To study the effectiveness of a low-threshold guided self-help intervention targeted at improving one's self image in people with anxiety and/or depressive symptoms and low self esteem. We expect to find both a significant improvement of self-…
ID
Source
Brief title
Condition
- Other condition
- Mood disorders and disturbances NEC
Synonym
Health condition
angststoornissen en -symptomen
Research involving
Sponsors and support
Intervention
Outcome measures
Primary outcome
The intervention's primary focus is enhancing self-esteem. The primary outcome
measure used in this study is the Rosenberg self-esteem scale (Rosenberg,
1965). This scale includes 10 statements (such as 'generally speaking, I am
content with myself'). The respondent then checks a score on a 4-point scale
which indicates the extent to which the respondent identifies with the
statement. Total scores vary from 0 to 30, higher scores indicate higher self
esteem. In a sample of the Dutch population, a mean score of 20.9 was reported
with a standard deviation of 4.4. Both international and Dutch studies report
high reliability, validity and internal homogeneity (Cronbach alpha .86; Franck
et al., 2008).
Secondary outcome
The study's secondary focus is establishing whether the intervention is
succesful in reducing anxiety and/or depressive symptoms.
Anxiety symptoms are measured with the Anxiety subscale of the Hospital Anxiety
and Depression Scale (the HADS-A). This is a validated 7-item self-report
measure of anxiety, with a 4-point scale. Total scores vary from 0 to 21, with
higher scores indicating more anxiety symptoms(Spinhoven et al., 1997).
Depressive symptoms are measured with the Center for Epidemiological Studies
Depression Scale (CES-D). This is a validated 20-item self report
questionnaire, with a 4-point scale. Total scores vary from 0 to 60, with
higher scores indicating more depressive symptoms (Radloff, 1977).
In order to establish whether the respondent uses other health care resources
and to establish the presence of work related problems as a consequence of the
psychological symptoms, the Tic-P will be administered. This questionnaire is
developed by the Institute of Medical Technology Assessment (iMTA) of the
Erasmus university and the Trimbos-institute and has been used in a variety of
different studies (van Dam et al., 1998; Hakkaart-van Roijen, 2002; Penninx et
al., 2008).
Quality of life is increasingly regarded as an important secondary outcome
measure. In order to establish quality of life, the SF-36 will be administered.
This is a 36-item self-report questionnaire involving a variety of subscales
that portray health-related quality of life (Ware and Sherbourne, 1992).
Background summary
Within the last decade, the concept of self has received more and more
attention within cognitive psychological theory and cognitive therapy.
Research indicates that a negative self-image may form a vulnerability and
sustaining factor in the development and course of a variety of mental health
problems, such as anxiety and depression (Glashouwer & de Jong, 2010; Risch et
al., 2010; Talbot, Harris & French, 2009; Mann e.a., 2004). This calls for
specific (preventive) interventions targeted at changing one's self image, and
at trials including changes in self image as a measure of effect, besides
measures of anxiety and depression. Such interventions, such as the 'white
book', which entails keeping a diary of concrete and positive feedback about
one's own personality and achievements, are now a regular feature of treatment
and secondary prevention programs for anxiety and depression. However, the
(surplus) effect of these types of interventions for the treatment and
prevention of anxiety and depression has hardly been studied.
Even when adequately treated, anxiety and depression carry a high risk of
recurrence (Spijker et al., 2002). In order to combat the onset and recurrence
of anxiety and depression, attention has shifted from a sole focus on treatment
of full-blown disorders to both indicated prevention (prevention of full blown
disorders for people with subclinical anxiety and depressive symptoms) as well
as secondary prevention (prevention of recurrence of anxiety and dperession in
patients who have been succesfully treated in the past (Cuijpers, 2003).
Indicated prevention interventions often involve short term low intensity
treatments that are administered through self help books, the Internet or a
group program. Self-help interventions have proven very effective, especially
when some form of guidance is offered (Cuijpers, Donker, van Straten, Li, &
Andersson, 2010).
Recently, a self-help book based on cognitive behavioural techniques targeted
at improving one's self image has been published (de Neef, 2010). In the
current study, the effectiveness of the use of this self-help book is s tudied
and compared to a wait list control group of people with low self esteem and
subclinical anxiety and/or depressive symptoms. Guidanceprovided to all
participants receiving the self-help book entails feedback and aswers to
questions regarding the assignments described in the book.
Study objective
To study the effectiveness of a low-threshold guided self-help intervention
targeted at improving one's self image in people with anxiety and/or depressive
symptoms and low self esteem. We expect to find both a significant improvement
of self-esteem (primary outcome measure) and a significant diminshment of
anxiety and depression.
Study design
The study involves a randomized open-label effectiveness trial, with an
experimental condition and a wait-list control group.
Intervention
Respondents in the experimental condition are offered the self-help book. The
intervention or course entails 6 different techniques, based on elements from
cognitive behavioural therapy. Duration of the intervention may vary from 6 to
10 weeks, depending on the pace of the individual respondent. Guidance by
specially trained students and research assistants is mainly focused on
motivating the respondent to work through the entire book, whilst providing
feedback and information in case of any misunderstanding of the assignments
described in the book. Respondents in the control condition are placed on a
wait-list. Throughout the waiting period they do not receive the self-help
book, but are free to seek help through the common channels. After the
follow-up period of 6 months, they are offered the self-help book, with the
same guidance provided by the university.
Study burden and risks
The respondent is requested to fill out a series of questionnaires at three
different occasions. Each series of questionnaires will take approximately 30
minutes. Time investment in taking the self-help course will vary, depending on
inidivual pace and motivation. The respondent suffers from mental health
symptoms that are perceived as distressing and/or limiting. Any intervention
targeted at alleviating these symptoms will inevitably entail some degree of
effort and time. However, the intervention included in the present study is
relatively short, very accessible and less strenuous than a specialized
treatment at a mental helath care institute. Also, the respondent is free to
seek alternative or extra treatment and is explicitly informed about this
right.
van der Boechorststraat 1
1081 BT Amsterdam
Nederland
van der Boechorststraat 1
1081 BT Amsterdam
Nederland
Listed location countries
Age
Inclusion criteria
1. The presence of clinically relevant anxiety and/or depressive symptoms as established by a score of 7 or higher on the HADS-A and/or a score of 16 or higher on the CES-D.
2. The participant is suffering from low self-esteem as established by administration of the Rosenberg self-esteem scale (Rosenberg, 1965).
3. The participant is troubled and/or limited by the aforementioned symptoms.
Exclusion criteria
Insufficient understanding of the Dutch language
Design
Recruitment
Followed up by the following (possibly more current) registration
No registrations found.
Other (possibly less up-to-date) registrations in this register
In other registers
| Register | ID |
|---|---|
| CCMO | NL33798.029.10 |
| OMON | NL-OMON21642 |