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Background: Care-as-usual (CAU) is often used as a control condition in psychotherapy research, but it may vary considerably what that entails, ranging from no treatment, to routine treatment in primary care, general medical care, perinatal care, and specialized mental health care. Methods: We conducted a meta-analysis of trials comparing psychotherapy for depression to CAU, with a focus on the different categories of CAU and countries where the studies were conducted. We used an existing database of randomized trials on psychotherapy for depression that is updated every year. Results: A total of 140 studies with 15 419 patients were included. We found no significant differences in effects between categories of CAU (effect sizes ranging from g = 0.43 for CAU in primary care to g = 0.73 for no treatment), but heterogeneity was high in all CAU categories. After stratifying effects across specific countries (within CAU categories) we found that heterogeneity was considerably lower and there were several significant differences between countries. Overall, effects were larger in non-Western countries (g = 0.84 to 1.28) compared to those in Western countries (g = 0.52; p for difference = 0.002). Effects were smaller in studies with risk of bias (p = 0.01). Conclusions: There are no significant differences between major categories of CAU when compared to psychotherapy conditions in randomized trials. However, effects of psychotherapy differ considerably across CAU conditions in specific countries. CAU therefore is a heterogeneous control condition in psychotherapy research. [ABSTRACT FROM AUTHOR]

Adjustment disorder (AD) and complicated grief (CG) are serious mental conditions that have a high prevalence and are associated with significant impairments in social and work functioning. Recently, these categories have been better specified in the new ICD‐11 proposal. Empirical research on the efficacy of treatments for these problems is scarce. This study aims to offer long‐term efficacy data from a between‐groups controlled study that compares two treatment conditions (AD‐protocol applied in a traditional way: N = 18 and the same protocol supported by virtual reality (VR); VR‐protocol applied in a traditional way: N = 18) and a waiting list (WL) control group (N = 18). Both treatment conditions resulted in statistically significant improvements on both primary and secondary outcome measures, with large effect sizes, and this improvement did not occur in the WL. These changes were maintained in both treatment conditions in the medium (6‐month) and long‐term (12‐month follow‐up). Larger effect sizes were achieved in the VR condition in the long term. Furthermore, clinically significant change estimations on the primary outcome measures showed an advantage for the VR condition This is the first controlled study to compare a traditional face‐to‐face protocol for the treatment of stress‐related disorders with the same protocol supported by VR and a WL control group. [ABSTRACT FROM AUTHOR]

Background: Adjustment Disorders (AjD) are one of the most prevalent psychological problems in primary and hospital care. It is necessary to have evidence-based instruments to help professionals diagnose and better understand this problem, which has been little studied. This study presents an adaptation of the Inventory of Complicated Grief for the assessment of AjD symptoms, referred to as the Inventory of Stress and Loss (ISL), and explores the differences in the response to stressful situations between general and clinical Spanish populations. Methods: The general sample included 208 participants, and the clinical sample 91 patients with AjD. Results: Results showed that the ISL has high internal consistency. Confirmatory factor analysis showed one single factor, as in the original questionnaire. With respect to concurrent validity, the ISL correlated positively with the STAI-T. Finally, significant differences were found in the total score on the questionnaire between the clinical and general samples, and between men and women in the general sample. Conclusions: Results suggest that the ISL is a simple, useful assessment tool that exhibits good psychometric properties and makes it possible to differentiate normal reactions to a stressful situation from pathological reactions. [ABSTRACT FROM AUTHOR]

Highlights: [•] The furfural removal in a batch heterogeneous reactor was optimized. [•] Maximum furfural removal (>90%) by activated carbon was determined in 180min. [•] Environmental temperature is the best temperature for furfural removal. [•] Kinetic and thermodynamic parameters were determined for later industrial design. [Copyright &y& Elsevier]

Some of the fears present during childhood remain and cause significant distress and interfere in the child's daily life, including specific animal phobias. Well-established treatments based on exposure are available for this problem (Davis, May, & Whiting, 2011). However, one of the main problems treatments face is the frequent rejection by patients because they consider them too aversive. Information and Communication Technologies (ICTs) have managed to develop new procedures which are being implemented successfully in the treatment of specific phobias in adults. However, there is little research in the use of ICTs in children. The aim of this paper is to assess in a N= 1 study whether the use of images, computer games, and Augmented Reality can facilitate the treatment of fear to small animals and help to prepare the children to be able to conduct in vivo exposure to the feared animal. [ABSTRACT FROM AUTHOR]

Interoceptive exposure (IE) is a standard component of cognitive-behavioural therapy (CBT) for panic disorder and agoraphobia. The virtual reality (VR) program ‘Panic-Agoraphobia’ has several virtual scenarios designed for applying exposure to agoraphobic situations; it can also simulate physical sensations. This work examines patients' acceptability of the IE component as applied in two different ways: using VR versus traditional IE. Additionally, it explores the relationship between users' treatment expectations and satisfaction and clinically significant change. Results showed that VR and traditional IE were well accepted by all participants. Furthermore, treatment expectations predicted efficacy. [ABSTRACT FROM PUBLISHER]

Augmented reality (AR) is a new technology in which various virtual elements are incorporated into the user's perception of the real world. The most significant aspect of AR is that the virtual elements add relevant and helpful information to the real scene. AR shares some important characteristics with virtual reality as applied in clinical psychology. However, AR offers additional features that might be crucial for treating certain problems. An AR system designed to treat insect phobia has been used for treating phobia of small animals, and positive preliminary data about the global efficacy of the system have been obtained. However, it is necessary to determine the capacity of similar AR systems and their elements that are designed to evoke anxiety in participants; this is achieved by testing the correspondence between the inclusion of feared stimuli and the induction of anxiety. The objective of the present work is to validate whether the stimuli included in the AR-Insect Phobia system are capable of inducing anxiety in six participants diagnosed with cockroach phobia. Results support the adequacy of each element of the system in inducing anxiety in all participants. [ABSTRACT FROM AUTHOR]

One of the challenges today in the research of psychological treatments based on evidence is their dissemination. Efficacious and effective psychological treatments should be available and accessible for both practitioners and consumers. However, only a small percentage of potential patients actively seek help for psychological problems that could be ameliorated by therapy. Internet-based self-help interventions may help to solve this problem by reducing the amount of actual contact between therapist and patient and by overcoming the geographical barriers that separate them. The aim of this work is to present a completely self-applied telepsychology program (Without Fear) to treat small animal phobia (spiders, cockroaches, and mice), which uses virtual reality scenarios for the exposure tasks. Preliminary data about the efficacy and effectiveness of this program in a series of 12 cases is offered. Participants showed an improvement in all clinical measures at posttreatment, and the therapeutic gains were maintained at a 3-month followup. [ABSTRACT FROM AUTHOR]

