human
***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: Background In a recent exploratory r and omised trial we found that a novel , internet-based psychoeducation programme for bipolar disorder ( Beating Bipolar ) was relatively easy to deliver and had a modest effect on psychological quality of life . We sought to explore the experiences of participants with respect to feasibility , acceptability and impact of Beating Bipolar . Methods Participants were invited to take part in a semi-structured interview . Thematic analysis techniques were employed ; to explore and describe participants ’ experiences , the data were analysed for emerging themes which were identified and coded . Results The programme was feasible to deliver and acceptable to participants where they felt comfortable using a computer . It was found to impact upon insight into illness , health behaviour , personal routines and positive attitudes towards medication . Many participants regarded the programme as likely to be most beneficial for those recently diagnosed . Conclusions An online psychoeducation package for bipolar disorder , such as Beating Bipolar , is feasible and acceptable to patients , has a positive impact on self-management behaviours and may be particularly suited to early intervention . Alternative ( non-internet ) formats should also be made available to patients Objective To explore patient experience of computerised cognitive behaviour therapy ( cCBT ) for depression in a pragmatic r and omised controlled trial ( R and omised Evaluation of the Effectiveness and Acceptability of Computerised Therapy , REEACT ) . Design Qualitative semistructured interviews with 36 participants . Participants Depressed patients with a Patient Health Question naire 9 of 10 or above recruited into the REEACT r and omised controlled trial . Setting Primary care setting s in Engl and . Results Participant experience was on a continuum , with some patients unable or unwilling to accept psychological therapy without interpersonal contact while others appreciated the enhanced anonymity and flexibility of cCBT . The majority of patients were ambivalent , recognising the potential benefits offered by cCBT but struggling with challenges posed by the severity of their illness , lack of support and limited personalisation of programme content . Low completion rates were commonly reported , although more positive patients reported greater engagement . Both positive and ambivalent patients perceived a need for monitoring or follow-up to support completion , while negative patients reported deliberate non-adherence due to dissatisfaction with the programme . Patients also reported that severity of depression impacted on engagement , and viewed cCBT as unsuitable for patients undergoing more severe depressive episodes . Conclusions The study demonstrates both the unique dem and s and benefits of computerised therapy . cCBT was preferred by some patients and rejected by others , but the majority of patients were ambivalent about the therapy . cCBT could be offered within a menu of options in stepped care if matched appropriately to individual patients or could be offered with enhanced support to appeal to a greater number of patients . Trial registration number IS RCT N91947481 AIMS The aim of the study was to investigate preferences in the general population regarding type of treatment for alcohol problems and the preferred setting for delivery of treatment and reasons for not seeking treatment for alcohol problems . METHOD Data were from a r and om , cross-sectional , interview survey of 9005 of the Swedish general population . Proportions of respondents preferring a certain treatment and source of treatment , and reasons suggested for why people do not seek treatment , were analysed in relation to number of st and ard drinks , employment status , education and income . RESULTS Most frequently endorsed forms of treatment were alcoholics anonymous or similar support groups and psychotherapy . More than 50 % preferred psychiatric or addiction specialist treatment . Around 10 % preferred primary health care and around 20 % the occupational health services . About 5 % preferred the social services . Respondents rated ' feeling ashamed ' as the most important reason why people would not seek help for alcohol problems . CONCLUSION Large majorities of the respondents preferred treatment in the health care services and few in the social services . Internet-based treatment and pharmacological treatment attracted few respondents , the majority preferring more traditional forms of treatment . Alcohol treatment remains a stigmatized field , evidence d by shame being the most commonly reported reason for not seeking treatment Background The prevalence of depression is high and results in huge costs for society . Internet-based cognitive behavioural treatment ( ICBT ) has been suggested for use in primary care and has been shown to be more effective when combined with human support . However , non-completion rates remain a challenge . Current recommendations state that steps to improve persistence with ICBT should be determined and the impact of therapist support on persistence explored . A few earlier studies have explored motivations to persist with ICBT without face-to-face therapist support . The present study explored the motivation to persist as experienced by a group of patients who sought help in primary care and used “ blended care ” , i.e. ICBT supported by short face-to-face consultations .  