Wendy Theresia Maria Pots

Effectiveness of online mindfulness-based interventions in improving mental health: A review and meta-analysis of randomised controlled trials.

Mindfulness-based interventions (MBIs) are increasingly being delivered through the Internet. Whereas numerous meta-analyses have investigated the effectiveness of face-to-face MBIs in the context of mental health and well-being, thus far a quantitative synthesis of the effectiveness of online MBIs is lacking. The aim of this meta-analysis was to estimate the overall effects of online MBIs on mental health. Fifteen randomised controlled trials were included in this study. A random effects model was used to compute pre-post between-group effect sizes, and the study quality of each of the included trials was rated. Results showed that online MBIs have a small but significant beneficial impact on depression (g=0.29), anxiety (g=0.22), well-being (g=0.23) and mindfulness (g=0.32). The largest effect was found for stress, with a moderate effect size (g=0.51). For stress and mindfulness, exploratory subgroup analyses demonstrated significantly higher effect sizes for guided online MBIs than for unguided online MBIs. In addition, meta-regression analysis showed that effect sizes for stress were significantly moderated by the number of intervention sessions. Effect sizes, however, were not significantly related to study quality. The findings indicate that online MBIs have potential to contribute to improving mental health outcomes, particularly stress. Limitations, directions for future research and practical implications are discussed.

Development of a web-based intervention for the indicated prevention of depression

BackgroundTo reduce the large public health burden of the high prevalence of depression, preventive interventions targeted at people at risk are essential and can be cost-effective. Web-based interventions are able to provide this care, but there is no agreement on how to best develop these applications and often the technology is seen as a given. This seems to be one of the main reasons that web-based interventions do not reach their full potential. The current study describes the development of a web-based intervention for the indicated prevention of depression, employing the CeHRes (Center for eHealth Research and Disease Management) roadmap. The goals are to create a user-friendly application which fits the values of the stakeholders and to evaluate the process of development.MethodsThe employed methods are a literature scan and discussion in the contextual inquiry; interviews, rapid prototyping and a requirement session in the value specification stage; and user-based usability evaluation, expert-based usability inspection and a requirement session in the design stage.ResultsThe contextual inquiry indicated that there is a need for easily accessible interventions for the indicated prevention of depression and web-based interventions are seen as potentially meeting this need. The value specification stage yielded expected needs of potential participants, comments on the usefulness of the proposed features and comments on two proposed designs of the web-based intervention. The design stage yielded valuable comments on the system, content and service of the web-based intervention.ConclusionsOverall, we found that by developing the technology, we successfully (re)designed the system, content and service of the web-based intervention to match the values of stakeholders. This study has shown the importance of a structured development process of a web-based intervention for the indicated prevention of depression because: (1) it allows the development team to clarify the needs that have to be met for the intervention to be of use to the target audience; and (2) it yields feedback on the design of the application that is broader than color and buttons, but encompasses comments on the quality of the service that the application offers.

Acceptance and commitment therapy as a web-based intervention for depressive symptoms: randomised controlled trial

BACKGROUND Depression is a highly prevalent disorder, causing a large burden of disease and substantial economic costs. Web-based self-help interventions seem promising in promoting mental health. AIMS To compare the efficacy of a guided web-based intervention based on acceptance and commitment therapy (ACT) with an active control (expressive writing) and a waiting-list control condition (Netherlands Trial Register NTR1296). METHOD Adults with depressive symptoms from the general population were randomised to ACT (n = 82), expressive writing (n = 67) or waiting-list control (n = 87). The main outcome was reduction in depressive symptoms assessed with the Center for Epidemiological Studies - Depression scale. RESULTS Significant reductions in depressive symptoms were found following the ACT intervention, compared with the control group (Cohens d = 0.56) and the expressive writing intervention (d = 0.36). The effects were sustained at 6-month and 12-month follow-up. CONCLUSIONS Acceptance and commitment therapy as a web-based public mental health intervention for adults with depressive symptoms can be effective and applicable.

