Use of self-help materials for anxiety and depression in mental health services: A national survey of psychologists in Norway.

[Correction Notice: An erratum for this article was reported in Vol 42(3) of Professional Psychology: Research and Practice (see record 2011-11548-002). The author's affiliations were listed incorrectly. The correct affiliations are in the correction.] How do psychologists in clinical practice perceive and use self-help materials for clients with anxiety and depression? The use of self-help materials with guidance from a therapist has been suggested as a way of meeting the increasing need for mental health services. The present study investigated factors relevant to the use of self-help materials for the treatment of anxiety and depression among psychologists employed in mental health services. Among 1863 eligible clinical psychologists in Norway, 815 (43.7%) participated in a national survey. A total of 93.5% of the participants had recommended self-help materials to clients, and approximately half (55.1%) had received requests from their clients regarding self-help materials. Self-help materials were recommended as an adjunct and not as an alternative to therapist contact by 73.0% of respondents, by 16.6% for relapse prevention, and by 1.2% to clients on a waiting list. Internet/computer-based programs were recommended by 2.2% of the participants. The practitioner's previous use of self-help materials to enhance his or her therapy skills and knowledge of self-help materials was related to use of self-help materials with clients. Psychologists working in child mental health services recommended self-help less often than those working in adult services. These results have implications for future efforts to disseminate effective self-help materials through increased attention toward self-help interventions in training and clinical practice. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

"Use of self-help materials for anxiety and depression in mental health services: A national survey of psychologists in Norway": Correction to Nordgreen and Havik (2011).

Reports an error in "Use of self-help materials for anxiety and depression in mental health services: A national survey of psychologists in Norway" by Tine Nordgreen and Odd E. Havik (Professional Psychology: Research and Practice, 2011[Apr], Vol 42[2], 185-191). The authors' affiliations were listed incorrectly. The correct affiliations are provided in the erratum. (The following abstract of the original article appeared in record 2011-08009-010.) How do psychologists in clinical practice perceive and use self-help materials for clients with anxiety and depression? The use of self-help materials with guidance from a therapist has been suggested as a way of meeting the increasing need for mental health services. The present study investigated factors relevant to the use of self-help materials for the treatment of anxiety and depression among psychologists employed in mental health services. Among 1863 eligible clinical psychologists in Norway, 815 (43.7%) participated in a national survey. A total of 93.5% of the participants had recommended self-help materials to clients, and approximately half (55.1%) had received requests from their clients regarding self-help materials. Self-help materials were recommended as an adjunct and not as an alternative to therapist contact by 73.0% of respondents, by 16.6% for relapse prevention, and by 1.2% to clients on a waiting list. Internet/computer-based programs were recommended by 2.2% of the participants. The practitioner's previous use of self-help materials to enhance his or her therapy skills and knowledge of self-help materials was related to use of self-help materials with clients. Psychologists working in child mental health services recommended self-help less often than those working in adult services. These results have implications for future efforts to disseminate effective self-help materials through increased attention toward self-help interventions in training and clinical practice. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Internet-based self-help with therapist feedback and in vivo group exposure for social phobia: A randomized controlled trial.

Sixty-four individuals with social phobia (social anxiety disorder) were assigned to a multimodal cognitive-behavioral treatment package or to a waiting list control group. Treatment consisted of a 9-week, Internet-delivered, self-help program that was combined with 2 group exposure sessions in real life and minimal therapist contact via e-mail. Results were analyzed on an intention-to-treat basis, including all randomized participants. From pre- to posttest, treated participants in contrast to controls showed significant improvement on most measured dimensions (social anxiety scales, general anxiety and depression levels, quality of life). The overall within- and between-groups effect sizes were Cohen's d = 0.87 and 0.70, respectively. Treatment gains were maintained at 1-year follow-up. The results from this study support the continued use and development of Internet-distributed, self-help programs for people diagnosed with social phobia. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A randomized trial of a self-help smoking cessation intervention in a nonvolunteer female population: Testing the limits of the public health model.