Methods To eluci date motivation in an everyday context and the meaning of patients ’ experiences we chose a phenomenological hermeneutical approach . We interviewed participants in the intervention group of a r and omized controlled trial that evaluated the efficacy of an ICBT programme called MoodGYM , an eHealth intervention used to treat depression . Fourteen participants , both completers and non-completers , went through individual , semi-structured interviews after they ended their treatment . Results Hope of recovery and a desire to gain control of one ’s life were identified as intrinsic motivators . The feeling of being able to freely choose how , when and where to complete the ICBT modules was identified as an important supporting condition and satisfied the participants ’ need for autonomy . Furthermore , the importance of a sense of belonging towards partners , friends or family was essential for motivation as was the ability to identify with ICBT content . Another supporting condition was the experience of connectedness when met with acknowledgement , flexibility and feedback from a qualified therapist in the face-to-face consultations . Conclusions A key finding was that participants were motivated to persist with ICBT when their overall need for relatedness was satisfied . This was achieved through a sense of belonging towards partners , friends and family . Connectedness with the therapist and the participant ’s ability to identify with the ICBT modules also gave a sense of relatedness . Improving these motivational aspects may increase patients ’ persistence with ICBT OBJECTIVE To explore expectations and experiences of online cognitive behavioural therapy ( CBT ) among primary -care patients with depression , focusing on how this mode of delivery impacts upon the therapeutic experience . DESIGN Qualitative study , using repeat semi-structured interviews with patients before and after therapy . The study was conducted in parallel with a r and omized controlled trial examining the effectiveness and cost-effectiveness of online CBT for patients with depression . PARTICIPANTS Twenty-four patients with depression recruited from five general practice s in southwest Engl and , who were offered up to 10 sessions of CBT , delivered via the internet by a psychologist . RESULTS Most participants accessed the therapy from their home computer and found this to be a major advantage , in terms of convenience and fitting therapy into their daily routine , with any technical problems quickly resolved . Two key themes regarding expectations and experiences of online CBT were : developing a virtual relationship with a therapist , and the process of communicating thoughts and emotions via an online medium . Online CBT seems to be acceptable to , and experienced as helpful by , certain subgroups of patients with depression , particularly those who are familiar with computers , feel comfortable with writing their feelings down , enjoy the opportunities to review and reflect that written ( or typed ) communication offers are attracted to the ' anonymity ' of an online therapeutic relationship and are open to the proactive requirements of CBT itself . However , on-line CBT may feed into the vulnerability of depressed people to negative thoughts , given the absence of visual cues and the immediate response of face-to-face interaction . CONCLUSIONS Online CBT has the potential to enhance care for patients with depression who are open to engaging in ' talking ' ( or typing ) therapies as part of their treatment . If online CBT is to be provided via the NHS , it is important to establish patient preferences regarding this mode of delivery and ensure that referral practice s are appropriately targeted . The results of our main trial will provide evidence regarding the effectiveness and cost-effectiveness of receiving therapy via this modality Postpartum depression impacts up to 15 % of Canadian women following childbirth . Remarkably , many women suffering from this disorder do not receive appropriate treatment . The aim of this study was to conduct a parallel-group r and omized controlled trial to determine the efficacy of Therapist-Assisted Internet-delivered Cognitive Behavior Therapy ( TA-ICBT ) for the treatment of postpartum depression . This study was registered with the International St and ard R and omized Controlled Trials ( IS RCT N : 85456371 ) and received funding from Canadian Institutes of Health Research ( # 101526 ) and the Saskatchewan Health Research Foundation . Fifty women who gave birth to an infant in the past year , who scored above 10 on the Edinburgh Postnatal Depression Scale ( EPDS ) , and who resided in Saskatchewan , Canada were eligible to participate . Participants were r and omly assigned to receive either TA-ICBT ( n = 25 ) or waitlist control ( n = 25 ) . The efficacy of the treatment was investigated at baseline and at seven- to 10-week follow-up . TA-ICBT participants were also contacted four-weeks following treatment completion . Symptoms of postpartum depression decreased more for participants in the TA-ICBT group ( average reduction of 6.24 points on the EPDS ; n = 21 included in analyses ) compared to those participants in the