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Urben S, Habersaat S, Palix J, Fegert JM, Schmeck K, Bürgin D, Seker S, Boonmann C, Schmid M. Examination of the importance of anger/irritability and limited prosocial emotion/callous-unemotional traits to understand externalizing symptoms and adjustment problems in adolescence: A 10-year longitudinal study. Front Psychiatry 2022; 13:939603. [PMID: 36245864 PMCID: PMC9556640 DOI: 10.3389/fpsyt.2022.939603] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 09/09/2022] [Indexed: 11/13/2022] Open
Abstract
Objective Within a longitudinal study (10-year follow-up), we aim to examine the role of anger/irritability and limited prosocial emotion/callous-unemotional traits in predicting externalizing symptoms and adjustment problems in individuals formerly in youth residential care institutions. Method These dimensions were assessed in 203 young adults, with baseline assessments during youth residential care and a follow-up 10 years later. Results In general, emotional problems and psychopathological symptoms did not reduce over time. Analyses of regression revealed that a younger age at baseline, anger/irritability both at baseline assessment, and regarding their aggravation over time refer to significant predictors of the level of externalizing symptoms at 10-year follow-up (R 2 = 0.431) and the worsening of externalizing symptoms over time (R 2 = 0.638). Anger/irritability has been observed to be a significant predictors of both the level of adjustment problems at 10-year follow-up (R 2 = 0.471) and its worsening over time (R 2 = 0.656). Discussion Our results suggest that dysregulation of anger/irritability is a key factor in the prediction of long-term externalizing symptoms and adjustment problems as well as its worsening over time. Possible implications for intervention and prevention are discussed.
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Affiliation(s)
- Sébastien Urben
- Division of Child and Adolescent Psychiatry, University Hospital of Lausanne (CHUV) and University of Lausanne, Lausanne, Switzerland
- *Correspondence: Sébastien Urben,
| | - Stéphanie Habersaat
- Department of Child and Adolescent Psychiatric Research, Psychiatric University Hospitals Basel (UPK), Basel, Switzerland
| | - Julie Palix
- Institute of Forensic Psychiatry, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Jörg M. Fegert
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Ulm, Ulm, Germany
| | - Klaus Schmeck
- Department of Child and Adolescent Psychiatric Research, Psychiatric University Hospitals Basel (UPK), Basel, Switzerland
| | - David Bürgin
- Department of Child and Adolescent Psychiatric Research, Psychiatric University Hospitals Basel (UPK), Basel, Switzerland
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Ulm, Ulm, Germany
| | - Süheyla Seker
- Department of Child and Adolescent Psychiatric Research, Psychiatric University Hospitals Basel (UPK), Basel, Switzerland
| | - Cyril Boonmann
- Department of Child and Adolescent Psychiatric Research, Psychiatric University Hospitals Basel (UPK), Basel, Switzerland
- Department of Forensic Child and Adolescent Psychiatry, Psychiatric University Hospitals Basel (UPK), Basel, Switzerland
| | - Marc Schmid
- Department of Child and Adolescent Psychiatric Research, Psychiatric University Hospitals Basel (UPK), Basel, Switzerland
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152
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Kooij LH, van der Pol TM, Daams JG, Hein IM, Lindauer RJL. Common elements of evidence-based trauma therapy for children and adolescents. Eur J Psychotraumatol 2022; 13:2079845. [PMID: 35759314 PMCID: PMC9225709 DOI: 10.1080/20008198.2022.2079845] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
UNLABELLED Background: Numerous evidence-based trauma therapies for children and adolescents have been developed over several decades to minimize the negative outcomes of post-traumatic stress disorder (PTSD). However, PTSD remains a complex construct and is associated with pervasive problems and high comorbidity. To gain more insight, much could be learnt from the similarities in trauma therapies. Objective: The purpose of this study is to derive common elements from evidence-based trauma therapies for children and adolescents. Method: Therapies were selected from a literature search. Five evidence-based trauma therapies were included in this study. A common element list was created through an existing and modified Delphi method, with a diverse group of Dutch trauma therapists. An element was deemed common when it appeared in three or more of the therapies. The final list was presented to international experts on the included trauma therapies. Results: A substantial commonality of techniques and mechanisms was found across the five evidence-based trauma therapies for children and adolescents, showing a strong overlap between therapies. Conclusion: The identified elements create a basis for research and clinical practice, with regard to targeted trauma therapies tailored to each individual child and his or her support system. This promotes therapy modules that are more flexible and accessible for both therapists and clients, in every environment, from specialized psychiatric units to sites with meagre resources. With current integrated knowledge, we can enhance the effectiveness of child psychiatry and refine trauma therapies. HIGHLIGHTS Using a modified Delphi method, a substantial commonality of techniques and mechanisms is found in evidence-based trauma therapies for children and adolescents.Understanding the techniques and mechanisms of trauma therapy could be of help in refining upcoming therapies, and creates a basis for future research.Commonalities promote therapy modules that are more flexible and accessible for both therapists and clients, in environments ranging from specialized psychiatric units to sites with meagre resources.