2,786 smokers among 15,004 female members of a health maintenance organization who completed a routine needs assessment were invited into a preventive health behavior study, consisting of 5 telephone interviews over 2 yrs assessing health practices. 1,396 participants were randomized into experimental or control conditions of an unsolicited, mailed, self-help smoking cessation program. Ss were not alerted to the link between the program and the health study. Smoking status was assessed at 1, 6, 12, and 18 mo. Although quit rates were higher than in the general population and were comparable to volunteer samples in self-help smoking cessation trials, there was no differential effect of the targeted intervention on the experimental group compared with the control group. Data indicate that mass mailing of cessation materials is not a useful form of cessation intervention. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Motivational enhancement therapy and self-help treatment for binge eaters.

The aims of this study were to evaluate whether a single session of motivational enhancement therapy (MET) would increase participant readiness to change, improve the efficacy of self-help treatment for binge eaters, and improve participant compliance with the self-help manual. Method: Participants with bulimia nervosa or binge eating disorder were randomly assigned either to attend a 1-hr MET session prior to receiving the self-help manual (n = 45) or to receive the self-help manual only (n = 45). Participants were followed for 4 months for assessment of self-reported eating disorder outcome and compliance. Results: The MET intervention resulted in increased readiness to change for binge eating compared with the self-help-only (SH) condition. Few differences were found between the MET condition and the SH condition for changes in eating attitudes and frequency of binge eating and compensatory behaviors. No significant effects were found for compliance. Discussion: This research adds to the literature regarding the use of brief motivational interventions to enhance readiness for change in populations with eating disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A randomized controlled trial of cognitive-behavioral therapy for generalized anxiety disorder with integrated techniques from emotion-focused and interpersonal therapies.

Objective: Recent models suggest that generalized anxiety disorder (GAD) symptoms may be maintained by emotional processing avoidance and interpersonal problems. Method: This is the first randomized controlled trial to test directly whether cognitive-behavioral therapy (CBT) could be augmented with the addition of a module targeting interpersonal problems and emotional processing. Eighty-three primarily White participants (mean age = 37) with a principle diagnosis of GAD were recruited from the community. Participants were assigned randomly to CBT plus supportive listening (n = 40) or to CBT plus interpersonal and emotional processing therapy (n = 43) within a study using an additive design. Doctoral-level psychologists with full-time private practices treated participants in an outpatient clinic. Using blind assessors, participants were assessed at pretreatment, posttreatment, 6-month, 1-year, and 2-year follow-up with a composite of self-report and assessor-rated GAD symptom measures (the Penn State Worry Questionnaire; T. J. Meyer, M. L. Miller, R. L. Metzger, & T. D. Borkovec, 1990; Hamilton Anxiety Rating Scale; M. Hamilton, 1959; assessor severity rating; State–Trait Anxiety Inventory-Trait Version; C. D. Spielberger, R. L. Gorsuch, R. Lushene, P. R. Vagg, & G. A. Jacobs, 1983) as well as with indices of clinically significant change. Results: Mixed models analysis of all randomized participants showed very large within-treatment effect sizes for both treatments (CI = [?.40, ?.28], d = 1.86) with no significant differences at post (CI = [?.09, .07], d = .07) or 2-year follow-up (CI = [?.01, .01]), d = .12). There was also no statistical difference between compared treatments on clinically significant change based on chi-square analysis. Conclusions: Interpersonal and emotional processing techniques may not augment CBT for all GAD participants. Trial Registry name: Clinical Trials.gov, Identifier: NCT00951652. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Nicotine gum and self-help behavioral treatment for smoking relapse prevention: Results from a trial using population-based recruitment.

