Rony Kayrouz

The Pain Course: a randomised controlled trial examining an internet-delivered pain management program when provided with different levels of clinician support

Abstract The present study evaluated an internet-delivered pain management program, the Pain Course, when provided with different levels of clinician support. Participants (n = 490) were randomised to 1 of 4 groups: (1) Regular Contact (n = 143), (2) Optional Contact (n = 141), (3) No Contact (n = 131), and (4) a treatment-as-usual Waitlist Control Group (n = 75). The treatment program was based on the principles of cognitive behaviour therapy and comprised 5 internet-delivered lessons provided over 8 weeks. The 3 Treatment Groups reported significant improvements (between-group Cohens d; avg. reduction) in disability (ds ≥ 0.50; avg. reduction ≥ 18%), anxiety (ds ≥ 0.44; avg. reduction ≥ 32%), depression (ds ≥ 0.73; avg. reduction ≥ 36%), and average pain (ds ≥ 0.30; avg. reduction ≥ 12%) immediately posttreatment, which were sustained at or further improved to 3-month follow-up. High treatment completion rates and levels of satisfaction were reported, and no marked or consistent differences were observed between the Treatment Groups. The mean clinician time per participant was 67.69 minutes (SD = 33.50), 12.85 minutes (SD = 24.61), and 5.44 minutes (SD = 12.38) for those receiving regular contact, the option of contact, and no clinical contact, respectively. These results highlight the very significant public health potential of carefully designed and administered internet-delivered pain management programs and indicate that these programs can be successfully administered with several levels of clinical support.

Improving Adherence and Clinical Outcomes in Self-Guided Internet Treatment for Anxiety and Depression: A 12-Month Follow-Up of a Randomised Controlled Trial

Background A recent paper reported the outcomes of a study examining a new self-guided internet-delivered treatment, the Wellbeing Course, for symptoms of anxiety or depression. This study found the intervention resulted in significant symptom reductions. It also found that automated emails increased treatment completion and clinical improvements in a subsample with elevated anxiety and depression. Aims To examine the clinical outcomes and the effect of automated emails at 12 months post-treatment. Method Participants, who were randomly allocated to a Treatment Plus Automated Emails Group (TEG; n = 100), a standard Treatment Group (TG; n = 106) or delayed-treatment Waitlist Control Group (Control; n = 51), were followed up at 12 months post-treatment. Eighty-one percent, 78% and 87% of participants in the TEG, TG and treated Waitlist Control Group provided symptom data at 12-month follow-up, respectively. The primary outcome measures were the Patient Health Questionnaire-9 Item Scale (PHQ-9) and the Generalized Anxiety Disorder-7 Item Scale (GAD-7). Results Significant improvements in symptoms of anxiety and depression were observed over time in both the TEG and TG (Fs >69, ps <.001) these were sustained from post-treatment to 12-month follow-up (ps >.05), and were associated with large effect sizes. No statistically significant differences in symptoms were found between the TEG and TG at post-treatment, 3-month or 12-month follow-up. Previously reported symptom differences between TEG and TG participants with comorbid symptoms were no longer present at 12-month follow-up (ps >.70). Conclusions The overall benefits of the Wellbeing Course were sustained at 12-month follow-up. Although automated emails facilitated Course completion and reductions in symptoms for participants with comorbid anxiety and depression from pre-post treatment, these differences were no longer observed at 12-month follow-up. The results indicate that automated emails promote more rapid treatment response for people with elevated and comorbid symptoms, but may not improve longer term outcomes. Trial Registration Australian and New Zealand Clinical Trials Registry ACTRN12610001058066

Facebook as an effective recruitment strategy for mental health research of hard to reach populations

Recent reports indicate that Facebook (FB) may facilitate recruitment of hard to reach participants into mental health research. The present study aimed to contribute to this emerging literature by exploring recruitment data from a recently completed trial of online treatment for symptoms of anxiety and depression that targeted Arab people. The present study compared traditional recruitment strategies such as media releases, emails, and print advertisements with Facebook strategies including boosting posts, promoting websites, events and FB public fan pages. The main outcomes of interest were the number of started applications and the time and cost per application associated with the FB and traditional recruitment strategies. A target sample of 350 was sought and a total of 81 participants applied to participate over the 42-week recruitment period. Overall, 86% of the resultant applications occurred via FB recruitment and a Poisson regression analysis indicated the FB strategies were more time-effective, recruiting participants 2.5 times faster than the traditional strategies. However, there were no differences in cost-effectiveness for FB (