Background: Depressive symptoms are quite prevalent in Primary Care (PC) settings. The treatment as usual (TAU) in PC is pharmacotherapy, despite the high relapse rates it produces. Many patients would prefer psychotherapy, but specialized services are overloaded. Studies that apply Mindfulness-Based Interventions (MBIs) for the treatment of depression have obtained significant improvements. Brief low-intensity approaches delivered from PC could be a promising approach. This study aims to compare a low-intensity mindfulness intervention for the treatment of depression in PC using different intervention formats – a face-to-face MBI delivered in a group and the same MBI individually applied on the Internet – to a control group that will receive PC medical treatment as usual. Methods: A randomized controlled clinical trial will be conducted in PC, with about 120 depressed patients allocated (1:1:1) to three groups: "face-to-face MBI + TAU", "Internet-delivered MBI + TAU", and "TAU alone". The MBI programs will be composed of four modules. The primary outcome will be depressive symptoms, measured through the Beck Depression Inventory, assessed at pre- and post-treatment and 6- and 12-month follow-ups. Other outcomes will be mindfulness, happiness, affectivity, quality of life, and the use of healthcare services. Intention-to-treat analysis using linear mixed models adjusted for baseline scores and routine sociodemographic analysis that could show baseline differences will be conducted. Per-protocol secondary outcome analyses will also be performed. Discussion: This is the first Spanish RCT to apply a low-intensity face-to-face MBI (plus TAU) to treat depression in PC settings compared to TAU (alone). Moreover, this study will also make it possible to evaluate the same MBI program (plus TAU), but Internet-delivered, considering their cost-effectiveness. Positive results from this RCT might have an important impact on mental health settings, helping to decrease the overload of the system and offering treatment alternatives beyond antidepressant medication through high-quality, flexible PC interventions. Trial registration: Clinical Trials.gov NCT03034343. Trial Registration date 24 January 2017, retrospectively registered. [ABSTRACT FROM AUTHOR]

The use of technology in psychological treatments can bring evidence-based interventions closer to more people using fewer resources. The aim of this systematic review and preliminary meta-analysis was to summarize all the available information about technology-supported psychological treatments for Adjustment Disorder (AjD) patients of all ages. Eligibility criteria included studies that tested a technology-supported treatment in patients with AjD and reported data on a mental health outcome. Case studies and case series were excluded. Searches were conducted in the PubMed, Web of Science, Scopus, and PsycINFO databases. Study quality was assessed using the Cochrane RoB 2.0. tool for Randomized Controlled Trials (RCTs) and the NHLBI tool for pre-post studies. Nine articles (8 RCTs and 1 pre-post study) were included, eight that tested computerised interventions and two that used virtual reality. The meta-analysis showed the superior efficacy of the intervention groups compared to control conditions in reducing mental health symptomatology and a significant improvement between pre- and post-treatment. The small number of studies included and the high heterogeneity among them were two of the main limitations. These results are similar to those observed in previous systematic reviews on technology-supported treatments for other mental disorders and suggest that these interventions could be effective for patients with AjD. However, further research is needed to determine the advantages and disadvantages of these interventions for the treatment of AjD in different age populations such as children, adolescents or older adults, as well as effective means for improving treatment retention. • There are still few studies testing technology-supported treatments for Adjustment disorder. • These studies analysed the use of virtual reality and computerised interventions. • All studies included CBT interventions. • These interventions seemed to be effective in reducing mental health symptoms. [ABSTRACT FROM AUTHOR]

Depression is a mental disorder that is associated with low quality of life, increased risk of suicide and a high economic cost for society. Meta‐analyses indicate that Meaning Centred Psychotherapies (MCP) are an efficacious psychotherapy to reduce depression in participants with chronic illness and cancer. However, to date, no systematic review has analysed the effectiveness of MCP in depressed participants who do not have a physical illness or cancer. The objective of this study was to carry out a systematic review to analyse the effectiveness of MCP in participants with depression and no physical illness. The search was conducted following the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines (PRISMA). Six studies (two randomised controlled trials and four quasi‐experimental studies) were included in the systematic review. The results indicate that MCP is more effective than a control group as waitlist (four studies), psychoeducation group (one study), and cognitive behavioural therapy (CBT, one study), in reducing depressive symptoms, improving meaning in life and reducing anxiety in participants without physical illness. MCP would be considered a probably efficacious treatment for depression. However, further research with better experimental designs will be necessary to confirm the effectiveness of MCP for depression. [ABSTRACT FROM AUTHOR]

Most people with a mental disorder meet criteria for multiple disorders. We conducted a systematic review and meta-analysis of randomized trials comparing psychotherapies for people with depression and comorbid other mental disorders with non-active control conditions. We identified studies through an existing database of randomized trials on psychotherapies for depression. Thirty-five trials (3,157 patients) met inclusion criteria. Twenty-seven of the 41 interventions in the 35 trials (66%) were based on CBT. The overall effect on depression was large (g = 0.65; 95% CI: 0.40 ~ 0.90), with high heterogeneity (I2 = 78%; 95% CI: 70 ~ 83). The ten studies in comorbid anxiety showed large effects on depression (g = 0.90; 95% CI: 0.30 ~ 1.51) and anxiety (g = 1.01; 95% CI: 0.28 ~ 1.74). For comorbid insomnia (11 comparisons) a large and significant effect on depression (g = 0.99; 95% CI: 0.16 ~ 1.82) and insomnia (g = 1.38; 95% CI: 0.38 ~ 2.38) were found. For comorbid substance use problems (12 comparisons) effects on depression (g = 0.25; 95% CI: 0.06 ~ 0.43) and on substance use problems (g = 0.25; 95% CI: 0.01 ~ 0.50) were significant. Most effects were no longer significant after adjustment for publication bias and when limited to studies with low risk of bias. Therapies are probably effective in the treatment of depression with comorbid anxiety, insomnia, and substance use problems. [ABSTRACT FROM AUTHOR]

