***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: This study examined the effectiveness and feasibility of therapist-guided Internet-delivered exposure ( EX ) and behavioral activation ( BA ) for complicated grief and rumination . Forty-seven bereaved individuals with elevated levels of complicated grief and grief rumination were r and omly assigned to three conditions : EX ( N=18 ) , BA ( N=17 ) , or a waiting-list ( N=12 ) . Treatment groups received 6 homework assignments over 6 to 8weeks . Intention-to-treat analyses showed that EX reduced complicated grief , posttraumatic stress , depression , grief rumination , and brooding levels relative to the control group at posttreatment ( d=0.7 - 1.2 ) . BA lowered complicated grief , posttraumatic stress , and grief rumination levels at posttreatment ( d=0.8 - 0.9 ) . At 3-month follow-up , effects of EX were maintained on complicated grief and grief rumination ( d=0.6 - 1.2 ) , and for BA on complicated grief , posttraumatic stress , and grief rumination ( d=0.8 - 0.9 ) . EX reduced depression more strongly than BA ( d=0.6 ) . Completers analyses corroborated results for EX , and partially those for BA , but no group differences were detected . BA suffered from high dropout ( 59 % ) , relative to EX ( 33 % ) and the waiting-list ( 17 % ) . Feasibility appeared higher for EX than BA . Results supported potential applicability of online exposure but not behavioral activation to decrease complicated grief and rumination OBJECTIVE Veterans who served in Operation Enduring Freedom ( OEF ) and Operation Iraqi Freedom ( OIF ) commonly experience alcohol misuse and symptoms of posttraumatic stress disorder ( PTSD ) following their return from deployment to a war zone . We conducted a r and omized clinical trial to evaluate the efficacy of a newly developed , 8-module , self-management web intervention ( VetChange ) based on motivational and cognitive-behavioral principles to reduce alcohol consumption , alcohol-related problems , and PTSD symptoms in returning combat veterans . METHOD Six hundred participants , recruited through targeted Facebook ads , were r and omized to either an Initial Intervention Group ( IIG ; n = 404 ) or a Delayed Intervention Group ( DIG ; n = 196 ) that waited 8 weeks for access to VetChange . Primary outcome measures were Drinks per Drinking Day , Average Weekly Drinks , Percent Heavy Drinking Days , and PTSD symptoms . Intent-to-treat analyses compared changes in outcome measures over time between IIG and DIG as well as within-group changes . RESULTS IIG participants demonstrated greater reductions in drinking ( p < .001 for each measure ) and PTSD symptoms ( p = .009 ) between baseline and end-of-intervention than did DIG participants between baseline and the end of the waiting period . DIG participants showed similar improvements to those in IIG following participation in VetChange .  Alcohol problems were also reduced within each group between baseline and 3-month follow-up . CONCLUSIONS Results indicate that VetChange is effective in reducing drinking and PTSD symptoms in OIF/OEF veterans . Further studies of VetChange are needed to assess web-based recruitment and retention methods and to determine VetChange 's effectiveness in demographic and clinical sub- population s of returning veterans Background : Although the evidence for the associations among self-efficacy , secondary traumatic stress ( STS ) and secondary posttraumatic growth ( SPTG ) is mounting , there is a lack of the experimental evidence for the influence of self-efficacy on positive and negative mental health outcomes among professionals indirectly exposed to trauma . Purpose : This study investigated the effects of an internet-based self-efficacy intervention ( the experimental condition ) , compared to an education ( the active control condition ) on STS and SPTG among workers exposed to traumatic events indirectly , through their clients . We hypothesized that the group assignment ( experimental vs. control ) would affect STS and SPTG indirectly , with a mediating role of self-efficacy beliefs . Methods : Participants were 168 health and human services professionals ( 78 % women ) , exposed indirectly to a traumatic event at work . They were r and omly assigned to either a 4-session internet-based self-efficacy intervention ( n = 87 ) or an education control group ( n = 81 ) which received information about coping re sources