Internetbasierte geleitete Selbsthilfeansätze bei Angststörungen und Depressionen

Das Spektrum internetbasierter psychologischer Behandlungsangebote bei psychischen Problemen und Erkrankungen bewegt sich zwischen webbasierten Selbsthilfeprogrammen, die das Internet als Informationsmedium verwenden, und Email-, Chat- und Video-Therapien, in welchen das Internet zu Kommunikationszwecken zwischen Hilfesuchenden und Professionellen genutzt wird. Dieser Beitrag fokussiert auf eine Beratungs- und Therapieform, die die Möglichkeiten des Internets als Informations- und Kommunikationsmedium in sogenannten geleiteten Selbsthilfeansätzen kombiniert. Internetbasierte geleitete Selbsthilfeansätze, in welchen Klienten während der Bearbeitung eines Selbsthilfeprogramms von Therapeuten via Internet (z.B. Email) unterstützt werden, wurden in den letzten Jahren intensiv erforscht. Im Bereich von Angststörungen und Depressionen liegen besonders viele Studien vor. Verschiedene Forschergruppen haben hier in der Regel große Behandlungseffekte gefunden, die mit der Wirkung von Face-to-Face-Therapien vergleichbar sind. In diesem Beitrag wird der geleitete Selbsthilfeansatz dargestellt und die empirische Evidenz diskutiert.

The potential of a mindfulness-enhanced, integrative neuropsychotherapy program for treating fatigue following stroke: A preliminary Study

Fatigue is a frequently reported symptom after a stroke. Although the phenomenology of poststroke fatigue is well known, clear definitions as well as diagnostic and therapeutic guidelines are missing. Poststroke fatigue can be regarded as a multidimensional phenomenon that might be influenced by neurological, physical, psychological, and cognitive factors. It can range from mild to severe and can affect every area of the activities of daily life. The objective of our preliminary study was to outline aspects of a specific treatment program for the management of poststroke fatigue. Eight patients were recruited for a mindfulness-enhanced, integrative neuropsychotherapy program. The treatment was a combination of neuropsychological interventions, psychoeducation, cognitive-behavioral therapy, and mindfulness techniques. The main treatment foci were (a) to facilitate an increased awareness of fatigue symptoms, (b) to help the patient detect and manage triggers of fatigue, and (c) to equip the patient with multiple self-help tools. Measures were assessed at the beginning, during, and at the end of treatment using self-assessment questionnaire for mental fatigue and related symptoms after neurological disorders and injuries. Significant pre- to post-assessment differences were observed. These findings suggest that patients may benefit from a specific treatment program in order to better adapt to poststroke fatigue. These findings encourage further investigation of this integrative treatment in larger samples that include adequate control treatments.

OSCAR – ein internetbasiertes Unterstützungsprogramm für Angehörige von Menschen mit einer Hirnverletzung: Pilotstudie

Erhöhte Depressivität und Ängstlichkeit sowie ein erhöhtes subjektives Belastungserleben sind bei Angehörigen von Menschen mit einer Hirnverletzung häufig. Die vorliegende Pilotuntersuchung widmet sich der Evaluation einer neuartigen Intervention, dem OSCAR Online-Coaching, einer internetbasierten Mehrkomponentenintervention. In einer randomisierten, kontrollierten Pilotstudie mit 35 TeilnehmerInnen wurde ein 16-wöchiges therapeutengeleitetes Selbsthilfeprogramm mit einer Wartekontrollgruppe verglichen. Als primäre Ergebnismasse wurde der Perceived Stress Questionnaire und das Zarit Burden Interview eingesetzt. Intention-to-treat-Analysen der unmittelbaren Effekte direkt nach der Intervention zeigten keine signifikanten Gruppenunterschiede auf den primären und auf sekundären Ergebnismassen. Im 6-Monate Follow-up, nach Zugang der Kontrollgruppe zur Intervention, wurde in der Gesamtstichprobe eine signifikante Reduktion des Caregiver Burden, depressiver Symptome, der Angst, sowie eine Zunahme positiver Emotionen gefunden. Die Zufriedenheit mit dem Programm war gut.

Internet-based stress management for women with preterm labour: a case-based experience report

Pregnant women with preterm labour (PTL) in pregnancy often experience increased distress and anxieties regarding both the pregnancy and the child's health. The pathogenesis of PTL is, among other causes, related to the stress-associated activation of the maternal-foetal stress system. In spite of these psychobiological associations, only a few research studies have investigated the potential of psychological stress-reducing interventions. The following paper will present an online anxiety and stress management self-help program for pregnant women with PTL. Structure and content of the program will be illustrated by a case-based experience report. L.B., 32 years (G3, P1), was recruited at gestational week 27 while hospitalized for PTL for 3 weeks. She worked independently through the program for 6 weeks and had regular written contact with a therapist. Processing the program had a positive impact on L.B.'s anxiety and stress levels, as well as on her experienced depressive symptoms and bonding to the foetus. As PTL and the risk of PTB are associated with distress, psychological stress-reducing interventions might be beneficial. This study examines the applicability of an online intervention for pregnant women with PTL. The case report illustrates how adequate low-threshold psychological support could be provided to these women.

