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 Subthreshold depression is a highly prevalent condition and a risk factor for developing a major depressive episode . Internet-based cognitive behaviour therapy may be a promising approach for the treatment of subthreshold depression . The current study had two aims : ( 1 ) to determine whether an internet-based cognitive behaviour therapy intervention and a group cognitive behaviour therapy intervention are more effective than a waiting-list control group ; and ( 2 ) to determine whether the effect of the internet-based cognitive behaviour therapy differs from the group cognitive behaviour therapy intervention . METHOD A total of 191 women and 110 men with subthreshold depression were r and omized into internet-based treatment , group cognitive behaviour therapy ( Lewinsohn 's Coping With Depression course ) , or a waiting-list control condition . The main outcome measure was treatment response after 10 weeks , defined as the difference in pre- and post-treatment scores on the Beck Depression Inventory ( BDI ) . Missing data , a major limitation of this study , were imputed using the Multiple Imputation ( MI ) procedure Data Augmentation . RESULTS In the waiting-list control group , we found a pre- to post-improvement effect size of 0.45 , which was 0.65 in the group cognitive behaviour therapy condition and 1.00 within the internet-based treatment condition . Helmert contrasts showed a significant difference between the waiting-list condition and the two treatment conditions ( p=0.04 ) and no significant difference between both treatment conditions ( p=0.62 ) . CONCLUSIONS An internet-based intervention may be at least as effective as a commonly used group cognitive behaviour therapy intervention for subthreshold depression in people over 50 years of age Background The Internet has potential as a medium for health behavior change programs , but no controlled studies have yet evaluated the impact of a fully automated physical activity intervention over several months with real-time objective feedback from a monitor . Objective The aim was to evaluate the impact of a physical activity program based on the Internet and mobile phone technology provided to individuals for 9 weeks . Methods A single-center , r and omized , stratified controlled trial was conducted from September to December 2005 in Bedfordshire , United Kingdom , with 77 healthy adults whose mean age was 40.4 years ( SD = 7.6 ) and mean body mass index was 26.3 ( SD = 3.4 ) . Participants were r and omized to a test group that had access to an Internet and mobile phone – based physical activity program  ( n = 47 ) or to a control group ( n = 30 ) that  received no support . The test group received tailored solutions for perceived barriers , a schedule to plan weekly exercise sessions with mobile phone and email reminders , a message board to share their experiences with others , and feedback on their level of physical activity . Both groups were issued a wrist-worn accelerometer to monitor their level of physical activity ;  only the test group received real-time feedback via the Internet . The main outcome measures were accelerometer data and self-report of physical activity . Results At the end of the study period , the test group reported a significantly greater increase over baseline than did the control group for perceived control ( P < .001 ) and intention/expectation to exercise ( P < .001 ) . Intent-to-treat analyses of both the accelerometer data ( P = .02 ) and leisure time self-report data ( P = .03 ) found a higher level of moderate physical activity in the test group . The average increase ( over the control group ) in accelerometer-measured moderate physical activity was 2 h 18 min per week . The test group also lost more percent body fat than the control group ( test group : −2.18 , SD = 0.59 ; control group : −0.17 , SD = 0.81 ; P = .04 ) . Conclusions A fully automated Internet and mobile phone – based motivation and action support system can significantly increase and maintain the level of physical activity in healthy adults Background and aims Psychodynamic psychotherapy ( PDT ) is an effective treatment for major depressive disorder ( MDD ) , but not all clients with MDD can receive psychotherapy . Using the Internet to provide psychodynamic treatments is one way of improving access to psychological treatments for MDD . The aim of this r and omised controlled trial was to investigate the efficacy of an Internet-based psychodynamic guided self-help treatment for MDD . Methods Ninety-two participants who were diagnosed with MDD according to the Mini-International Neuropsychiatric Interview were r and omised to treatment or an active control . The treatment consisted of nine treatment modules based on psychodynamic principles with online therapist contact . The active control condition was a structured support intervention and contained psychoeducation and scheduled weekly contacts online . Both interventions lasted for 10 weeks . The primary outcome measure was the Beck Depression Inventory-II ( BDI-II ) . Results Mixed-effects model analyses of all r and omised participants showed that participants receiving Internet-based PDT made large and superior improvements compared with the active control group on the BDI-II ( between-group Cohen 's d = 1.11 ) . Treatment effects were maintained at a 10-month follow-up . Conclusions Internet-based psychodynamic guided self-help is an efficacious treatment for MDD that has the potential to increase accessibility and availability of PDT for MDD . Trial Registration Clinical trials.gov : BACKGROUND Major depression can be treated by means of cognitive-behavioural therapy , but as skilled therapists are in short supply there is a need for self-help approaches . Many individuals with depression use the internet for discussion of symptoms and to share their experience . AIMS To investigate the effects of an internet-administered self-help programme including participation in a monitored , web-based discussion group , compared with participation in web-based discussion group only . METHOD A r and omised controlled trial was conducted to compare the effects of internet-based cognitive-behavioural therapy with minimal therapist contact ( plus participation in a discussion group ) with the effects of participation in a discussion group only . RESULTS Internet-based therapy with minimal therapist contact , combined with activity in a discussion group , result ed in greater reductions of depressive symptoms compared with activity in a discussion group only ( waiting-list control group ) . At 6 months ' follow-up , improvement was maintained to a large extent . CONCLUSIONS Internet-delivered cognitive cognitive-behavioural therapy should be pursued further as a complement or treatment alternative for mild-to-moderate depression Internet-delivered self-help for  depression  with therapist guidance has shown efficacy in several trials . Results from meta-analyses suggest that guidance is important and that self-help programs without support are less effective . However , there are no direct experimental comparisons between guided and unguided internet-based treatments for depression . The present study compared the benefits of a 10-week web-based unguided self-help treatment with the same intervention complemented with weekly therapist support via e-mail . A waiting-list control group was also included . Seventy-six individuals meeting the diagnostic criteria of major depression or dysthymia were r and omly assigned to one of the three conditions . The Beck Depression Inventory ( BDI-II ) was used as the primary outcome measure . Secondary outcomes included general psychopathology , interpersonal problems , and quality of life .  Sixty-nine participants ( 91 % ) completed the assessment at posttreatment and 59 ( 78 % ) at 6-month follow-up . Results showed significant symptom reductions in both treatment groups compared to the waiting-list control group . At posttreatment , between-group effect sizes on the BDI-II were d = .66 for unguided self-help versus waiting-list and d = 1.14 for guided self-help versus waiting-list controls . In the comparison of the two active treatments , small-to-moderate , but not statistically significant effects in favor of the guided condition were found on all measured dimensions . In both groups , treatment gains were maintained at 6-month follow-up . The findings provide evidence that internet-delivered treatments for depression can be effective whether support is added or not . However , all participants were interviewed in a structured diagnostic telephone interview before inclusion , which prohibits conclusions regarding unguided treatments that are without any human contact Background Depression is a burdensome , recurring mental health disorder with high prevalence . Even in developed countries , patients have to wait for several months to receive treatment . In many parts of the world there is only one mental health professional for over 200 people . Smartphones are ubiquitous and have a large complement of sensors that can potentially be useful in monitoring behavioral patterns that might be indicative of depressive symptoms and providing context -sensitive intervention support . Objective The objective of this study is 2-fold , first to explore the detection of daily-life behavior based on sensor information to identify subjects with a clinical ly meaningful depression level , second to explore the potential of context sensitive intervention delivery to provide in-situ support for people with depressive symptoms . Methods A total of 126 adults ( age 20 - 57 ) were recruited to use the smartphone app Mobile Sensing and Support ( MOSS )  , collecting context -sensitive sensor information and providing just-in-time interventions derived from cognitive behavior therapy . Real-time learning-systems were deployed to adapt to each subject ’s preferences to optimize recommendations with respect to time , location , and personal preference . Biweekly , participants were asked to complete a  self-reported depression survey ( PHQ-9 ) to track symptom