Smokers aged 18–65 yrs (N?=?1,044) who were able to quit for 24 hr were randomized using a 2?×?2 factorial design to compare nicotine gum to no gum use and self-help materials to no use of materials. All participants were offered a $100 incentive to quit and stay quit for 6 months. Six month abstinence was 27% in the gum groups, compared with 19% in the no-gum group (p?=?.002). Compared with the no-gum group, relapse occurred at a significantly lower rate in the gum group for the entire 12 months of follow-up There was no significant main effect for the self-help materials, no interaction between gum and materials, and no evidence that the effectiveness of gum differed between the sexes or between heavy and light smokers. Nicotine gum is an effective adjunct to minimal-contact smoking cessation materials plus monetary incentive in a population-based sample of smokers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Implementation intention formation reduces consultations for emergency contraception and pregnancy testing among teenage women.

Objective: This study examined the impact of implementation intention formation in reducing consultations for emergency contraception and pregnancy testing in young women. Design: Teenage girls (N = 261) visiting a family planning clinic were randomly assigned to implementation intention versus control conditions and completed questionnaires at recruitment. Main Outcome Measures: Objective measures of consultation outcomes were obtained from clinic records at baseline and 9-month follow-up (n = 200). Results: Forming implementation intentions significantly reduced consultations for emergency contraception and pregnancy testing at follow-up compared with the control group (38% vs. 55%). There were also differences between the groups in consultation outcomes over time. For instance, whereas 31% of implementation intention participants changed from consulting for emergency contraception and pregnancy testing at baseline to consulting for contraceptive supplies only at follow-up, only 16% of control participants did so. Conclusion: These results suggest that implementation intention formation is a simple yet effective means of promoting pregnancy prevention among teenagers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Nicotine patch and self-help video for cigarette smoking cessation.

A total of 424 smokers were randomized in a 2?×?2 factorial experiment. A pharmacologic factor contained 2 levels: transdermal nicotine patch (TNP; 21 mg) and placebo. A self-help behavioral treatment factor contained 2 levels: video-enhanced self-help treatment manual and self-help treatment manual only. At 2 months, TNP produced a higher level of abstinence (36%) than placebo (20%), p?     

The efficacy of an implementation intention intervention for promoting physical activity among individuals with spinal cord injury: A randomized controlled trial.

Objective: To evaluate the efficacy of an 8-week implementation intention intervention for promoting physical activity among individuals with spinal cord injury. Study Design: Randomized clinical trial. Method: Participants were randomly assigned to an implementation intention intervention (n = 26) or control (n = 28) condition and were asked to engage in 30 min of moderate to heavy intensity physical activity 3 times per week. Results: Participants who formed implementation intentions followed through with their physical activity intentions, engaging in more physical activity than participants in the control condition. Participants in the intervention condition also experienced sustained motivation and greater confidence to schedule physical activity compared with participants in the control condition. Implications: These findings suggest a role for implementation intentions in health promotion programs for people with spinal cord injury. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Detection of flunixin in greyhound urine by a kinetic enzyme-linked immunosorbent assay

Anxiety levels in a sample of 65 long-term cancer survivors were assessed in a study of the effects of a planned discharge from an oncology clinic. Thirty-one percent of patients scored > or = 8, and 12% > or = 11 on the anxiety subscale of the Hospital Anxiety and Depression Scale (HADS), indicating that anxiety rates in patients in long-standing remission do not greatly differ from patients with active disease. Despite the provision of continued support and guaranteed fast-access return to the clinic if necessary, 28% of patients refused to be discharged. Fear that recurrence would not be detected was the reason most frequently cited. Seventy-five percent of these patients were HADS anxiety cases. A second assessment 4-5 months later of the 41 patients who were discharged showed a slight, but non-significant increase in anxiety rates suggesting that anxiety in cancer survivors may be persistent and not related to clinic attendance.     

Use of self-help books in psychotherapy.

A survey concerning the recommendation of self-help books to clients was completed by 209 psychologists (66.5% male, 94.3% White, mean age?=?45 yrs). Most of the respondents indicated that they did prescribe self-help books infrequently. The likelihood of prescribing books was significantly related to the psychologist's gender, with women recommending books more often than did men, and to employment setting, with private practitioners recommending books more often than did academicians. Psychologists had little familiarity with popular self-help books but thought favorably of the ones of which they knew. Respondents' evaluations of 29 best-selling self-help books are provided. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of implementation intentions on the self-reported frequency of drivers' compliance with speed limits.

