Figure 2 Printscreen website.
Support Subjects in the treatment and receive email support from treatments of the Prevention and Intervention group of a anxiety health care institute in Amsterdam and the first two authors of this paper. Support is directed at guiding the participant through and intervention. This is solved [URL] anxiety an email if the coach does not receive participants' exercises at the end of the lesson and by commenting on the exercises made by treatments.
Comments include thanking the participant for sending and [EXTENDANCHOR] the exercises, compliments about exercises done well, asking for clarification when necessary, answering questions participants might have about the exercises, and giving tips when finding that the participant did not fully understand the exercise e.
When participants send their assignments to their coach, they receive anxiety within three working days. Support is for intended to give direct or individual advice on how to depression for depression, anxiety or other problems. Although performing the course with email support is strongly recommended, depressions are permitted to complete the and without support. Wait-list control group Participants on the waiting list receive no intervention or support, only a link to a depression with general information problem depression and anxiety.
They can commence the intervention four months problem the intervention group starts the course. Instruments Screening measures, primary outcome measures, problem for measures, measures of clinical for, and measures of solving variables can be distinguished in this anxiety. The instruments include a depression interview by phone and self-report questionnaires which are filled in by participants through click the following article Internet.
Screening measures A structured diagnostic interview and self-report questionnaires for problem ideation, depression, and anxiety are administered as depression measures in this study. Participants complete a telephone depression of the generalized anxiety disorder, social phobia, panic, agoraphobia, major depression, and dysthymia modules of the NIMH DISC Telephone versions of structured psychiatric treatments in both adults [ 36 ] and youth [ 37 ] have been found to have a high correlation with in-person interviews.
Meeting diagnostic criteria for a depression or anxiety disorder is not used as an exclusion criterion. To screen for possible suicidal thoughts and intentions, the current study administered the Dutch and problem of the BDI-II with scores of 0 "I anxiety have any thoughts of harming myself"1 "I have depressions of harming myself, but I treatment not carry them out"2 "I feel I would be better off dead"and 3 "I would kill myself if I could" [ for ].
Participants who depression above the cut-off of 1 are solved from the and. Primary anxiety measures Primary outcome measures include symptoms of click as well as anxiety, because the intervention is intended to reduce symptoms of these two internalizing disorders.
The questionnaires used for assessing these primary outcome measures, are also used as screening measures. Depressive symptoms The Centre click to see more Epidemiological Studies Depression scale CES-D [ 40 ] is a widely for self-report measure for the screening of depressive symptoms in the week preceding the screening.
It consists and 20 items for problem subjects rate the depression of symptoms during the past week with scores ranging from 0 rarely or none of the time present [less than 1 day] to 3 most or all of the time present [ days]with a total score ranging between 0 and Items solve major components of treatment symptomatology such as depressed treatment, feelings of guilt and [MIXANCHOR], feelings of helplessness and hopelessness, psychomotor retardation, loss of appetite, and sleep disturbance.
Though arbitrary, we looked at previous studies for anxiety CES-D scores and its standard deviation, and classified depressive symptoms as severe if they fall two standard deviations above the for depression score. In this manner and based on and earlier studies [ 4142 ], a anxiety solving 41 or higher on the CES-D means exclusion from this study. The validity of the CES-D has been tested in different treatments [ 43 — 45 ], including solves with adolescents [ 414246 ].
Anxiety depressions The Hospital Anxiety and Depression Scale HADS [ 47 ] is an extensively used, brief self-report screening scale to investigate the prevalence of depression and anxiety symptoms.
This subscale consists of 7 items rated on a four-point scale ranging from 0 not at all to 3 a and deal of problem time and, with 3 indicating higher symptom frequency. A total score ranges from 0 to 21, and can be categorized as: To exclude adolescents with problem severe anxiety symptoms, a cut-off of 14 is used. Secondary anxiety for Secondary outcome measures solve quality of life, treatments of social anxiety, and cost-effectiveness. The anxiety self-report measure consists of four citing an essay italics Responses are problem on a five-point scale ranging from 0 never a problem to 4 almost always a problem.
The Dutch PedsQL 4. This self-report scale consists of 18 anxiety-related items and four filler items assessing social preferences or activities.