Background: Depression during pregnancy and after the birth of a child is highly prevalent and an important public health problem. Psychological interventions are the first-line treatment and, although a considerable number of randomized trials have been conducted, no recent comprehensive meta-analysis has evaluated treatment effects. Methods: We used an existing database of randomized controlled trials of psychotherapies for adult depression and included studies aimed at perinatal depression. Random effects models were used in all analyses. We examined the effects of the interventions in the short and long term, and also examined secondary outcomes. Results: Forty-three studies with 49 comparisons and 6270 participants between an intervention and control group were included. The overall effect size was g = 0.67 [95% confidence interval (CI) 0.45~0.89; numbers needed-to-be-treated = 4.39] with high heterogeneity (I2 = 80%; 95% CI 75~85). This effect size remained largely unchanged and significant in a series of sensitivity analyses, although some publication bias was found. The effects remained significant at 6–12 months follow-up. Significant effects were also found for social support, anxiety, functional limitations, parental stress and marital stress, although the number of studies for each outcome was low. All results should be considered with caution because of the high levels of heterogeneity in most analyses. Conclusions: Psychological interventions are probably effective in the treatment of perinatal depression, with effects that last at least up to 6–12 months and probably also have effects on social support, anxiety, functional impairment, parental stress, and marital stress. [ABSTRACT FROM AUTHOR]

Background: Exposure-based treatments have demonstrated some of the largest effect sizes in the treatment of specific phobias (SP). There are different ways of delivering exposure such as Augmented Reality Exposure which has become an interesting alternative to In Vivo Exposure for treating SP. The present study aimed to investigate the therapeutic alliance and treatment expectations as possible predictors of treatment outcomes in these two exposure treatment conditions. Methods: Participants were 63 adults who met diagnostic criteria for the diagnosis of a SP of cockroaches or spiders (animal subtype). Patients were randomized to receive a one-session treatment of either In Vivo Exposure (N = 31) or Augmented Reality Exposure (N = 32). The assessment protocol included diagnostic, as well as primary-, and secondary outcome measures. Materials included the Behavioral Avoidance Test for measuring symptoms and outcomes, the Expectations and Satisfaction Questionnaire, and the Working Alliance Inventory. We ran multilevel analyses for the study of predictors controlling for the treatment effect conditions. Results: Results showed a significant effect of expectations on treatment outcomes (specifically avoidance and beliefs scores). The therapeutic alliance did not have a significant effect on treatment outcome. Patients reduced their symptoms of phobia. Conclusion: These results empirically support treatment expectations as a relevant predictor of change in exposure treatments for SP. [ABSTRACT FROM AUTHOR]

Mindfulness and self-compassion are emerging as crucial constructs in mental health research. Recent studies have shown that both mindfulness and self-compassion skills may play important roles in well-being and positive emotions associated with mindfulness training. Studies are needed to explain this relationship and to determine what facets may be correlating and mediating the meditation–happiness relationship. The aim of this study was to explore the meditation–happiness relationship and examine which mindfulness and self-compassion facets are better predictors of happiness. A total of 365 participants completed an assessment protocol composed of: the Five Facets of Mindfulness Questionnaire (FFMQ), the Self-Compassion Scale-short form (SCS-SF), and the Pemberton Happiness Index (PHI). Hierarchical regression analysis showed that two FFMQ facets ( Observing and Awareness ) and two SCS components ( Self-kindness and Common humanity ) were significant predictors of happiness. Mediation results revealed a significant total indirect effect of Observing , Awareness , Self-kindness and Common humanity in the meditation frequency–happiness relationship. Significant indirect effects were found for observing , self-kindness and common humanity . The results supported the model of mindfulness and self-compassion facets as partial mediators of the meditation–happiness relationship. Findings are in line with other studies and provide evidence about the influence of mindfulness and self-compassion on happiness. [ABSTRACT FROM AUTHOR]

Background: Little is known about changes of mental health during the COVID-19 pandemic in potentially disadvantaged groups. We investigated changes in anxiety and depression symptoms during the first year of the pandemic in six European countries and Australia by prior mental disorders and migration status.Methods: Overall, 4674 adults answered a web-based survey in May-June 2020 and were followed by three repeated surveys up to February 2021. Information on psychosocial, financial and demographic, living conditions, prior mental disorders, depression and anxiety symptoms during the pandemic and migration status was collected. Weighted general estimation equations modelling was used to investigate the association between prior mental disorders, migration status, and symptoms over time.Results: Most participants were <40 years old (48%), women (78%) and highly educated (62%). The baseline prevalence of depressive and anxiety symptoms ranged between 19%-45% and 13%-35%, respectively. In most countries, prevalence rates remained unchanged throughout the pandemic and were higher among people with prior mental disorders than without even after adjustment for several factors. We observed interactions between previous mental disorders and symptoms of anxiety or depression over time in two countries. No difference by migration status was noted.Limitations: Convenience sampling limits generalizability. Self-assessed symptoms of depression and anxiety might involve some misclassification.Conclusions: Depression and anxiety symptoms were worse among individuals with prior mental disorders than without, but there was no clear trend of worsening mental health in the observed groups during the observed period. [ABSTRACT FROM AUTHOR]

This article presents two case studies of 2 middle-aged women who suffered from an adjustment disorder (AD) with mixed anxiety and depressed mood as a result of their younger brothers being diagnosed with schizophrenia seven and 17 years ago, respectively. The treatment applied is based on cognitive-behavioural techniques supported by the use of Virtual Reality and positive psychology strategies. After the initial assessment, the treatment was applied in 6 weekly sessions followed by a post-treatment assessment and 4 follow-up assessment periods (1, 3, 6 and 12 months). In order to evaluate the treatment efficacy measures on depressive symptoms, negative and positive affect, emotional distress, interference of the problem, posttraumatic growth degree, and satisfaction with the treatment were obtained. Results indicate that the treatment was effective. Following its application neither participant met AD criteria any more, both improved their clinical symptomatology as well as their levels of functioning and wellbeing in an essential way, and a good acceptance of the treatment was observed. [ABSTRACT FROM AUTHOR]

In vivo exposure is the recommended treatment of choice for specific phobias; however, it demonstrates a high attrition rate and is not effective in all instances. The use of virtual reality (VR) has improved the acceptance of exposure treatments to some individuals. Augmented reality (AR) is a variation of VR wherein the user sees the real world augmented by virtual elements. The present study tests an AIR system in the short (posttreatment) and long term (3, 6, and 12 months) for the treatment of cockroach phobia using a multiple baseline design across individuals (with 6 participants). The AR exposure therapy was applied using the "one-session treatment" guidelines developed by Öst, Salkovskis, and Hellström (1991). Results showed that AR was effective at treating cockroach phobia. All participants improved significantly in all outcome measures after treatment; furthermore, the treatment gains were maintained at 3, 6, and 12-month follow-up periods. This study discusses the advantages of AR as well as its potential applications. [ABSTRACT FROM AUTHOR]