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Affiliation(s)
- Lieke H Kooij
- Department of Child and Adolescent Psychiatry, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Thimo M van der Pol
- Department of Child and Adolescent Psychiatry, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Joost G Daams
- Medical Library, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Irma M Hein
- Department of Child and Adolescent Psychiatry, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Ramón J L Lindauer
- Department of Child and Adolescent Psychiatry, Amsterdam UMC, University of Amsterdam, the Netherlands
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153
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Wittenborn AK, Woods SB, Priest JB, Morgan PC, Tseng CF, Huerta P, Edwards C. Couple and family interventions for depressive and bipolar disorders: Evidence base update (2010-2019). JOURNAL OF MARITAL AND FAMILY THERAPY 2022; 48:129-153. [PMID: 34750834 DOI: 10.1111/jmft.12569] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 10/23/2021] [Indexed: 06/13/2023]
Abstract
This article systematically reviews the evidence base for couple and family interventions for depressive and bipolar disorders published from 2010 to 2019. Included in the review were intervention studies on depression for couples (n = 6), depression for families (n = 13), and bipolar for families (n = 5); zero studies on couple interventions for bipolar were located. Well-established interventions include cognitive and/or behavioral couple and family interventions for depression and psychoeducational family interventions for bipolar. Attachment-based couple and family interventions for depression are probably efficacious. Finally, family psychoeducation for depression is possibly efficacious, and integrative couple interventions and family play-based interventions for depression are experimental. Couple and family interventions also improved relationship dynamics, which is noteworthy since poor relationships are associated with non-remission, relapse, and recurrence of depressive and bipolar symptoms. Future research is needed on couple interventions for bipolar disorders and interventions for minoritized populations.
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Affiliation(s)
- Andrea K Wittenborn
- Human Development and Family Studies, Michigan State University, East Lansing, Michigan, USA
- Psychiatry and Behavioral Medicine, Michigan State University, Grand Rapids, Michigan, USA
| | - Sarah B Woods
- Family and Community Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Jacob B Priest
- Psychological and Quantitative Foundations, University of Iowa, Iowa City, Iowa, USA
| | - Preston C Morgan
- Human Development and Family Studies, Michigan State University, East Lansing, Michigan, USA
| | - Chi-Fang Tseng
- Human Development and Family Studies, Michigan State University, East Lansing, Michigan, USA
| | - Patricia Huerta
- Human Development and Family Studies, Michigan State University, East Lansing, Michigan, USA
| | - Caitlin Edwards
- Human Development and Family Studies, Michigan State University, East Lansing, Michigan, USA
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154
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Sampaio F, Feldman I, Lavelle TA, Skokauskas N. The cost-effectiveness of treatments for attention deficit-hyperactivity disorder and autism spectrum disorder in children and adolescents: a systematic review. Eur Child Adolesc Psychiatry 2022; 31:1655-1670. [PMID: 33751229 PMCID: PMC9666301 DOI: 10.1007/s00787-021-01748-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 02/17/2021] [Indexed: 12/24/2022]
Abstract
Economic evaluations can help decision makers identify what services for children with neurodevelopmental disorders provide best value-for-money. The aim of this paper is to review the best available economic evidence to support decision making for attention deficit-hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) in children and adolescents. We conducted a systematic review of economic evaluations of ADHD and ASD interventions including studies published 2010-2020, identified through Econlit, Medline, PsychINFO, and ERIC databases. Only full economic evaluations comparing two or more options, considering both costs and consequences were included. The quality of the studies was assessed using the Drummond checklist. We identified ten studies of moderate-to-good quality on the cost-effectiveness of treatments for ADHD and two studies of good quality of interventions for ASD. The majority of ADHD studies evaluated pharmacotherapy (n = 8), and two investigated the economic value of psychosocial/behavioral interventions. Both economic evaluations for ASD investigated early and communication interventions. Included studies support the cost-effectiveness of behavioral parenting interventions for younger children with ADHD. Among pharmacotherapies for ADHD, different combinations of stimulant/non-stimulant medications for children were cost-effective at willingness-to-pay thresholds reported in the original papers. Early intervention for children with suspected ASD was cost-effective, but communication-focused therapy for preschool children with ASD was not. Prioritizing more studies in this area would allow decision makers to promote cost-effective and clinically effective interventions for this target group.
