Meyran Boniel-Nissim

A comprehensive review and a meta-analysis of the effectiveness of Internet-based psychotherapeutic interventions

ABSTRACT Internet-based psychotherapeutic interventions have been used for more than a decade, but no comprehensive review and no extensive meta-analysis of their effectiveness have been conducted. We have collected all of the empirical articles published up to March 2006 (n = 64) that examine the effectiveness of online therapy of different forms and performed a meta-analysis of all the studies reported in them (n = 92). These studies involved a total of 9,764 clients who were treated through various Internet-based psychological interventions for a variety of problems, whose effectiveness was assessed by different types of measures. The overall mean weighted effect size was found to be 0.53 (medium effect), which is quite similar to the average effect size of traditional, face-to-face therapy. Next, we examined interacting effects of various possible relevant moderators of the effects of online therapy, including type of therapy (self-help web-based therapy versus online communication-based etherapy), type of outcome measure, time of measurement of outcome (post-therapy or follow-up), type of problem treated, therapeutic approach, and communication modality, among others. A comparison between face-to-face and Internet intervention as reported on in 14 of the studies revealed no differences in effectiveness. The findings of this meta-analysis, and review of additional Internet therapy studies not included in the meta-analysis, provide strong support for the adoption of online psychological interventions as a legitimate therapeutic activity and suggest several insights in regard to its application. Limitations of the findings and recommendations concerning Internet-based therapy and future research are discussed.

Fostering empowerment in online support groups

Online support groups have been used extensively, in numerous areas of distress, for 15 years. Researchers have presented conflicting findings and ideas about their effectiveness in helping people cope with respective problems. Our review of quantitative studies and our qualitative exploration of the nature of the experiences that occur in such groups show that several factors operate to potentially affect participants. Personal and interpersonal dynamics, which are central in producing effects in these groups, are induced and accelerated by the powerful online disinhibition effect. These factors, including the very impact of writing, expressions of emotions, collecting information and thereby improving understanding and knowledge, developing social relationships, and enhancing decision-making skills and consequent behavioral actions all serve as possible generators of a sense of personal empowerment for people in distress. This view may explain why empirical research has frequently found little or no specific outcomes from participating in online support groups; however, it has found much support for nonspecific personal impacts of this means of intervention. Thus, we contend that online support groups are designed to foster, and many of them actually do, well-being, a sense of control, self-confidence, feelings of more independence, social interactions, and improved feelings-all nonspecific but highly important psychological factors. As such, participating in an online support group could foster personal empowerment, which is much needed in handling specific conditions of distress. Nonetheless, this participation has potential costs, too, especially developing dependence, distancing from in-person contacts, and exposure to unpleasant experiences typical of social engagement in cyberspace.

Exploring substance use normalization among adolescents: A multilevel study in 35 countries

The substance use normalization thesis predicts that adolescent substance users are less likely to report substance use risk factors in high than in low prevalence countries. This study tests whether national population-level alcohol, cigarette and cannabis prevalence rates moderate the strength of the relationship between individual level social and behavioral risk factors and individual level alcohol, cigarette and cannabis use. Data from 2009/2010 Health Behaviour in School-Aged Children Study (N = 68,045, age = 15) from 35 countries was analyzed using logistic Hierarchical Linear Modeling. As expected based on low cannabis prevalence rates in all countries studied, no evidence of normalization was found for recent cannabis use. Also in line with the normalization thesis, results show that for substance use that reaches above 40% in at least some of the countries studied (drunkenness, alcohol and cigarette use), adolescents who reported use are less likely to report social and behavioral risk factors in high prevalence countries than in low prevalence countries. However, support for the normalization thesis was only partial in that results show that in models where evidence for normalization was found, there are risk factors that predict substance use to an equal degree regardless of country level prevalence rates. The current research shows that the normalization thesis is a useful framework for understanding the contextual aspects of adolescent alcohol, tobacco, and cannabis use. The study has implications for drug prevention as it suggests that selective prevention efforts may be particularly useful in low prevalence countries where screening based on risk factors may usefully identify adolescents at most risk for developing drug use problems. This approach may be less useful in high prevalence countries where screening based on risk factors is less likely to satisfactorily identify those at risk for developing drug use problems.

Parental, peer and school experiences as predictors of alcohol drinking among first and second generation immigrant adolescents in Israel

BACKGROUND Ecological perspectives stress the importance of environmental predictors of adolescent alcohol use, yet little research has examined such predictors among immigrant adolescents. This study examines parental, peer and school predictors of alcohol drinking (casual drinking, binge drinking and drunkenness) among Israeli-born adolescents and first and second generation adolescent immigrants from the Former Soviet Union (FSU) and Ethiopia in Israel. METHODS The study uses data from the 2010 to 2011 Israeli Health Behaviors of School age Children (HBSC) survey and includes a representative sample of 3059 adolescents, aged 11-17. Differences between the groups for drinking were examined using Pearsons chi square. Logistic regression models were used to examine group specific predictors of drinking. RESULTS First generation FSU and both Ethiopian groups reported higher levels of binge drinking and drunkenness than Israeli-born adolescents. All immigrant groups reported lower levels of parental monitoring than native born adolescents; both first generation groups reported difficulties talking to parents; and first generation FSU and second generation Ethiopian adolescents reported greater time with friends. Group specific logistic regression models suggest that while parent, peer and school variables all predicted alcohol use among Israeli adolescents, only time spent with peers consistently predicted immigrant alcohol use. CONCLUSIONS Findings highlight specific vulnerability of first generation FSU and second generation Ethiopian adolescents to high levels of drinking and the salience of time spent with peers as predicting immigrant adolescent drinking patterns. They suggest that drinking patterns must be understood in relation to country of origin and immigration experience of a particular group.

The role of identity and psychosomatic symptoms as mediating the relationship between discrimination and risk behaviors among first and second generation immigrant adolescents

The study examines psychosomatic symptoms, and host and heritage identities as mediators of the relationship between discrimination and aggressive behavior and substance use. Israeli data from the 2013-14 Health Behaviors of School-aged Children study included a representative sample of 1503 first- and second-generation immigrant adolescents aged 11-17 years (45.2% male) from the Former Soviet Union and Ethiopia in Israel. Structural equation modeling, controlling for age, gender, family affluence and immigrant generation, showed different pathways for the two groups. For FSU-heritage adolescents, the relationship between discrimination and aggressive behavior and substance use was partially mediated by psychosomatic symptoms. Lower host and heritage identities also predicted psychosomatic symptoms. For Ethiopian-heritage adolescents, the relationship between discrimination and outcomes was fully mediated by psychosomatic symptoms and a weaker host identity. Results support an externalizing model, whereby discrimination leads to a weaker host identity and increased psychosomatic symptoms, associated with substance use and aggressive behavior.