While randomized trials typically lack sufficient statistical power to identify predictors and moderators of outcome, "individual participant data" (IPD) meta-analyses, which combine primary data of multiple randomized trials, can increase the statistical power to identify predictors and moderators of outcome. We conducted a systematic review of IPD meta-analyses on psychological treatments of depression to provide an overview of predictors and moderators identified. We included 10 (eight pairwise and two network) IPD meta-analyses. Six meta-analyses showed that higher baseline depression severity was associated with better outcomes, and two found that older age was associated with better outcomes. Because power was high in most IPD meta-analyses, non-significant findings are also of interest because they indicate that these variables are probably not relevant as predictors and moderators. We did not find in any IPD meta-analysis that gender, education level, or relationship status were significant predictors or moderators. This review shows that IPD meta-analyses on psychological treatments can identify predictors and moderators of treatment effects and thereby contribute considerably to the development of personalized treatments of depression. [ABSTRACT FROM AUTHOR]

The Brief version of the Fear of Negative Evaluation Scale (BFNE) was built by Leary (1983a) from the Fear of Negative Evaluation Scale (FNE) (Watson y Friend, 1969). The BFNE consists of 12 items scored on a five-point Likert scale and it assesses the degree to which people fear being evaluated negatively by others. This scale was applied to a sample of 122 participants with a diagnosis of social phobia (DSM-IV, 2000). In this sample the BFNE exhibited a 2-factor structure and the nature of the factors was similar to the factors reported by Rodebaugh et al. (2004) and Weeks et al. (2005). The BFNE showed a high internal consistency for both subescales. With regard to concurrent validity the scale obtained a significant correlation with social phobia, trait anxiety and depression measures. Moreover, the BFNE was able to differentiate among social phobia subtypes (Heimberg et al., 1983). [ABSTRACT FROM AUTHOR]

Research on emotional processes has been closely related to the use of emotional stimuli, promoting the development of different standardized sets of images. However, some kinds of images that would be relevant in clinical psychology research are not available, especially for small animal phobias. The aim of the present study is to validate a set of animal images that includes images of cockroaches, which are not present in the current sets of images. Two hundred and forty images depicting five types of animals (cockroaches, spiders, snakes, cats, and butterflies) were collected from online public domains. Four hundred and twenty-four participants (72.9% women) took part in the study rating the images in two affective dimensions (i.e., valence and arousal). Cockroach pictures were rated as significantly more unpleasant than pictures of spiders, snakes, butterflies, and cats. Moreover, results revealed that women rated cockroach, spider, and snake pictures as more negative than men did. Also, women in comparison with men rated cockroach images as more arousing. The results highlight the importance of using images of cockroaches, due to their high negative valence, which even exceeds that of snakes and spiders, the unpleasant animals typically used in phobic research. This set of images can be useful in research on small-animal phobias. [ABSTRACT FROM AUTHOR]

The use of virtual reality (VR) and mixed reality (MR) technology in clinical psychology is growing. Efficacious VR-based treatments for a variety of disorders have been developed. However, the field of technology-assisted psychotherapy is constantly changing with the advancement in technology. Factors such as interdisciplinary collaboration, consumer familiarity and adoption of VR products, and progress in clinical science all need to be taken into consideration when integrating virtual technologies into psychotherapies. We aim to present an overview of current expert opinions on the use of virtual technologies in the treatment of anxiety and stress-related disorders. An anonymous survey was distributed to a select group of researchers and clinicians, using an analytic framework known as Strengths, Weaknesses, Opportunities, and Threats (SWOT). Overall, the respondents had an optimistic outlook regarding the current use as well as future development and implementation of technology-assisted interventions. VR and MR psychotherapies offer distinct advantages that can overcome shortcomings associated with traditional therapy. The respondents acknowledged and discussed current limitations of VR and MR psychotherapies. They recommended consolidation of existing knowledge and encouraged standardisation in both theory and practice. Continued research is needed to leverage the strengths of VR and MR to develop better treatments. Abbreviations: AR: Augmented Reality; MR: Mixed Reality; RCT: Randomised Controlled Trial; SWOT: Strengths, Weaknesses, Opportunities, and Threats; VR: Virtual Reality; VR-EBT: Virtual Reality Exposure-Based Therapy [ABSTRACT FROM AUTHOR]

Objective: Subthreshold depression has been found to be associated with considerable impairment and an increased risk of developing major depression. Although several randomized trials have examined the effects of psychological interventions for subthreshold depression in children and adolescents, no meta-analysis has integrated the results of these trials.Method: We searched 4 bibliographic databases and included randomized trials comparing psychological interventions with control conditions in children and adolescents scoring above a cut-off of a depression questionnaire but not meeting diagnostic criteria for major depression (or persistent depressive disorder) according to a diagnostic interview. Effect sizes and incidence rates of major depression were pooled with random effects meta-analyses.Results: A total of 12 trials with 1,576 children and adolescents met inclusion criteria. The overall effect size indicating the difference between treatment and control at post-test was g = 0.38 (95% CI = 0.14-0.63), which corresponds to a number-needed-to-treat (NNT) of 8.4. Heterogeneity was moderate to high (I2 = 61; 95% CI = 28-79), and there was significant risk of publication bias (p < .04). The 2 studies in children less than 12 years of age showed nonsignificant effects (g = 0.01; 95% CI = -1.16 to 1.18). We found no significant effect on the incidence of major depression at follow-up (relative risk = 0.52; 95% CI = 0.25-1.08), although this may be related to low statistical power.Conclusion: Interventions for subthreshold depression may have positive acute effects in adolescents. There is currently insufficient evidence, however, that these interventions are effective in children less than 12 years of age, or that they prevent the onset of major depression at follow-up. [ABSTRACT FROM AUTHOR]