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Affiliation(s)
- Filipa Sampaio
- Department of Public Health and Caring Sciences, Uppsala University, Husargatan 3, P.O Box 564, 751 22, Uppsala, Sweden.
| | - Inna Feldman
- grid.8993.b0000 0004 1936 9457Department of Public Health and Caring Sciences, Uppsala University, Husargatan 3, P.O Box 564, 751 22 Uppsala, Sweden ,grid.12650.300000 0001 1034 3451Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Tara A. Lavelle
- grid.67033.310000 0000 8934 4045Center for the Evaluation of Value and Risk, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA USA
| | - Norbert Skokauskas
- grid.5947.f0000 0001 1516 2393Regional Centre for Child and Youth Mental Health and Child Welfare, IPH, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway ,Child and Adolescent Mental Health Services, St. Olav Hospital, Trondheim, Norway
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155
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Capobianco L, Nordahl H. A Brief History of Metacognitive Therapy: From Cognitive Science to Clinical Practice. COGNITIVE AND BEHAVIORAL PRACTICE 2021. [DOI: 10.1016/j.cbpra.2021.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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156
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157
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Bringmann LF, Albers C, Bockting C, Borsboom D, Ceulemans E, Cramer A, Epskamp S, Eronen MI, Hamaker E, Kuppens P, Lutz W, McNally RJ, Molenaar P, Tio P, Voelkle MC, Wichers M. Psychopathological networks: Theory, methods and practice. Behav Res Ther 2021; 149:104011. [PMID: 34998034 DOI: 10.1016/j.brat.2021.104011] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 11/05/2021] [Accepted: 11/27/2021] [Indexed: 12/19/2022]
Abstract
In recent years, network approaches to psychopathology have sparked much debate and have had a significant impact on how mental disorders are perceived in the field of clinical psychology. However, there are many important challenges in moving from theory to empirical research and clinical practice and vice versa. Therefore, in this article, we bring together different points of view on psychological networks by methodologists and clinicians to give a critical overview on these challenges, and to present an agenda for addressing these challenges. In contrast to previous reviews, we especially focus on methodological issues related to temporal networks. This includes topics such as selecting and assessing the quality of the nodes in the network, distinguishing between- and within-person effects in networks, relating items that are measured at different time scales, and dealing with changes in network structures. These issues are not only important for researchers using network models on empirical data, but also for clinicians, who are increasingly likely to encounter (person-specific) networks in the consulting room.
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Affiliation(s)
- Laura F Bringmann
- University of Groningen, University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), P.O. Box 30.001 (CC72), 9700 RB, Groningen, the Netherlands; University of Groningen, Faculty of Behavioural and Social Sciences, Department of Psychometrics and Statistics, Grote Kruisstraat 2/1, 9712 TS, Groningen, the Netherlands.
| | - Casper Albers
- University of Groningen, Faculty of Behavioural and Social Sciences, Department of Psychometrics and Statistics, Grote Kruisstraat 2/1, 9712 TS, Groningen, the Netherlands
| | - Claudi Bockting
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, the Netherlands; Department of Psychiatry, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Denny Borsboom
- Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands
| | - Eva Ceulemans
- KU Leuven, Faculty of Psychology and Educational Sciences, Leuven, Belgium
| | - Angélique Cramer
- RIVM National Institute for Public Health and the Environment, the Netherlands
| | - Sacha Epskamp
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, the Netherlands; Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands
| | - Markus I Eronen
- Department of Theoretical Philosophy, University of Groningen, the Netherlands
| | - Ellen Hamaker
- Department of Methodology and Statistics, Utrecht University, the Netherlands
| | - Peter Kuppens
- KU Leuven, Faculty of Psychology and Educational Sciences, Leuven, Belgium
| | - Wolfgang Lutz
- Department of Psychology, University of Trier, Germany
| | | | - Peter Molenaar
- Department of Human Development and Family Studies, The Pennsylvania State University, USA
| | - Pia Tio
- Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands; Department of Methodology and Statistics, Tilburg University, Tilburg, the Netherlands
| | - Manuel C Voelkle
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Marieke Wichers
- University of Groningen, University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), P.O. Box 30.001 (CC72), 9700 RB, Groningen, the Netherlands
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158
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Yuan XH, Peng J, Hu SW, Yang Y, Bai YJ. Cognitive behavioral therapy on personality characteristics of cancer patients. World J Clin Cases 2021; 9:9386-9394. [PMID: 34877274 PMCID: PMC8610857 DOI: 10.12998/wjcc.v9.i31.9386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/06/2021] [Accepted: 09/23/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The main treatment methods for cancer include surgery, radiotherapy, chemotherapy, targeted drug therapy and so on. Patients often feel anger, anxiety, depression, and other negative psychological reactions in the process of treatment.
AIM To explore the effects of cognitive behavioral therapy on the personality characteristics of cancer patients.
