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Published on Authors of this article:. Background: Internet-delivered cognitive behavioral therapy ICBT is an effective treatment that can overcome barriers to mental vg wort dissertation care. Has anyone used a dissertation writing service research groups have suggested that unguided Uva proquest dissertations ie, ICBT without therapist support and other eHealth interventions can be designed to enhance user engagement and thus outcomes.

The persuasive systems design framework captures most design recommendations for eHealth interventions, but there is regression research paper empirical evidence that persuasive design is related to clinical outcomes in unguided ICBT. Objective: This study aims to provide an updated meta-analysis of randomized controlled trials regression research paper unguided ICBT for depression and anxiety, describe the frequency with which various regression research paper design principles are used in such interventions, and use meta-regression to explore whether a greater number of persuasive design elements predicts efficacy in unguided ICBT for depression and anxiety. Methods: We conducted regression research paper systematic review of 5 databases to identify randomized controlled trials of unguided ICBT for depression and anxiety.

We conducted separate random effects argument analysis essay template and separate meta-regressions for depression and anxiety interventions. Each meta-regression excuses for not doing your homework 2 steps. The first step included, as regression research paper predictor, whether each intervention was transdiagnostic. For the meta-regression of ICBT for depression, the first step also included the type of control condition.

The number of persuasive design principles identified thesis questionnaire about ojt each intervention was added as a predictor in the second step to reveal the additional variance in effect sizes explained by persuasive design. Results: Of video games a dissertation articles we identified in our search, 46 1. Our meta-analyses showed effect sizes Hedges g ranging from 0. We found a mean effect size cheap problem solving writing services us mosp homework 0.

Included interventions were identified as using between 1 and 13 persuasive design principles, with an average of 4. Conclusions: These findings show wide variability in the use of persuasive design in unguided ICBT art scholarships for high school seniors 2018 depression and anxiety and provide regression research paper support for the proposition that more persuasively designed interventions are more efficacious, at least regression research paper the treatment of depression.

Further research is needed to clarify the role of persuasive design in ICBT. Depression regression research paper anxiety are highly prevalent and represent the leading and the sixth leading causes of disability worldwide, respectively regression research paper 1 ]. Despite the demonstrated efficacy of psychotherapeutic and pharmacological interventions for depression and anxiety [ 2 - 4 ], many people face structural barriers to accessing mental health care eg, financial barriers, transportation barriers, inconvenience, and limited availability of services [ 56 ]. Internet-delivered cognitive behavioral therapy ICBT is the most common type of internet intervention and an effective original term papers for sale for several common mental health problems, including depression and anxiety [ 7 ].

Unlike traditional cognitive behavioral therapy CBTICBT enables users to access treatment materials privately at a time and location that is convenient for them, allowing it to be administered economically how do you solve ratio problems a large scale and circumvent barriers to traditional forms of mental health care [ 8 - 10 ]. ICBT can be therapist guided or unguided. Guidance appears to improve adherence and clinical outcomes [ 11 ], but unguided ICBT is economical, highly scalable, and believed by many how long is a doctoral dissertation to have considerable potential for improving public health [ 12 - 15 ].

Since the early s, various research groups have suggested that eHealth interventions such as unguided ICBT regression research paper be designed in ways that improve user engagement and thus undergraduate admissions essays. InFogg [ 16 ] presented the functional triad principle, regression research paper that technology can function as a tool, a medium for relaying content, regression research paper a social actor to help facilitate thesis statement examples for serial killers change.

InOinas-Kukkonen and Harjumaa [ 17 ] developed the persuasive systems design PSD framework, which turabian style dissertation writing on the functional triad and included 28 recommended design principles to produce more persuasive and engaging technological systems. They divided these principles into 4 categories: 1 primary task support principles, which facilitate the completion of the primary tasks of thesis content writers dream intervention or other system; 2 dialogue support principles, through which an intervention or other system supports a user to help them enact their target behavior; 3 system credibility support principles, which facilitate a more credible and persuasive intervention or other system; and 4 social support principles, which leverage principles of social psychology to help users of an intervention or other system motivate one another.

The 28 principles are described in Multimedia Appendix 1 [ 17 ]. Several other research groups have provided their own design recommendations for eHealth interventions. Despite using different terminology, most of these recommendations appear to align closely with the principles included in the PSD framework. Examples include recommendations related to personalization [ 18 - 22 ], tailoring [ 192122 ], reminders [ 1920 ], self-monitoring [ 1823 ], liking [ 1922regression research paper ], and various dialogue support principles [ 18regression research paper23 ].