progression . Wilcoxon tests were conducted to compare scores before and after intervention . Correlation analysis was used to test the relationship between adherence and change in PHQ-9 . One hundred twenty features were constructed based on smartphone usage and sensors including  accelerometer , Wifi  , and  global positioning systems ( GPS  )  . Machine-learning models used these features to infer behavior and context for PHQ-9 level prediction and tailored intervention delivery . Results A total of 36 subjects used MOSS for ≥2 weeks . For subjects with clinical depression ( PHQ-9≥11 ) at baseline and adherence ≥8 weeks ( n=12 ) , a significant drop in PHQ-9 was observed ( P=.01 ) . This group showed a negative trend between adherence and change in PHQ-9 scores ( rho=−.498 , P=.099 ) . Binary classification performance for biweekly PHQ-9 sample s ( n=143 ) , with a cutoff of PHQ-9≥11 , based on R and om Forest and Support Vector Machine leave-one-out cross validation result ed in 60.1 % and 59.1 % accuracy , respectively . Conclusions Proxies for social and physical behavior derived from smartphone sensor data was successfully deployed to deliver context -sensitive and personalized interventions to people with depressive symptoms . Subjects who used the app for an extended period of time showed significant reduction in self-reported symptom severity . Nonlinear classification models trained on features extracted from smartphone sensor data including Wifi , accelerometer , GPS , and phone use , demonstrated a proof of concept for the detection of depression superior to r and om classification . While findings of effectiveness must be reproduced in a RCT to proof causation , they pave the way for a new generation of digital health interventions leveraging smartphone sensors to provide context sensitive information for in-situ support and unobtrusive monitoring of critical mental health states Depression is among the most prevalent disorders worldwide . In view of numerous treatment barriers , internet-based interventions are increasingly adopted to " treat the untreated " . The present trial ( registered as NCT01401296 ) was conducted over the internet and aim ed to assess the efficacy of an online self-help program for depression ( Deprexis ) . In r and om order , participants with elevated depression symptoms received program access or were allocated to a wait-list control condition . After eight weeks , participants were invited to take part in an online re- assessment . To compensate for common problems of online studies , such as low completion rates and unclear diagnostic status , reminders and incentives were used , and clinical diagnoses were externally confirmed in a subgroup of 29 % of participants . Relative to the wait-list group , program users experienced significant symptom decline on the Beck Depression Inventory ( BDI ; primary outcome ) , the Dysfunctional Attitudes Scale ( DAS ) , the Quality of Life scale ( WHOQOL-BREF ) and the Rosenberg Self-Esteem Scale ( RSE ) . Compared to wait-list participants , symptom decline was especially pronounced among those with moderate symptoms at baseline as well as those not currently consulting a therapist . Completion ( 82 % ) and re-test reliability of the instruments ( r = .72-.87 ) were good . The results of this trial suggest that online treatment can be beneficial for people with depression , particularly for those with moderate symptoms Background . Psychodynamic psychotherapy is a psychological treatment approach that has a growing empirical base . Research has indicated an association between therapist-facilitated affective experience and outcome in psychodynamic therapy . Affect-phobia therapy ( APT ) , as outlined by McCullough et al. , is a psychodynamic treatment that emphasizes a strong focus on expression and experience of affect . This model has neither been evaluated for depression nor anxiety disorders in a r and omized controlled trial . While Internet-delivered psychodynamic treatments for depression and generalized anxiety disorder exist , they have not been based on APT . The aim of this r and omized controlled trial was to investigate the efficacy of an Internet-based , psychodynamic , guided self-help treatment based on APT for depression and anxiety disorders . Methods . One hundred participants with diagnoses of mood and anxiety disorders participated in a r and omized ( 1:1 ratio ) controlled trial of an active group versus a control condition . The treatment group received a 10-week , psychodynamic , guided self-help treatment based on APT that was delivered through the Internet . The treatment consisted of eight text-based treatment modules and included therapist contact ( 9.5 min per client and week , on average ) in a secure online environment . Participants in the control group also received online therapist support and clinical monitoring of symptoms , but received no treatment modules . Outcome measures were the 9-item Patient Health Question naire Depression Scale ( PHQ-9 ) and the 7-item Generalized Anxiety Disorder Sc 
