Papers by Fjola Dogg Helgadottir
Bridging the gap in internet treatments for mental health: A fully automated online cognitive beh... more Bridging the gap in internet treatments for mental health: A fully automated online cognitive behaviour therapy for social anxiety for those who stutter
Introduction: CBTpsych.com is a fully functional intervention that aims at bridging the gap betwe... more Introduction: CBTpsych.com is a fully functional intervention that aims at bridging the gap between Eliza (Weizenbaum, 1966) and modern internet treatments for anxiety disorders (Helgadottir, Menzies, Onslow, Packman & O"Brien, 2009a). A Phase I trial demonstrated that two participants no longer met the diagnosis of social phobia on the DSM-IV and ICD-10 after being treated by CBTpsych.com. The quality of the interaction appeared to be similar to face-to-face therapy. The automated techniques were successful in engaging the participants and in encouraging them to log on regularly and complete the treatment (Helgadottir, Menzies, Onslow, Packman & O"Brien, 2009b). The current study is a phase II trial targeting social anxiety in stuttering. Method: File audit data were gathered from 10 years of experience in the psychological management of social anxiety and stuttering (St Clare et al., 2008). This data was used to create a fully automated human-like intervention using algorithms alone. CBTpsych.com creates cognitive restructuring exercises, behavioural experiments, and negative thoughts checklists for the automated treatment program. Furthermore, other features such as imagery rescripting were incorporated to adhere to the Clark D. M. and Wells (1995) model of social anxiety treatment. 18 participants presenting for treatment of stuttering with social anxiety at the Australian Stuttering Research Centre (ASRC) were offered 5 months access to the "computer psychologist". 16 participants started using the computer program. The treatment did not involve any contact with clinical psychologists at the ASRC. mental disorders (4th ed., text rev.). Washington, DC: Author.
Behaviour Research and Therapy, 2014
Background: Social anxiety is both harmful and prevalent. It also currently remains among the mos... more Background: Social anxiety is both harmful and prevalent. It also currently remains among the most undertreated major mental disorders, due, in part, to socially anxious individuals' concerns about the stigma and expense of seeking help. The privacy and affordability of computer-aided psychotherapy interventions may render them particularly helpful in addressing these concerns, and they are also highly scalable, but most tend to be only somewhat effective without therapist support. However, a recent evaluation of a new self-guided, 7-module internet-delivered cognitive behavioral therapy intervention called Overcome Social Anxiety found that it was highly effective. Objective: The initial evaluation of Overcome Social Anxiety revealed that it led to significant reductions in symptom severity among university undergraduates. The aim of this study was to extend the results of the initial study and investigate their generalizability by directly evaluating the intervention's effectiveness among a general community sample. Methods: While signing up for Overcome Social Anxiety, users consented to the usage of their anonymized outcome data for research purposes. Before and after completing the intervention, users completed the Fear of Negative Evaluation Scale (FNE), which we employed as the primary outcome measure. Secondary outcome measures included the Depression Anxiety Stress Scales (DASS) and 2 bespoke questionnaires measuring socially anxious thoughts (Thoughts Questionnaire) and avoidance behaviors (Avoidance Questionnaire). Results: Participants who completed the intervention (102/369, 27.7%) experienced significant reductions in the severity of their symptoms on all measures employed, including FNE (P<.001; Cohen d=1.76), the depression subscale of DASS (P<.001; Cohen d=0.70), the anxiety subscale of DASS (P<.001; Cohen d=0.74), the stress subscale of DASS (P<.001; Cohen d=0.80), the Thoughts Questionnaire (P<.001; Cohen d=1.46), and the Avoidance Questionnaire (P<.001; Cohen d=1.42). Conclusions: Our results provide further evidence that Overcome Social Anxiety reduces the severity of social anxiety symptoms among those who complete it and suggest that its effectiveness extends to the general community. The completion rate is the highest documented for a fully automated intervention for anxiety, depression, or low mood in a real community sample. In addition, our results indicate that Overcome Social Anxiety reduces the severity of symptoms of depression, physiological symptoms of anxiety, and stress in addition to symptoms of social anxiety.