METHODS According to the matching design requirements, 150 cancer patients were divided into 3 groups based on sex, age, condition, and cultural background. Patients in the control group received conventional treatment. Patients in experimental group 1 received an intervention based on conventional treatment combined with cognitive behavioral therapy. Patients in experimental group 2 received family members' participation in addition to the treatment given in experimental group 1. An Eysenck personality questionnaire was used to investigate all the patients before and after the intervention, and the scores for psychosis, introversion, neuroticism, and concealment degree were analyzed.
RESULTS Compared with the control group, for experimental group 1 and experimental group 2 before and after the intervention, the four dimensions of mental quality, neuroticism, introversion and concealment degree all decreased, and the difference was statistically significant (P < 0.05). After the intervention, there were no obvious or statistically significant differences (P > 0.05) among the control group, experimental group 1, and experimental group 2 for two personality traits, psychoticism and neuroticism, both inside and outside degree and all four dimensions.
CONCLUSION Simple cognitive behavioral therapy could not change the personality characteristics of cancer patients quickly, but the patients’ personality characteristics were significantly improved after treatment.
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Affiliation(s)
- Xiao-Hui Yuan
- Zunyi Medical University, Zunyi 563000, Guizhou Province, China
| | - Juan Peng
- Teaching and Research Office of Medical Psychology, Zunyi Medical University, Zunyi 563003, Guizhou Province, China
| | - Shu-Wei Hu
- Zunyi Medical University, Zunyi 563000, Guizhou Province, China
| | - Yong Yang
- Zunyi Medical University, Zunyi 563000, Guizhou Province, China
| | - Yu-Ju Bai
- Department of Oncology, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China
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159
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Hanssen I, Scheepbouwer V, Huijbers M, Regeer E, Lochmann van Bennekom M, Kupka R, Speckens A. Adverse or therapeutic? A mixed-methods study investigating adverse effects of Mindfulness-Based Cognitive Therapy in bipolar disorder. PLoS One 2021; 16:e0259167. [PMID: 34735517 PMCID: PMC8568103 DOI: 10.1371/journal.pone.0259167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 10/08/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Mindfulness-Based Interventions (MBIs) are widely used in clinical and non-clinical populations, but little attention has been given to potential adverse effects (AEs). AIMS This study aimed to gain insight in the prevalence and course of AEs during Mindfulness-Based Cognitive Therapy (MBCT) for patients with bipolar disorder (BD). METHOD The current mixed-methods study was conducted as part of a RCT on (cost-) effectiveness of MBCT in 144 patients with BD (Trial registered on 25th of April 2018, ClinicalTrials.gov, NCT03507647). During MBCT, occurrence of AEs was monitored prospectively, systematically, and actively (n = 72). Patients who reported AEs were invited for semi-structured interviews after completing MBCT (n = 29). Interviews were analysed with directed content analysis, using an existing framework by Lindahl et al. RESULTS AEs were reported by 29 patients, in seven of whom the experiences could not be attributed to MBCT during the interview. AEs were reported most frequently up to week 3 and declined afterwards. Baseline anxiety appeared to be a risk factor for developing AEs. Seven existing domains of AEs were observed: cognitive, perceptual, affective, somatic, conative, sense of self, and social. Influencing factors were subdivided into predisposing, precipitating, perpetuating, and mitigating factors. With hindsight, more than half of patients considered the reported AEs as therapeutic rather than harmful. CONCLUSIONS Although the occurrence of AEs in MBCT for patients with BD is not rare, even in this population with severe mental illness they were not serious or had lasting bad effects. In fact, most of them were seen by the patients as being part of a therapeutic process, although some patients only experienced AEs as negative.