Disorder-specific versus transdiagnostic and clinician-guided versus self-guided internet-delivered treatment for panic disorder and comorbid disorders: A randomized controlled trial

US37 per participant) and traditional strategies (

Intergenerational and cross-cultural differences in emotional wellbeing, mental health service utilisation, treatment-seeking preferences and acceptability of psychological treatments for Arab Australians

US40 per participant). The findings of the current study add to existing literature detailing the value of FB recruitment strategies, alongside more traditional strategies, as a way of recruiting hard-to-reach populations for research. However, more research is needed to explore alternative and optimal strategies for the successful recruitment of hard to reach populations via FB and other online social media platforms.

Exploring the efficacy and acceptability of Internet-delivered cognitive behavioural therapy for young adults with anxiety and depression: An open trial

Transdiagnostic cognitive behaviour therapy (TD-CBT) aims to target the symptoms of multiple disorders whereas disorder-specific CBT (DS-CBT) targets the symptoms of principal disorders. This study compared the relative benefits of internet-delivered TD-CBT and DS-CBT when provided in clinician-guided (CG-CBT) and self-guided (SG-CBT) formats for people with a principal diagnosis of Panic Disorder (PD). Participants (n=145) were randomly allocated to receive TD-CBT or DS-CBT and CG-CBT or SG-CBT. Large reductions in symptoms of PD (Cohens d ≥ 0.71; avg. reduction ≥ 36%) and moderate-to-large reductions in symptoms of comorbid depression (Cohens d ≥ 0.71; avg. reduction ≥ 33%), generalised anxiety disorder (Cohens d ≥ 0.91; avg. reduction ≥ 34%) and social anxiety disorder (Cohens d ≥ 0.50; avg. reduction ≥ 15%) were found over the 24-month follow-up period. Highlighting their efficacy and acceptability, no marked and consistent differences were observed between TD-CBT and DS-CBT or CG-CBT and DS-CBT.

A pilot study of self-guided internet-delivered cognitive behavioural therapy for anxiety and depression among Arabs

Background: Little is known about the intergenerational and cross-cultural differences in emotional wellbeing and acceptability of psychological treatments for Arab Australians. Aim: To contribute to the emerging data about the mental health status and needs of Arab Australians. Method: An Internet survey examined psychological distress and functional impairment as measured by the Kessler 10 Item scale (K-10) and the Sheehan Disability Scale (SDS) among Arab Australians. Additional questions enquired about their help-seeking behaviours, barriers to accessing psychological treatments and preferences for delivery of psychological treatments. A total of 252 participants were recruited through public talks, media and online promotions. Results: Forty-three percent of the respondents reported moderate-to-severe functional impairment (M = 9.5; standard deviation (SD) = 1.8), 32% reported high psychological distress (M = 28.5; SD = 5.4) and 30% were born overseas. First-generation Arab Australians experiencing high psychological distress (i.e. K-10 ≥ 22), reported a greater preference for Internet-delivered treatment when compared to their second-generation counterparts. Only 18% of the sample reported seeking help from a mental health professional in the past year. The significant barriers reported by respondents with high psychological distress were poor mental health literacy, lack of time and stigma. Respondents preferred face-to-face (90%) over Internet-delivered treatment (55%). Finally, Arab Australians experienced higher psychological distress and underutilised mental health services when compared to the Australian population. Conclusion: Targeted public health campaigns that make culturally relevant interventions such as modifying existing Internet-delivered treatment for Arab Australians may reduce barriers and increase treatment options for this population.

A pilot study of a clinician-guided internet-delivered cognitive behavioural therapy for anxiety and depression among Arabs in Australia, presented in both English and Arabic languages