    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 Subthreshold depression is a highly prevalent condition and a risk factor for developing a major depressive episode . Internet-based cognitive behaviour therapy may be a promising approach for the treatment of subthreshold depression . The current study had two aims : ( 1 ) to determine whether an internet-based cognitive behaviour therapy intervention and a group cognitive behaviour therapy intervention are more effective than a waiting-list control group ; and ( 2 ) to determine whether the effect of the internet-based cognitive behaviour therapy differs from the group cognitive behaviour therapy intervention . METHOD A total of 191 women and 110 men with subthreshold depression were r and omized into internet-based treatment , group cognitive behaviour therapy ( Lewinsohn 's Coping With Depression course ) , or a waiting-list control condition . The main outcome measure was treatment response after 10 weeks , defined as the difference in pre- and post-treatment scores on the Beck Depression Inventory ( BDI ) . Missing data , a major limitation of this study , were imputed using the Multiple Imputation ( MI ) procedure Data Augmentation . RESULTS In the waiting-list control group , we found a pre- to post-improvement effect size of 0.45 , which was 0.65 in the group cognitive behaviour therapy condition and 1.00 within the internet-based treatment condition . Helmert contrasts showed a significant difference between the waiting-list condition and the two treatment conditions ( p=0.04 ) and no significant difference between both treatment conditions ( p=0.62 ) . CONCLUSIONS An internet-based intervention may be at least as effective as a commonly used group cognitive behaviour therapy intervention for subthreshold depression in people over 50 years of age Background The Internet has potential as a medium for health behavior change programs , but no controlled studies have yet evaluated the impact of a fully automated physical activity intervention over several months with real-time objective feedback from a monitor . Objective The aim was to evaluate the impact of a physical activity program based on the Internet and mobile phone technology provided to individuals for 9 weeks . Methods A single-center , r and omized , stratified controlled trial was conducted from September to December 2005 in Bedfordshire , United Kingdom , with 77 healthy adults whose mean age was 40.4 years ( SD = 7.6 ) and mean body mass index was 26.3 ( SD = 3.4 ) . Participants were r and omized to a test group that had access to an Internet and mobile phone – based physical activity program  ( n = 47 ) or to a control group ( n = 30 ) that  received no support . The test group received tailored solutions for perceived barriers , a schedule to plan weekly exercise sessions with mobile phone and email reminders , a message board to share their experiences with others , and feedback on their level of physical activity . Both groups were issued a wrist-worn accelerometer to monitor their level of physical activity ;  only the test group received real-time feedback via the Internet . The main outcome measures were accelerometer data and self-report of physical activity . Results At the end of the study period , the test group reported a significantly greater increase over baseline than did the control group for perceived control ( P < .001 ) and intention/expectation to exercise ( P < .001 ) . Intent-to-treat analyses of both the accelerometer data ( P = .02 ) and leisure time self-report data ( P = .03 ) found a higher level of moderate physical activity in the test group . The average increase ( over the control group ) in accelerometer-measured moderate physical activity was 2 h 18 min per week . The test group also lost more percent body fat than the control group ( test group : −2.18 , SD = 0.59 ; control group : −0.17 , SD = 0.81 ; P = .04 ) . Conclusions A fully automated Internet and mobile phone – based motivation and action support system can significantly increase and maintain the level of physical activity in healthy adults Background and aims Psychodynamic psychotherapy ( PDT ) is an effective treatment for major depressive disorder ( MDD ) , but not all clients with MDD can receive psychotherapy . Using the Internet to provide psychodynamic treatments is one way of improving access to psychological treatments for MDD . The aim of this r and omised controlled trial was to investigate the efficacy of an Internet-based psychodynamic guided self-help treatment for MDD . Methods Ninety-two participants who were diagnosed with MDD according to the Mini-International Neuropsychiatric Interview were r and omised to treatment or an active control . The treatment consisted of nine treatment modules based on psychodynamic principles with online therapist contact . The active control condition was a structured support intervention and contained psychoeducation and scheduled weekly contacts online . Both interventions lasted for 10 weeks . The primary outcome measure was the Beck Depression Inventory-II ( BDI-II ) . Results Mixed-effects model analyses of all r and omised participants showed that participants receiving Internet-based PDT made large and superior improvements compared with the active control group on the BDI-II ( between-group Cohen 's d = 1.11 ) . Treatment effects were maintained at a 10-month follow-up . Conclusions Internet-based psychodynamic guided self-help is an efficacious treatment for MDD that has the potential to increase accessibility and availability of PDT for MDD . Trial Registration Clinical trials.gov : BACKGROUND Major depression can be treated by means of cognitive-behavioural therapy , but as skilled therapists are in short supply there is a need for self-help approaches . Many individuals with depression use the internet for discussion of symptoms and to share their experience . AIMS To investigate the effects of an internet-administered self-help programme including participation in a monitored , web-based discussion group , compared with participation in web-based discussion group only . METHOD A r and omised controlled trial was conducted to compare the effects of internet-based cognitive-behavioural therapy with minimal therapist contact ( plus participation in a discussion group ) with the effects of participation in a discussion group only . RESULTS Internet-based therapy with minimal therapist contact , combined with activity in a discussion group , result ed in greater reductions of depressive symptoms compared with activity in a discussion group only ( waiting-list control group ) . At 6 months ' follow-up , improvement was maintained to a large extent . CONCLUSIONS Internet-delivered cognitive cognitive-behavioural therapy should be pursued further as a complement or treatment alternative for mild-to-moderate depression Internet-delivered self-help for  depression  with therapist guidance has shown efficacy in several trials . Results from meta-analyses suggest that guidance is important and that self-help programs without support are less effective . However , there are no direct experimental comparisons between guided and unguided internet-based treatments for depression . The present study compared the benefits of a 10-week web-based unguided self-help treatment with the same intervention complemented with weekly therapist support via e-mail . A waiting-list control group was also included . Seventy-six individuals meeting the diagnostic criteria of major depression or dysthymia were r and omly assigned to one of the three conditions . The Beck Depression Inventory ( BDI-II ) was used as the primary outcome measure . Secondary outcomes included general psychopathology , interpersonal problems , and quality of life .  Sixty-nine participants ( 91 % ) completed the assessment at posttreatment and 59 ( 78 % ) at 6-month follow-up . Results showed significant symptom reductions in both treatment groups compared to the waiting-list control group . At posttreatment , between-group effect sizes on the BDI-II were d = .66 for unguided self-help versus waiting-list and d = 1.14 for guided self-help versus waiting-list controls . In the comparison of the two active treatments , small-to-moderate , but not statistically significant effects in favor of the guided condition were found on all measured dimensions . In both groups , treatment gains were maintained at 6-month follow-up . The findings provide evidence that internet-delivered treatments for depression can be effective whether support is added or not . However , all participants were interviewed in a structured diagnostic telephone interview before inclusion , which prohibits conclusions regarding unguided treatments that are without any human contact Background Depression is a burdensome , recurring mental health disorder with high prevalence . Even in developed countries , patients have to wait for several months to receive treatment . In many parts of the world there is only one mental health professional for over 200 people . Smartphones are ubiquitous and have a large complement of sensors that can potentially be useful in monitoring behavioral patterns that might be indicative of depressive symptoms and providing context -sensitive intervention support . Objective The objective of this study is 2-fold , first to explore the detection of daily-life behavior based on sensor information to identify subjects with a clinical ly meaningful depression level , second to explore the potential of context sensitive intervention delivery to provide in-situ support for people with depressive symptoms . Methods A total of 126 adults ( age 20 - 57 ) were recruited to use the smartphone app Mobile Sensing and Support ( MOSS )  , collecting context -sensitive sensor information and providing just-in-time interventions derived from cognitive behavior therapy . Real-time learning-systems were deployed to adapt to each subject ’s preferences to optimize recommendations with respect to time , location , and personal preference . Biweekly , participants were asked to complete a  self-reported depression survey ( PHQ-9 ) to track symptom