Effects of a Transdiagnostic Internet Intervention («velibra») for Anxiety Disorders in Primary Care: Results of a Randomized Controlled Trial

Internet-based cognitive behavioral self-help treatment (ICBT) for anxiety disorders has shown promising results in several trials, but there is yet a lack of studies of ICBT in „real world” primary care settings. In this randomized controlled trial we recruited participants through general practitioners. The aim of the study was to examine whether treatment-as-usual (TAU) in primary care settings plus ICBT is superior to TAU alone in reducing anxiety symptoms and other outcome measures among individuals meeting diagnostic criteria of a least one of three anxiety disorders (social anxiety disorder, panic disorder with or without agoraphobia, generalized anxiety disorder). 150 adults fulfilling diagnostic criteria for a least one of the anxiety disorders according to a diagnostic interview are randomly assigned to one of the two conditions: TAU plus ICBT versus TAU. Randomization is stratified by primary disorder, medication (yes/no) and concurrent psychotherapy. ICBT consists of a transdiagnostic and tailored Internet-based self-help program for several anxiety disorders which also includes cognitive bias modification for interpretation (CBM-I). Primary outcomes are symptoms of disorder-specific anxiety measures and diagnostic status after the intervention (9 weeks). Secondary outcomes include primary outcomes at 3-month follow-up and secondary measures such as general symptomatology, depression, quality of life, adherence to ICBT and satisfaction with ICBT. The study is currently being completed. Primary results along with results for specific subgroups (e.g. primary diagnosis, concurrent medication and/or psychotherapy) will be presented and discussed.

A sorrow shared is a sorrow halved? Internet-based group therapy versus individual therapy for social anxiety disorder: A randomized controlled trial

Purpose: Social anxiety disorder is one of the most researched conditions in the field of Internet-based self-help. Various studies have shown that cognitive-behavioral treatments can be efficacious to reduce social phobic symptoms. Most of the interventions tested include some form of support, whereas the efficacy of a web-based group format has yet to be investigated. The present study aims at investigating the possible added value of therapist-guided group support in an Internet-based guided self-help treatment for SAD. Methods: A total of 150 adults with a diagnosis of SAD are randomly assigned to either a wait-list control group or one of two active treatment conditions. Participants in the two active conditions use the same Internet-based self-help program, either with individual guidance by a therapist or with the support of a therapist-guided group of 6 individuals. In the group condition, participants communicate with each other via an integrated, protected discussion forum. The primary outcome variables are symptoms of SAD and diagnostic status immediately after the intervention (12 weeks) and at 6-month follow-up. Secondary endpoints are general symptomatology, depression, quality of life and adherence to treatment. Furthermore, process variables such as group processes and the working alliance are studied. Results: Results are currently being analyzed. Results at post-treatment will be presented and discussed. Potential moderating and mediating variables of treatment success will be addressed. Conclusion: The results of this study should indicate whether therapist-guided group support could enhance the efficacy of an internet based self-help treatment for SAD. This novel treatment format, if shown efficacious, could represent a cost-effective option and could be further modified to treat other conditions.

Adjustment Disorders Are Uniquely Suited for eHealth Interventions: Concept and Case Study

Background: Adjustment disorders (also known as mental distress in response to a stressor) are among the most frequently diagnosed mental disorders in psychiatry and clinical psychology worldwide. They are also commonly diagnosed in clients engaging in deliberate self-harm and in those consulting general practitioners. However, their reputation in research-oriented mental health remains weak since they are largely underresearched. This may change when the International Statistical Classification of Diseases-11 (ICD-11) by the World Health Organization is introduced, including a new conceptualization of adjustment disorders as a stress-response disorder with positively defined core symptoms. Objective: This paper provides an overview of evidence-based interventions for adjustment disorders. Methods: We reviewed the new ICD-11 concept of adjustment disorder and discuss the the rationale and case study of an unguided self-help protocol for burglary victims with adjustment disorder, and its possible implementation as an eHealth intervention. Results: Overall, the treatment with the self-help manual reduced symptoms of adjustment disorder, namely preoccupation and failure to adapt, as well as symptoms of depression, anxiety, and stress. Conclusions: E-mental health options are considered uniquely suited for offering early intervention after the experiences of stressful life events that potentially trigger adjustment disorders.

