This adaptive randomized controlled trial evaluates the efficacy of a transdiagnostic, internet-delivered psychological intervention for emotional disorders, tailored to patient´s early clinical response. 366 adults with clinically significant symptoms of depression and/or anxiety will begin a 12 module self-applied program. Based on sympron reduction after the first three modules, participants will be classified as early or late responders and randomized into different experimental arms. The main hypothesis is that a hybrid format (self-applied modules plus synchronous sessions with a therapist) will yield better outcomes for late responders. Outcomes include symptom reduction, emotional regulation and internet based therapheutic alliance.
To assess its effectiveness, two formats will be compared: the original, consisting of 12 self-administered modules, and a hybrid format, which includes two synchronous sessions with a trained therapist. Early responders will either continue with the original intervention or discontinue treatment; while late responders will receive the hybrid format or continue with the original intervention. The primary expected result is that the hybrid format will improve treatment outcomes for late responders compared to the self-applied format. The findings are expected to inform clinical practice by highlighting the importance of assessing symptomatic response throughout treatment, especially in its early phases
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
366
Is a manualized treatment for emotional disorders delivered through an interactive multimedia platform. The self applied format consists of 12 self applied modules (psychoeducation, emotional processing, cognitive flexibility training, exposure, coping strategies, maladaptive behaviors, avoidance, etc)
Hybrid format: 12 self applied modules with two synchronous sessions with a trained therapist
Clinical Outcomes in Routine Evaluation (CORE-34, Evans et al., 2002)
Is a self report questionnaire designed to assess psychological distress and global functioning across four domains: subjective well being, problems/symptoms, functioning and risk. Items are rated on a 5 point Likert scale. The instrument has demostrated good psychometrics properties. Higher scores indicate greater psychological distress.
Time frame: Day 1 Week 1, 2, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13 Week 25 Year 1
Patient Health Questionnaire (PHQ-9; Kroenke et al., 2001)
Is a 9 item self report scale used to asses the severity of depressive symptoms over the past two weeks. Items are rated on a 4 point Likert scale (0-3). Is widely used in clinical and research settings, with strong psychometric properties of reliability and validity.
Time frame: Day 1 Week 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13 Week 25 Year 1
Generalized Anxiety Disorder scale (GAD-7, Spitzer et al., 2006)
Is a 7 item self report questionnaire designed to asses the severity to generalized anxiety symptoms over the past two weeks. Items are rated in a 4 point Likert scale (0-3). Is widely used in clinical and research settings, with strong psychometrics properties of reliability and validity.
Time frame: Day 1 Week 1, 2, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13 Week 25 1 Year
State Difficulties in Emotion Regulation Scale (S-DERS, Lavender et al., 2017)
Is a 21 item self report scale that asseses momentary difficulties in emotion regulation across 4 domains: nonacceptance, modulation, awareness and clarity. Respondents rate their emotional experience in a 5 points Likert scale. The instrument is sensitive to short term fluctuations and is suitable for evaluating changes in emotion regulation during treatment.
Time frame: Day 1 Week 4, 8, 13 Week 25 Year 1
Inventory of Interpersonal Problems (IIP32, Horowitz, 2000)
Is is a self-report questionnaire designed to assess interpersonal difficulties experienced over the past month. It covers eight dimensions of interpersonal functioning (e.g., being too controlling, socially inhibited, or self-sacrificing). Each item is rated on a 5-point Likert scale. The IIP-32 is a widely validated and efficient tool for identifying interpersonal patterns relevant to psychological distress and treatment planning.
Time frame: Day 1 Week 4, 8, 13 Week 25 Year 1
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