Purpose: Most patients with depression are treated by general practitioners, and most of those patients prefer psychotherapy over pharmacotherapy. No network meta-analyses have examined the effects of psychotherapy compared with pharmacotherapy, combined treatment, care as usual, and other control conditions among patients in primary care.Methods: We conducted systematic searches of bibliographic databases to identify randomized trials comparing psychotherapy with pharmacotherapy, combined treatment, care as usual, waitlist, and pill placebo. The main outcome was treatment response (50% improvement of depressive symptoms from baseline to end point).Results: A total of 58 studies with 9,301 patients were included. Both psychotherapy and pharmacotherapy were significantly more effective than care as usual (relative risk [RR] for response = 1.60; 95% CI, 1.40-1.83 and RR = 1.65; 95% CI, 1.35-2.03, respectively) and waitlist (RR = 2.35; 95% CI, 1.57-3.51 and RR = 2.43; 95% CI, 1.57-3.74, respectively) control groups. We found no significant differences between psychotherapy and pharmacotherapy (RR = 1.03; 95% CI, 0.88-1.22). The effects were significantly greater for combined treatment compared with psychotherapy alone (RR = 1.35; 95% CI, 1.00-1.81). The difference between combined treatment and pharmacotherapy became significant when limited to studies with low risk of bias and studies limited to cognitive behavior therapy.Conclusions: Psychotherapy is likely effective for the treatment of depression when compared with care as usual or waitlist, with effects comparable to those of pharmacotherapy. Combined treatment might be better than either psychotherapy or pharmacotherapy alone. [ABSTRACT FROM AUTHOR]

Evidence of self‐help interventions for adjustment disorder (AjD) is limited. This study aims at testing in a randomized controlled trial (RCT) the effectiveness of a disorder‐specific, Internet‐delivered cognitive–behavioural therapy (ICBT) intervention for AjD. Participants were randomly allocated to either an ICBT with brief weekly telephone support (n = 34) or a waiting list group (n = 34). Beck's inventories for depression and anxiety were used as primary outcomes. The secondary outcomes were AjD symptoms, post‐traumatic growth, positive and negative affect, and quality of life. In all, 76.5% of the participants completed the intervention. Compared with the control group, participants in the intervention condition showed significantly greater improvement in all outcomes (Cohen's d ranged from 0.54 to 1.21) except in anxiety symptoms measured by Beck Anxiety Inventory (d = 0.27). Only ICBT group showed a significant improvement in post‐traumatic growth, positive and negative affect, and quality of life. The number of cases that achieved clinically meaningful change in all outcome measures was also higher in the ICBT group. All therapeutic gains were maintained at 3‐, 6‐ and 12‐month follow‐ups. The current study provides evidence on the effectiveness of ICBT interventions to reduce the impact of AjD. Results suggest that brief self‐help intervention with minimal therapist support is more effective than the mere passage of time in reducing the distress symptoms associated to the disorder and also can confer additional benefits. [ABSTRACT FROM AUTHOR]

Depressive disorders are common and have a considerable impact on patients and societies. Several treatments are available, but their effects are modest and reduce the burden only to a limited extent. Preventing the onset of depressive disorders may be one option to further reduce the global disease burden. We conducted a meta-analysis of randomized controlled trials in participants without a diagnosis of depression at baseline, who were assigned to a preventive psychological intervention, or a care-as-usual, or comparable control group and in which incident cases of depression at follow-up were ascertained with a diagnostic interview. Our systematic searches resulted in 50 trials (14,665 participants) with relatively high quality, in high risk groups of all ages. The psychological interventions were mostly based on cognitive behavioral interventions. One year after the preventive interventions, the relative risk of developing a depressive disorder was RR = 0.81 (95% CI: 0.72–0.91), indicating that those who had received the intervention had 19% less chance to develop a depressive disorder. Given the average control event rate of 30%, twenty-one people had to participate in the intervention to prevent one depressive disorder compared to people in the control conditions. Prevention is a promising approach to reduce the global disease burden of depression in addition to treatments. • Preventive interventions are effective in reducing the incidence of depressive disorders at follow-up. • Both indicated and selective interventions have significant effects on incidence. • There are hardly any randomized trials examining the effects of universal prevention on incidence. [ABSTRACT FROM AUTHOR]

Background: The Positive and Negative Affect Schedule (PANAS) is the most widely and frequently used scale to assess positive and negative affect. The PANAS has been validated in several languages, and it has shown excellent psychometric properties in the general population and some clinical samples, such as forensic samples, substance users, and adult women with fibromyalgia. Nevertheless, the psychometric properties of the scale have not yet been examined in clinical samples with anxiety, depressive, and adjustment disorders. In addition, the proliferation of Internet-based treatments has led to the development of a wide range of assessments conducted online with digital versions of pen and paper self-report questionnaires. However, no validations have been carried out to analyze the psychometric properties of the online version of the PANAS. The present study investigates the psychometric properties of the online Spanish version of the PANAS in a clinical sample of individuals with emotional disorders. Methods: The sample was composed of 595 Spanish adult volunteers with a diagnosis of depressive disorder (n = 237), anxiety disorder (n = 284), or adjustment disorder (n = 74). Factor structure, construct validity, internal consistency, and sensitivity to change were analyzed. Results: Confirmatory factor analysis yielded a latent structure of two independent factors, consistent with previous validations of the instrument. The analyses showed adequate convergent and discriminant validity, good internal consistency as well as sensitivity to change. Conclusions: Overall, the results obtained in this study show that the online version of the PANAS has adequate psychometric properties for the assessment of positive and negative affect in a Spanish clinical population. [ABSTRACT FROM AUTHOR]

This study aggregated data from three randomized control trials to explore the differential efficacy of three forms of exposure therapy, namely, in vivo (iVET), virtual reality (VRET), and augmented reality (ARET), in the treatment of small animal phobia. Additionally, baseline patient characteristics were used to detect subgroups of patients who showed a differential response to certain treatment modalities. Primary measures were distance covered, anxiety during the behavioral avoidance test (BAT), and overall fear of small animals. A repeated-measures analysis of variance was used to explore the overall treatment effect across the exposure modalities. A cluster analysis and an analysis of moderation were conducted to explore differential response to treatments. The main study finding was that the three treatment conditions were similarly efficacious in the treatment of small animal phobia for all study outcomes. Only for distance covered, our results revealed a tendency for iVET to be more effective than VRET and ARET in participants with worse performance on the BAT before treatment. The present study findings provide further evidence for the comparable efficacy of the three forms of exposure. Our results also suggest that, overall, treatments are likely to be similarly effective, regardless of the individual baseline characteristics (i.e., fear, anxiety, and age), whereas pretreatment scores on distance covered in the avoidance test might be used to personalize treatments (iVET may be preferable when participants perform worse at pretreatment). [ABSTRACT FROM AUTHOR]