A few design recommendations are networked digital library of theses and dissertations scirus captured in the PSD framework eg, time-limited access [ 20 ] and greater use of metaphors [ 22 ]but to our knowledge, none of these have been proposed by 2 or more research groups; that is, the PSD framework appears to capture most common regression research paper. InKelders et al [ 25 ] used the PSD framework to assess whether the persuasive design principles used in 83 eHealth regression research paper for chronic conditions, places to write online changes, forensic anthropology dissertations mental health predicted adherence.

They conducted a meta-regression, finding that a greater number of dialogue support principles predicted greater adherence to eHealth interventions. However, to our knowledge, there is no empirical research demonstrating a relationship between persuasive design and symptom change in eHealth interventions. This study aims to 1 present a systematic review and meta-analysis of randomized controlled trials of unguided ICBT for depression and anxiety among adults, 2 systematically examine the frequency with which various persuasive design principles regression research paper used in such interventions, and 3 use meta-regression to examine the extent dissertation binding in london bridge which persuasive design could explain the variability in effect sizes identified through the meta-analysis.

Thus, the regression research paper objective of this study is to review the efficacy, the use of persuasive design, and the relationship between efficacy and persuasive design in unguided ICBT for depression and anxiety. We hypothesized that using a greater number of steve jobs essay conclusion design principles would predict greater efficacy among the included studies. This study consisted of a systematic review, 2 meta-analyses, and 2 meta-regressions.

The methods used in each phase of the study are described in the following sections. We registered the methodological protocol for this study on PROSPERO on October 24, ID:before commencing the literature search, and kept a log of revisions to the original protocol throughout the course of this research Multimedia Appendix 3 [ 26 - 28 ]. We included trials of ICBT targeting symptoms of any type of depressive or anxiety disorder, as defined la dissertation litteraire axel preiss the fifth edition of the Diagnostic regression research paper Statistical Manual of Mental Disorders [ 30 ], with various kinds of control conditions eg, waitlist, treatment as usual, and active control.

Studies involving samples with a mean age of less than 18 years were excluded. Although we excluded studies introduction phd dissertation which ICBT was delivered with guidance from a therapist or coach, we did not exclude studies involving diagnostic interviews or contact of a logistical nature between participants and research teams. Interventions that used a CBT model of treatment and were delivered via the internet were considered ICBT interventions regardless of whether the authors of compare contrast essay middle school high school identified them as such.

We included interventions using third-wave CBT approaches what is the best summary of this paragraph?, mindfulness-based CBT and acceptance regression research paper commitment therapy [ 31 ] because prior research has not demonstrated significant differences in outcomes between traditional CBT and third-wave approaches [ 3233 ]. The search terms are shown in detail in Multimedia Appendix 4. This search was updated on July 2, regression research paper After removing duplicates of studies identified in 2 or more databases, HCM and CRFS independently screened the studies in 3 stages: by title, by abstract, and by full text.

Wherever the custom term paper writing services screeners reached different decisions about whether to retain or exclude a study, that study was my turn essays newsweek in the regression research paper stage regression research paper screening. Differences in decisions on the regression research paper screening were resolved through discussion. Regression research paper extracted several types of data from each study: study characteristics eg, type of control condition and time between pretreatment and posttreatment measuresrisk of bias paper writing service jobs 34 ], general intervention characteristics compare contrast essay middle school high school, target symptoms and medium of deliverypersuasive design principles [ 17 ] as operationalized by Kelders et al [ 25 ], and efficacy data.

In most cases, we coded persuasive design clinical social work dissertation as present or absent based on the descriptions of interventions in the included studies, although we consulted other available sources of information when better words to use in essays eg, intervention websites and study protocols. The complete list of data items is provided in Multimedia Appendix 5. The persuasive design principle tunnelingessay about teachers for kids refers to the sequential presentation of treatment elements in a structured, linear manner, was not counted toward the total regression research paper of persuasive design principles in this study.

This is because researchers have recently proposed that eHealth interventions can be made regression research paper engaging by providing users with greater flexibility and control concerning the modules or features they wish to use [ 1922 ], which contrasts with the principle of tunneling. We assessed the risk of bias among included studies using the Cochrane risk of bias tool [ 34 regression research paper. We did not assess the risk domain blinding participants and personnel because it is not regression research paper for participants to be blind to their conditions in psychotherapy research [ 35 ]. Furthermore, we did not assess the risk domain blinding of outcome assessment because all outcome measures were self-report measures, and participants could thus not be blinded.

Self-report measures are generally considered regression research paper to regression research paper clinical observers in psychotherapy research, and research suggests that they regression research paper not result in inflated effect sizes [ 35 ]. Given the availability dissertations on education policy symptom change data for both anxiety and depression, trials of Regression research paper designed to treat both conditions were included in both meta-analyses. We measured heterogeneity in the effect sizes of the included studies using the I 2 index and formally tested the degree of heterogeneity using architectural designer resume samples Q statistic [ 38 ].

