***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Online therapy offers many advantages over face-to-face therapy . Interapy includes psychoeducation , screening , effect measures , and a protocol -driven treatment via the Internet for people suffering from posttraumatic stress . The present article reports the results of a controlled trial on the Internet-driven treatment of posttraumatic stress and grief in a group of people who manifested mild to relatively severe trauma symptoms . Participants in the treatment condition ( n=69 ) improved significantly more than participants in the waiting-list control condition ( n=32 ) on trauma-related symptoms and general psychopathology . The effect sizes were large . On most subscales , more than 50 % of the treated participants showed reliable change and clinical ly significant improvement , with the highest percentages being found for depression and avoidance Background Posttraumatic stress disorder ( PTSD ) develops in 10 - 20 % of injury patients . We developed a novel , self-guided Internet-based intervention ( called Trauma TIPS ) based on techniques from cognitive behavioral therapy ( CBT ) to prevent the onset of PTSD symptoms . Objective To determine whether Trauma TIPS is effective in preventing the onset of PTSD symptoms in injury patients . Methods Adult , level 1 trauma center patients were r and omly assigned to receive the fully automated Trauma TIPS Internet intervention ( n=151 ) or to receive no early intervention ( n=149 ) .  Trauma TIPS consisted of psychoeducation , in vivo exposure , and stress management techniques . Both groups were free to use care as usual ( non protocol ized talks with hospital staff ) . PTSD symptom severity was assessed at 1 , 3 , 6 , and 12 months post injury with a clinical interview ( Clinician-Administered PTSD Scale ) by blinded trained interviewers and self-report instrument ( Impact of Event Scale — Revised ) . Secondary outcomes were acute anxiety and arousal ( assessed online ) , self-reported depressive and anxiety symptoms ( Hospital Anxiety and Depression Scale ) , and mental health care utilization . Intervention usage was documented . Results The mean number of intervention logins was 1.7 , SD 2.5 , median 1 , interquartile range ( IQR ) 1 - 2 . Thirty-four patients in the intervention group did not log in ( 22.5 % ) , 63 ( 41.7 % ) logged in once , and 54 ( 35.8 % ) logged in multiple times ( mean 3.6 , SD 3.5 , median 3 , IQR 2 - 4 ) . On clinician-assessed and self-reported PTSD symptoms , both the intervention and control group showed a significant decrease over time ( P<.001 ) without significant differences in trend . PTSD at 12 months was diagnosed in 4.7 % of controls and 4.4 % of intervention group patients . There were no group differences on anxiety or depressive symptoms over time . Post hoc analyses using latent growth mixture modeling showed a significant decrease in PTSD symptoms in a subgroup of patients with severe initial symptoms ( n=20 ) ( P<.001 ) . Conclusions Our results do not support the efficacy of the Trauma TIPS Internet-based early intervention in the prevention of PTSD symptoms for an unselected population of injury patients . Moreover , uptake was relatively low since one-fifth of individuals did not log in to the intervention . Future research should therefore focus on innovative strategies to increase intervention usage , for example , adding gameplay , embedding it in a blended care context , and targeting high-risk individuals who are more likely to benefit from the intervention . Trial Registration International St and ard R and omized Controlled Trial Number ( IS RCT N ) : 57754429 ; http://www.controlled-trials.com/IS RCT N57754429 ( Archived by WebCite at http://webcitation.org/6FeJtJJyD ) Background Suicide , attempted suicide and suicidal thoughts are major public health problems worldwide . Effective face-to-face treatments are Cognitive Behavioural Therapy ( CBT ) , Dialectical Behavioural Therapy ( DBT ) and Problem Solving Treatment ( PST ) . However , about two-thirds of persons who die by suicide have not been in contact with mental health care services in the preceding year , and many have never been treated . Furthermore , many patients do not disclose their suicidal thoughts to their care provider . This may be out of shame , due to fear of stigma or due to lack of trust in ( mental ) health care . Since many suicidal individuals seek information online , the internet provides an opportunity to reach suicidal individuals who would not be contacted otherwise . By providing a self-help intervention online , persons can anonymously learn to gain control over their suicidal thoughts . There is convincing evidence that self-help is effective for a number of mental disorders . In this study the effectiveness for suicidal thoughts is examined . Methods / Design In this study , a recently developed self-help intervention will be evaluated in a R and omized Controlled Trial . The intervention is based on Cognitive Behavioural Therapy and is aim ed at subjects who experience mild to moderate suicidal thoughts . This is defined as a score between 1 and 26 on the Beck Scale for Suicidal Ideation ( BSS ) . Higher and lower scores are excluded . In addition , severely depressed subjects are excluded . In total , 260 subjects will be r and omly allocated to the intervention-condition ( N = 130 ) or to the information-control condition ( N = 130 ) . Self-report question naires will be filled out at baseline , 6 weeks after baseline and 18 weeks after baseline . Primary outcome measure is the reduction in frequency and intensity of suicidal thoughts . Secondary outcome measures are the reduction of hopelessness , anxiety and depression , sleeplessness , worry and quality of life measures . Discussion This study is the first to evaluate the effectiveness of a web-based self-help intervention for suicidal thoughts . Several limitations and strengths of the design are discussed . Trial Registration Netherl and s Trial Register , OBJECTIVE The aim of this article was to evaluate the effectiveness of an information provision web-based early intervention via a r and omized controlled trial for children and their parents following pediatric unintentional injury . METHOD Participants were r and omly assigned to an  intervention ( n = 29 ) or a  control group ( n = 27 ) following baseline measurements . Further assessment was taken at 4 - 6 weeks and 6 months post-trauma event . RESULTS Analyses revealed that children within the intervention group reported improved anxiety , in comparison to a worsening of symptoms for children in the control group . Furthermore , children who had higher baseline trauma scores reported the intervention to be helpful . CONCLUSIONS The intervention showed promising results in its ability to aid child recovery OBJECTIVE The authors report an 8-week r and omized , controlled proof-of-concept trial of a new therapist-assisted , Internet-based , self-management cognitive behavior therapy versus Internet-based supportive counseling for posttraumatic stress disorder ( PTSD ) . METHOD Service members with PTSD from the attack on the Pentagon on September 11th or the Iraq War were r and omly assigned to self-management cognitive behavior therapy ( N=24 ) or supportive counseling ( N=21 ) . RESULTS The dropout rate was similar to regular cognitive behavior therapy ( 30 % ) and unrelated to treatment arm . In the intent-to-treat group , self-management cognitive behavior therapy led to sharper declines in daily log-on ratings of PTSD symptoms and global depression . In the completer group , self-management cognitive behavior therapy led to greater reductions in PTSD , depression , and anxiety scores at 6 months . One-third of those who completed self-management cognitive behavior therapy achieved high-end state functioning at 6 months . CONCLUSIONS Self-management cognitive behavior therapy may be a way of delivering effective treatment to large numbers with unmet needs and barriers to care This study compared the efficacy of an Internet-based , 8-week self-help program for traumatic event-related consequences ( SHTC ) ( n = 13 ) to a  wait-list ( WL ) condition ( n = 14 ) . The SHTC consisted of cognitive-behavioral modules that progressed from the least anxiety-provoking component ( i.e. , information ) to the most anxiety-provoking ( i.e. , exposure ) . Participants were those who had experienced a traumatic event and had been experiencing sub clinical levels of symptoms associated with the event . Participants mastered the material in each module before proceeding to the next module . Pre- and post-treatment assessment s revealed that SHTC participants decreased avoidance behavior , frequency of intrusive symptoms , state anxiety , and depressive symptoms , and increased coping skills and coping self-efficacy significantly more than WL participants . SHTC participants demonstrated more clinical ly significant improvement than WL individuals Background Suicidal ideation is highly prevalent , but often remains untreated . The Internet can be used to provide accessible interventions . Objective To evaluate the cost-effectiveness of an online , unguided , self-help intervention for reducing suicidal ideation . Methods A total of 236 adults with mild to moderate suicidal thoughts , defined as scores between 1 - 26 on the Beck Scale for Suicide Ideation ( BSS ) , were recruited in the general population and r and omized to the intervention ( n = 116 ) or to a waitlist , information-only , control group ( n = 120 ) . The intervention aim ed to decrease the frequency and intensity of suicidal ideation and consisted of 6 modules based on cognitive behavioral techniques . Participants in both groups had unrestricted access to care as usual . Assessment s took place at baseline and 6 weeks later ( post-test ) . All question naires were self-report and administered via the Internet . Treatment response was defined as a clinical ly significant decrease in suicidal ideation on the BSS . Total per-participant costs encompassed costs of health service uptake , participants ’ out-of-pocket expenses , costs stemming from production losses , and intervention costs . These were expressed in Euros ( € ) for the reference year 2009 . Results At post-test , treatment response was 35.3 % and 20.8 % in the experimental and control conditions , respectively . The incremental effectiveness was 0.35 − 0.21 = 0.15 ( SE 0.06 , P = .01 ) . The annualized incremental costs were −€5039 per participant . Therefore , the mean incremental cost-effectiveness ratio ( ICER ) was estimated to be −€5039/0.15 = −€34,727 after rounding ( US −$41,325 ) for an additional treatment response , indicating annual cost savings per treatment responder . Conclusions This is the first trial to indicate that online self-help to reduce suicidal ideation is feasible , effective , and cost saving . Limitations included reliance on self-report and a short timeframe ( 6 weeks ) . Therefore , replication with a longer follow-up period is recommended 
    Output:
    
The results showed that research into  online psychological crisis intervention  has been conducted in several different countries , especially the Netherl and s and Australia , and that the users of these tools benefit from them .
Online crisis interventions  have been developed and research ed in many countries around the world .