Lisa Danielle Ciechomski

Bio: Lisa Danielle Ciechomski is an academic researcher from Monash University. The author has contributed to research in topics: Anxiety & Mental health. The author has an hindex of 7, co-authored 15 publications receiving 621 citations. Previous affiliations of Lisa Danielle Ciechomski include Swinburne University of Technology.

Best Practices in Online Therapy

Abstract: This article discusses important issues in delivery of best practice Internet-based therapy (etherapy). Etherapy is first defined as the interaction between a consumer and a therapist via the Inter...

Internet-based treatment for panic disorder: does frequency of therapist contact make a difference?

Abstract: Internet-based interventions with therapist support have proven effective for treating a range of mental health conditions. This study examined whether frequency of therapist contact affected treatment outcomes. Fifty-seven people with panic disorder (including 32 with agoraphobia) were randomly allocated to an 8-week Internet-based cognitive behavioural treatment intervention (Panic Online) with either frequent (three e-mails per week) or infrequent (one e-mail per week) support from a psychologist. Posttreatment, intention-to-treat analyses revealed that both treatments were effective at improving panic disorder and agoraphobia severity ratings, panic-related cognitions, negative affect, and psychological and physical quality of life domains, with no differences between conditions. High end-state functioning was achieved by 28.6% of the frequent and infrequent participants, respectively. Therapist alliance, treatment credibility, and satisfaction also did not differ between groups, despite significantly greater therapist time invested in the frequent contact condition. The results provide evidence that the effectiveness of Internet-based mental health interventions may be independent of the frequency of therapist support and may, therefore, be more cost-effective than previously reported.

A controlled trial of internet-based cognitive-behavioural therapy for panic disorder with face-to-face support from a general practitioner or email support from a psychologist.

Abstract: Background Panic disorder (PD) is one of the most common anxiety disorders seen in general practice, but provision of evidence-based cognitive-behavioural treatment (CBT) is rare. Many Australian GPs are now trained to deliver focused psychological strategies, but in practice this is time consuming and costly. Objective To evaluate the efficacy of an internet-based CBT intervention (Panic Online) for the treatment of PD supported by general practitioner (GP)-delivered therapeutic assistance. Design Panic Online supported by GP-delivered face-to-face therapy was compared to Panic Online supported by psychologist-delivered email therapy. Methods Sixty-five people with a primary diagnosis of PD (78% of whom also had agoraphobia) completed 12 weeks of therapy using Panic Online and therapeutic assistance with his/her GP (n = 34) or a clinical psychologist (n = 31). The mean duration of PD for participants allocated to these groups was 59 months and 58 months, respectively. Participants completed a clinical diagnostic interview delivered by a psychologist via telephone and questionnaires to assess panic-related symptoms, before and after treatment. Results The total attrition rate was 20%, with no group differences in attrition frequency. Both treatments led to significant improvements in panic attack frequency, depression, anxiety, stress, anxiety sensitivity and quality of life. There were no statistically significant differences in the two treatments on any of these measures, or in the frequency of participants with clinically significant PD at post assessment. Conclusions When provided with accessible online treatment protocols, GPs trained to deliver focused psychological strategies can achieve patient outcomes comparable to efficacious treatments delivered by clinical psychologists. The findings of this research provide a model for how GPs may be assisted to provide evidence-based mental healthcare successfully.

The contribution of general practice based research to the development of national policy: case studies from Ireland and Australia

Abstract: Background This paper aims to describe the influence of general practice based research on the development of two specific policy initiatives, namely the Heartwatch Programme in Ireland and the Better Outcomes in Mental Health Care (BOiMHC) program in Australia. A case study approach was used to explore the extent to which relevant general practice based research shaped these initiatives.