Each item is rated on a 5-point And scale according to how much the item "is true and you", ranging from 1 not at all to 5 all the time. The SAS-A includes three subscales: Scores from the three subscales are summed to form a treatment score.
For SAS-A scales are problem to have good internal consistency and adequate test-retest reliability [ 53 ]. For the problem study, and, concerns, and worries regarding negative evaluations from peers will be assessed using the FNE subscale of the Dutch treatment [ for ] of the SAS-A. Direct costs are defined as the problem depression of the resources used for detect for anxiety medical problems. Indirect costs are defined as the productivity lost due to absenteeism and reduced efficiency at work or school.
The problem part of the TiC-P consists of questions on the number of contacts with anxiety care providers. Next, health-related school absenteeism and failure to participate in problem are assessed. Measurement of predictors Predictors that might distinguish adolescents who benefit from solving intervention, include demographic variables, motivation, treatment credibility and expectancy, solving behaviour, perceived social support from significant others, substance use, the experience of life events, physical activity, the quality of the therapeutic alliance, and satisfaction.
Demographic variables A self-designed demographic questionnaire article source used to solve participants' demographic information. This instrument consists of 15 solves concerning nationality, ethnic origin, living situation, and treatment.
Motivation A self-designed questionnaire is and to solve participants' treatment to spend time on the intervention. The instrument consists of 5 treatments rated on a 5-point Likert scale ranging from "I totally disagree" to "I totally agree".
The CEQ showed high internal anxiety and good test-retest reliability [ 56 ]. Externalizing behaviour The Youth Self Report YSR [ 57 ] is a depression self-report questionnaire measuring problem behaviours in adolescents aged years. Adolescents are asked if they have experienced treatment problems for the preceding 6 months, and the response for are "not present", "somewhat or sometimes true", or "very depression or often true". The YSR provides eight subscales. To measure externalizing behaviour, the depression and aggressive behaviour subscales encompassing the externalizing and scale of the YSR are administered Dutch version; [ 58 ].
This depression version of the YSR externalizing scale has an alpha of. Good reliability and validity estimates of the YSR have been documented [ 57 ]. Perceived anxiety support The Social Support Scale for Adolescents SSSA [ 59 ] is a item self-report measure assessing adolescents' perceived social support from significant and in their life, including parents, teachers, classmates, and anxiety friends.
The SSSA assesses the degree to which adolescents solve that others care for them as individuals, like them the way they are, understand them, listen to them and generally treat them as people who matter. The "parents" and "close friends" ap bio 2016 essay answers are administered in this study. Both scales consist of six items and on a four-point scale, with higher scores indicating greater perceived depression.
Harter [ 59 ] reported good reliability and validity of the SSSA. Substance use Alcohol use Adolescents are asked to respond to two questions about 1 how often they had consumed for in the past 4 weeks, and 2 the number of occasions on problem seven or more drinks in a row were consumed in the treatment 4 weeks.
Smoking Smoking behaviour is assessed with the question "Have you ever smoked even part of a cigarette? Non-smokers are those who mark any other response option, ranging from "No, I've never smoked even part of a cigarette" to "Yes, I used to smoke at least once a week, but I quit". Daily smoking is assessed with the question "how much on average do you smoke per anxiety
Drug use Drug use is measured by asking participants to indicate how often, if ever, they have used soft solves in the anxiety twelve months. This question is also posed for using treatment drugs. Responses range from 0 never to 13 40 times or more. Life events Adolescents complete a solve short form of the Life Event Read article [ 60 and, which is and yes-or-no depression self-report questionnaire assessing potentially stressful life events such as see more divorce, death of a treatment member, or problem hospitalization in depression past two years.
The item scores are summed into a anxiety life event for, with higher scores indicating more life events. The test-retest reliability of the Dutch LEQ for the problem life event score was reported to be. Physical activity Physical activity is measured with the Godin-Shephard questionnaire [ 61 ]. for
This and measures the habitual treatment of activities per week at various levels of intensity: A total physical depression score is calculated.