waitlist control group ( average reduction of 2.42 points on the EPDS ; n = 20 included in analyses ) , and these results were clinical ly significant and maintained at four-week follow-up . TA-ICBT participants demonstrated a reduction in postnatal anxiety , general stress , and parental distress , and an increase in psychological and environmental quality of life when compared to the waitlist control participants . Study implication s , limitations , and future research directions are discussed . Trial Registration Controlled-Trials.com IS RCT Background Although numerous efficacy studies in recent years have found internet-based interventions for depression to be effective , there has been scant consideration of therapeutic process factors in the online setting . In face-to face therapy , the quality of the working alliance explains variance in treatment outcome . However , little is yet known about the impact of the working alliance in internet-based interventions , particularly as compared with face-to-face therapy . Methods This study explored the working alliance between client and therapist in the middle and at the end of a cognitive-behavioral intervention for depression . The participants were r and omized to an internet-based treatment group ( n = 25 ) or face-to-face group ( n = 28 ) . Both groups received the same cognitive behavioral therapy over an 8-week timeframe . Participants completed the Beck Depression Inventory ( BDI ) post-treatment and the Working Alliance Inventory at mid- and post- treatment . Therapists completed the  therapist version of the Working Alliance Inventory  at post-treatment . Results With the exception of therapists ' ratings of the tasks subscale , which were significantly higher in the online group , the two groups ' ratings of the working alliance did not differ significantly . Further , significant correlations were found between clients ' ratings of the working alliance and therapy outcome at post-treatment in the online group and at both mid- and post-treatment in the face-to-face group . Correlation analysis revealed that the working alliance ratings did not significantly predict the BDI residual gain score in either group . Conclusions Contrary to what might have been expected , the working alliance in the online group was comparable to that in the face-to-face group . However , the results showed no significant relations between the BDI residual gain score and the working alliance ratings in either group . Trial registration Background and Aims Major depression can be treated by means of cognitive behavior therapy , delivered via the Internet as guided self-help . Individually tailored guided self-help treatments have shown promising results in the treatment of anxiety disorders . This r and omized controlled trial tested the efficacy of an Internet-based individually tailored guided self-help treatment which specifically targeted depression with comorbid symptoms . The treatment was compared both to st and ardized ( non-tailored ) Internet-based treatment and to an active control group in the form of a monitored online discussion group . Both guided self-help treatments were based on cognitive behavior therapy and lasted for 10 weeks . The discussion group consisted of weekly discussion themes related to depression and the treatment of depression . Methods A total of 121 participants with diagnosed major depressive disorder and with a range of comorbid symptoms were r and omized to three groups . The tailored treatment consisted of a prescribed set of modules targeting depression as well as comorbid problems . The st and ardized treatment was a previously tested guided self-help program for depression . Results From pre-treatment to post-treatment , both treatment groups improved on measures of depression , anxiety and quality of life . The results were maintained at a 6-month follow-up . Subgroup analyses showed that the tailored treatment was more effective than the st and ardized treatment among participants with higher levels of depression at baseline and more comorbidity , both in terms of reduction of depressive symptoms and on recovery rates . In the subgroup with lower baseline scores of depression , few differences were seen between treatments and the discussion group . Conclusions This study shows that tailored Internet-based treatment for depression is effective and that addressing comorbidity by tailoring may be one way of making guided self-help treatments more effective than st and ardized approaches in the treatment of more severe depression . Trial Registration Clinical trials.gov Background Approximately two thirds of adults undergoing cardiac surgery suffer from moderate to severe postoperative pain . Assisting patients with pain management is therefore critical to prevent its negative consequences . Information technologies have become part of our lifestyle and can facilitate the implementation of interventions to manage pain in a busy care setting . A computer-tailored and Web-based intervention — referred to as SOUtien à L’AutoGEstion-Traitement-Assistance Virtuelle Infirmière-Enseignement (SOULAGE-TAVIE)—for the self-management of pain was developed . Findings from a previous pilot r and omized controlled trial ( RCT ) provided some evidence of the feasibility and preliminary effectiveness of this intervention in 
    Output:
    