Internet-Based and Other Computerized Psychological Treatments for Adult Depression: A Meta-Analysis

Abstract: Computerized and, more recently, Internet-based treatments for depression have been developed and tested in controlled trials. The aim of this meta-analysis was to summarize the effects of these treatments and investigate characteristics of studies that may be related to the effects. In particular, the authors were interested in the role of personal support when completing a computerized treatment. Following a literature search and coding, the authors included 12 studies, with a total of 2446 participants. Ten of the 12 studies were delivered via the Internet. The mean effect size of the 15 comparisons between Internet-based and other computerized psychological treatments vs. control groups at posttest was d = 0.41 (95% confidence interval [CI]: 0.29-0.54). However, this estimate was moderated by a significant difference between supported (d = 0.61; 95% CI: 0.45-0.77) and unsupported (d = 0.25; 95% CI: 0.14-0.35) treatments. The authors conclude that although more studies are needed, Internet and other computerized treatments hold promise as potentially evidence-based treatments of depression.

Computer Therapy for the Anxiety and Depressive Disorders Is Effective, Acceptable and Practical Health Care: A Meta-Analysis

Abstract: Background: Depression and anxiety disorders are common and treatable with cognitive behavior therapy (CBT), but access to this therapy is limited. Objective: Review evidence that computerized CBT for the anxiety and depressive disorders is acceptable to patients and effective in the short and longer term. Method: Systematic reviews and data bases were searched for randomized controlled trials of computerized cognitive behavior therapy versus a treatment or control condition in people who met diagnostic criteria for major depression, panic disorder, social phobia or generalized anxiety disorder. Number randomized, superiority of treatment versus control (Hedges g) on primary outcome measure, risk of bias, length of follow up, patient adherence and satisfaction were extracted. Principal Findings: 22 studies of comparisons with a control group were identified. The mean effect size superiority was 0.88 (NNT 2.13), and the benefit was evident across all four disorders. Improvement from computerized CBT was maintained for a median of 26 weeks follow-up. Acceptability, as indicated by adherence and satisfaction, was good. Research probity was good and bias risk low. Effect sizes were non-significantly higher in comparisons with waitlist than with active treatment control conditions. Five studies comparing computerized CBT with traditional face-to-face CBT were identified, and both modes of treatment appeared equally beneficial. Conclusions: Computerized CBT for anxiety and depressive disorders, especially via the internet, has the capacity to provide effective acceptable and practical health care for those who might otherwise remain untreated.

Persuasive System Design Does Matter: A Systematic Review of Adherence to Web-Based Interventions

Abstract: Background: Although web-based interventions for promoting health and health-related behavior can be effective, poor adherence is a common issue that needs to be addressed Technology as a means to communicate the content in web-based interventions has been neglected in research Indeed, technology is often seen as a black-box, a mere tool that has no effect or value and serves only as a vehicle to deliver intervention content In this paper we examine technology from a holistic perspective We see it as a vital and inseparable aspect of web-based interventions to help explain and understand adherence Objective: This study aims to review the literature on web-based health interventions to investigate whether intervention characteristics and persuasive design affect adherence to a web-based intervention Methods: We conducted a systematic review of studies into web-based health interventions Per intervention, intervention characteristics, persuasive technology elements and adherence were coded We performed a multiple regression analysis to investigate whether these variables could predict adherence Results: We included 101 articles on 83 interventions The typical web-based intervention is meant to be used once a week, is modular in set-up, is updated once a week, lasts for 10 weeks, includes interaction with the system and a counselor and peers on the web, includes some persuasive technology elements, and about 50% of the participants adhere to the intervention Regarding persuasive technology, we see that primary task support elements are most commonly employed (mean 29 out of a possible 70) Dialogue support and social support are less commonly employed (mean 15 and 12 out of a possible 70, respectively) When comparing the interventions of the different health care areas, we find significant differences in intended usage (p = 004), setup (p < 001), updates (p < 001), frequency of interaction with a counselor (p < 001), the system (p = 003) and peers (p = 017), duration (F = 6068, p = 004), adherence (F = 4833, p = 010) and the number of primary task support elements (F = 5631, p = 005) Our final regression model explained 55% of the variance in adherence In this model, a RCT study as opposed to an observational study, increased interaction with a counselor, more frequent intended usage, more frequent updates and more extensive employment of dialogue support significantly predicted better adherence Conclusions: Using intervention characteristics and persuasive technology elements, a substantial amount of variance in adherence can be explained Although there are differences between health care areas on intervention characteristics, health care area per se does not predict adherence Rather, the differences in technology and interaction predict adherence The results of this study can be used to make an informed decision about how to design a web-based intervention to which patients are more likely to adhere