Papers by Lisanne Warmerdam
2012 25th IEEE International Symposium on Computer-Based Medical Systems (CBMS), 2012
FP7 ICT4Depression project aims at providing a set of tools to further improve both patient outco... more FP7 ICT4Depression project aims at providing a set of tools to further improve both patient outcome and increase of access to treatment of the patients suffering from major depression.
Depression is expected to be the disorder with the highest disease burden in high-income countrie... more Depression is expected to be the disorder with the highest disease burden in high-income countries by the year 2030. ICT4Depression (ICT4D) is a European FP7 project which aims to contribute to alleviate this burden by making use of depression treatment and ICT innovations. In this project we developed an ICT-based system for use in primary care that aims to improve access as well as actual care delivery for depressed adults. Innovative technologies within the ICT4D system include 1) flexible self-help treatments for depression, 2) automatic assessment of the patient using mobile phone and web-based communication 3) wearable biomedical sensor devices for monitoring activities and electrophysiological indicators, 4) computational methods for reasoning about the state of a patient and the risk of relapse (reasoning engine) and 5) a flexible system architecture for monitoring and supporting people using continuous observations and feedback via mobile phone and the web. The general objective of the ICT4D project is to test the feasibility and acceptability of the ICT4D system within a pilot study in the Netherlands and in Sweden during 2012 and 2013.
Medical engineering & physics, 2014
In this paper, the authors describe a method of accurately detecting human activity using a smart... more In this paper, the authors describe a method of accurately detecting human activity using a smartphone accelerometer paired with a dedicated chest sensor. The design, implementation, testing and validation of a custom mobility classifier are also presented. Offline analysis was carried out to compare this custom classifier to de-facto machine learning algorithms, including C4.5, CART, SVM, Multi-Layer Perceptrons, and Naïve Bayes. A series of trials were carried out in Ireland, initially involving N=6 individuals to test the feasibility of the system, before a final trial with N=24 subjects took place in the Netherlands. The protocol used and analysis of 1165min of recorded activities from these trials are described in detail in this paper. Analysis of collected data indicate that accelerometers placed in these locations, are capable of recognizing activities including sitting, standing, lying, walking, running and cycling with accuracies as high as 98%.
Psychotherapy Research, 2013
In this study we explored predictors and moderators of response to Internet-based cognitive behav... more In this study we explored predictors and moderators of response to Internet-based cognitive behavioral therapy (CBT) and Internet-based problem-solving therapy (PST) for depressive symptoms. The sample consisted of 263 participants with moderate to severe depressive symptoms. Of those, 88 were randomized to CBT, 88 to PST and 87 to a waiting list control condition. Outcomes were improvement and clinically significant change in depressive symptoms after 8 weeks. Higher baseline depression and higher education predicted improvement, while higher education, less avoidance behavior and decreased rational problem-solving skills predicted clinically significant change across all groups. No variables were found that differentially predicted outcome between Internet-based CBT and Internet-based PST. More research is needed with sufficient power to investigate predictors and moderators of response to reveal for whom Internet-based therapy is best suited.
Journal of Affective Disorders, 2013
Background: By identifying which predictors and moderators lead to beneficial outcomes, accurate ... more Background: By identifying which predictors and moderators lead to beneficial outcomes, accurate selection of the best initial treatment will have significant benefits for depressed individuals. Method: An automated, fully self-guided randomized controlled internet-delivered noninferiority trial was conducted comparing two new interventions (Interpersonal Psychotherapy [IPT; n ¼620] and Cognitive Behavioral Therapy [CBT; n ¼610]) to an active control intervention (MoodGYM; n ¼613) over a period of 4 weeks to spontaneous visitors of an internet-delivered therapy website (e-couch). A range of putative predictors and moderators (socio-demographic characteristics [age, gender, marital status, education level], clinical characteristics [depression/anxiety symptoms, disability, quality of life, medication use], skills [mastery and dysfunctional attitudes] and treatment preference) were assessed using internet-delivered self-report measures at baseline and immediately following treatment and at six months follow-up. Analyses were conducted using Mixed Model Repeated Measures (MMRM). Results: Female gender, lower mastery and lower dysfunctional attitudes predicted better outcome at post-test and/or follow-up regardless of intervention. No overall differential effects for condition on depression as a function of outcome were found. However, based on time-specific estimates, a significant interaction effect of age was found. For younger people, internet-delivered IPT may be the preferred treatment choice, whereas older participants derive more benefits from internet-delivered CBT programs.