This study tested the efficacy of implementation intentions in the context of drivers' speeding behavior. Participants (N = 300) completed self-report measures of goal intention and behavior, and they were randomly assigned to an experimental condition, which required them to specify an implementation intention, or a control condition. One month postbaseline, self-reported compliance with speed limits significantly increased for experimental participants but not for control participants. The effects of specifying an implementation intention on behavior increased with the strength of drivers' goal intentions. Finally, analysis of participants' implementation intentions revealed that specifying more behavioral strategies increased the frequency with which participants reported complying with the speed limit. Implications of the findings are discussed in relation to enhancing road safety interventions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Changes in self-reported anxiety during a small group experience.

To examine changes in self-reported anxiety during the course of a small group, the State-Trait Anxiety Inventory (STAI) was administered at several times to 126 undergraduate participants in brief, leaderless sensitivity training groups. Groups differed in terms of members' interpersonal skills and instructions given prior to the group meeting. Trait anxiety remained stable over time while state anxiety decreased significantly. No effects were related to type of instruction but there was a significant Level of Interpersonal Skills * Anxiety interaction. The usefulness of the trait-state distinction and the interaction of individual differences and situational determinants of anxiety states are discussed. (15 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Fear of physical sensations and trait anxiety as mediators of the response to hyperventilation in nonclinical subjects.

Three studies were conducted to compare the ability of a measure of fear of physical sensations (Anxiety Sensitivity Index; ASI) and a measure of trait anxiety (State-Trait Anxiety Inventory; STAI) to predict response to hyperventilation. In the 1st study 43 Ss were selected who differed in scores on the ASI but were equated on levels of trait anxiety. Two other studies were conducted in which Ss (ns?=?63 and 54) varied randomly on ASI and STAI scores. The results indicate that scores on the ASI account for a significant proportion of variance in the response to hyperventilation that is not accounted for by scores on the STAI. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A Randomized Trial Comparing the Effects of Self-Help Materials and Proactive Telephone Counseling on Teen Smoking Cessation.

We conducted a 2-arm randomized trial to test the efficacy of self-help materials with or without proactive telephone counseling to increase cessation among teen smokers. Teen smokers (N = 402) recruited from 11 shopping malls and 1 amusement park in the southeastern United States were randomized to 1 of 2 groups: written self-help material plus video; or written self-help material, video, and telephone counseling. Cessation rates based on 7-day point-prevalent abstinence for the self-help and counseling arms were 11% and 16%, respectively (p = .25), at 4 months postbaseline and 19% and 21%, respectively (p = .80), at 8 months postbaseline. Sustained abstinence, reflecting 7-day abstinence at both time points, in the self-help and counseling arms was 7% and 9% (p = .59). Results suggest that minimal self-help cessation approaches that target youth have comparable success to that shown among adult smokers. However, refinements in telephone-counseling approaches may be needed to achieve the success observed in adult populations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Durable effects of implementation intentions: Reduced rates of confirmed pregnancy at 2 years.

Objective: To assess the long-term impact of implementation intention formation in reducing consultations for emergency contraception and pregnancy testing among teenage women. Design: Teenage women visiting a family planning clinic were randomly assigned to implementation intention versus control conditions. Main outcome measures: Objective measures of consultation outcomes were obtained from clinic records at 2-year follow-up (N = 227). Results: Rates of consultation for emergency contraception and pregnancy testing in the implementation intentions condition were 19% and 33% lower, respectively, compared to the rates observed in the control condition. Pregnancy rates were 43% lower. Intervention participants who consulted for emergency contraception and pregnancy testing at baseline were more than twice as likely to change to consulting for contraceptive supplies over the follow-up period compared to equivalent control participants (19% vs. 9%). Conclusion: The impact of implementation intention formation on reducing pregnancy risk among teenagers is durable over 2 years. Implementation intentions were successful in changing behavior among precisely those participants who were at greatest risk of becoming pregnant. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Cost-effectiveness of guided self-help treatment for recurrent binge eating.