agent
***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: Background In a recent exploratory r and omised trial we found that a novel , internet-based psychoeducation programme for bipolar disorder ( Beating Bipolar ) was relatively easy to deliver and had a modest effect on psychological quality of life . We sought to explore the experiences of participants with respect to feasibility , acceptability and impact of Beating Bipolar . Methods Participants were invited to take part in a semi-structured interview . Thematic analysis techniques were employed ; to explore and describe participants ’ experiences , the data were analysed for emerging themes which were identified and coded . Results The programme was feasible to deliver and acceptable to participants where they felt comfortable using a computer . It was found to impact upon insight into illness , health behaviour , personal routines and positive attitudes towards medication . Many participants regarded the programme as likely to be most beneficial for those recently diagnosed . Conclusions An online psychoeducation package for bipolar disorder , such as Beating Bipolar , is feasible and acceptable to patients , has a positive impact on self-management behaviours and may be particularly suited to early intervention . Alternative ( non-internet ) formats should also be made available to patients Objective To explore patient experience of computerised cognitive behaviour therapy ( cCBT ) for depression in a pragmatic r and omised controlled trial ( R and omised Evaluation of the Effectiveness and Acceptability of Computerised Therapy , REEACT ) . Design Qualitative semistructured interviews with 36 participants . Participants Depressed patients with a Patient Health Question naire 9 of 10 or above recruited into the REEACT r and omised controlled trial . Setting Primary care setting s in Engl and . Results Participant experience was on a continuum , with some patients unable or unwilling to accept psychological therapy without interpersonal contact while others appreciated the enhanced anonymity and flexibility of cCBT . The majority of patients were ambivalent , recognising the potential benefits offered by cCBT but struggling with challenges posed by the severity of their illness , lack of support and limited personalisation of programme content . Low completion rates were commonly reported , although more positive patients reported greater engagement . Both positive and ambivalent patients perceived a need for monitoring or follow-up to support completion , while negative patients reported deliberate non-adherence due to dissatisfaction with the programme . Patients also reported that severity of depression impacted on engagement , and viewed cCBT as unsuitable for patients undergoing more severe depressive episodes . Conclusions The study demonstrates both the unique dem and s and benefits of computerised therapy . cCBT was preferred by some patients and rejected by others , but the majority of patients were ambivalent about the therapy . cCBT could be offered within a menu of options in stepped care if matched appropriately to individual patients or could be offered with enhanced support to appeal to a greater number of patients . Trial registration number IS RCT N91947481 AIMS The aim of the study was to investigate preferences in the general population regarding type of treatment for alcohol problems and the preferred setting for delivery of treatment and reasons for not seeking treatment for alcohol problems . METHOD Data were from a r and om , cross-sectional , interview survey of 9005 of the Swedish general population . Proportions of respondents preferring a certain treatment and source of treatment , and reasons suggested for why people do not seek treatment , were analysed in relation to number of st and ard drinks , employment status , education and income . RESULTS Most frequently endorsed forms of treatment were alcoholics anonymous or similar support groups and psychotherapy . More than 50 % preferred psychiatric or addiction specialist treatment . Around 10 % preferred primary health care and around 20 % the occupational health services . About 5 % preferred the social services . Respondents rated ' feeling ashamed ' as the most important reason why people would not seek help for alcohol problems . CONCLUSION Large majorities of the respondents preferred treatment in the health care services and few in the social services . Internet-based treatment and pharmacological treatment attracted few respondents , the majority preferring more traditional forms of treatment . Alcohol treatment remains a stigmatized field , evidence d by shame being the most commonly reported reason for not seeking treatment Background The prevalence of depression is high and results in huge costs for society . Internet-based cognitive behavioural treatment ( ICBT ) has been suggested for use in primary care and has been shown to be more effective when combined with human support . However , non-completion rates remain a challenge . Current recommendations state that steps to improve persistence with ICBT should be determined and the impact of therapist support on persistence explored . A few earlier studies have explored motivations to persist with ICBT without face-to-face therapist support . The present study explored the motivation to persist as experienced by a group of patients who sought help in primary care and used “ blended care ” , i.e. ICBT supported by short face-to-face consultations .  