BMJ (Clinical research ed.), 2013
To assess how initial severity of depression affects the benefit derived from low intensity inter... more To assess how initial severity of depression affects the benefit derived from low intensity interventions for depression. Meta-analysis of individual patient data from 16 datasets comparing low intensity interventions with usual care. Primary care and community settings. 2470 patients with depression. Low intensity interventions for depression (such as guided self help by means of written materials and limited professional support, and internet delivered interventions). Depression outcomes (measured with the Beck Depression Inventory or Center for Epidemiologic Studies Depression Scale), and the effect of initial depression severity on the effects of low intensity interventions. Although patients were referred for low intensity interventions, many had moderate to severe depression at baseline. We found a significant interaction between baseline severity and treatment effect (coefficient -0.1 (95% CI -0.19 to -0.002)), suggesting that patients who are more severely depressed at basel...
International Journal of Services Technology and Management, 2008
... Lisanne Warmerdam studied psychology at the University of Amsterdam, the Netherlands. ... An ... more ... Lisanne Warmerdam studied psychology at the University of Amsterdam, the Netherlands. ... An intermediate method is formed by an ex post rationalisation approach based on survey questions, where actual visitors are inquired about the motives of their behaviour, Page 6. ...
This paper examines whether a holistic element affected the valuations of visitors to the Anne Fr... more This paper examines whether a holistic element affected the valuations of visitors to the Anne Frank House, an en-site historical museum. The holistic approach views a museum as a whole entity and not as the sum of individual items. For the purposes of our research, we developed a new set of instruments, based on a literature survey and practical experience.
European Psychiatry, 2007
Purpose. e In the past decades, the effects of problem-solving therapy (PST) for depression have ... more Purpose. e In the past decades, the effects of problem-solving therapy (PST) for depression have been examined in several randomized controlled studies. However, until now no meta-analysis has tried to integrate the results of these studies.
Psychotherapy Research, 2008
Clinical Psychology Review, 2007
Activity scheduling is a behavioral treatment of depression in which patients learn to monitor th... more Activity scheduling is a behavioral treatment of depression in which patients learn to monitor their mood and daily activities, and how to increase the number of pleasant activities and to increase positive interactions with their environment. We conducted a meta-analysis of randomized effect studies of activity scheduling. Sixteen studies with 780 subjects were included. The pooled effect size indicating the difference between intervention and control conditions at post-test was 0.87 (95% CI: 0.60~1.15). This is a large effect. Heterogeneity was low in all analyses. The comparisons with other psychological treatments at post-test resulted in a non-significant pooled effect size of 0.13 in favor of activity scheduling. In ten studies activity scheduling was compared to cognitive therapy, and the pooled effect size indicating the difference between these two types of treatment was 0.02. The changes from post-test to follow-up for activity scheduling were non-significant, indicating that the benefits of the treatments were retained at follow-up. The differences between activity scheduling and cognitive therapy at follow-up were also non-significant. Activity scheduling is an attractive treatment for depression, not only because it is relatively uncomplicated, time-efficient and does not require complex skills from patients or therapist, but also because this meta-analysis found clear indications that it is effective.
Psychologie & Gezondheid, 2009
Internet-based treatment for adults with depressive symptoms: A randomized controlled trial Many ... more Internet-based treatment for adults with depressive symptoms: A randomized controlled trial Many depressed people don’t receive help for their symptoms and there are various barriers that impede help-seeking. The Internet may offer interesting alternatives for reaching and helping people with depression. Depression can be treated effectively with Internet-based cognitive behavioral therapy (CBT). But a short intervention, based on problem solving therapy (PST), could constitute a worthwhile alternative for CBT. In this study we evaluated the effectiveness of Internet-based CBT and Internet-based PST in comparison to a waiting list control group (WL), and determined the differences between the two treatments. A total of 263 participants were randomized to the three conditions. The main inclusion criterion was presence of depressive symptoms (≥ 16 on the Center for Epidemiological Studies Depression scale). CBT and PST consisted of eight and five weekly lessons, respectively. Participants were supported by e-mail. Self-report measures of depression, anxiety and quality of life were filled in at pretest and after five, eight and 12 weeks. Between-group effect sizes for depressive symptoms were 0.54 for CBT after eight weeks (95% confidence interval (CI): 0.25 – 0.84) and 0.47 for PST after five weeks (95% CI: 0.17 – 0.77). These effects were further improved at 12 weeks (CBT: 0.69, 95% CI: 0.41 – 0.98; PST: 0.65, 95% CI: 0.36 – 0.95). For anxiety, effect sizes were also at a medium level. Effect sizes for quality of life were low. After 12 weeks, clinical significant change was significant higher for CBT (N = 34, 38.6%) and PST (N = 30, 34.1%) than for WL (N = 0). Both Internet-based treatments are effective in reducing depressive symptoms, although the effect of PST is realized more quickly.