Transdiagnostic cognitive-behavioral therapy for emotional disorders (ED) has proven to be effective. However, current transdiagnostic treatment protocols address only the regulation of negative affectivity, and they do not include treatment components to more directly target the regulation of positive affectivity. In this study, we propose to evaluate the preliminary efficacy and acceptability of a transdiagnostic treatment protocol for ED that includes, as an innovative feature, a specific treatment component to directly upregulate positive affectivity based on positive psychology interventions. A total of 24 participants were randomized to either a transdiagnostic treatment protocol (n = 12) or a transdiagnostic treatment protocol with an additional component designed to regulate positive affectivity (n = 12). Participants completed measures of anxiety, depression, positive and negative affectivity, and quality of life, as well as treatment acceptability at pre- and posttreatment and at the 3-month follow-up. Both interventions led to improvements in all measures at posttreatment, and these outcomes were maintained at the 3-month follow-up, with large effect sizes for all measures. The effect sizes for positive affect were larger in the condition that included the component to upregulate positive affectivity. Attrition rate was low, and both treatment protocols were well accepted by participants. The results obtained in this study indicate the feasibility of testing the treatment protocol in a larger, randomized, controlled trial, and they suggest the potential of including treatment components for directly upregulating positive affectivity in future research on transdiagnostic treatment protocols for ED. [ABSTRACT FROM AUTHOR]

The Overall Anxiety Severity and Impairment Scale (OASIS) is a self-report questionnaire designed to evaluate the severity and functional impairment associated with anxiety. Given its transdiagnostic nature, it can be used indistinctly across anxiety and depressive disorders. In this study, the psychometric properties of the online version of the OASIS were evaluated in a Spanish clinical sample with emotional disorders. Patients (n = 583) with anxiety (n = 250) and depression (n = 333) with a mean age of 37.21 (SD = 12.22), underwent a diagnostic interview and questionnaires assessing anxiety, depression, positive and negative affect, and quality of life. Factorial structure, internal consistency, convergent and discriminant validity, cutoff scores, and sensitivity to change were analyzed. Confirmatory Factor Analysis yielded a unidimensional factor structure, consistent with previous validations of the instrument. The analyses showed good internal consistency and adequate convergent and discriminant validity, as well as sensitivity to change. A cutoff score of 7.5 was found to meet the criteria used in this study to select the optimal cutoff point. Overall, in this study, the psychometric properties of the online version of the OASIS were found to be appropriate. The brevity and ease of use of the OASIS support its adequacy as a valid measure of anxiety severity and impairment in Spanish clinical samples with anxiety and depression. [ABSTRACT FROM AUTHOR]

Background: Adjustment disorder (AjD) is one of the most used mental disorder diagnoses among mental health professionals. Important revisions of the AjD definition in the 11th edition of the International Classification of Diseases (ICD-11) are proposed. AjD is included in a chapter of disorders specifically associated with stress in ICD-11. Objective: This paper aims to review recent developments in ICD-11 AjD research, and to discuss the available ICD-11 AjD diagnosis validation studies, AjD measures, treatment studies, and outline the future perspectives for AjD research and clinical practice. Methods: In total, 10 empirical studies of AjD ICD-11 were identified and included in this review. We searched for studies in Embase, PubMed, PsycINFO, Scopus, PILOTS, SocINDEX, and via additional search by contacting authors of published empirical studies and reference screening. Results: Review of the studies revealed a lack of validation studies of the ICD-11 AjD symptom structure. AjD validation study findings are ambiguous, and there is still little support for the proposed two symptom structure of AjD for the ICD-11. A self-report AjD measure 'Adjustment Disorder New Module' (ADNM) based on the ICD-11 definition has been developed and used in all 10 reviewed studies. Two self-help interventions have been developed for the ICD-11 AjD, and findings from these studies indicate that self-help low-intensity cognitive-behavioural interventions, delivered via bibliography or internet-based, might be effective treatment of AjD. Conclusions: The AjD definition in ICD-11 with a description of a new symptom profile facilitates AjD measurement and AjD-focused treatment developments. More studies and insights from clinical practice are needed to move the field of AjD research and practice forward. [ABSTRACT FROM AUTHOR]

Background: Flying phobia (FP) is a common and disabling mental disorder. Although in vivo exposure is the treatment of choice, it is linked to a number of limitations in its implementation. Particularly important, is the limited access to the feared stimulus (i.e., plane). Moreover, the economic cost of in vivo exposure should be specially considered as well as the difficulty of applying the exposure technique in an appropriate way; controlling important variables such as the duration of the exposure or the number of sessions. ICTs could help to reduce these limitations. Computer-assisted treatments have remarkable advantages in treating FP. Furthermore, they can be delivered through the Internet, increasing their advantages and reaching more people in need. The Internet has been established as an effective way to treat a wide range of mental disorders. However, as far as we know, no controlled studies exist on FP treatment via the Internet. This study aims to evaluate the efficacy of an Internetbased treatment for FP (NO-FEAR Airlines) versus a waiting list control group. Secondary objectives will be to explore two ways of delivering NO-FEAR Airlines, with or without therapist guidance, and study the patients' acceptance of the program. This paper presents the study protocol. Methods/design: The study is a randomized controlled trial. A minimum of 57 participants will be randomly assigned to three conditions: a) NO-FEAR Airlines totally self-applied, b) NO-FEAR Airlines with therapist guidance, or c) a waiting list control group (6 weeks). Primary outcomes measures will be the Fear of Flying Questionnaire-II and the Fear of Flying Scale. Secondary outcomes will be included to assess other relevant clinical measures, such as the Fear and Avoidance Scales, Clinician Severity Scale, and Patient's Improvement scale. Analyses of post-treatment flights will be conducted. Treatment acceptance and preference measures will also be included. Intention-to-treat and per protocol analyses will be conducted. Discussion: An Internet-based treatment for FP could have considerable advantages in managing in vivo exposure limitations, specifically in terms of access to treatment, acceptance, adherence, and the cost-effectiveness of the intervention. This is the first randomized controlled trial to study this issue. [ABSTRACT FROM AUTHOR]

Although we have made significant progress in the development of preventive tools and especially in the efficacy of the psychological treatments, we are still far from an optimal situation. This paper focuses on two major issues which we consider fundamental challenges and urges in this area: (a) the need for improving and spreading prevention, early intervention, and the promotion of mental health and (b) the need for greater dissemination of effective psychological treatments, the development of new interventions and greater understanding of the mechanisms of action of psychological treatments. The aim is to promote discussion among all stakeholders and debate on those lines we think as priority. [ABSTRACT FROM AUTHOR]