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Affiliation(s)
- Imke Hanssen
- Department of Psychiatry, Centre for Mindfulness, Radboud University Medical Centre, Nijmegen, The Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
| | - Vera Scheepbouwer
- Department of Psychiatry, Centre for Mindfulness, Radboud University Medical Centre, Nijmegen, The Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
| | - Marloes Huijbers
- Department of Psychiatry, Centre for Mindfulness, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Eline Regeer
- Altrecht institute for Mental Health Care, Outpatient Clinic For Bipolar Disorder, Utrecht, The Netherlands
| | - Marc Lochmann van Bennekom
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
- Pro Persona Mental Health Care, Outpatient Clinic for Bipolar Disorder, Nijmegen, The Netherlands
| | - Ralph Kupka
- Altrecht institute for Mental Health Care, Outpatient Clinic For Bipolar Disorder, Utrecht, The Netherlands
- Amsterdam UMC, Vrije Universiteit, Amsterdam Public Health Research Institute, Department of Psychiatry, Amsterdam, The Netherlands
| | - Anne Speckens
- Department of Psychiatry, Centre for Mindfulness, Radboud University Medical Centre, Nijmegen, The Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
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160
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Hoffmann D, Rask CU, Hedman-Lagerlöf E, Jensen JS, Frostholm L. Efficacy of internet-delivered acceptance and commitment therapy for severe health anxiety: results from a randomized, controlled trial. Psychol Med 2021; 51:2685-2695. [PMID: 32404226 PMCID: PMC8579157 DOI: 10.1017/s0033291720001312] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 04/06/2020] [Accepted: 04/21/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Health anxiety is common, disabling and costly due to patients' extensive use of health care services. Internet-delivered treatment may overcome barriers of accessibility to specialized treatment. We aimed to evaluate the efficacy of internet-delivered acceptance and commitment therapy (iACT). METHODS A randomized, controlled trial of iACT versus an internet-delivered discussion forum (iFORUM), performed in a Danish university hospital setting. Patients self-referred and underwent video-diagnostic assessment. Eligible patients (≥18 years) with health anxiety were randomized to 12 weeks of intervention. The randomization was blinded for the assessor. The primary outcome was between-group unadjusted mean differences in health anxiety symptoms measured by the Whiteley-7 Index (WI-7, range 0-100) from baseline to 6-month follow-up (6-MFU) using intention to treat and a linear mixed model. The study is registered at clinicaltrials.gov, number NCT02735434. RESULTS A total of 151 patients self-referred, and 101 patients were randomized to iACT (n = 53) or iFORUM (n = 48). A mean difference in change over time of 19.0 points [95% confidence interval (CI) 10.8-27.2, p < 0.001] was shown on the WI-7, and a large standardized effect size of d = 0.80 (95% CI 0.38-1.23) at 6-MFU. The number needed to treat was 2.8 (95% CI 1.8-6.1, p < 0.001), and twice as many patients in iACT were no longer clinical cases (35% v. 16%; risk ratio 2.17, 95% CI 1.00-4.70, p = 0.050). Adverse events were few and insignificant. CONCLUSIONS iACT for health anxiety led to sustained effects at 6-MFU. The study contributes to the development of easily accessible treatment options and deserves wider application.
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Affiliation(s)
- Ditte Hoffmann
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Noerrebrogade 44, bldg. 2C, 1, 8000Aarhus C, Denmark
| | - Charlotte Ulrikka Rask
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Palle Juul-Jensens Boulevard 175, ent. K, 8200Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Blvd. 82, 8200, Aarhus, Denmark
| | - Erik Hedman-Lagerlöf
- Department of Clinical Neuroscience, Karolinska Institute, Tomtebodavägen 18A, 5, 171 77Stockholm, Sweden
| | - Jens Søndergaard Jensen
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Noerrebrogade 44, bldg. 2C, 1, 8000Aarhus C, Denmark
| | - Lisbeth Frostholm
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Noerrebrogade 44, bldg. 2C, 1, 8000Aarhus C, Denmark
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161
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van der Wal JM, van Borkulo CD, Deserno MK, Breedvelt JJF, Lees M, Lokman JC, Borsboom D, Denys D, van Holst RJ, Smidt MP, Stronks K, Lucassen PJ, van Weert JCM, Sloot PMA, Bockting CL, Wiers RW. Advancing urban mental health research: from complexity science to actionable targets for intervention. Lancet Psychiatry 2021; 8:991-1000. [PMID: 34627532 DOI: 10.1016/s2215-0366(21)00047-x] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 01/27/2021] [Accepted: 01/28/2021] [Indexed: 12/30/2022]
Abstract
Urbanisation and common mental disorders (CMDs; ie, depressive, anxiety, and substance use disorders) are increasing worldwide. In this Review, we discuss how urbanicity and risk of CMDs relate to each other and call for a complexity science approach to advance understanding of this interrelationship. We did an ecological analysis using data on urbanicity and CMD burden in 191 countries. We found a positive, non-linear relationship with a higher CMD prevalence in more urbanised countries, particularly for anxiety disorders. We also did a review of meta-analytic studies on the association between urban factors and CMD risk. We identified factors relating to the ambient, physical, and social urban environment and showed differences per diagnosis of CMDs. We argue that factors in the urban environment are likely to operate as a complex system and interact with each other and with individual city inhabitants (including their psychological and neurobiological characteristics) to shape mental health in an urban context. These interactions operate on various timescales and show feedback loop mechanisms, rendering system behaviour characterised by non-linearity that is hard to predict over time. We present a conceptual framework for future urban mental health research that uses a complexity science approach. We conclude by discussing how complexity science methodology (eg, network analyses, system-dynamic modelling, and agent-based modelling) could enable identification of actionable targets for treatment and policy, aimed at decreasing CMD burdens in an urban context.
