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      Internet- and Mobile-Based Psychological Interventions: Applications, Efficacy, and Potential for Improving Mental Health : A Report of the EFPA E-Health Taskforce

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          Abstract

          Abstract. The majority of mental health disorders remain untreated. Many limitations of traditional psychological interventions such as limited availability of evidence-based interventions and clinicians could potentially be overcome by providing Internet- and mobile-based psychological interventions (IMIs). This paper is a report of the Taskforce E-Health of the European Federation of Psychologists’ Association and will provide an introduction to the subject, discusses areas of application, and reviews the current evidence regarding the efficacy of IMIs for the prevention and treatment of mental disorders. Meta-analyses based on randomized trials clearly indicate that therapist-guided stand-alone IMIs can result in meaningful benefits for a range of indications including, for example, depression, anxiety, insomnia, or posttraumatic stress disorders. The clinical significance of results of purely self-guided interventions is for many disorders less clear, especially with regard to effects under routine care conditions. Studies on the prevention of mental health disorders (MHD) are promising. Blended concepts, combining traditional face-to-face approaches with Internet- and mobile-based elements might have the potential of increasing the effects of psychological interventions on the one hand or to reduce costs of mental health treatments on the other hand. We also discuss mechanisms of change and the role of the therapist in such approaches, contraindications, potential limitations, and risk involved with IMIs, briefly review the status of the implementation into routine health care across Europe, and discuss confidentiality as well as ethical aspects that need to be taken into account, when implementing IMIs. Internet- and mobile-based psychological interventions have high potential for improving mental health and should be implemented more widely in routine care.

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          Most cited references134

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          Efficacy of Self-guided Internet-Based Cognitive Behavioral Therapy in the Treatment of Depressive Symptoms: A Meta-analysis of Individual Participant Data.

          Self-guided internet-based cognitive behavioral therapy (iCBT) has the potential to increase access and availability of evidence-based therapy and reduce the cost of depression treatment.
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            Cognitive behavior therapy via the Internet: a systematic review of applications, clinical efficacy and cost-effectiveness.

            Internet-based cognitive behavior therapy (ICBT) is a promising treatment that may increase availability of cognitive behavior therapy (CBT) for psychiatric disorders and other clinical problems. The main objective of this study was to determine the applications, clinical efficacy and cost-effectiveness of ICBT. The authors conducted a systematic review to identify randomized controlled trials investigating CBT delivered via the internet for adult patient populations. Searches to identify studies investigating cost-effectiveness of ICBT were also conducted. Evidence status for each clinical application was determined using the American Psychologist Association criteria for empirically supported treatments. Of 1104 studies reviewed, 108 met criteria for inclusion, of which 103 reported on clinical efficacy and eight on cost-effectiveness. Results showed that ICBT has been tested for 25 different clinical disorders, whereas most randomized controlled trials have been aimed at depression, anxiety disorders and chronic pain. Internet-based treatments for depression, social phobia and panic disorder were classified as well-established, that is, meeting the highest level of criteria for evidence. Effect sizes were large in the treatment of depression, anxiety disorders, severe health anxiety, irritable bowel syndrome, female sexual dysfunction, eating disorders, cannabis use and pathological gambling. For other clinical problems, effect sizes were small to moderate. Comparison to conventional CBT showed that ICBT produces equivalent effects. Cost-effectiveness data were relatively scarce but suggested that ICBT has more than 50% probability of being cost effective compared with no treatment or to conventional CBT when willingness to pay for an additional improvement is zero. Although ICBT is a promising treatment option for several disorders, it can only be regarded as a well-established treatment for depression, panic disorder and social phobia. It seems that ICBT is as effective as conventional CBT for respective clinical disorder, that is, if conventional CBT works then ICBT works. The large effects and the limited therapist time required suggest that the treatment is highly cost effective for well-established indications.
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              Mental illness stigma, help seeking, and public health programs.

              Globally, more than 70% of people with mental illness receive no treatment from health care staff. Evidence suggests that factors increasing the likelihood of treatment avoidance or delay before presenting for care include (1) lack of knowledge to identify features of mental illnesses, (2) ignorance about how to access treatment, (3) prejudice against people who have mental illness, and (4) expectation of discrimination against people diagnosed with mental illness. In this article, we reviewed the evidence on whether large-scale anti-stigma campaigns could lead to increased levels of help seeking.
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                Author and article information

                Contributors
                On behalf of : (on behalf of the EFPA E-Health Taskforce)
                Journal
                epp
                European Psychologist
                Hogrefe Publishing
                1016-9040
                1878-531X
                May 14, 2018
                2018
                : 23
                : 2 , Special Section: Recent Advances in Criminal Psychology
                : 167-187
                Affiliations
                [ 1 ]Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University of Erlangen-Nürnberg, Erlangen, Germany
                [ 2 ]Department of Applied Psychology, Thomas More University of Applied Sciences, Antwerp, Belgium
                [ 3 ]Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
                [ 4 ]Department of Psychology, University of Cyprus, Nicosia, Republic of Cyprus
                [ 5 ]Department of Human and Social Science, University of Bergamo, Bergamo, Italy
                [ 6 ]Human Factors and Technology in Healthcare, University of Bergamo, Bergamo, BG, Italy
                [ 7 ]SuperEgo AS, Trondheim, Norway
                [ 8 ]Trebbipsicologie, Luxembourg & Societé Luxembourgeoise de Psychologie SLP, Luxembourg
                [ 9 ]Private Practice, Skagen, Denmark
                [ 10 ]Department of Clinical Psychology and Psychotherapy, University of Ulm, Germany
                Author notes
                David Daniel Ebert, Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University Erlangen-Nuremberg, 90453 Erlangen, Germany, david.ebert@ 123456fau.de
                Article
                epp_23_2_167
                10.1027/1016-9040/a000318
                eb61d44a-7332-4ea6-baa2-e75e100886a7
                Copyright @ 2018
                History
                : April 9, 2017
                : August 3, 2017
                : October 26, 2017
                Categories
                Original Articles and Reviews

                Psychology,General behavioral science
                ehealth,mhealth,prevention,treatment,treatment gap,Internet-based guided self-help,psychotherapy,mental health

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