Jonas Eimontas

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

BackgroundAdjustment 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/designThis 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.DiscussionStudy 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 registrationThe study was retrospectively registered with the Australian and New Zealand Clinical Trials Registry with the registration number ACTRN12616000883415. Registered 5 July, 2016.

“No Posttraumatic Stress Disorder in Lithuania”: National Health Care Fails to Identify PTSD: PTSD in Lithuanian Health Care

Lithuanian National Health Insurance (NHI) registry data from 2014 and 2015 were used to estimate the annual rates of posttraumatic stress disorder (PTSD) and other stress-related disorders in Lithuania. A large gap was found between 12-month PTSD prevalence based on epidemiological data and annual PTSD rates based on health care service utilization in Lithuania. Estimations from the health care services utilization data revealed that only about 0.01% to 0.02% of the population in Lithuania is diagnosed with PTSD annually, indicating that the national health care system identifies only about 1% of potential PTSD cases in Lithuania. The low rates of PTSD diagnoses in the health care system seem to indicate a lack of recognition of psychological trauma among general practitioners and mental health professionals in Lithuania. The lack of visibility of PTSD in the national health care system could be a major barrier to the treatment of PTSD in the country. The study indicates the importance of social factors, especially the recognition of trauma and PTSD, among health care professionals.

‘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

Abstract 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 Self-Help Intervention for ICD-11 Adjustment Disorder: Preliminary Findings

Adjustment disorder is one of the most diagnosed mental disorders. However, there is a lack of studies of specialized internet-based psychosocial interventions for adjustment disorder. We aimed to analyze the outcomes of an internet-based unguided self-help psychosocial intervention BADI for adjustment disorder in a two armed randomized controlled trial with a waiting list control group. In total 284 adult participants were randomized in this study. We measured adjustment disorder as a primary outcome, and psychological well-being as a secondary outcome at pre-intervention (T1) and one month after the intervention (T2). We found medium effect size of the intervention for the completer sample on adjustment disorder symptoms. Intervention was effective for those participants who used it at least one time in 30-day period. Our results revealed the potential of unguided internet-based self-help intervention for adjustment disorder. However, high dropout rates in the study limits the generalization of the outcomes of the intervention only to completers.

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

ABSTRACT 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.

Music performance anxiety among students of the academy in Lithuania

ABSTRACT Music performance anxiety (MPA) affects amateurs, students and professional musicians. We aimed to analyse MPA among students of music performance in a higher education academy in Lithuania. A sample of 258 music performance arts students of the Lithuanian Music and Theatre Academy participated in this study. The Kenny Music Performance Anxiety Inventory (K-MPAI) was used for assessment of MPA. High MPA was associated with less concert activity, poorer perceived performance self-efficacy, and lower academic achievement grades. We did not find gender effects on MPA. Results revealed that 20.2% of the students reported difficulties in coping with MPA. Our findings inform music educators about the need to address MPA and coping with MPA in the process of teaching.

Perspectives of E-health Interventions for Stress-Related Disorders: A Critical Review

The aim of this paper is to review the current status of e-health interventions and discuss the main controversies and issues related to e-health definitions, forms of IT-based interventions, limitations and advantages, as well as directions for future research. Alongside the benefits that rapid development of ITbased psychosocial interventions bring to the mental health care system, they also bring challenges for patients, professionals, and researchers in the field in regard to methodology and terminology. There is also a huge variety of different forms of IT-based interventions. The popularity of these interventions is growing because of their convenience, cost-effectiveness, fewer stigmas attached to them, and other benefits. On the other hand, there are legal, ethical, confidentiality, and other questions that need to be considered. IT-based interventions for stress-related disorders share all of these difficulties. However, we also need to look at problems that come from dealing with a specific disorder. Research of IT-based interventions for stressrelated disorders confirms their effectiveness but also shows that their effectiveness can depend on the user’s and intervention’s qualities, hence more research on these variables is needed.