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      REMOTION Blended Transdiagnostic Intervention for Symptom Reduction and Improvement of Emotion Regulation in an Outpatient Psychotherapeutic Setting: Protocol for a Pilot Randomized Controlled Trial

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          Abstract

          Background

          Emotion regulation has been identified as an important transdiagnostic factor relevant to the treatment of mental health disorders. Many empirically validated psychotherapeutic treatments incorporate elements targeting emotion regulation. Most of these treatment approaches are conceptualized as standard face-to-face treatments not as blended treatments, which include an internet-based intervention.

          Objective

          The aim of this study is to examine, for the first time, a new internet-based intervention—REMOTION—that will be provided transdiagnostically, as an add-on to psychotherapy, to provide a blended treatment format.

          Methods

          A total of 70 participants will be assigned (1:1 allocation ratio) to either the intervention group (REMOTION + psychotherapy) or the treatment-as-usual group that receives psychotherapy alone. To maximize external validity, a typical outpatient treatment sample of patients diagnosed with a range of disorders such as depression, anxiety disorders, and adjustment disorder will be recruited from a university outpatient clinic. Patients with bipolar disorder, psychotic disorders, or acute suicidality will be excluded from the study. The feasibility and potential effectiveness of the intervention will be examined by assessing data at baseline, 6 weeks (post), and 12 weeks (follow-up). The primary outcome is general symptom severity, assessed with the Brief Symptom Inventory. Secondary outcomes are emotion regulation, depressive symptoms, anxiety symptoms, health related quality of life, well-being, and a variety of feasibility parameters. Quantitative data will be analyzed on an intention-to-treat basis.

          Results

          Participant recruitment and data collection started in February 2020, and as of November 2020, are ongoing. Results for the study are expected in 2022.

          Conclusions

          This pilot randomized controlled trial will inform future studies using transdiagnostic blended treatment.

          Trial Registration

          ClinicalTrials.gov NCT04262726; http://clinicaltrials.gov/ct2/show/NCT04262726

          International Registered Report Identifier (IRRID)

          DERR1-10.2196/20936

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          Most cited references81

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          Multidimensional Assessment of Emotion Regulation and Dysregulation: Development, Factor Structure, and Initial Validation of the Difficulties in Emotion Regulation Scale

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            Validation and standardization of the Generalized Anxiety Disorder Screener (GAD-7) in the general population.

            The 7-item Generalized Anxiety Disorder Scale (GAD-7) is a practical self-report anxiety questionnaire that proved valid in primary care. However, the GAD-7 was not yet validated in the general population and thus far, normative data are not available. To investigate reliability, construct validity, and factorial validity of the GAD-7 in the general population and to generate normative data. Nationally representative face-to-face household survey conducted in Germany between May 5 and June 8, 2006. Five thousand thirty subjects (53.6% female) with a mean age (SD) of 48.4 (18.0) years. The survey questionnaire included the GAD-7, the 2-item depression module from the Patient Health Questionnaire (PHQ-2), the Rosenberg Self-Esteem Scale, and demographic characteristics. Confirmatory factor analyses substantiated the 1-dimensional structure of the GAD-7 and its factorial invariance for gender and age. Internal consistency was identical across all subgroups (alpha = 0.89). Intercorrelations with the PHQ-2 and the Rosenberg Self-Esteem Scale were r = 0.64 (P < 0.001) and r = -0.43 (P < 0.001), respectively. As expected, women had significantly higher mean (SD) GAD-7 anxiety scores compared with men [3.2 (3.5) vs. 2.7 (3.2); P < 0.001]. Normative data for the GAD-7 were generated for both genders and different age levels. Approximately 5% of subjects had GAD-7 scores of 10 or greater, and 1% had GAD-7 scores of 15 or greater. Evidence supports reliability and validity of the GAD-7 as a measure of anxiety in the general population. The normative data provided in this study can be used to compare a subject's GAD-7 score with those determined from a general population reference group.
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              Emotion-regulation strategies across psychopathology: A meta-analytic review.

              We examined the relationships between six emotion-regulation strategies (acceptance, avoidance, problem solving, reappraisal, rumination, and suppression) and symptoms of four psychopathologies (anxiety, depression, eating, and substance-related disorders). We combined 241 effect sizes from 114 studies that examined the relationships between dispositional emotion regulation and psychopathology. We focused on dispositional emotion regulation in order to assess patterns of responding to emotion over time. First, we examined the relationship between each regulatory strategy and psychopathology across the four disorders. We found a large effect size for rumination, medium to large for avoidance, problem solving, and suppression, and small to medium for reappraisal and acceptance. These results are surprising, given the prominence of reappraisal and acceptance in treatment models, such as cognitive-behavioral therapy and acceptance-based treatments, respectively. Second, we examined the relationship between each regulatory strategy and each of the four psychopathology groups. We found that internalizing disorders were more consistently associated with regulatory strategies than externalizing disorders. Lastly, many of our analyses showed that whether the sample came from a clinical or normative population significantly moderated the relationships. This finding underscores the importance of adopting a multi-sample approach to the study of psychopathology. Copyright 2009 Elsevier B.V. All rights reserved.
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                Author and article information

                Contributors
                Journal
                JMIR Res Protoc
                JMIR Res Protoc
                ResProt
                JMIR Research Protocols
                JMIR Publications (Toronto, Canada )
                1929-0748
                November 2020
                12 November 2020
                : 9
                : 11
                : e20936
                Affiliations
                [1 ] Department of Clinical Psychology and Psychotherapy University of Bern Bern Switzerland
                [2 ] University Hospital of Psychiatry and Psychotherapy University of Bern Bern Switzerland
                [3 ] Department of Psychology and Psychotherapy Witten/Herdecke University Witten Germany
                Author notes
                Corresponding Author: Laura Luisa Bielinski laura.bielinski@ 123456psy.unibe.ch
                Author information
                https://orcid.org/0000-0002-4145-6253
                https://orcid.org/0000-0001-5137-0755
                https://orcid.org/0000-0003-3302-7229
                https://orcid.org/0000-0003-0190-4442
                https://orcid.org/0000-0002-0149-4554
                https://orcid.org/0000-0001-9809-0275
                https://orcid.org/0000-0002-2432-7791
                Article
                v9i11e20936
                10.2196/20936
                7691093
                33180026
                0c72be8e-5aa2-483c-923d-bafe3cf74e3a
                ©Laura Luisa Bielinski, Tobias Krieger, Franz Moggi, Leonie Trimpop, Ulrike Willutzki, Christoph Nissen, Thomas Berger. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 12.11.2020.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Research Protocols, is properly cited. The complete bibliographic information, a link to the original publication on http://www.researchprotocols.org, as well as this copyright and license information must be included.

                History
                : 2 June 2020
                : 14 July 2020
                : 10 August 2020
                : 27 October 2020
                Categories
                Protocol
                Protocol

                blended therapy,internet-based intervention,emotion regulation,transdiagnostic,online therapy

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