Análisis de bocinas en MatLab

El presente proyecto parte de un programa utilizado en las prácticas de laboratorio en la asignatura Antenas y Compatibilidad Electromagnética del sexto semestre llamado SABOR, que pretende ser actualizado para que en las nuevas versiones de los sistemas operativos ofrecidos por la compañía Windows pueda ser operativo. El objetivo principal será diseñar e implementar nuevas funcionalidades así como desarrollar mejoras y corregir errores del mismo. Para su mejor entendimiento se ha creado una herramienta en entorno MATLAB para analizar uno de los tipos más comunes de Apertura que se utilizan actualmente, las bocinas. Dicha herramienta es una interfaz gráfica que tiene como entradas las variables elementales de diseño de la apertura como por ejemplo: dimensiones de la propia bocina o los parámetros generales comunes a todas ellas. A su vez, el software nos genera algunos de los parámetros de salida fundamentales de las antenas: Directividad, Ancho de haz, Centro de fase y Spillover. Para el correcto desarrollo del software se ha realizado numerosas pruebas con el fin de depurar y corregir errores con respecto a la anterior versión del SABOR. Por otra parte se ha hecho también hincapié en la funcionalidad del programa para que sea más intuitivo y evitar complejidades. El tipo de antena que se pretende estudiar es la bocina que consiste en una guía de onda en la cual el área de la sección se va incrementando progresivamente hasta un extremo abierto, que se comporta como una apertura. Se utilizan extensamente en satélites comerciales para coberturas globales desde órbitas geoestacionarias, pero el uso más común es como elemento de radiación para reflectores de antenas. Los tipos de bocinas que se van a examinar en la herramienta son: Sectorial H, Sectorial E, Piramidal, Cónica, Cónica Corrugada y Piramidal Corrugada. El proyecto está desarrollado de manera que pueda servir de información teórico-práctico de todo el software SABOR. Por ello, el documento además de revisar la teoría de las bocinas analizadas, mostrará la información relacionada con la programación orientado a objetos en entorno MATLAB cuyo objetivo propio es adquirir una nueva forma de pensamiento acerca del proceso de descomposición de problemas y desarrollo de soluciones de programación. Finalmente se ha creado un manual de autoayuda para dar soporte al software y se han incluido los resultados de diversas pruebas realizadas para poder observar todos los detalles de su funcionamiento, así como las conclusiones y líneas futuras de acción. ABSTRACT This Project comes from a program used in the labs of the subject Antennas and Electromagnetic Compatibility in the sixth semester called SABOR, which aims to be updated in order to any type of computer running a Windows operating systems(Windows 7 and subsequent versions). The main objectives are design and improve existing functionalities and develop new features. In addition, we will correct mistakes in earlier versions. For a better understanding a new custom tool using MATLAB environment has been created to analyze one of the most common types of apertura antenna which is used for the moment, horns. This tool is a graphical interface that has elementary design variables as a inputs, for example: Dimensions of the own horn or common general parameters of all horns. At the same time, the software generate us some of the fundamental parameters of antennas output like Directivity, Beamwidth, Phase centre and Spillover. This software has been performed numerous tests for the proper functioning of the Software and we have been cared in order to debug and correct errors that were detected in earlier versions of SABOR. In addition, it has also been emphasized the program's functionality in order to be more intuitive and avoiding unnecessary barriers or complexities. The type of antenna that we are going to study is the horn which consists of a waveguides which the section area has been gradually increasing to an open-ended, that behaves as an aperture. It is widely used in comercial satellites for global coverage from geostationary orbits. However, the most common use is radiating element for antenna reflectors. The types of horns which is going to be considered are: Rectangular H-plane sectorial, Rectangular E-plane sectorial, Rectangular Pyramidal, Circular, Corrugated Circular and Corrugated Pyramidal. The Project is developed so that it can be used as practical-theorical information around the SABOR software. Therefore, In addition to thoroughly reviewing the theory document of analyzed horns, it display information related to the object-oriented programming in MATLAB environment whose goal leads us to a new way of thinking about the process of decomposition of problems and solutions development programming. Finally, it has been created a self-help manual in order to support the software and has been included the results of different tests to observe all the details of their operations, as well as the conclusions and future action lines.

