To review current evidence for the clinical and cost-effectiveness of self-management interventions for panic disorder, phobias and obsessive-compulsive disorder (OCD).
Papers were identified through computerized searches of databases for the years between 1995 and 2003, manual searches and personal contacts. Only randomized-controlled trials were reviewed.
Ten studies were identified (one OCD, five panic disorder, four phobias). Effective self-management interventions included cognitive-behavioural therapy (CBT) and exposure to the trigger stimuli for phobias and panic disorders. All involved homework. There was evidence of effectiveness in terms of improved symptoms and psychological wellbeing when compared with standard care, waiting list or relaxation. Brief interventions and computer-based interventions were effective for most participants. In terms of quality, studies were mainly based on small samples, lacked long-term follow-up, and failed to address cost-effectiveness.
Despite the limitations of reviewed studies, there appears to be sufficient evidence to warrant greater exploration of self-management in these disorders.
"Strategies of self-management support are based on knowledge and information transfer to increase health literacy and facilitate the development of skills, as well as promoting the use of available health resources . Self-management support promotes control and responsibility, thus strengthening the patients’ confidence in their own ability to manage his or her psychological symptoms, as well as their impact on his or her daily life . "
[Show abstract][Hide abstract] ABSTRACT: Anxiety, Depression and Somatoform (ADSom) disorders are highly prevalent in primary care. Managing these disorders is time-consuming and requires strong commitment on behalf of the General Practitioners (GPs). Furthermore, the management of these patients is restricted by the high patient turnover rates in primary care practices, especially in the German health care system.In order to address this problem, we implement a complex, low-threshold intervention by an Advanced Practice Nurse (APN) using a mixture of case management and counseling techniques to promote self-management in these patients. Here we present the protocol of the "Self-Management Support for Anxiety, Depression and Somatoform Disorders in Primary Care" (SMADS)-Study.
The study is designed as a cluster-randomized controlled trial, comparing an intervention and a control group of 10 primary care practices in each case. We will compare the effectiveness of the intervention applied by an APN with usual GP-care. A total of 340 participants will be enrolled in the study, 170 in either arm. We use the Patient Health Questionnaire-German version (PHQ-D) as a screening tool for psychiatric symptoms, including patients with a score above 5 on any of the three symptom scales. The primary outcome is self-efficacy, measured by the General Self-Efficacy Scale (GSE), here used as a proxy for self-management. As secondary outcomes we include the PHQ-D symptom load and questionnaires regarding coping with illness and health related quality of life. Outcome assessments will be applied 8 weeks and 12 months after the baseline assessment.
The SMADS-study evaluates a complex, low threshold intervention for ambulatory patients presenting ADSom-symptoms, empowering them to better manage their condition, as well as improving their motivation to engage in self-help and health-seeking behaviour. The benefit of the intervention will be substantiated, when patients can enhance their expected self-efficacy, reduce their symptom load and engage in more self-help activities to deal with their everyday lives. After successfully evaluating this psychosocial intervention, a new health care model for the management of symptoms of anxiety, depression and somatoform disorders for ambulatory patients could emerge, supplementing the work of the GP.Trial registration: Clinicaltrials.gov Identifier: NCT01726387.
"A review of the literature on Internetbased mental health programs informed the design of the material to maximize its effectiveness and usability (e.g., Barlow et al., 2005; Griffiths et al., 2007; Spek et al., 2006). Specifically, the program includes weekly phone and email contact with a coach, and is designed to be an interactive work-book, with examples and activities to encourage practice and enhance learning of material. "
[Show abstract][Hide abstract] ABSTRACT: Internet-based intervention programs can improve mental health outcomes, and may offer a novel medium for reducing emotional distress in post-secondary students. This paper describes the development and usability testing of a new cognitive behavioral therapy-based program, “Feeling Better” designed to reduce symptoms of emotional distress in post-secondary students. An iterative qualitative usability testing approach was used to assess the program’s usability (i.e., ease of navigation, clarity, efficiency and acceptability). Three cycles of participant feedback and feedback from counselling centre staff was coded and used to iteratively modify the interface. Changes were both structural (e.g., shortening sections) and stylistic (e.g., aesthetic features), remodeling “Feeling Better” into a user-friendly platform ready to be used and its effects evaluated in further studies.
Computers in Human Behavior 11/2010; 26(6-26):1419-1426. DOI:10.1016/j.chb.2010.04.020 · 2.69 Impact Factor
"Panic disorder (with or without agoraphobia) is a common mental disorder with 12 month prevalence in Australia of approximately 3.5% (Andrews, Henderson, & Hall, 2001) and is associated with considerable disability (Massion, Warshaw, & Keller, 1993). Panic disorder can be treated effectively with cognitive behavioural therapy (CBT) (Barlow, Ellard, Hainsworth, Jones, & Fisher, 2005; Butler, Chapman, Forman, & Beck, 2006; Otto, Smits, and Reese, 2004), however, in Australia only approximately 39% of people with panic disorder report seeking treatment in the preceding 12 months (Sanderson, Andrews, Corry, & Lapsley, 2003). Barriers to treatment seeking for panic disorder include the avoidance associated with the agoraphobia that is often present, as well as reasons common to low treatment seeking for other common mental disorders including barriers associated with geographical location, the lack of trained therapists, the potential expense of treatment, and lack of awareness about treatment options and effectiveness (Proudfoot, 2004; Titov, 2007). "
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