Ali Sarkohi

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 Cohens 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

Abstract 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.

The process of developing an internet-based CBT self-help program for Arabic-speaking immigrants in Sweden (Preprint)

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.