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Affiliation(s)
- Junus M van der Wal
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, Netherlands; Department of Psychiatry, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, Netherlands; Department of Public Health, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, Netherlands
| | - Claudia D van Borkulo
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, Netherlands; Department of Psychological Methods, University of Amsterdam, Amsterdam, Netherlands
| | - Marie K Deserno
- Department of Psychological Methods, University of Amsterdam, Amsterdam, Netherlands; Centre for Lifespan Psychology, Max Planck Institute for Human Development, Berlin, Germany
| | - Josefien J F Breedvelt
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, Netherlands; National Centre for Social Research, London, UK; Department of Psychiatry, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, Netherlands
| | - Mike Lees
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, Netherlands; Informatics Institute, University of Amsterdam, Amsterdam, Netherlands
| | - John C Lokman
- Department of Psychiatry, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, Netherlands
| | - Denny Borsboom
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, Netherlands; Department of Psychological Methods, University of Amsterdam, Amsterdam, Netherlands
| | - Damiaan Denys
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, Netherlands; Department of Psychiatry, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, Netherlands
| | - Ruth J van Holst
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, Netherlands; Department of Psychiatry, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, Netherlands
| | - Marten P Smidt
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, Netherlands; Swammerdam Institute for Life Sciences, University of Amsterdam, Amsterdam, Netherlands
| | - Karien Stronks
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, Netherlands; Department of Public Health, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, Netherlands
| | - Paul J Lucassen
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, Netherlands; Swammerdam Institute for Life Sciences, University of Amsterdam, Amsterdam, Netherlands
| | - Julia C M van Weert
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, Netherlands; Amsterdam School of Communication Research/ASCoR, University of Amsterdam, Amsterdam, Netherlands
| | - Peter M A Sloot
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, Netherlands; Institute for Advanced Study, University of Amsterdam, Amsterdam, Netherlands; National Centre for Cognitive Science, ITMO University, St Petersburg, Russia
| | - Claudi L Bockting
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, Netherlands; Department of Psychiatry, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, Netherlands.
| | - Reinout W Wiers
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, Netherlands; Department of Developmental Psychology, University of Amsterdam, Amsterdam, Netherlands
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162
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Markussen HV, Aasdahl L, Viksveen P, Hedberg B, Rise MB. A treatment strategy for meeting life as it is. Patients' and therapists' experiences of brief therapy in a district psychiatric centre: A qualitative study. PLoS One 2021; 16:e0258990. [PMID: 34705864 PMCID: PMC8550582 DOI: 10.1371/journal.pone.0258990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 10/09/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Young adults increasingly seek help for mental health problems. In 2016, a district psychiatric centre in Norway started a brief treatment program to provide early and effective help for moderate depression and anxiety. AIM Exploring patients' and therapists' experiences of brief therapy, especially how the time limitation influences the treatment process. METHODS Individual interviews with 12 patients and focus group interviews with eight therapists analyzed using systematic text condensation. RESULTS The results constitute five themes: (1) Time-limit as a frame for targeted change, (2) Clarifying expectations and accountability, (3) Shared agreement on a defined treatment-project, (4) Providing tools instead of searching for causes, and (5) Learning to cope-not being cured. CONCLUSION Time-limitation in brief therapy appeared to play a positive role, helping the therapists to structure the therapeutic process and strengthening patients' motivation. Shared understanding and activation during brief therapy may reinforce patients' responsibility and expectations to achieve individual goals. Brief therapy can be viewed as the start of a personal process towards "mastering life as it is". More research is needed to investigate the patients' long-term outcomes after treatment and to shed light on the potential for, and limitations of, mastering everyday-life.
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Affiliation(s)
- Hilde V. Markussen
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- St. Olavs Hospital, Trondheim University Hospital, Nidaros District Psychiatric Centre, Trondheim, Norway
| | - Lene Aasdahl
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Unicare Helsefort Rehabilitation Centre, Rissa, Norway
| | - Petter Viksveen
- SHARE–Centre for Resilience in Healthcare, Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Berith Hedberg
- IMPROVE Research Group, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Marit B. Rise
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- St. Olavs Hospital, Trondheim University Hospital, Nidaros District Psychiatric Centre, Trondheim, Norway
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163
