Invited Address: Lee M. Ritterband, PhD—2011-An E-Health Odyssey or the Internet As the Instrument for Behavior Change

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CE Credit: 1

Length: 50 minutes

Session offered by Division 38.

This talk will focus on the brief history and considerable future of Internet interventions. Similarities of Internet interventions will be presented, while also highlighting the substantial variations among programs. For example, some interventions are fully automated, while others make use of regular email contact with a clinician. Some rely on downloading documents from a website, while others employ interactivity, video and audio to increase engagement. Obviously, variations significantly complicate discussions surrounding these programs, including their effectiveness, utility, and viability as a sustained treatment option. Sound research is critical to tease apart which interventions and intervention elements result in behavior change and symptom improvement, and through which mechanisms these changes occur. Using theory and behavior change models to guide Internet intervention development is necessary. There are methodological issues facing the field that must be addressed, and potential methods of moving forward despite these challenges will be offered. All this said, Internet interventions are not dissimilar to face-to-face treatment where differences in approach, environment and clinicians present challenges to making generalizations about treatment effectiveness.

To highlight the nature of these programs, several Internet interventions will be presented in more detail, including one designed for an adult population and one designed for a pediatric audience. One program, developed for adults with chronic insomnia, is based on well-established face-to-face cognitive-behavioral therapy for insomnia, incorporating the primary components of sleep restriction, stimulus control, sleep hygiene, cognitive restructuring, and relapse prevention. Users complete daily sleep diaries and individually-tailored recommendations are computed using algorithms developed for the Internet intervention. Another Internet intervention, for pediatric encopresis, is designed for children and parents to use together. The primary program content covers three aspects of treatment: 1) anatomy, physiology and pathophysiology of digestion; 2) education on clean-out and laxative treatments; and 3) behavioral treatment for encopresis; there is also additional treatment information that is tailored to the individual user. In both these programs, multimedia capabilities are used to encourage adherence and interaction with the program, including automated email reminders and tracking of daily symptoms via diaries. Program features will be demonstrated and outcomes from clinical trials will be highlighted.

Learning Objective 1
Define Internet interventions and identify variations across programs.

Learning Objective 2
Appreciate the potential impact of different types of Internet interventions.

Presenters: Lee M. Ritterband, PhD