Methods To eluci date motivation in an everyday context and the meaning of patients ’ experiences we chose a phenomenological hermeneutical approach . We interviewed participants in the intervention group of a r and omized controlled trial that evaluated the efficacy of an ICBT programme called MoodGYM , an eHealth intervention used to treat depression . Fourteen participants , both completers and non-completers , went through individual , semi-structured interviews after they ended their treatment . Results Hope of recovery and a desire to gain control of one ’s life were identified as intrinsic motivators . The feeling of being able to freely choose how , when and where to complete the ICBT modules was identified as an important supporting condition and satisfied the participants ’ need for autonomy . Furthermore , the importance of a sense of belonging towards partners , friends or family was essential for motivation as was the ability to identify with ICBT content . Another supporting condition was the experience of connectedness when met with acknowledgement , flexibility and feedback from a qualified therapist in the face-to-face consultations . Conclusions A key finding was that participants were motivated to persist with ICBT when their overall need for relatedness was satisfied . This was achieved through a sense of belonging towards partners , friends and family . Connectedness with the therapist and the participant ’s ability to identify with the ICBT modules also gave a sense of relatedness . Improving these motivational aspects may increase patients ’ persistence with ICBT OBJECTIVE To explore expectations and experiences of online cognitive behavioural therapy ( CBT ) among primary -care patients with depression , focusing on how this mode of delivery impacts upon the therapeutic experience . DESIGN Qualitative study , using repeat semi-structured interviews with patients before and after therapy . The study was conducted in parallel with a r and omized controlled trial examining the effectiveness and cost-effectiveness of online CBT for patients with depression . PARTICIPANTS Twenty-four patients with depression recruited from five general practice s in southwest Engl and , who were offered up to 10 sessions of CBT , delivered via the internet by a psychologist . RESULTS Most participants accessed the therapy from their home computer and found this to be a major advantage , in terms of convenience and fitting therapy into their daily routine , with any technical problems quickly resolved . Two key themes regarding expectations and experiences of online CBT were : developing a virtual relationship with a therapist , and the process of communicating thoughts and emotions via an online medium . Online CBT seems to be acceptable to , and experienced as helpful by , certain subgroups of patients with depression , particularly those who are familiar with computers , feel comfortable with writing their feelings down , enjoy the opportunities to review and reflect that written ( or typed ) communication offers are attracted to the ' anonymity ' of an online therapeutic relationship and are open to the proactive requirements of CBT itself . However , on-line CBT may feed into the vulnerability of depressed people to negative thoughts , given the absence of visual cues and the immediate response of face-to-face interaction . CONCLUSIONS Online CBT has the potential to enhance care for patients with depression who are open to engaging in ' talking ' ( or typing ) therapies as part of their treatment . If online CBT is to be provided via the NHS , it is important to establish patient preferences regarding this mode of delivery and ensure that referral practice s are appropriately targeted . The results of our main trial will provide evidence regarding the effectiveness and cost-effectiveness of receiving therapy via this modality Postpartum depression impacts up to 15 % of Canadian women following childbirth . Remarkably , many women suffering from this disorder do not receive appropriate treatment . The aim of this study was to conduct a parallel-group r and omized controlled trial to determine the efficacy of Therapist-Assisted Internet-delivered Cognitive Behavior Therapy ( TA-ICBT ) for the treatment of postpartum depression . This study was registered with the International St and ard R and omized Controlled Trials ( IS RCT N : 85456371 ) and received funding from Canadian Institutes of Health Research ( # 101526 ) and the Saskatchewan Health Research Foundation . Fifty women who gave birth to an infant in the past year , who scored above 10 on the Edinburgh Postnatal Depression Scale ( EPDS ) , and who resided in Saskatchewan , Canada were eligible to participate . Participants were r and omly assigned to receive either TA-ICBT ( n = 25 ) or waitlist control ( n = 25 ) . The efficacy of the treatment was investigated at baseline and at seven- to 10-week follow-up . TA-ICBT participants were also contacted four-weeks following treatment completion . Symptoms of postpartum depression decreased more for participants in the TA-ICBT group ( average reduction of 6.24 points on the EPDS ; n = 21 included in analyses ) compared to those participants in the