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Stapelberg NJC, Bowman C, Woerwag-Mehta S, Walker S, Davies A, Hughes I, Michel K, Pisani AR, Van Engelen H, Delos M, Hageman T, Fullerton-Smith K, Krishnaiah R, McDowell S, Cameron A, Scales TL, Dillon C, Gigante T, Heddle C, Mudge N, Zappa A, Edwards M, Gutjahr S, Joshi H, Turner K. A lived experience co-designed study protocol for a randomised control trial: the Attempted Suicide Short Intervention Program (ASSIP) or Brief Cognitive Behavioural Therapy as additional interventions after a suicide attempt compared to a standard Suicide Prevention Pathway (SPP). Trials 2021; 22:723. [PMID: 34674732 PMCID: PMC8529364 DOI: 10.1186/s13063-021-05658-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 09/27/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Despite being preventable, suicide is a leading cause of death and a major global public health problem. For every death by suicide, many more suicide attempts are undertaken, and this presents as a critical risk factor for suicide. Currently, there are limited treatment options with limited underpinning research for those who present to emergency departments with suicidal behaviour. The aim of this study is to assess if adding one of two structured suicide-specific psychological interventions (Attempted Suicide Short Intervention Program [ASSIP] or Brief Cognitive Behavioural Therapy [CBT] for Suicide Prevention) to a standardised clinical care approach (Suicide Prevention Pathway [SPP]) improves the outcomes for consumers presenting to a Mental Health Service with a suicide attempt. METHODS This is a randomised controlled trial with blinding of those assessing the outcomes. People who attempt suicide or experience suicidality after a suicide attempt, present to the Gold Coast Mental Health and Specialist Services, are placed on the Suicide Prevention Pathway (SPP), and meet the eligibility criteria, are offered the opportunity to participate. A total of 411 participants will be recruited for the study, with 137 allocated to each cohort (participants are randomised to SPP, ASSIP + SPP, or CBT + SPP). The primary outcomes of this study are re-presentation to hospitals with suicide attempts. Presentations with suicidal ideation will also be examined (in a descriptive analysis) to ascertain whether a rise in suicidal ideation is commensurate with a fall in suicide attempts (which might indicate an increase in help-seeking behaviours). Death by suicide rates will also be examined to ensure that representations with a suicide attempt are not due to participants dying, but due to a potential improvement in mental health. For participants without a subsequent suicide attempt, the total number of days from enrolment to the last assessment (24 months) will be calculated. Self-reported levels of suicidality, depression, anxiety, stress, resilience, problem-solving skills, and self- and therapist-reported level of therapeutic engagement are also being examined. Psychometric data are collected at baseline, end of interventions, and 6,12, and 24 months. DISCUSSION This project will move both ASSIP and Brief CBT from efficacy to effectiveness research, with clear aims of assessing the addition of two structured psychological interventions to treatment as usual, providing a cost-benefit analysis of the interventions, thus delivering outcomes providing a clear pathway for rapid translation of successful interventions. TRIALS REGISTRATION ClinicalTrials.gov NCT04072666 . Registered on 28 August 2019.
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Affiliation(s)
- Nicolas J C Stapelberg
- Department of Mental Health and Specialist Services Gold Coast University Hospital, 1 Hospital Boulevard, Southport, Queensland, 4215, Australia
- Faculty Health Sciences and Medicine, Bond University, 14 University Drive, Robina, Queensland, 4226, Australia
| | - Candice Bowman
- Department of Mental Health and Specialist Services Gold Coast University Hospital, 1 Hospital Boulevard, Southport, Queensland, 4215, Australia.
| | - Sabine Woerwag-Mehta
- Department of Mental Health and Specialist Services Gold Coast University Hospital, 1 Hospital Boulevard, Southport, Queensland, 4215, Australia
- Faculty Health Sciences and Medicine, Bond University, 14 University Drive, Robina, Queensland, 4226, Australia
| | - Sarah Walker
- Department of Mental Health and Specialist Services Gold Coast University Hospital, 1 Hospital Boulevard, Southport, Queensland, 4215, Australia
| | - Angela Davies
- Department of Mental Health and Specialist Services Gold Coast University Hospital, 1 Hospital Boulevard, Southport, Queensland, 4215, Australia
- Lived Experience Suicide Prevention Research Advisory Committee (this committee was convened specifically for this study and is supported by the Gold Coast Mental Health and Specialist Services Peer Workers), Southport, Australia
| | - Ian Hughes
- Office for Research Governance and Development, Gold Coast Health, 1 Hospital Boulevard, Southport, Queensland, 4215, Australia
| | - Konrad Michel
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Anthony R Pisani
- Departments of Psychiatry and Pediatrics, University of Rochester, 300 Crittenden Blvd., BOX PSYCH, Rochester, NY, 14642, USA
| | - Heidy Van Engelen
- Department of Mental Health and Specialist Services Gold Coast University Hospital, 1 Hospital Boulevard, Southport, Queensland, 4215, Australia
| | - Mia Delos
- Department of Mental Health and Specialist Services Gold Coast University Hospital, 1 Hospital Boulevard, Southport, Queensland, 4215, Australia
| | - Tamara Hageman
- Department of Mental Health and Specialist Services Gold Coast University Hospital, 1 Hospital Boulevard, Southport, Queensland, 4215, Australia
| | - Kim Fullerton-Smith
- Department of Mental Health and Specialist Services Gold Coast University Hospital, 1 Hospital Boulevard, Southport, Queensland, 4215, Australia
