, 0.80, respectively). The controlled effect sizes for the outcome variables were significantly smaller (Hedges’s g: 0.41, 0.11, 0.22), but robust for the reduction of global severity at short-term. In general, medication classes yielded comparable effect sizes independent of predictors of treatment outcome. Of the placebo controlled studies, results showed that opioid antagonists and mood stabilizers, particularly the glutamatergic agent topiramate combined with a cognitive intervention and lithium for gamblers with bipolar disorders demonstrated promising results. However, more rigorously designed, large-scale randomized controlled trials with extended placebo lead-in periods are necessary. Moreover, future studies need to monitor concurrent psychosocial treatments, the type of comorbidity, use equivalent measurement tools, include outcome variables according to the Banff, Alberta Consensus, and provide follow-up data in order to broaden the knowledge about the efficacy of pharmacological treatments for this disabling condition.

Humor trainings have positive effects on mental health and well-being. However, studies investigating the effects of humor trainings in clinical samples are still rare. This study investigated the efficacy and feasibility of a humor training for people suffering from depression, anxiety and adjustment disorders. Based on a diagnostic interview (SCID I and II), 37 people were randomized into a training (n = 19) or wait list control group (n = 18) and completed questionnaires at pre, post, and 1 month follow-up. After the training group had completed its training and evaluation measures, the wait list control group received the training and the outcomes of the group were additionally evaluated (post2 and follow-up2). After training, improvements in humor-related outcomes were observed for the training group, but these were relativized when compared to the wait list control group. Secondary outcomes remained unaffected by the training. In addition, the training group reported interpersonal difficulties. Within-group analyses of the wait list control group after completion of their training showed effects on almost all primary and secondary outcomes and feedback indicated a better atmosphere. In summary, the different outcomes of the two groups are surprising and can show potential moderators of efficacy, such as interpersonal and group-specific climate variables. Since moderators of humor trainings in clinical samples have not been investigated at all, future studies should consider integrating them into their design. The study was retrospectively registered in the German Clinical Trials Register ( DRKS00012443 ) on May 16, 2017.

Blended interventions aim to capitalise on the strengths of both computer-based and face-to-face therapy. Studies on this innovative treatment format remain scare. This especially accounts for the group treatment of depression. The present study applied eclectic psychotherapy methods to an adult sample exhibiting a variety of depressive symptoms (N = 46). Participants were recruited by a newspaper inlet and randomised either to a treatment or a waiting list condition. Computer supported components were multimedia group sessions, e-learning, online videos and worksheets, remote therapist-patient communication and online pre-post-assessment. Large between-group effect sizes on primary outcome depressiveness (CES-D) (F(1,44) = 4.88, p = 0.032; d = 0.87) and secondary outcome personal resources (resource scales) (F(1,44) = 9.04, p = 0.004; d = 0.73 to F(1,44) = 8.82 p = 0.005, d = 1.15) were found in the intention to treat analysis (ANOVA). Subjective evaluation of the intervention revealed high treatment adherence (91%) and high perceived relevance of supportive computer and multimedia components. Participants rated computer and multimedia components comparable to treatment elements such as group interaction or specific cognitive behavioural exercises, and 25% associated the utilisation of those components with treatment success. Depressiveness and age did not predict the utilisation and the appraisal of computer and multimedia components. Results provide preliminary support for the acceptability and feasibility of the investigated blended treatment in a group with non-specific depressive symptoms. However, small sample size and lack of diagnostics restrict generalizability. Additional research in clinical settings is needed.

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: Internet and mobile devices can help to improve psychological treatments. Blended group therapy (bGT) has been investigated a several times for anxiety and depression. This mixed methods study is the first to evaluate bGT with a focus on the therapist’s perspective. Objective: To investigate the therapist-related feasibility of bGT. Methods: Twenty-seven patients, diagnosed with major depression (48% male, compulsory education= 29.6%), entered treatment at a university outpatient clinic. A computer- and mobile-based system supported the treatment during and between group sessions. Eight novice therapists participated in semi-structured interviews, a subsequent cross-validation survey, and logs on online guidance time and content. Results: Large to very large pre- to post-treatment effects were found for depression (CES-D; d= 1.51) and general health (d= 1.31). Effects for the secondary outcomes were in the medium range (d= 0.38 – d= 0.71). Tracked completion of online- and mobile tasks (67 – 76%) was comparable to group attendance. The therapists described the support system as helpful in terms of treatment intensification, treatment engagement, and the establishment of the therapeutic relationship. Weekly online guidance took 10.3 minutes per patient, including guidance on exercises (67%) and intimate communication (33%). Conclusions: Results suggest a high feasibility of bGT in a gender-balanced, moderately educated sample. bGT provides group therapists with tools for individual care, resulting in an optimization of the therapy process, and high completion rates of the implemented app- and online elements. Clinical Trial: German trial register (DRKS-No.: DRKS00010888)