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      A pilot study of a clinician-guided internet-delivered cognitive behavioural therapy for anxiety and depression among Arabs in Australia, presented in both English and Arabic languages

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          Abstract

          The present pilot study examined the efficacy and acceptability of an internet-delivered Cognitive Behaviour Therapy (iCBT) intervention delivered in both English and Arabic languages to Arab Australians, aged 18 and over, with symptoms of depression and anxiety. Thirteen participants with at least mild symptoms of depression on the (Patient Health Questionnaire 9-item; PHQ-9; total scores ≥ 5) or anxiety (Generalised Anxiety Disorder 7-item; GAD-7; total scores ≥ 5) accessed the online Arabic Wellbeing Course, which consisted of five online lessons delivered over eight weeks with weekly clinician support. Measures of depression, anxiety, distress and disability were administered at pre-treatment, post-treatment and 3-month follow-up. Data were analysed using generalised estimation equation (GEE) modelling. Seventy-seven percent (10/13) of participants completed the five lessons over eight weeks, with 10/13 providing post-treatment and 3-month follow-up data. Participants improved significantly across all outcome measures, with large within-group effect sizes based on estimated marginal means (Cohen's d) at post-treatment ( d = 1.18 to 1.62) and 3-month follow-up ( d = 1.28 to 1.72). In addition, 40% and 38% of participants obtained, at least, a 50% improvement in symptoms of both anxiety and depression at 3-month follow-up respectively. Participants rated the Arabic Wellbeing Course as acceptable, and 70% of those who completed follow-up questionnaires reported accessing the course in both English and Arabic languages. Notwithstanding the limitations of an open trial design, these results are encouraging and indicate that culturally modified clinician-guided internet-delivered versions of Western psychological interventions have the potential for increasing access to treatment for Arabic-speaking Australians, and potentially other groups.

          Highlights

          • This pilot study examined the efficacy of an internet-delivered Cognitive Behaviour Therapy (iCBT) for Arab Australians.

          • iCBT was found to be effective and acceptable among Arab Australian participants.

          • Seventy percent of participants who completed follow up data reported accessing the Course in both English and Arabic languages.

          • iCBT has the potential for increasing access to treatment for Arabic-speaking Australians, and other groups.

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          Most cited references34

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          The Patient Health Questionnaire Somatic, Anxiety, and Depressive Symptom Scales: a systematic review.

          Depression, anxiety and somatization are the most common mental disorders in primary care as well as medical specialty populations; each is present in at least 5-10% of patients and frequently comorbid with one another. An efficient means for measuring and monitoring all three conditions would be desirable. Evidence regarding the psychometric and pragmatic characteristics of the Patient Health Questionnaire (PHQ)-9 depression, generalized anxiety disorder (GAD)-7 anxiety and PHQ-15 somatic symptom scales are synthesized from two sources: (1) four multisite cross-sectional studies (three conducted in primary care and one in obstetric-gynecology practices) comprising 9740 patients, and (2) key studies from the literature that have studied these scales. The PHQ-9 and its abbreviated eight-item (PHQ-8) and two-item (PHQ-2) versions have good sensitivity and specificity for detecting depressive disorders. Likewise, the GAD-7 and its abbreviated two-item (GAD-2) version have good operating characteristics for detecting generalized anxiety, panic, social anxiety and post-traumatic stress disorder. The optimal cutpoint is > or = 10 on the parent scales (PHQ-9 and GAD-7) and > or = 3 on the ultra-brief versions (PHQ-2 and GAD-2). The PHQ-15 is equal or superior to other brief measures for assessing somatic symptoms and screening for somatoform disorders. Cutpoints of 5, 10 and 15 represent mild, moderate and severe symptom levels on all three scales. Sensitivity to change is well-established for the PHQ-9 and emerging albeit not yet definitive for the GAD-7 and PHQ-15. The PHQ-9, GAD-7 and PHQ-15 are brief well-validated measures for detecting and monitoring depression, anxiety and somatization. Copyright 2010. Published by Elsevier Inc.
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            Advantages and limitations of Internet-based interventions for common mental disorders.

            Several Internet interventions have been developed and tested for common mental disorders, and the evidence to date shows that these treatments often result in similar outcomes as in face-to-face psychotherapy and that they are cost-effective. In this paper, we first review the pros and cons of how participants in Internet treatment trials have been recruited. We then comment on the assessment procedures often involved in Internet interventions and conclude that, while online questionnaires yield robust results, diagnoses cannot be determined without any contact with the patient. We then review the role of the therapist and conclude that, although treatments including guidance seem to lead to better outcomes than unguided treatments, this guidance can be mainly practical and supportive rather than explicitly therapeutic in orientation. Then we briefly describe the advantages and disadvantages of treatments for mood and anxiety disorders and comment on ways to handle comorbidity often associated with these disorders. Finally we discuss challenges when disseminating Internet interventions. In conclusion, there is now a large body of evidence suggesting that Internet interventions work. Several research questions remain open, including how Internet interventions can be blended with traditional forms of care. Copyright © 2014 World Psychiatric Association.
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              To GEE or not to GEE: comparing population average and mixed models for estimating the associations between neighborhood risk factors and health.

              Two modeling approaches are commonly used to estimate the associations between neighborhood characteristics and individual-level health outcomes in multilevel studies (subjects within neighborhoods). Random effects models (or mixed models) use maximum likelihood estimation. Population average models typically use a generalized estimating equation (GEE) approach. These methods are used in place of basic regression approaches because the health of residents in the same neighborhood may be correlated, thus violating independence assumptions made by traditional regression procedures. This violation is particularly relevant to estimates of the variability of estimates. Though the literature appears to favor the mixed-model approach, little theoretical guidance has been offered to justify this choice. In this paper, we review the assumptions behind the estimates and inference provided by these 2 approaches. We propose a perspective that treats regression models for what they are in most circumstances: reasonable approximations of some true underlying relationship. We argue in general that mixed models involve unverifiable assumptions on the data-generating distribution, which lead to potentially misleading estimates and biased inference. We conclude that the estimation-equation approach of population average models provides a more useful approximation of the truth.
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                Author and article information

                Contributors
                Journal
                Internet Interv
                Internet Interv
                Internet Interventions
                Elsevier
                2214-7829
                16 June 2016
                September 2016
                16 June 2016
                : 5
                : 5-11
                Affiliations
                Department of Psychology, Macquarie University, Sydney, Australia
                Author notes
                [* ]Corresponding author at: eCentreClinic, Department of Psychology, Macquarie University, North Ryde 2109, Australia. rony.kayrouz@ 123456mq.edu.au
                Article
                S2214-7829(16)30015-X
                10.1016/j.invent.2016.06.002
                6096205
                30135801
                b6c6924c-4752-424d-9cf9-762e20da19a1
                © 2016 The Authors

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 5 March 2016
                : 9 May 2016
                : 8 June 2016
                Categories
                Full length Article

                arabic,arab australians,anxiety,depression,internet-delivered treatment,transdiagnostic

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