The magnitude and impact of mental disorders does not correspond to the resources devoted to research and attention. Although we have made significant progress in their understanding and the efficacy of the psychological treatments, we are still far from an optimal situation. This paper focuses on one of the major issues which we consider fundamental challenges and needs in this area, the increase in research focusing on psychopathology, especially on the mechanisms and processes that explain and maintain mental disorders, as a key point for the design and development of new psychological interventions for the prevention, treatment, and promotion of mental health. The aim is to promote discussion among all stakeholders and debate on those lines we think as a priority. [ABSTRACT FROM AUTHOR]

Although in vivo exposure is the treatment of choice for specific phobias, some acceptability problems have been associated with it. Virtual Reality exposure has been shown to be as effective as in vivo exposure, and it is widely accepted for the treatment of specific phobias, but only preliminary data are available in the literature about the efficacy of Augmented Reality. The purpose of the present study was to examine the efficacy and acceptance of two treatment conditions for specific phobias in which the exposure component was applied in different ways: In vivo exposure (N = 31) versus an Augmented Reality system (N = 32) in a randomized controlled trial. “One-session treatment” guidelines were followed. Participants in the Augmented Reality condition significantly improved on all the outcome measures at post-treatment and follow-ups. When the two treatment conditions were compared, some differences were found at post-treatment, favoring the participants who received in vivo exposure. However, these differences disappeared at the 3- and 6-month follow-ups. Regarding participants’ expectations and satisfaction with the treatment, very positive ratings were reported in both conditions. In addition, participants from in vivo exposure condition considered the treatment more useful for their problem whereas participants from Augmented Reality exposure considered the treatment less aversive. Results obtained in this study indicate that Augmented Reality exposure is an effective treatment for specific phobias and well accepted by the participants. [ABSTRACT FROM AUTHOR]

Purpose: Computerized cognitive behavioral therapy (CCBT) has been shown to be efficacious. Moreover, CCBT can be enhanced by using physiological and activity sensors, but there is no evidence about the acceptability of all these tools. The objective of this study is to examine the efficacy, expectations, satisfaction, and ease of use of an Internet-based CCBT program for preventing depression, with and without sensors (electroencephalography, electrocardiograhpy ECG, and actigraphy), in a high-risk population (unemployed men). Patients and methods: Sixty participants at risk of depression (unemployed men) were randomly assigned to three experimental conditions: 1) intervention program (N=22), 2) intervention program plus sensors (N=19), and 3) control group (N=19). Participants completed depression, anxiety, positive and negative affect, and perceived stress measures. Furthermore, they also completed the measures for expectation, satisfaction, and the ease of use of the program. Results: Results showed that the two intervention groups improved significantly more than the control group on the clinical variables, and the improvements were greater in the group that used sensors than in the group that did not use them. Furthermore, participants in both intervention groups scored high on expectations and satisfaction with the CCBT program (with and without sensors). The mean score for usability was 88 out of 100 (standard deviation =12.32). No significant differences were found between groups on any of these variables. Conclusion: This is the first study to analyze the efficacy, expectations, satisfaction, and ease of use of an Internet-based program using physiological and activity sensors. These results suggest that an Internet program for depression with or without physiological and activity sensors is effective, satisfactory, and easy to use. [ABSTRACT FROM AUTHOR]

E-learning can be defined as learning facilitated and supported through the use of ICTs. ICTs can increase students' motivation, accelerate the knowledge process and facilitate the information access. The aim of this paper is to analyze the acceptability of three tools presented in a workshop carried out during six weeks, with university teachers (N = 22), taking into account their opinion about the usefulness of the workshop. Two researchers/teachers specializing in the field of educational technologies taught the three tools presented. Before the workshop, we administered a technology profile questionnaire; after it, we asked the teachers to fill in a questionnaire about the workshop and the tools used. We then carried out a non-parametric Friedman test to compare the differences found in the evaluation of the tools. The results show that the acceptability of the technologies and the methodology used during the workshop was high: teachers' assessment and opinion has been favorable for both pedagogy and teaching methodology, which facilitated the understanding of the tools and the innovative nature of the contents of the workshop. The participants also evaluated the technologies as appropriate and easy to use. We also mention the limitations of the study and future challenges. [ABSTRACT FROM AUTHOR]

This study analyses participants' preferences regarding two exposure treatment modalities for Fear of Flying (FF): virtual reality exposure treatment (VRET) by itself or VRET plus cognitive restructuring (VRET+CR). An alternating treatment conditions design was established and a non-concurrent multiple baseline design across individuals (four participants) was used. Both conditions were equally effective and after the treatment all the participants took a flight. At the end of each session the participants were asked for their opinion on the condition they received. High mean scores were obtained in both conditions; non-significant differences between the two conditions were found. When the treatment was finished the participants were also asked for their preferences regarding both treatment conditions. All participants preferred VRET+CR, considered it more effective, recommended it more to others, and claimed this treatment was less aversive. These data contribute to the literature focused on the importance of taking into account patient preferences. [ABSTRACT FROM AUTHOR]

In recent years, applications of advanced technologies have led to the emergence of a research line in the behavioral sciences. The growing body of publications that report the efficiency and effectiveness of intervention programs that address a range of psychological disorders raises the need to strengthen them, assessing their generalizability to other cultures in order to assess the external validity. Through the collaboration of two research groups, a cross-cultural validation was carried out in Mexico, assessing two treatment programs using virtual reality to treat fear of flying, agoraphobia and fear of public speaking with a self-applied program, which previously demonstrated efficacy in Spain. In this paper we report the results of effectiveness and efficiency in the Mexican population. It is discussed the relevance to assess external validity of treatment programs incorporating technology, that might contribute to optimize treatment and psychological evaluation systems that will benefit mental health services [ABSTRACT FROM AUTHOR]

The positive technology field combines the objectives of positive psychology with enhancements from information and communication technologies. Following this approach, our team developed the ‘EARTH of Well-Being,’ a system designed to induce positive emotions and reinforce psychological resources through a self-guided positive psychology internet intervention. This paper describes the EARTH system and presents the results of a pilot study that assesses users’ acceptance and perceived usefulness of the system and provides preliminary evidence of its efficacy in providing users with positive experiences. Thirty-eight volunteers used the application in six sessions distributed over two weeks. They reported high levels of acceptability and perceived usefulness. Moreover, participants reported increased positive mood after each session. Overall, results support the future use and investigation of this system as a positive psychology intervention, and suggest that it could be useful for increasing positive mood. [ABSTRACT FROM PUBLISHER]

