ZIEL: Internet-Based Self-Help for Adjustment Problems: Results of a Randomized Controlled Trial
Open accessAbstract
Adjustment Disorder (AjD) represents a healthcare paradox. On the one hand, it is one of the most diagnosed mental disorders worldwide. On the other hand, AjD and its possible treatment options remain a severely neglected field of research. In this context, we developed a self-guided online intervention for adjustment problems, named ZIEL, and tested its efficacy. It is based on and extends a bibliotherapeutic treatment approach for symptoms of AjD. In our study, a total of 98 individuals who had experienced a life event in the last two years, were randomly assigned to care as usual (CAU) or an online intervention group (CAU + online intervention). The primary endpoint was AjD symptom severity measured by Adjustment Disorder–New Module 20 (ADNM-20). Secondary endpoints were depressive symptoms, quality of life and other variables such as satisfaction and usability. Both the intervention and the control group improved comparably well regarding the severity of adjustment disorder symptoms post-treatment. However, participants in the intervention group showed significantly fewer depressive symptoms and a significantly higher quality of life (Cohen’s d: 0.89 (BDI) and −0.49 (SF-12)). The intervention was well-received by users with an above average usability rating. Overall, the results suggest that the ZIEL intervention has the promise to contribute to the treatment of AjD and reduce symptom burden by means of a scalable low-barrier approach.
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Several studies of online therapeutic interventions for people with AjD have shown small to medium effect-size improvements in experimental groups.
“Several studies have been published assessing the effectiveness of online therapeutic interventions aimed at people with AjD. All were based on CBT principles. Their promising results show small to medium effect-size improvements in experimental groups [39–42].”
From Effectiveness and mediators of change of an online CBT intervention for students with adjustment disorder—study protocol for a randomized controlled trial (2023) · cites this paper as [39]
The Results (section 3.3) report small-to-medium improvements on AjD symptom subscales within the ZIEL intervention group. However, the primary AjD symptom measure showed a large within-group effect (d = 1.04), and its small between-group effect (d = 0.31) was not significant. Describing this study’s results simply as small-to-medium improvements omits those qualifications. (LLM, conf=0.88)
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- Authors
- Moser, C., Bachem, R., Berger, T., & Maercker, A.
- Affiliations
- University of Bern (CH)
- University of Zurich (CH)
- Psychopathology and Clinical Intervention, University of Zürich, 8050 Zürich, Switzerland
- Corresponding author
- Moser, Christian
- Venue
- Journal of Clinical Medicine
- Publisher
- MDPI AG
- Published
- 2019-10-11
- Volume
- 8
- Issue
- 10
- Pages
- 1655
- ISSN
- 2077-0383 (ISSN-L)
- PMC
- PMC6832125
- OpenAlex
- W2979459378
- Cited by
- 31
- References
- 48
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 3 · 2023: 7 · 2022: 6 · 2021: 3 · 2020: 9
- FWCI
- 5.08
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Journal of Clinical Medicine (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Zurich Open Repository and Archive (University of Zurich) (acceptedVersion, cc-by)
- BORIS (University Library Bern) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Zurich Open Repository and Archive (University of Zurich) (submittedVersion, cc-by)
- Zurich Open Repository and Archive (University of Zurich)
- Topics
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Keywords
- adjustment disorder, online self-help, online intervention, bibliotherapy, life events, depressive symptoms, quality of life, usability
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