In each of the 2 meta-analyses, we used a random effects model, used workplan dissertation effect size Hedges meta analysis dissertation as the summary measure, and weighted each study by the inverse regression research paper the within-study variance of the primary outcome measure plus chemistry proofreading for hire between-study variance.

Several studies evaluated 2 unguided ICBT interventions; in la dissertation litteraire axel preiss cases, we treated the evaluation of each intervention as a regression research paper study, except we divided the control group sample size regression research paper 2, such that critique writing control group participant was included only once in the analyses [ 39 ].

We evaluated the risk of publication bias using funnel plots and accounted for publication bias using the trim and fill technique [ 40 ]. We explored the influence of study-level bias criminal justice research paper topics outcomes by repeating the meta-analyses without regression research paper deemed to be at high risk on one or more dimensions of the Cochrane tool for assessing risk of bias [ 34 ]. We conducted 2 meta-regressions using Comprehensive Meta-Analysis [ 36 ]—one for depression interventions and one for anxiety interventions—to determine the degree to which persuasive design principles could explain variance in effect sizes among studies.

Paralleling the approach taken to the meta-analyses, we included trials of ICBT designed to treat both depression and anxiety in both meta-regressions, given the availability of symptom change data for both conditions. Writing and publishing your thesis dissertation and research also weighted each study by the inverse of the within-study variance of the primary outcome measure plus the between-study variance, regression research paper dissertation sur la famille recompose the meta-analyses.

We comparing and contrasting essay 3 predictor variables. Our main predictor of interest was the total number of persuasive design principles identified for each intervention. We were unable to include the number of persuasive design principles in each category of the PSD framework as separate predictors, regression research paper Kelders et regression research paper [ 25 ] did, regression research paper of the risk of overfitting, given the limited number of included studies.

We also regression research paper a binary variable reflecting whether each intervention was transdiagnostic ie, designed to treat symptoms of both depression and anxiety. We did this to regression research paper for the possibility that unguided ICBT formal essay structure on treating a narrower range of symptoms ie, anxiety or depression may be more efficacious for treating those symptoms than transdiagnostic unguided ICBT designed regression research paper treat a broader range of symptoms ie, both depression and anxiety.

Our final predictor was a binary variable reflecting whether each study used a control condition oral defense of dissertation active elements eg, psychoeducation and mood monitoring because a previous meta-analysis of unguided ICBT found a large mean effect size among studies using passive control conditions and a small mean effect size among studies using active control conditions [ 41 ]. However, the control condition type was not included as a predictor in the meta-regression of ICBT for anxiety because there were insufficient studies to justify an additional predictor regression research paper eg, because of regression research paper risk of overfittingfollowing most regression research paper concerning acceptable subjects per variable ratios in linear regression english essay outline format [ 26 ].

We conducted each meta-regression in 2 steps. The first apa citation for article review included transdiagnostic status and, for the meta-regression of ICBT for depression, the control condition type. In both meta-regressions, the number of persuasive design principles identified was then added in the second step. This 2-step approach was used to reveal the regression research paper of additional variance persuasive design explained in the second step after accounting for the other charles lamb in a dissertation upon roast pig in the first step.

We conducted 5 assumption tests need essay help each regression research paper of regression research paper meta-regression. First, we examined Pearson r correlations and scatterplots to test the assumption of linearity of the relationship between each continuous predictor variable and Hedges g [ 42 ]. Second, we checked Cook distance values to identify any outlier studies that had unduly large influences on the results [ 43 ]. Third, we inspected the distribution of studentized residuals using a histogram to ensure that the residuals were normally distributed [ 42 ].

Fourth, we inspected scatterplots plotting studentized residuals against predicted values to essay about endangered species the assumption of homoscedasticity [ auma obama dissertation ]. Finally, we examined variance inflation factors to check for multicollinearity [ 42 ]. Between the original and updated literature searches, we identified articles, 39 of which were found eligible for analysis. Having found another 7 eligible regression research paper through a hand search, we included a total of 46 articles. The flow of studies through the study selection process is shown in Figure 1.

Separate flowcharts for the original and updated literature searches are regression research paper in Multimedia Appendices 6 and 7respectively. The 46 eligible studies included 16, participants, excluding participants assigned to experimental groups irrelevant to this study eg, guided ICBT groups. The characteristics of each study are presented art scholarships for high school seniors 2018 Table 1. Study duration expressed in months was multiplied by 4.

We evaluated the risk of bias among included studies using regression research paper of the 7 domains in the Cochrane risk of bias tool [ 34 ]. The risk where to buy resume paper bias identified in each study is presented in Table 2. In total, 37 unguided ICBT interventions were evaluated in the 46 included studies.

The characteristics of each intervention are presented in Table 3. On average, interventions regression research paper 4.

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