Journal of Behavior Therapy and Experimental Psychiatry, 2010
The purpose of this study was to evaluate treatment specificity and potential mediators of two on... more The purpose of this study was to evaluate treatment specificity and potential mediators of two online therapies for depressive symptoms. We conducted a randomized controlled trial in which 263 participants were randomized to online cognitive behavioral therapy (CBT), online problem-solving therapy (PST) or a waiting list control group. Both treatments were more effective than the control group in reducing dysfunctional attitudes, worry, negative problem orientation and enhancing feelings of control. No differences between the treatments were found on each of the potential mediators. Furthermore, results suggest that dysfunctional attitudes, worrying, a negative problem orientation and perceived control all played a mediating role in CBT as well as in PST. Our findings suggest that regardless of the theoretical background to the therapy, the psychological processes necessary for symptom reduction seem to be comparable.
European Journal of Psychiatry, 2008
... Pim Cuijpers, Annemieke van Straten, Lisanne Warmerdam. ... Results: The mean effect size ind... more ... Pim Cuijpers, Annemieke van Straten, Lisanne Warmerdam. ... Results: The mean effect size indicating the difference between individual and group therapies in depressive symptomatology at post-test was 0.20 (95% CI: [0.05 0.35]; p < 0.01), in favor of individual therapies, with a ...
Depression and Anxiety, 2009
Background: A large number of studies have shown that psychological treatments have significant e... more Background: A large number of studies have shown that psychological treatments have significant effects on depression. Although several studies have examined the relative effects of psychological and combined treatments, this has not been studied satisfactorily in recent statistical meta-analyses. Method: We conducted a meta-analysis of randomized studies in which a psychological treatment was compared to a combined treatment consisting of the same psychological treatment with a pharmacological therapy. For each of these studies we calculated the effect size indicating the difference between the psychological and the combined treatment. Results: All inclusion criteria were met by 18 studies, with a total of 1,838 subjects. The mean effect size indicating the difference between psychological and combined treatment was 0.35 (95% CI: 0.24∼0.45; P<0.001), with low heterogeneity. Subgroup analyses indicated that the difference between psychological and combined treatments was significantly smaller in studies in which cognitive behavior therapy was examined. We also found a trend (P<0.1) indicating that the difference between psychological and combined treatment was somewhat larger in studies aimed at specific populations (older adults, chronic depression, HIV patients) than in studies with adults, and in studies in which Trycyclic antidepressants or SSRIs were examined, compared to studies in which a medication protocol or another antidepressant was used. At follow-up, no difference between psychological and combined treatments was found. Conclusion: We conclude that combined treatment is more effective than psychological treatment alone. However, it is not clear whether this difference is relevant from a clinical perspective. Depression and Anxiety, 2009. © 2008 Wiley-Liss, Inc.
Tsg, 2010
Hoewel geïndiceerde preventie beschikbaar is voor ongeveer 80% van de Nederlandse bevolking tegen... more Hoewel geïndiceerde preventie beschikbaar is voor ongeveer 80% van de Nederlandse bevolking tegen geen of geringe kosten neemt slechts een klein deel van de mensen met subklinische depressies daaraan deel. In dit artikel geven we een overzicht van dit probleem. In grote lijnen zijn er drie groepen oorzaken. Ten eerste oorzaken bij de potentiële deelnemers, zoals bijvoorbeeld dat zij zichzelf niet beschouwen als een hoogrisicogroep, dat zij zich niet bewust zijn van het feit dat zij een subklinische depressie hebben, dat zij veronderstellen dat de interventies niet effectief zijn en dat zij niet willen deelnemen vanwege het stigma dat geassocieerd is met depressie. Ten tweede zijn er oorzaken in de organisatie van de zorg, zoals de positionering in de tweede lijn. Ten derde zijn er oorzaken die te maken hebben met de recruteringswijze (open werving in de algemene bevolking). Mogelijke oplossingen kunnen gevonden worden in het organiseren van massamediale campagnes, de ontwikkeling van preventieve internetinterventies, aanpassing van interventies aan specifieke doelgroepen, een positionering van de interventies in de eerste lijn, integratie in ‘community’ interventies, en systematische screening van potentiële deelnemers. We concluderen dat hoewel preventie een belangrijke rol kan spelen bij de vermindering van de ziektelast van depressie, zullen we eerst moeten onderzoeken waarom de deelnamecijfers zo laag zijn en hoe dit verbeterd kan worden. Low participation rates in interventions preventing the onset of depressive disorders Although indicated prevention of depression is available for about 80% of the Dutch population at no or minimal costs, only a small proportion of those with subthreshold depression makes use of these services. In this paper we give a description of the Dutch preventive services in mental health care and the problem of low participation rates. We also describe possible causes, which include causes in the participants, in the service system, and in the communication to the public about these services, as well as possible solutions to this problem. There are three main groups of reasons why the participation rates are low: reasons within the participants (e.g., who may not consider themselves as being at risk; who think the interventions are not effective; or are not willing to participate because of the stigma associated with depression); reasons within the health care system; and reasons associated with the communication about the preventive services. Possible solutions to solve the problem include the organisation of mass media campaigns, develop internet-based preventive interventions, adapting preventive interventions to the need of specific subpopulations, to position the services in primary care, to integrate the interventions in community-broad interventions, and to systematically screen high-risk groups for potential participants. We conclude that prevention may play an important role in public mental health to reduce the enormous burden of depression. However, before that can be realized more research is needed to explore why participation rates are low and how these rates can be improved.