The Use of Humor in Therapy : Research-Based Training Recommendations

Despite its essential and universal nature, humor has historically received limited attention from the behavioral sciences, particularly as compared to other affective experiences like anger and sadness. Some authors (e.g., Bell & Malhi, 2009; Provine, 2000a; Roeckelein, 2002) suggest that this is because researchers have traditionally failed to "take humor seriously" and, according to O'Connell (cited in Roeckelein, 2002), have too often pursued its study in a piecemeal manner lacking scientific rigor, resulting in "no comprehensive network of facts about the development and purposes of humor in human existence" (p. 1). Roeckelein (2002) found not a single mention of humor, laughter, wit, comedy, or theories relating to these topics in introductory psychology textbooks published between 1930 and 1996.While research interest in the area has grown, especially over the last decade, it remains an elusive and nebulous topic, more likely to be examined in specialty psychology texts (e.g., social psychology and child development) than general ones (Martin, 2007; Roeckelein, 2002). Organizations (e.g., The International Society for Humor Studies; The Association for the Advancement of Therapeutic Humor), journals (e.g., Humor: International Journal of Humor Research) and internet phenomena such as "The Humor Project" (www.humorproiect.com) have made great strides in integrating information about humor from discreet fields such as the arts and humanities, biological and social sciences, education, and business management. Still, the therapeutic potential of humor remains a relatively young subject of serious scientific inquiry (Marci, Moran, & Orr, 2004; Sala, Krupat, & Roter, 2002). While humor does make appearances in self-help books and publications addressing clinical applications, these sources are much ...

Migration in the Central Mediterranean. Jean Monnet Occasional Papers 02/2013

In the last decade irregular immigration has emerged as a “security” challenge (in the language of International Relations military “threat”) in the Mediterranean region particularly in the central, sub-region1. The designation of this issue as a “security challenge” or “threat” is itself controversial and will be discussed further down. This paper focuses on the situation in the central Mediterranean involving mainly four countries namely Italy, Libya, Malta and Tunisia all of which have long standing historic links and bilateral relations and participate in the so called “5+5” Dialogue in the Western Mediterranean. Two of these Central Mediterranean countries (Italy, Malta) are EU member states and Tunisia has a long standing relationship with the EU [Association Agreement, Barcelona Process (EMP), Neighbourhood Policy (ENP), Union for the Mediterranean (UfM)] while Libya so far has no formal relations at all with the EU. This paper analyses some of the aspects of migration in the central Mediterranean focusing on the link between the domestic and international politics of the issue in Italy and Malta and contrasting the different approaches taken. For example, although Italy and Malta both resort to self-help and both try to involve the EU in helping them tackle the problem, they do this in a markedly different way: Italy uses the EU as a supplement to its independent and bilateral efforts while Malta looks to the EU as the major solution to the problem. Lacking the power and influence to deal with the issue, Malta tends to see the problem as primarily a multilateral issue or one that can only be tackled in concert with stronger powers in the region preferably within an EU context. On the other hand, Italy has been keen in involving the EU but decided to go it alone when this option turned out to be a dead end. In this paper I also try to show the extent (or limitations) to which multilateral initiatives such as the “5+5” and Euro operation really play a decisive role in incentivizing or facilitating inter-state cooperation or joint solutions. This paper also refers to the EU acquis, the notion of solidarity (norms) and the extent to which it is implemented as well as a number of connected issues. The subjects of this paper, the Mediterranean Boat People, have been referred to by various names in the literature, all of which may be more or less deficient in actually defining them all. They have been referred to as “illegal” or “irregular” immigrants, “refugees” in search of international protection, “migrants at sea” and “boat people”. The use of “boat people” dispenses with the need of having to define the various categories of migrants involved and is thus preferred in this paper.

Efficacy of an Internet-based, individually tailored smoking cessation program: A randomized trial

Introduction: Self-help computer-based programs are easily accessible and cost-effective interventions with a great recruitment potential. However, each program is different and results of meta-analyses may not apply to each new program; therefore, evaluations of new programs are warranted. The aim of this study was to assess the marginal efficacy of a computer-based, individually tailored program (the Coach) over and above the use of a comprehensive Internet smoking cessation website. Methods: A two-group randomized controlled trial was conducted. The control group only accessed the website, whereas the intervention group received the Coach in addition. Follow-up was conducted by e-mail after three and six months (self-administrated questionnaires). Of 1120 participants, 579 (51.7%) responded after three months and 436 (38.9%) after six months. The primary outcome was self-reported smoking abstinence over four weeks. Results: Counting dropouts as smokers, there were no statistically significant differences between intervention and control groups in smoking cessation rates after three months (20.2% vs. 17.5%, p¼0.25, odds ratio (OR)¼1.20) and six months (17% vs. 15.5%, p¼0.52, OR¼1.12). Excluding dropouts from the analysis, there were statistically significant differences after three months (42% vs. 31.6%, p¼0.01, OR¼1.57), but not after six months (46.1% vs. 37.8%, p¼0.081, OR¼1.41). The program also significantly increased motivation to quit after three months and self-efficacy after three and six months. Discussion: An individually tailored program delivered via the Internet and by e-mail in addition to a smoking cessation website did not significantly increase smoking cessation rates, but it increased motivation to quit and self-efficacy.

Annual seminar report.

Mode of access: Internet.

La Palabra alhambre de MASH.

Mode of access: Internet.

Assistive technology : a selective bibliography.

Shipping list no.: 92-0304-P.

Access to multimedia technology by people with sensory disabilities /

"March 13, 1998."