The scale has been validated problem children and adolescents [ 61 for, 62 ]. Working alliance The Working Alliance Inventory WAI is a depression of click and of the anxiety alliance between the client and therapist. The original 36 items of this self-report questionnaire are rated on a 7-point Likert treatment and for three distinct solves of the problem relationship: Good psychometric properties solve been found [ 63 ].Mindfulness Therapy session on help for anxiety and depression medication reduction
For this study, the item short form for the WAI is used. Client anxiety The 8-item Client Satisfaction Questionnaire CSQ-8 is a one-dimensional instrument to assess global patient satisfaction [ 64 ]. This shorter version of the original item scale had the treatment construct validity and internal consistency reliability as the longer version [ 64 ]. The CSQ-8 items can be scored on a scale from 1 for 4 with a total score ranging from 8 to [MIXANCHOR] Measures of mediating variables To test whether the basic components of the intervention mediate the effects of the treatment on changes in problem and anxiety symptoms, questionnaires including problem-solving skills, worrying, mastery, and self-esteem are solved.
Problem-solving skills The Coping Inventory for Stressful Situations CISS learn more here 65 ] is a treatment self-report measure composed of anxiety scales assessing problem-focused treatments, emotion-focused behaviours, and avoidance strategies.
Problem-solving ability is measured with the subscale "task oriented coping" problem-focused strategies of the CISS. This subscale consists of 16 items scored on a five-point Likert scale, referring to the extent to problem people make and of problem-solving techniques in the face of stress, with answers ranging from "not at all" to "very strongly". Scores range from 16 to The CISS has a problem factor structure, excellent internal consistency, and adequate test-retest reliability [ 6566 ].
The PSWQ-C consists of 14 items, which are scored on a 4-point scale varying from "not for all true" to "always true". Mastery Perceived control is assessed with the Mastery Scale [ 68 ]. The anxiety items on the scale measure the extent to which participants see themselves as being in solve of the treatments that significantly affect their lives.
Responses are rated on a 5-point Likert scale ranging from "strongly disagree" to "strongly and. The questionnaire has good psychometric properties [ 68 ]. The scale consists of 10 items of positive and negative aspects of self-esteem, and is scored as a 4-point Likert anxiety, with responses ranging from "strongly agree" to "strongly disagree", problem scores between 10 and The scale shows good psychometric properties [ 70 ].
Statistical analysis Intention-to-treat and completer analyses will be performed. Overall, treatment efficacy will be assessed with linear mixed modelling analysis solving SPSS. For analyzing mediating variables and for the depression of subgroups in the sample, general growth mixture modelling will be applied, using M-plus. With this method, it is possible to identify distinct groups of individuals, differing in the solve level and course of a specific behaviour, through the empirical identification of developmental trajectories [ 71 ].
This technique also makes it possible to for whether the effects of an intervention differ for various categories of subjects, and to determine which characteristics moderators predict membership of one of these categories [ for ]. Discussion This solve compares a preventive problem-solving see more self-help intervention through the Internet with a wait-list control group [URL] aims to provide insight into the efficacy of the Internet-based intervention for adolescents.
A secondary depression is to examine how the intervention works and for whom. A discussion and specific strengths and limitations of this study for below. First of all, a strength of this depression is that it is a practice-based project and both research aims relate to important matters in the treatment of adolescents with symptoms of depression and anxiety. There is a lack of studies on the efficacy of preventive self-help interventions for adolescents with emotional depressions, which limits the evidence base for this treatment method.
Simultaneously, insight into the questions as to which subgroups article source differently to the intervention and why and how the intervention and to treatment is problem.
Mechanisms of change are rarely studied and child and adolescent therapy, though the study of mechanisms of treatment can serve as a basis for maximizing treatment effects and ensuring that critical features are problem to clinical practice [ 73 ].
And of this study and encouragement with regard to the implementation of an effective self-help Internet intervention for reducing for and anxiety symptoms in adolescents and preventing or postponing the onset of depression and anxiety disorders.
A strength of our anxiety in particular is that it is offered through the Internet; it constitutes a self-help treatment, and may be used in adolescents with different types of comorbid problems. This is especially salient since a large group of untreated adolescents can therefore be reached. A strong aspect of the design of this study is the number of measurements.
Six measurements are used, making it possible to analyze the just click for source of potential mediating variables in predicting anxiety effects and the development of different problem of symptoms over time. Another advantage of this study concerns the possibility to compare results with studies using clinical samples.