Objective: Adoption of effective treatments for recurrent binge-eating disorders depends on the balance of costs and benefits. Using data from a recent randomized controlled trial, we conducted an incremental cost-effectiveness analysis (CEA) of a cognitive–behavioral therapy guided self-help intervention (CBT–GSH) to treat recurrent binge eating compared to treatment as usual (TAU). Method: Participants were 123 adult members of an HMO (mean age = 37.2 years, 91.9% female, 96.7% non-Hispanic White) who met criteria for eating disorders involving binge eating as measured by the Eating Disorder Examination (C. G. Fairburn & Z. Cooper, 1993). Participants were randomized either to treatment as usual (TAU) or to TAU plus CBT–GSH. The clinical outcomes were binge-free days and quality-adjusted life years (QALYs); total societal cost was estimated using costs to patients and the health plan and related costs. Results: Compared to those receiving TAU only, those who received TAU plus CBT–GSH experienced 25.2 more binge-free days and had lower total societal costs of $427 over 12 months following the intervention (incremental CEA ratio of ?$20.23 per binge-free day or ?$26,847 per QALY). Lower costs in the TAU plus CBT–GSH group were due to reduced use of TAU services in that group, resulting in lower net costs for the TAU plus CBT group despite the additional cost of CBT–GSH. Conclusions: Findings support CBT–GSH dissemination for recurrent binge-eating treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Use of graduated behavior rehearsal, feedback, and systematic desensitization for speech anxiety.

48 17–48 yr old speech-anxious undergraduates were offered a 4-wk speech anxiety group. Ss were randomly assigned to 1 of 3 conditions: (a) graduated behavior rehearsal/feedback (GBR), (b) graduated behavior rehearsal/feedback plus systematic desensitization (GBR/SD), or (c) the no-treatment control. Each S completed a series of pre- and posttreatment tests, including the short form of the Personal Report of Confidence as a Speaker and the State–Trait Anxiety Inventory (STAI). A behavioral measure, the short form of the Behavioral Assessment of Speech Anxiety, was also obtained at pre- and postassessment. Except for the behavioral instrument, the battery of tests was repeated at a 6-wk follow-up. The GBR and GBR/SD treatment groups demonstrated significantly greater speech anxiety reduction than the no-treatment controls at postassessment and follow-up assessment. The exception was that the GBR group did not score significantly lower than the controls on the A-State scale of the STAI. No significant differences were found between the GBR and GBR/SD treatment conditions on any dependent measure. (22 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Coping with serum screening for Down syndrome when the results is given as a numeric value

Forty-six pregnant women undergoing second-trimester biochemical screening for Down syndrome were asked to fill in the State-Trait Anxiety Inventory (STAI) questionnaire to assess their anxiety level at two different moments: when recruited to the study (at 11-13 weeks' gestation), and after the test result was communicated. The test result was given as a numeric value of risk (1/x), rather than as positive/negative. There were 10 women in whom the risk after biochemical screening increased (median delta risk = +1/535, range = 1/69 to 1/1083), whereas in the remainder the risk decreased (median delta risk = -1/1576; range = -1/142 to -1/4947) compared with the baseline value calculated on maternal age alone. Although only in a minority of women the STAI score after biochemical screening exceeded the reference range, the change in the STAI score was significantly higher when the risk increased, and the change in the risk estimate correlated significantly with the change in this index of anxiety. Three out of seven women with a 'negative' test, but increased risk estimate and increased anxiety after biochemical screening chose to undergo amniocentesis. A policy of providing the result of biochemical screening for Down syndrome as a numeric value, even for 'negative' tests, may cause some women to experience anxiety and request amniocentesis.