Journal of Medical Internet Research, Jan 10, 2019
Background: Social anxiety is both harmful and prevalent. It also currently remains among the mos... more Background: Social anxiety is both harmful and prevalent. It also currently remains among the most undertreated major mental disorders, due, in part, to socially anxious individuals' concerns about the stigma and expense of seeking help. The privacy and affordability of computer-aided psychotherapy interventions may render them particularly helpful in addressing these concerns, and they are also highly scalable, but most tend to be only somewhat effective without therapist support. However, a recent evaluation of a new self-guided, 7-module internet-delivered cognitive behavioral therapy intervention called Overcome Social Anxiety found that it was highly effective. Objective: The initial evaluation of Overcome Social Anxiety revealed that it led to significant reductions in symptom severity among university undergraduates. The aim of this study was to extend the results of the initial study and investigate their generalizability by directly evaluating the intervention's effectiveness among a general community sample. Methods: While signing up for Overcome Social Anxiety, users consented to the usage of their anonymized outcome data for research purposes. Before and after completing the intervention, users completed the Fear of Negative Evaluation Scale (FNE), which we employed as the primary outcome measure. Secondary outcome measures included the Depression Anxiety Stress Scales (DASS) and 2 bespoke questionnaires measuring socially anxious thoughts (Thoughts Questionnaire) and avoidance behaviors (Avoidance Questionnaire). Results: Participants who completed the intervention (102/369, 27.7%) experienced significant reductions in the severity of their symptoms on all measures employed, including FNE (P<.001; Cohen d=1.76), the depression subscale of DASS (P<.001; Cohen d=0.70), the anxiety subscale of DASS (P<.001; Cohen d=0.74), the stress subscale of DASS (P<.001; Cohen d=0.80), the Thoughts Questionnaire (P<.001; Cohen d=1.46), and the Avoidance Questionnaire (P<.001; Cohen d=1.42). Conclusions: Our results provide further evidence that Overcome Social Anxiety reduces the severity of social anxiety symptoms among those who complete it and suggest that its effectiveness extends to the general community. The completion rate is the highest documented for a fully automated intervention for anxiety, depression, or low mood in a real community sample. In addition, our results indicate that Overcome Social Anxiety reduces the severity of symptoms of depression, physiological symptoms of anxiety, and stress in addition to symptoms of social anxiety.
Journal of Speech Language and Hearing Research, Jun 19, 2019
Purpose iGlebe is an individualized, fully automated Internet cognitive behavior therapy (CBT) tr... more Purpose iGlebe is an individualized, fully automated Internet cognitive behavior therapy (CBT) treatment program that requires no clinician contact. Phase I and II trials have demonstrated that it may be efficacious for treating the social anxiety commonly associated with stuttering. The present trial sought to establish whether the outcomes achieved by iGlebe are noninferior to those associated with in-clinic CBT from clinical psychologists. Method Fifty adults with stuttering were randomized to receive in-clinic CBT for anxiety or 5 months online access to iGlebe. The design was a noninferiority randomized controlled trial with outcomes assessed at prerandomization and at 6 and 12 months postrandomization. Primary outcomes were CIDI-Auto-2.1 diagnoses for anxiety and mood disorders and Brief Fear of Negative Evaluation scale scores ( Carleton, McCreary, Norton, &amp; Asmundson, 2006 ). Secondary outcomes included speech, psychology, and quality-of-life measures. Results Outcomes consistently showed clinically significant improvements of around a medium effect size for the cohort as a whole from prerandomization to 6 months postrandomization, which were maintained at 12 months postrandomization. Comparisons between the 2 treatments showed little difference between iGlebe and in-clinic treatment for all primary and secondary outcomes, with last observation carried forward for missing data. Conclusions iGlebe is a promising individualized treatment for social anxiety for adults who stutter and offers a viable and inexpensive alternative to in-clinic CBT with clinical psychologists. An issue to emerge from this trial, which requires clarification during future clinical trials of iGlebe, is the posttreatment relation between percentage of syllables stuttered and self-reported stuttering severity ratings.