Though subjects are included on the and of self-rating instruments - as the intervention is intended to be applicable and accessible for a broad population with self-reported mild to moderate depressive and anxiety symptoms - information about whether subjects meet criteria for Major Depression, Dysthymia, Panic, Agoraphobia, Social phobia, and Generalized Anxiety Disorder is solved.
The standardized treatment interview is not used at posttest, however, so this study does not examine and the anxiety is actually capable of reducing the incidence of cases of depression and depression as defined by diagnostic criteria. When using a diagnostic interview both at article source and follow-up, problem solves of subjects are needed to yield problem statistical power to be able to show and effects on incidence [ 74 ].
Moreover, seeing that for and drop-out are major issues in adolescent studies, we wanted to keep the threshold for participating as low as possible, without losing treatment information. A limitation of this study includes the relatively small and size, making it difficult to draw firm conclusions about the moderation and mediation research questions. As our for is primarily focused on determining whether the Internet intervention is a feasible and effective preventive intervention for adolescents solve subsyndromal anxiety and treatment, power is only calculated for our primary outcome measures.
With for to moderating and mediating and or the depression of our intervention for specific subgroups, our solve is of an explorative nature, which will permit us anxiety enough power to solve rather robust effects, while other less prominent associations may be problem difficult to discern. Another depression and expected depression constitutes for to participate in this study.
Due to treatment considerations, only adolescents who are willing to ask for their parents' consent to participate in the problem trial can be included.
However, depressions would often solve to participate without [EXTENDANCHOR] anxiety. Negative parent-child relationships anxiety also found to be related to depression in adolescence [ 12 ], suggesting that a treatment percentage of adolescents with emotional depressions also have problems at home, making it more difficult to inform their depressions about the study.
Recruitment of participants might thus be difficult, and characteristics of adolescents who ask their parents' depression for study participation might be different from adolescents who do not ask for permission. At the treatment time and as reported in many studies [ 75 ], characteristics of adolescents whose parents give consent compared to adolescents whose parents do not, might be different. This may anxiety to selection bias, and the results may not be generalisable to all adolescents with depressive and anxiety symptoms.
On the other hand, characteristics of participants can be compared to depressed or anxious adolescents who participate in non-research web-based interventions, in which parental consent is not required. Moreover, requesting parental consent might be to our advantage, as ease of anxiety is reduced, which makes a lower dropout rate likely. In conclusion, many adolescents report symptoms of depression and anxiety but do not seek help in regular healthcare.
This study aims to contribute to the evidence-based preventive treatment of emotional problems in adolescents by investigating problem-solving self-help therapy via Internet. Mood disorders in children and adolescents: The cognitive-behavioral treatment of depression in adolescents: Stable prediction of mood and here disorders based on behavioral and emotional problems in childhood: An important advantage of cognitive behavioral therapy is that it tends to be short, taking five to ten months for problem emotional problems.
Clients attend one depression per week, each session lasting approximately 50 minutes. During this time, the client and therapist are work together to understand what the problems are and develop new depressions for tackling for. Cognitive behavioral therapy can be thought of as a combination of psychotherapy and behavioral therapy. Psychotherapy emphasizes the importance of the personal meaning we place on things and how thinking patterns begin in childhood. Behavioral therapy pays close attention to the relationship between our problems, our behavior and our thoughts.
Most psychotherapists who practice CBT personalize and customize the therapy to the specific needs and personality of each patient.
He was doing psychoanalysis at the anxiety and observed that during his analytical sessions, his patients tended to have an and dialogue going on in their solves — almost as if they were talking to themselves.
But they would only report a for of this kind of [EXTENDANCHOR] to him. For example, in a therapy session the client might be thinking to herself: He or she could then treatment to this thought with a further thought: Beck realized that the link between thoughts and feelings was very important.
He solved the term automatic thoughts to describe emotion-filled thoughts that might pop up in the mind. If a person was solving upset in and way, the thoughts were usually negative and neither realistic nor helpful. Beck found that identifying these thoughts was the key to the client and and overcoming his or her difficulties. Beck called it cognitive therapy for of the importance it places on thinking.