Background: The highest prevalence of mental health problems is amongst people aged 18–24, with anxiety disorders and depression the most common disorders in this age group. Few young adults seek and receive effective care, prompting calls for the development of ‘youth friendly’ services. The Internet is a modality that has the potential to facilitate engagement with, and delivery of psychological treatments to, young adults. To date, however, no therapist-guided Internet-delivered treatments have been developed specifically for young adults experiencing depression and anxiety. Aims: To examine the efficacy and acceptability of a new therapist-guided Internet-delivered treatment for young adults aged 18–24 with symptoms of depression and anxiety. Method: Participants accessed the Mood Mechanic Course, which consisted of four lessons delivered over 5 weeks. Measures of depression, anxiety, distress and disability were gathered before and after treatment, and at 3-month follow-up. Results were provided by 78% and 83% of participants at post-treatment and 3-month follow-up, respectively. Data were analysed using mixed linear model analyses. The trial was registered as: ACTRN12612001099819. Results: Treatment significantly reduced depression and anxiety symptom severity, disability and distress at post-treatment and 3-month follow-up. Large within-group effect sizes were found at post-treatment and 3-month follow-up on all measures using both completer and estimated marginal means (Cohen’s d = 1.02 to 1.41 and 0.94 to 1.45, respectively). The therapist spent an average of 37 minutes (SD = 18 minutes) in contact with participants during treatment. Participants rated the treatment as acceptable. Conclusions: Treatment gains recorded at post-treatment were sustained at 3-month follow-up, and were consistent with those reported in meta-analyses of Internet-delivered treatments developed for the broader adult population with depression and anxiety. These results provide encouraging preliminary evidence for the efficacy of therapist-guided Internet-delivered treatments for anxiety and depression tailored for young adults.

Fatal torment – From psychosis-driven index offence to trauma: A case study in forensic psychotherapy, trauma therapy and matricide

This pilot study examined the efficacy and acceptability of a self-guided and culturally modified internet-delivered Cognitive Behaviour Therapy (iCBT) treatment for Arab people, aged 18 and over, with symptoms of depression and anxiety. Thirty-six participants from seven countries, with at least mild symptoms of depression (Patient Health Questionnaire 9-item; PHQ-9; total scores ≥ 5) or anxiety (Generalised Anxiety Disorder 7-item; GAD-7; total scores ≥ 5) accessed the online Arabic Wellbeing Course, which consisted of five online lessons delivered over eight weeks and presented in the English language. Standard measures of depression, anxiety, distress and disability were administered at pre-treatment, post-treatment and 3-month follow-up. Thirty-six percent of participants completed the five lessons over eight weeks, with 61% and 36% providing post-treatment and 3-month follow-up data respectively. Participants reported significant improvements (within-group Cohens d; avg. reduction) in depression (ds ≥ 1.20; avg. reduction ≥ 46%), anxiety (ds ≥ 1.15; avg. reduction ≥ 45%), disability (ds ≥ 0.81; avg. reduction ≥ 35%) and psychological distress (ds ≥ 0.91; avg. reduction ≥ 24%) immediately post-treatment, which were sustained at or further improved to 3-month follow-up. Participants rated the Arabic Wellbeing Course as acceptable. Notwithstanding the absence of a control group, low follow-up questionnaire completion rates and the Course not being translated in Arabic, these results are encouraging and contribute to a growing body of literature indicating that, with minor modifications, internet-delivered interventions have the potential of increasing access to treatment for immigrant groups.

The frequency of actions and thoughts scale: development and psychometric validation of a measure of adaptive behaviours and cognitions

The present pilot study examined the efficacy and acceptability of an internet-delivered Cognitive Behaviour Therapy (iCBT) intervention delivered in both English and Arabic languages to Arab Australians, aged 18 and over, with symptoms of depression and anxiety. Thirteen participants with at least mild symptoms of depression on the (Patient Health Questionnaire 9-item; PHQ-9; total scores ≥ 5) or anxiety (Generalised Anxiety Disorder 7-item; GAD-7; total scores ≥ 5) accessed the online Arabic Wellbeing Course, which consisted of five online lessons delivered over eight weeks with weekly clinician support. Measures of depression, anxiety, distress and disability were administered at pre-treatment, post-treatment and 3-month follow-up. Data were analysed using generalised estimation equation (GEE) modelling. Seventy-seven percent (10/13) of participants completed the five lessons over eight weeks, with 10/13 providing post-treatment and 3-month follow-up data. Participants improved significantly across all outcome measures, with large within-group effect sizes based on estimated marginal means (Cohens d) at post-treatment (d = 1.18 to 1.62) and 3-month follow-up (d = 1.28 to 1.72). In addition, 40% and 38% of participants obtained, at least, a 50% improvement in symptoms of both anxiety and depression at 3-month follow-up respectively. Participants rated the Arabic Wellbeing Course as acceptable, and 70% of those who completed follow-up questionnaires reported accessing the course in both English and Arabic languages. Notwithstanding the limitations of an open trial design, these results are encouraging and indicate that culturally modified clinician-guided internet-delivered versions of Western psychological interventions have the potential for increasing access to treatment for Arabic-speaking Australians, and potentially other groups.