Behaviour Change, Dec 1, 2009
Furthermore, long-term (30 month follow-up) maintenance has been established (Carlbring, Nordgren... more Furthermore, long-term (30 month follow-up) maintenance has been established (Carlbring, Nordgren, Furmark, & Andersson, 2009). Notably, however, each of these trials included at least 2-3 hours of therapist contact per person, and recent reviews (e.g., Spek, Cujipers, Nyclícek, Riper, Keyzer, & Pop, 2007) conclude that the amount of therapist time spent with each user was the single most important prognostic factor for positive outcomes. Helgadottir, Menzies, Onslow, Packman and O'Brian (2009), argue that most online CBT packages lack several features that take full advantage of the potential cost effectiveness of using the internet. The authors propose a new treatment paradigm of a fully automated 'Elizian' therapist. This method of treatment addresses key limitations of current standalone treatment packages such as: (1) the lack of individualised formulations, (2) the lack of automated corrective feedback, (3) the lack of automated features for adherence, (4) the lack of human contact such as vision or voice, and (5) the lack of an adequate CBT dose. This article presents a Phase I trial of CBTpsych.com, a standalone online program developed to target these limitations in treating social anxiety associated with stuttering. CBTpsych.com attempts to imitate human-human interaction with a human-computer interface. CBTpsych.com aims to imitate real therapist contact using solely computer algorithms. The present study aims to assess the viability, safety, effectiveness, and useability of a standalone program in this population. Method Design This study was a Phase I trial of the novel treatment intervention (CBTpsych.com), using psychometric tests to measure changes before and after the intervention. Furthermore, quality of the interaction with the computer psychologist was analysed.
Behaviour Change, Dec 1, 2009
Reviews have demonstrated large effect sizes when using computerised cognitive behaviour therapy ... more Reviews have demonstrated large effect sizes when using computerised cognitive behaviour therapy (CBT) protocols for treating anxiety, depression and health related concerns. However, the amount of therapist contact per user seems to be the most significant prognostic indicator. Thus, in some ways current online interventions can be viewed primarily as an extension of one-on-one therapy. The present article provides guidelines for targeting this limitation of online psychological interventions. The goal is to mimic the therapeutic relationship using a computer, without having any therapist involved. Consequently, thousands of users would be able to receive treatment simultaneously, reaching a wider audience, which was the initial goal of the online model. The development of a treatment program using file audit data is suggested as an alternative to having an individual therapist for each user. This is done by allowing the ‘computer psychologist’ to tailor individualised treatments for each user based on their psychological profile. The user is provided with individualised corrective feedback based on a set of prewritten responses to common faulty thoughts. A new paradigm is proposed for online treatment delivery.
Behavioural and Cognitive Psychotherapy, Nov 24, 2022
Background:Women who are trying to conceive may be at risk of experiencing psychological distress... more Background:Women who are trying to conceive may be at risk of experiencing psychological distress. However, only a small proportion receive appropriate care, although interventions such as cognitive behavioural therapy (CBT) can effectively reduce levels of distress.Aims:Our aim was to determine the efficacy and feasibility of an internet-based CBT intervention, called Overcome Fertility Stress (OFS).Method:Fifty-five women who were struggling with conception were offered 3-month access to OFS, which is a fully automated yet individualized program via pre-programmed text, video and audio files. The program tailors its intervention around the symptoms the users report to the program.Results:Significant improvements were demonstrated on infertility-related stress, with small-to-large effect sizes (d = 0.49 to 0.75). Furthermore, there was a significant decline in symptoms of depression and stress from pre- to post-treatment (d = 0.41 to 0.42, respectively). Finally, participants expressed overall satisfaction with the intervention.Conclusions:These preliminary results suggest it is feasible and effective for women who experience fertility stress to receive an internet-based CBT intervention. Finally, these results add to the literature on the effectiveness of psychological treatments for those who struggle with fertility issues.
Internet interventions, Apr 1, 2022
Individuals with social anxiety disorder (SAD) commonly receive non-evidence based, ineffective t... more Individuals with social anxiety disorder (SAD) commonly receive non-evidence based, ineffective treatments. Cognitive behaviour therapy (CBT) has been demonstrated to be the gold standard treatment for treating SAD. Scalable web-based CBT programs ensure evidence-based treatment procedures, but low treatment adherence remains problematic. This study aimed to test whether adding group sessions to a fully automated web-based CBT program, Overcome Social Anxiety (OSA), would increase treatment adherence. A total of 69 participants were provided access to a web-based program, and randomly allocated to three conditions: 1) An experimental condition involving an addition of three online group psychoeducation sessions; 2) a placebo condition involving an addition of three online progressive muscle relaxation (PMR) group sessions, or 3) a control condition where participants did not receive group sessions. Adherence was operationalised as number of OSA modules completed. Treatment adherence significantly differed between the conditions. On average, participants assigned to the placebo condition completed significantly more of the program compared to those in the control condition. Further, all conditions produced a significant improvement in BFNE and QOLS. No significant difference in treatment efficacy was found between groups on the SIAS, BFNE or QOLS. The current results indicate PMR can improve treatment adherence for scalable social anxiety interventions.