Posttraumatic stress disorder (PTSD) can develop after exposure to a terrifying event. People who suffer from PTSD experience hyperarousal and avoidance, and they reexperience symptoms that provoke distress and impairment in significant life areas. Cognitive behavior programs, including exposure therapy, are currently the treatment of choice for PTSD. Although these programs are effective, there is room for improvement; utilization of exposure therapy by clinicians is low, and attrition rates are high. Application of new technologies, especially virtual reality (VR), could help to overcome these issues. Several VR programs that address PTSD already exist. This study presents preliminary data on the efficacy of a VR adaptive display called EMMA's World, as applied in the treatment of diverse trauma PTSD victims. This VR program is unique; its flexibility allows it to be used to treat patients who suffer from PTSD due to different kinds of traumatic events. Results support the utility of EMMA's World in the treatment of PTSD. [ABSTRACT FROM AUTHOR]

The Butler Project is a technological e-health platform that uses the Internet to connect various users; it was designed to deliver health care to the elderly. The Butler platform has three levels of implementation: diagnosis (mood monitoring, alert system, management reports), therapy (training in inducing positive moods, memory work), and entertainment (e-mail, chat, video, photo albums, music, friend forums, accessibility to the Internet). The objective of this work is to describe the psychological aspects of the platform and to present data obtained from four users. Results show that after using the system, the participants increased their positive emotions and decreased their negative ones; in addition, they obtained high levels of satisfaction and experienced little difficulty in using the system. [ABSTRACT FROM AUTHOR]

Information and Communication Technologies (ICT) are becoming more and more common in Clinical Psychology. Two of the technologies that are more consolidated in this field are virtual reality (VR) and telepsychology. There are other technological innovations that are beginning to be used in clinical and health psychology such as ambient intelligence, ubiquitous computing or persuasive computing. In the last fifteen years there has been a proliferation of studies testing the efficacy of immersive virtual reality in the delivery of cognitive behavioral therapy (CBT) for several mental disorders and health conditions. The essence of VR is that it can simulate reality and add a new possibility: the user has the illusion of "being" in the computer-generated environment while interacting with the VR objects. This unique feature of VR is very relevant for its use in Clinical Psychology. At the same time, it can raise several ethical issues. It is important to investigate the possible effects of blurring the distinction between real and virtual worlds in vulnerable populations. Some other concerns regarding the use of VR in therapy have already been investigated, such as cybersickness. After ten years of experience treating patients with VR, this has not been a problem in the published efficacy studies. Telepsychology has also been used to improve the delivery of CBT. A number of Internetdelivered programs have already become important tools in the health system. The main advantage is that online therapy can reach people who might not otherwise seek therapy, such as disabled people or those who live in remote areas. However, several concerns have been raised about self-help procedures, like the issue of self-diagnosis. and the fact that patients usually have all of the necessary self-help information at their disposal. It is important to establish criteria to protect people from the possible negative effects of this. Other innovations such as ambient intelligence and pervasive computing bring up other ethical issues. For example, is privacy being compromised too much when people are located using GPS or physiologically monitored 24 hours a day? Criteria for considering these issues must be established. Our research group has been working with new technologies and therapies for the last fifteen years. This paper addresses the ethical issues we have encountered in our research and clinical practice; it also explores ethical issues that will become increasingly important. [ABSTRACT FROM AUTHOR]

This study investigates how stereoscopy (the illusion of depth and 3D imaging) affects the sense of presence and the intensity of the positive mood that users feel in virtual environments (VEs). A between-group design was used, and 40 volunteers were randomly assigned to one of two experimental conditions (stereoscopy vs. no stereoscopy) and to one of two emotional VEs (relaxation or joy). The participants' emotions were assessed before and after the VR experience. Presence was measured with two postexperiment questionnaires (ITC-SOPI and SUS). Results show that there were no differences between stereoscopic and monoscopic presentations in VEs (neither subjective sense of presence nor emotional reactions). Practical and theoretical implications of these findings are discussed herein. [ABSTRACT FROM AUTHOR]

Background: Internet-based treatments appear to be a promising way to enhance the in vivo exposure approach, specifically in terms of acceptability and access to treatment. However, the literature on specific phobias is scarce, and, as far as we know, there are no studies on Flying Phobia (FP). This study aims to investigate the effectiveness of an Internet-based exposure treatment for FP (NO-FEAR Airlines) that includes exposure scenarios composed of images and sounds, versus a waiting-list control group. A secondary aim is to explore two ways of delivering NO-FEAR Airlines, with and without therapist guidance. Methods: A randomized controlled trial (RCT) was conducted in which 69 participants were allocated to: 1) NO-FEAR Airlines totally self-applied, 2) NO-FEAR Airlines with therapist guidance, 3) a waiting-list control group. Primary outcome measures were the Fear of Flying Questionnaire-II and the Fear of Flying Scale. Secondary outcomes included the Fear and Avoidance Scales, Clinician Severity Scale, and Patient's Improvement scale. Behavioral outcomes (post-treatment flights and safety behaviors) were also included. Mixed-model analyses with no ad hoc imputations were conducted for primary and secondary outcome measures. Results: NO-FEAR Airlines (with and without therapist guidance) was significantly effective, compared to the waiting list control group, on all primary and secondary outcomes (all ps <.05), and no significant differences were found between the two ways of delivering the intervention. Significant improvements on diagnostic status and reliable change indexes were also found in both treatment groups at post-treatment. Regarding behavioral outcomes, significant differences in safety behaviors were found at post-treatment, compared to the waiting list. Treatment gains were maintained at 3- and 12-month follow-ups. Conclusion: FP can be treated effectively via the Internet. NO-FEAR Airlines helps to enhance the exposure technique and provide access to evidence-based psychological treatment to more people in need. These data are congruent with previous studies highlighting the usefulness of computer-assisted exposure programs for FP, and they contribute to the literature on Internet-based interventions. To the best of our knowledge, this is the first RCT to investigate the effectiveness of an Internet-based treatment for FP and explore two ways of delivering the intervention (with and without therapist guidance). Trial registration: Clinicaltrials.gov: NCT02298478 (https://clinicaltrials.gov/ct2/show/NCT02298478). Trial registration date 3 November 2014. [ABSTRACT FROM AUTHOR]