The Efficacy of Mindfulness-Based Cognitive Therapy as a Public Mental Health Intervention for Adults with Mild to Moderate Depressive Symptomatology: A Randomized Controlled Trial

Objective Although there has been growing evidence for the efficacy of mindfulness-based cognitive therapy (MBCT) for different clinical populations, its effectiveness as a public mental health intervention has not been studied. The present study evaluates a community-based MBCT intervention for adults with mild to moderate depressive symptomatology in a large multi-site, pragmatic randomized controlled trial. Method The participants with mild to moderate depressive symptomatology were recruited from the general population and randomized to the MBCT intervention (n = 76) or to a waiting list control group (n = 75). Participants completed measures before and after the intervention. Participants in the experimental condition also completed these measures at a 3-month follow-up. Results In the experimental condition significant reductions in depression, anxiety, and experiential avoidance, and improvements in mindfulness and emotional- and psychological mental health were found, compared to the waiting list (effect sizes Cohens d = 0.31–0.56). These effects were sustained at the 3-month follow-up. The likelihood of a clinically significant change in depressive symptoms was significantly higher for the MBCT group [odds ratio (OR) 3.026, p<0.01 at post-treatment; NNT = 5.10]. Discussion MBCT as a public mental health intervention for adults with mild to moderate depressive symptoms seems effective and applicable in a natural setting. Trial Registration Nederlands Trial Register NTR2096

How and for whom does web-based acceptance and commitment therapy work? Mediation and moderation analyses of web-based ACT for depressive symptoms

BackgroundAcceptance and Commitment Therapy (ACT) has been demonstrated to be effective in reducing depressive symptoms. However, little is known how and for whom therapeutic change occurs, specifically in web-based interventions. This study focuses on the mediators, moderators and predictors of change during a web-based ACT intervention.MethodsData from 236 adults from the general population with mild to moderate depressive symptoms, randomized to either web-based ACT (n = 82) or one of two control conditions (web-based Expressive Writing (EW; n = 67) and a waiting list (n = 87)), were analysed. Single and multiple mediation analyses, and exploratory linear regression analyses were performed using PROCESS and linear regression analyses, to examine mediators, moderators and predictors on pre- to post- and follow-up treatment change of depressive symptoms.ResultsThe treatment effect of ACT versus the waiting list was mediated by psychological flexibility and two mindfulness facets. The treatment effect of ACT versus EW was not significantly mediated. The moderator analyses demonstrated that the effects of web-based ACT did not vary according to baseline patient characteristics when compared to both control groups. However, higher baseline depressive symptoms and positive mental health and lower baseline anxiety were identified as predictors of outcome across all conditions. Similar results are found for follow-up.ConclusionsThe findings of this study corroborate the evidence that psychological flexibility and mindfulness are distinct process mechanisms that mediate the effects of web-based ACT intervention. The results indicate that there are no restrictions to the allocation of web-based ACT intervention and that web-based ACT can work for different subpopulations.Trial registrationNetherlands Trial Register NTR2736. Registered 6 February 2011.

Living to the fullest! Mindfulness-based interventions as public mental health interventions for depression

Interventions that are easily available, attractive and feasible help to broaden the effect public mental health interventions can have on depression. In this thesis, a specific subset of Mindfulness-based Interventions (MBIs) as public mental health interventions for people with mild to moderate depressive symptoms is studied, namely a community-based Mindfulness Based Cognitive Therapy (MBCT) and a web-based Acceptance and Commitment Therapy (ACT) intervention. Our first goal was to study whether MBCT, originally developed to prevent the relapse of people diagnosed with recurrent depression, could be effective as a public mental health intervention for people who have depressive symptoms. The adaptation was, in large part, a reduction in mindfulness meditation exercises, from 45 minutes to 15 minutes a day. The study showed that the community-based MBCT was effective for people with depressive symptoms. Our second goal was to study whether web-based or online public mental health interventions based on mindfulness were effective. Although current public mental health interventions have been demonstrated to be effective, they seem to have low impact due to the stigma and a mismatch in acceptability to users. Ensuring availability of interventions on the Internet can enhance the impact of public mental health interventions and improve the quality of health care. In our meta-analysis, online MBIs as public mental health interventions showed a beneficial impact on mental health outcomes, suggesting that online MBIs have the potential to contribute to promoting mental health. Our third goal was to broaden the availability of online MBIs in a (cost-)effective way by developing a web-based intervention for adults with mild to moderate depressive symptoms. We developed the web-based intervention “Living to the Full”, based on ACT and mindfulness, using persuasive technologies to increase adherence. The web-based intervention proved to be superior over time in effectiveness compared to both the active and the waiting list control group. Psychological flexibility and mindfulness appeared to be the central therapeutic mechanisms in the web-based intervention, confirming theoretical framework of ACT. Furthermore, we found that, at least for the target group, there seems to be no reason to exclude people from web-based ACT.