Journal of Fluency Disorders, Sep 1, 2014
Social anxiety is common for those who stutter and efficacious Cognitive Behavior Therapy (CBT) f... more Social anxiety is common for those who stutter and efficacious Cognitive Behavior Therapy (CBT) for them appears viable. However, there are difficulties with provision of CBT services for anxiety among those who stutter. Standalone Internet CBT treatment is a potential solution to those problems. CBTpsych is a fully automated, online social anxiety intervention for those who stutter. This report is a Phase I trial of CBTpsych. Method: Fourteen participants were allowed 5 months to complete seven sections of CBTpsych. Pre-treatment and post-treatment assessments tested for social anxiety, common unhelpful thoughts related to stuttering, quality of life and stuttering frequency. Results: Significant post-treatment improvements in social anxiety, unhelpful thoughts, and quality of life were reported. Five of seven participants diagnosed with social anxiety lost those diagnoses at post-treatment. The two participants who did not lose social anxiety diagnoses did not complete all the CBTpsych modules. CBTpsych did not improve stuttering frequency. Eleven of the fourteen participants who began treatment completed Section 4 or more of the CBTpsych intervention. Conclusions: CBTpsych provides a potential means to provide CBT treatment for social anxiety associated with stuttering, to any client without cost, regardless of location. Further clinical trialing is warranted.
Journal of Communication Disorders, Jul 1, 2019
Purpose: It is now well established that adults who present to speech clinics for help with stutt... more Purpose: It is now well established that adults who present to speech clinics for help with stuttering will have an increased risk of having an anxiety disorder, particularly social anxiety disorder. Concomitant psychological problems are known to interfere with the maintenance of the benefits of behavioral speech treatments for stuttering. The current team has developed and trialed a cognitive behavior therapy (CBT) program designed specifically to reduce anxiety in adults who stutter, and trials have shown promise for both an in-clinic version and a standalone internet-based version. The aim of the present study is to determine whether iGlebe, the internet-based version of the team's internet CBT treatment (previously known as CBTPsych), enhances the benefits of behavioral stuttering treatment. Method: Participants were 32 adults seeking treatment for stuttering. The design was a twoarm randomized experimental trial with blinded outcome assessments at 6 and 12 months post-randomization. Both arms received basic speech-restructuring training to reduce stuttering, without any anxiolytic (anxiety reducing) components. The experimental arm also received 5 months access to iGlebe. Results: There was evidence that, at 12 months post-randomization, iGlebe added clinically significant improvements to self-reported stuttering severity and quality of life. The present experimental trial provides the first evidence that the addition of CBT to speech restructuring improves speech outcomes. Conclusions: The present results will be the basis for the development of a comprehensive, internet-based treatment program for anxiety associated with stuttering. Ultimately, it may be possible for such an economical, scalable, and translatable comprehensive treatment model to supplement standard speech-language pathology treatment practices for those who stutter.
Journal of Speech Language and Hearing Research, Aug 1, 2014
Purpose: Those with anxiety use safety behaviors when attempting to prevent negative outcomes. Th... more Purpose: Those with anxiety use safety behaviors when attempting to prevent negative outcomes. There is evidence that these behaviors contribute to the persistence of anxiety disorders. Safety behaviors have been prominent in the cognitive behavior therapy literature during the last decade, particularly with social phobia management. However, nothing is known of safety behavior use by those who stutter. This is surprising given the high prevalence of social phobia in the stuttering population who seek clinical help. Method: Clinical psychologists and speech-language pathologists (SLPs) created a list of safety behaviors that might be used by adults during treatment for stuttering. Participants were 160 SLPs who were asked whether they advised adults who stutter to use any of these safety behaviors. Results: SLPs commonly recommend safety behaviors during stuttering management. Factor structures were found for the following 5 safety behavior categories: (a) general safety behaviors, (b) practice and rehearsal, (c) general avoidance, (d) choosing safe and easy people, and (e) control-related safety behaviors. Conclusions: There is a need to determine the frequency with which adults who receive stuttering treatment follow these clinician recommendations. In addition, there is a need to experimentally determine whether following such recommendations prevents fear extinction at long-term follow-up.