BMC Psychiatry, 2007
Background Depression is a highly prevalent condition, affecting more than 15% of the adult popul... more Background Depression is a highly prevalent condition, affecting more than 15% of the adult population at least once in their lives. Guided self-help is effective in the treatment of depression. The purpose of this study is to investigate the effectiveness of two Internet-based guided self-help treatments with adults reporting elevated depressive symptoms. Other research questions concern the identification of potential mediators and the search for subgroups who respond differently to the interventions. Methods This study is a randomized controlled trial with three conditions: two treatment conditions and one waiting list control group. The two treatment conditions are Internet-based cognitive behavior therapy and Internet-based problem-solving therapy. They consist of 8 and 5 weekly lessons respectively. Both interventions are combined with support by e-mail. Participants in the waiting list control group receive the intervention three months later. The study population consists of adults from the general population. They are recruited through advertisements in local and national newspapers and through banners on the Internet. Subjects with symptoms of depression (≥ 16 on the Center for Epidemiological Studies Depression scale) are included. Other inclusion criteria are having sufficient knowledge of the Dutch language, access to the Internet and an e-mail address. Primary outcome is depressive symptoms. Secondary outcomes are anxiety, quality of life, dysfunctional cognitions, worrying, problem solving skills, mastery, absence at work and use of healthcare. We will examine the following variables as potential mediators: dysfunctional cognitions, problem solving skills, worrying, anxiety and mastery. Potential moderating variables are: socio-demographic characteristics and symptom severity. Data are collected at baseline and at 5 weeks, 8 weeks, 12 weeks and 9 months after baseline. Analyses will be conducted on the intention-to-treat sample. Discussion This study evaluates two Internet-based treatments for depression, namely cognitive behavioral therapy and problem-solving therapy. The effectiveness of Internet-based problem-solving therapy suggest that this may be a worthwhile alternative to other more intensive treatment options. Strengths and limitations of this study are discussed. Trial registration Current Controlled Trials ISRCTN16823487
Journal of Medical Internet Research, 2008
Background: Depression is a highly prevalent condition, affecting more than 15% of the adult popu... more Background: Depression is a highly prevalent condition, affecting more than 15% of the adult population at least once in their lives. Guided self-help is effective in the treatment of depression. The purpose of this study is to investigate the effectiveness of two Internet-based guided self-help treatments with adults reporting elevated depressive symptoms. Other research questions concern the identification of potential mediators and the search for subgroups who respond differently to the interventions.
BMC Health Services Research, 2010
Background: Although indicated prevention of depression is available for about 80% of the Dutch p... more Background: Although indicated prevention of depression is available for about 80% of the Dutch population at little or no cost, only a small proportion of those with subthreshold depression make use of these services. Methods: A narrative review is conducted of the Dutch preventive services in mental health care, also addressing the problem of low participation rates. We describe possible causes of these low participation rates, which may be related to the participants themselves, the service system, and the communication to the public, and we put forward possible solutions to this problem. Results: There are three main groups of reasons why the participation rates are low: reasons within the participants (e.g., not considering themselves as being at risk; thinking the interventions are not effective; or being unwilling to participate because of the stigma associated with depression); reasons within the health care system; and reasons associated with the communication about the preventive services. Possible solutions to increasing the participation rate include organizing mass media campaigns, developing internet-based preventive interventions, adapting preventive interventions to the needs of specific subpopulations, positioning the services in primary care, integrating the interventions in community-wide interventions, and systematically screening high-risk groups for potential participants. Discussion: Prevention could play an important role in public mental health in reducing the enormous burden of depression. However, before this can be realized more research is needed to explore why participation rates are low and how these rates can be improved.
BMC Psychiatry, 2008
Background: A large number of randomized controlled studies have clearly demonstrated that psycho... more Background: A large number of randomized controlled studies have clearly demonstrated that psychological interventions are effective in the treatment of depression. The number of studies in this area is increasing rapidly. In this paper, we present a database of controlled and comparative outcome studies on psychological treatments of depression, based on a series of meta-analyses published by our group. The database can be accessed freely through the Internet.
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Papers by Lisanne Warmerdam