progression . Wilcoxon tests were conducted to compare scores before and after intervention . Correlation analysis was used to test the relationship between adherence and change in PHQ-9 . One hundred twenty features were constructed based on smartphone usage and sensors including  accelerometer , Wifi  , and  global positioning systems ( GPS  )  . Machine-learning models used these features to infer behavior and context for PHQ-9 level prediction and tailored intervention delivery . Results A total of 36 subjects used MOSS for ≥2 weeks . For subjects with clinical depression ( PHQ-9≥11 ) at baseline and adherence ≥8 weeks ( n=12 ) , a significant drop in PHQ-9 was observed ( P=.01 ) . This group showed a negative trend between adherence and change in PHQ-9 scores ( rho=−.498 , P=.099 ) . Binary classification performance for biweekly PHQ-9 sample s ( n=143 ) , with a cutoff of PHQ-9≥11 , based on R and om Forest and Support Vector Machine leave-one-out cross validation result ed in 60.1 % and 59.1 % accuracy , respectively . Conclusions Proxies for social and physical behavior derived from smartphone sensor data was successfully deployed to deliver context -sensitive and personalized interventions to people with depressive symptoms . Subjects who used the app for an extended period of time showed significant reduction in self-reported symptom severity . Nonlinear classification models trained on features extracted from smartphone sensor data including Wifi , accelerometer , GPS , and phone use , demonstrated a proof of concept for the detection of depression superior to r and om classification . While findings of effectiveness must be reproduced in a RCT to proof causation , they pave the way for a new generation of digital health interventions leveraging smartphone sensors to provide context sensitive information for in-situ support and unobtrusive monitoring of critical mental health states Depression is among the most prevalent disorders worldwide . In view of numerous treatment barriers , internet-based interventions are increasingly adopted to " treat the untreated " . The present trial ( registered as NCT01401296 ) was conducted over the internet and aim ed to assess the efficacy of an online self-help program for depression ( Deprexis ) . In r and om order , participants with elevated depression symptoms received program access or were allocated to a wait-list control condition . After eight weeks , participants were invited to take part in an online re- assessment . To compensate for common problems of online studies , such as low completion rates and unclear diagnostic status , reminders and incentives were used , and clinical diagnoses were externally confirmed in a subgroup of 29 % of participants . Relative to the wait-list group , program users experienced significant symptom decline on the Beck Depression Inventory ( BDI ; primary outcome ) , the Dysfunctional Attitudes Scale ( DAS ) , the Quality of Life scale ( WHOQOL-BREF ) and the Rosenberg Self-Esteem Scale ( RSE ) . Compared to wait-list participants , symptom decline was especially pronounced among those with moderate symptoms at baseline as well as those not currently consulting a therapist . Completion ( 82 % ) and re-test reliability of the instruments ( r = .72-.87 ) were good . The results of this trial suggest that online treatment can be beneficial for people with depression , particularly for those with moderate symptoms Background . Psychodynamic psychotherapy is a psychological treatment approach that has a growing empirical base . Research has indicated an association between therapist-facilitated affective experience and outcome in psychodynamic therapy . Affect-phobia therapy ( APT ) , as outlined by McCullough et al. , is a psychodynamic treatment that emphasizes a strong focus on expression and experience of affect . This model has neither been evaluated for depression nor anxiety disorders in a r and omized controlled trial . While Internet-delivered psychodynamic treatments for depression and generalized anxiety disorder exist , they have not been based on APT . The aim of this r and omized controlled trial was to investigate the efficacy of an Internet-based , psychodynamic , guided self-help treatment based on APT for depression and anxiety disorders . Methods . One hundred participants with diagnoses of mood and anxiety disorders participated in a r and omized ( 1:1 ratio ) controlled trial of an active group versus a control condition . The treatment group received a 10-week , psychodynamic , guided self-help treatment based on APT that was delivered through the Internet . The treatment consisted of eight text-based treatment modules and included therapist contact ( 9.5 min per client and week , on average ) in a secure online environment . Participants in the control group also received online therapist support and clinical monitoring of symptoms , but received no treatment modules . Outcome measures were the 9-item Patient Health Question naire Depression Scale ( PHQ-9 ) and the 7-item Generalized Anxiety Disorder Sc 
    Output:
    