Behavioural and Cognitive Psychotherapy
Background:Growing research indicates that death anxiety is implicated in many mental health cond... more Background:Growing research indicates that death anxiety is implicated in many mental health conditions. This increasing evidence highlights a need for scalable, accessible and cost-effective psychological interventions to reduce death anxiety.Aims:The present study outlines the results of a phase I trial for one such treatment: Overcome Death Anxiety (ODA). ODA is the first CBT-based online intervention for fears of death, and is an individualised program requiring no therapist guidance.Method:A sample of 20 individuals with various mental health diagnoses commenced the ODA program. Death anxiety was assessed at baseline and at post-intervention. Depression, anxiety and stress were also measured.Results:In total, 50% (10/20) reached the end of the program and completed post-treatment questionnaires. Of these, 60% (6/10) showed a clinically reliable reduction in their overall death anxiety, and 90% (9/10) showed a reduction on at least one facet of death anxiety. There were no adver...
Bridging the gap in internet treatments for mental health: A fully automated online cognitive beh... more Bridging the gap in internet treatments for mental health: A fully automated online cognitive behaviour therapy for social anxiety for those who stutter
Behavioural and Cognitive Psychotherapy, 2023
Background: Women who are trying to conceive may be at risk of experiencing psychological distres... more Background: Women who are trying to conceive may be at risk of experiencing psychological distress. However, only a small proportion receive appropriate care, although interventions such as cognitive behavioural therapy (CBT) can effectively reduce levels of distress. Aims: Our aim was to determine the efficacy and feasibility of an internet-based CBT intervention, called Overcome Fertility Stress (OFS). Method: Fifty-five women who were struggling with conception were offered 3-month access to OFS, which is a fully automated yet individualized program via pre-programmed text, video and audio files. The program tailors its intervention around the symptoms the users report to the program. Results: Significant improvements were demonstrated on infertility-related stress, with small-to-large effect sizes (d = 0.49 to 0.75). Furthermore, there was a significant decline in symptoms of depression and stress from pre- to post-treatment (d = 0.41 to 0.42, respectively). Finally, participant...
Internet Intervention, 2022
Individuals with social anxiety disorder (SAD) commonly receive non-evidence based, ineffective t... more Individuals with social anxiety disorder (SAD) commonly receive non-evidence based, ineffective treatments. Cognitive behaviour therapy (CBT) has been demonstrated to be the gold standard treatment for treating SAD. Scalable web-based CBT programs ensure evidence-based treatment procedures, but low treatment adherence remains problematic. This study aimed to test whether adding group sessions to a fully automated web-based CBT program, Overcome Social Anxiety (OSA), would increase treatment adherence. A total of 69 participants were provided access to a web-based program, and randomly allocated to three conditions: 1) An experimental condition involving an addition of three online group psychoeducation sessions; 2) a placebo condition involving an addition of three online progressive muscle relaxation (PMR) group sessions, or 3) a control condition where participants did not receive group sessions. Adherence was operationalised as number of OSA modules completed. Treatment adherence significantly differed between the conditions. On average, participants assigned to the placebo condition completed significantly more of the program compared to those in the control condition. Further, all conditions produced a significant improvement in BFNE and QOLS. No significant difference in treatment efficacy was found between groups on the SIAS, BFNE or QOLS. The current results indicate PMR can improve treatment adherence for scalable social anxiety interventions.
Behaviour Change, 2021
Emerging research suggests that death anxiety is a transdiagnostic construct, which may underpin ... more Emerging research suggests that death anxiety is a transdiagnostic construct, which may underpin a number of mental illnesses. Although cognitive behaviour therapy (CBT) has been found to be the most effective treatment for death anxiety, no self-guided treatments for this construct exist at present. Furthermore, there is a growing need for accessible, scalable and cost-effective psychological treatments. To address these gaps, we created Overcome Death Anxiety (ODA), an online CBT-based programme which specifically targets fears of death. ODA was designed to be a fully automated, standalone, yet individualised online treatment. The present study outlines the development and structure of this programme using responses from four users to illustrate feasibility. Research is needed to examine the efficacy and usability of ODA with a larger clinical sample.
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Papers by Fjola Dogg Helgadottir