waitlist control group ( average reduction of 2.42 points on the EPDS ; n = 20 included in analyses ) , and these results were clinical ly significant and maintained at four-week follow-up . TA-ICBT participants demonstrated a reduction in postnatal anxiety , general stress , and parental distress , and an increase in psychological and environmental quality of life when compared to the waitlist control participants . Study implication s , limitations , and future research directions are discussed . Trial Registration Controlled-Trials.com IS RCT Background Although numerous efficacy studies in recent years have found internet-based interventions for depression to be effective , there has been scant consideration of therapeutic process factors in the online setting . In face-to face therapy , the quality of the working alliance explains variance in treatment outcome . However , little is yet known about the impact of the working alliance in internet-based interventions , particularly as compared with face-to-face therapy . Methods This study explored the working alliance between client and therapist in the middle and at the end of a cognitive-behavioral intervention for depression . The participants were r and omized to an internet-based treatment group ( n = 25 ) or face-to-face group ( n = 28 ) . Both groups received the same cognitive behavioral therapy over an 8-week timeframe . Participants completed the Beck Depression Inventory ( BDI ) post-treatment and the Working Alliance Inventory at mid- and post- treatment . Therapists completed the  therapist version of the Working Alliance Inventory  at post-treatment . Results With the exception of therapists ' ratings of the tasks subscale , which were significantly higher in the online group , the two groups ' ratings of the working alliance did not differ significantly . Further , significant correlations were found between clients ' ratings of the working alliance and therapy outcome at post-treatment in the online group and at both mid- and post-treatment in the face-to-face group . Correlation analysis revealed that the working alliance ratings did not significantly predict the BDI residual gain score in either group . Conclusions Contrary to what might have been expected , the working alliance in the online group was comparable to that in the face-to-face group . However , the results showed no significant relations between the BDI residual gain score and the working alliance ratings in either group . Trial registration Background and Aims Major depression can be treated by means of cognitive behavior therapy , delivered via the Internet as guided self-help . Individually tailored guided self-help treatments have shown promising results in the treatment of anxiety disorders . This r and omized controlled trial tested the efficacy of an Internet-based individually tailored guided self-help treatment which specifically targeted depression with comorbid symptoms . The treatment was compared both to st and ardized ( non-tailored ) Internet-based treatment and to an active control group in the form of a monitored online discussion group . Both guided self-help treatments were based on cognitive behavior therapy and lasted for 10 weeks . The discussion group consisted of weekly discussion themes related to depression and the treatment of depression . Methods A total of 121 participants with diagnosed major depressive disorder and with a range of comorbid symptoms were r and omized to three groups . The tailored treatment consisted of a prescribed set of modules targeting depression as well as comorbid problems . The st and ardized treatment was a previously tested guided self-help program for depression . Results From pre-treatment to post-treatment , both treatment groups improved on measures of depression , anxiety and quality of life . The results were maintained at a 6-month follow-up . Subgroup analyses showed that the tailored treatment was more effective than the st and ardized treatment among participants with higher levels of depression at baseline and more comorbidity , both in terms of reduction of depressive symptoms and on recovery rates . In the subgroup with lower baseline scores of depression , few differences were seen between treatments and the discussion group . Conclusions This study shows that tailored Internet-based treatment for depression is effective and that addressing comorbidity by tailoring may be one way of making guided self-help treatments more effective than st and ardized approaches in the treatment of more severe depression . Trial Registration Clinical trials.gov Background Approximately two thirds of adults undergoing cardiac surgery suffer from moderate to severe postoperative pain . Assisting patients with pain management is therefore critical to prevent its negative consequences . Information technologies have become part of our lifestyle and can facilitate the implementation of interventions to manage pain in a busy care setting . A computer-tailored and Web-based intervention — referred to as SOUtien à L’AutoGEstion-Traitement-Assistance Virtuelle Infirmière-Enseignement (SOULAGE-TAVIE)—for the self-management of pain was developed . Findings from a previous pilot r and omized controlled trial ( RCT ) provided some evidence of the feasibility and preliminary effectiveness of this intervention in 
    Output:
    