and consequences of stressors at work or at home . STS , SPTG , and self-efficacy were measured at the baseline ( Time 1 ) , 1-month follow-up ( Time 2 ) and 2-month follow-up ( Time 3 ) . Results : Analysis of covariance showed that the group assignment had a significant effect on STS ( Time 2 ) and self-efficacy ( Time 2 ) , with lower STS and higher self-efficacy reported by the self-efficacy intervention participants . Compared to the experimental group , the active control ( education ) group participants reported higher SPTG at Time 2 . Mediation analyses indicated that the group assignment had indirect effects on STS and SPTG at Time 3 . Workers who experienced increases in self-efficacy ( Time 2 ) through the intervention were more likely to report lower STS and higher SPTG at Time 3 . Conclusion : Elucidating the mediating processes that explain why an intervention for secondary trauma works is essential in order to develop more effective support systems that promote improved mental health outcomes among health and human services professionals . Prevention programs for workers exposed indirectly to traumatic events may target self-efficacy enhancement and education OBJECTIVE To compare computer-delivered and therapist-delivered treatments for people with depression and comorbid addictive disorders . DESIGN R and omised controlled clinical trial . SETTING AND PARTICIPANTS Our study was conducted between January 2005 and August 2007 at seven study clinics in rural and urban New South Wales . Participants were 274 people who had a Beck Depression Inventory II ( BDI-II ) score ≥ 17 and were using alcohol and /or cannabis at harmful levels in the month before baseline . They were self-referred or referred from other sources such as outpatient drug treatment clinics , general practice s and non-government support agencies . INTERVENTIONS Participants were r and omly allocated to receive ( 1 ) integrated cognitive behaviour therapy and motivational interviewing ( CBT/MI ) delivered by a therapist ; ( 2 ) integrated CBT/MI delivered by computer , with brief therapist assistance at the end of each session ( clinician-assisted computerised [ CAC ] treatment ) , or ( 3 ) person-centred therapy ( PCT ) , consisting of supportive counselling given by a therapist ( the control group ) . All three treatments were delivered according to a manual developed specifically for the study . MAIN OUTCOME MEASURES Changes in depression , alcohol use and cannabis use at 3 months after baseline ; significant predictors of change in the primary outcome variables . RESULTS Compared with computer- or therapist-delivered CBT/MI , PCT was associated with significantly less reduction in depression and alcohol consumption at 3 months . CAC therapy was associated with improvement at least equivalent to that achieved by therapist-delivered treatment , with superior results as far as reducing alcohol consumption . Change in depression was significantly predicted by change in alcohol use ( in the same direction ) and an ability to determine primacy , irrespective of whether this was for drug use or depression . Change in alcohol use was significantly predicted by changes in cannabis use and depression , and change in cannabis use by change in alcohol use . In the regression model , treatment allocation did not independently predict change , but was associated with significant reduction in depression and alcohol use at 3 months . CONCLUSIONS Over a 3-month period , CBT/MI was associated with a better treatment response than supportive counselling . CAC therapy was associated with greater reduction in alcohol use than therapist-delivered treatment . TRIAL REGISTRATION NUMBER ACTRN12610000274077 Background Guided self-help interventions for PTSD ( post-traumatic stress disorder ) are a promising tool for the dissemination of contemporary psychological treatment . Objective This study investigated the efficacy of the Chinese version of the My Trauma Recovery ( CMTR ) website . Methods In an urban context , 90 survivors of different trauma types were recruited via Internet advertisements  and allocated to a r and omized controlled trial ( RCT ) with a waiting list control condition . In addition , in a rural context , 93 survivors mainly of the 2008 Sichuan earthquake were recruited in-person for a parallel RCT in which the website intervention was conducted in a counseling center and guided by volunteers . Assessment was completed online on a professional Chinese survey website . The primary outcome measure was the Post-traumatic Diagnostic Scale ( PDS ) ; secondary outcome measures were Symptom Checklist 90-Depression ( SCL-D ) , Trauma Coping Self-Efficacy Scale ( CSE ) , Post-traumatic Cognitive Changes ( PCC ) , and Social Functioning Impairment ( SFI ) question naires adopted from the My Trauma Recovery website . Results For the urban sample , findings indicated a significant group × time interaction in post-traumatic symptom severity ( F 1,88=7.65 , P=.007 ) . CMTR reduced post-traumatic symptoms significantly with high effect size after one month of treatment ( F 1,45=15.13 , Cohen ’s d=0.81 , P<.001 ) and the reduction was sustained over a 3-month follow-up ( F 1,45=17.29 , Cohen ’s d=0.87 , P<.001 ) . In the rural sample , the group × time interaction was also significant in post-traumatic symptom severity ( F 1,91=5.35 , P=.02 ) . Post-traumatic symptoms decreased significantly after treatment ( F 1,48=43.97 , Cohen ’s d=1.34 , P<.001 ) and during the follow-up period ( F 1,48=24.22 , Cohen ’s d=0.99 , P<.001 ) . Additional outcome measures ( post-traumatic cognitive changes , depression ) indicated a range of positive effects , in particular in the urban sample ( group × time interactions : F 1,88=5.32 - 8.37 , all Ps<.03 ) , contributing to the positive evidence for self-help interventions . Differences in the effects in the two RCTs are exploratorily explained by sociodemographic , motivational , and setting feature differences between the two sample s. Conclusions These findings give support for the short-term efficacy of CMTR in the two Chinese population s and contribute to the literature that self-help Web-based programs can be used to provide mental health help for traumatized persons . Trial Registration Australia New Zeal and Clinical Trials Registry ( ANZCTR ) : ACTRN12611000951954 ; https://www.anzctr.org.au/Trial/ Registration /Trial Review .aspx?ACTRN=12611000951954 ( Archived by WebCite at http://www.webcitation.org/6G7WyNODk ) 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 : Internet-based methods for provision of psychological support and intervention to cancer survivors hold promise for increasing the public impact of such treatments . Purpose : The goal of this controlled pilot study was to examine the effect and potential mechanisms of action of a self-guided , Internet-based coping-skills training group on quality of life outcomes in women with early-stage breast cancer . Methods : Sixty-two women completed baseline evaluations and were r and omized into either a small online coping group or a waiting-list control condition . Results : No main effects for treatment were observed at the 12-week follow up . However , there was a significant interaction between baseline self-reported health status and treatment , such that women with poorer self-perceived health status showed greater improvement in perceived health over time when assigned to the treatment condition . Linguistic analyses revealed that positive changes across quality of life variables were associated with greater expression of negative emotions such as sadness and anxiety , greater cognitive processing , and lower expression of health-related concerns . Conclusions : These results demonstrate the potential efficacy of self-guided Internet coping groups while highlighting the limitations of such groups Objective : Veterans suffering from posttraumatic stress disorder ( PTSD ) may avoid or fail to follow through with a full course of face-to-face mental health treatment for a variety of reasons . We conducted a pilot effectiveness trial of an online intervention for veterans with current PTSD to determine the feasibility , safety , and preliminary effectiveness of an online writing intervention ( i.e. , Warriors Internet Recovery & EDucation [ WIRED ] ) as an adjunct to face-to-face psychotherapy . Method : Veterans ( N = 34 ) who had served in Iraq or Afghanistan with current PTSD subsequent to deployment-related trauma were r and omized to Veterans Affairs ( VA ) mental health treatment as usual ( TAU ) or to treatment as usual plus the online intervention ( TAU + WIRED ) . All research participants were recruited from the Trauma Services Program , 
    Output:
    
Conclusions This review demonstrates an emerging evidence base supporting e-Mental Health to treat symptoms of PTSD