| | - Ravikumar Krishnaiah
- Department of Mental Health and Specialist Services Gold Coast University Hospital, 1 Hospital Boulevard, Southport, Queensland, 4215, Australia
| | - Sarah McDowell
- Department of Mental Health and Specialist Services Gold Coast University Hospital, 1 Hospital Boulevard, Southport, Queensland, 4215, Australia
| | - Alison Cameron
- Department of Mental Health and Specialist Services Gold Coast University Hospital, 1 Hospital Boulevard, Southport, Queensland, 4215, Australia
| | - Trudy-Lee Scales
- Department of Mental Health and Specialist Services Gold Coast University Hospital, 1 Hospital Boulevard, Southport, Queensland, 4215, Australia
| | - Cherie Dillon
- Lived Experience Suicide Prevention Research Advisory Committee (this committee was convened specifically for this study and is supported by the Gold Coast Mental Health and Specialist Services Peer Workers), Southport, Australia
| | - Titta Gigante
- Department of Mental Health and Specialist Services Gold Coast University Hospital, 1 Hospital Boulevard, Southport, Queensland, 4215, Australia
- Lived Experience Suicide Prevention Research Advisory Committee (this committee was convened specifically for this study and is supported by the Gold Coast Mental Health and Specialist Services Peer Workers), Southport, Australia
| | - Cindy Heddle
- Lived Experience Suicide Prevention Research Advisory Committee (this committee was convened specifically for this study and is supported by the Gold Coast Mental Health and Specialist Services Peer Workers), Southport, Australia
| | - Natalie Mudge
- Lived Experience Suicide Prevention Research Advisory Committee (this committee was convened specifically for this study and is supported by the Gold Coast Mental Health and Specialist Services Peer Workers), Southport, Australia
| | - Anne Zappa
- Lived Experience Suicide Prevention Research Advisory Committee (this committee was convened specifically for this study and is supported by the Gold Coast Mental Health and Specialist Services Peer Workers), Southport, Australia
| | - Michelle Edwards
- Department of Mental Health and Specialist Services Gold Coast University Hospital, 1 Hospital Boulevard, Southport, Queensland, 4215, Australia
- Lived Experience Suicide Prevention Research Advisory Committee (this committee was convened specifically for this study and is supported by the Gold Coast Mental Health and Specialist Services Peer Workers), Southport, Australia
| | - Sigi Gutjahr
- Department of Mental Health and Specialist Services Gold Coast University Hospital, 1 Hospital Boulevard, Southport, Queensland, 4215, Australia
| | - Hitesh Joshi
- Department of Mental Health and Specialist Services Gold Coast University Hospital, 1 Hospital Boulevard, Southport, Queensland, 4215, Australia
| | - Kathryn Turner
- Department of Mental Health and Specialist Services Gold Coast University Hospital, 1 Hospital Boulevard, Southport, Queensland, 4215, Australia
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Jonassen R. Editorial: The Cognitive Neuropsychological Hypothesis in Pediatric Anxiety and the Advantage of Revealing Early Changes in Brain Mechanisms Associated With Therapeutic Effects. J Am Acad Child Adolesc Psychiatry 2021; 60:1187-1189. [PMID: 33600936 DOI: 10.1016/j.jaac.2021.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 02/09/2021] [Indexed: 11/16/2022]
Abstract
There is a pressing need to improve treatment, and clinical trials should not only focus on efficacy, but also on identifying the underlying mechanisms through which treatments operate.1 Treatment with a serotonergic antidepressant is commonly used to treat pediatric anxiety disorders, including generalized anxiety disorder (GAD). Serotonergic antidepressants require considerable time to induce clinically observed responses, and tolerability and efficacy are difficult to predict. Risk and precautions have been widely discussed and are weighed against urgent needs for interventions early in life that may prevent recurrent mental health complaints. Drug-induced molecular, cellular, and chemical effects result in neurocognitive changes, which are believed to occur before behavioral changes. Assessments of early neurocognitive changes may therefore be a powerful tool to reveal key mechanisms through which antidepressants work. When the neurofunctional mechanisms believed to cause the symptoms are restored, the clinical manifestation of symptom improvement is expected. The degree of symptom improvement should also follow the degree of positive changes in neurocognitive function. Many patients do not respond early enough in the course of symptom evolution,2,3 and thus assessments of early neurocognitive mechanisms may guide treatment individualization during titration of doses and effects.
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Affiliation(s)
- Rune Jonassen
- Faculty of Health Sciences, Oslo Metropolitan University, Norway.
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165
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Anxiety disorders among adolescents and young adults: Prevalence and mental health care service utilization in a regional epidemiological study in Germany. J Anxiety Disord 2021; 83:102453. [PMID: 34303082 DOI: 10.1016/j.janxdis.2021.102453] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 06/30/2021] [Accepted: 07/09/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Anxiety disorders are among the most prevalent mental disorders. While it is known that a majority of individuals with anxiety disorders remains untreated, actual treatment rates for adolescents and young adults in Germany remain largely unknown. METHODS As part of the Behavior and Mind Health (BeMIND) study, examining a random community sample of 14-21-year-olds (Dresden; Germany; N = 1,180), the lifetime prevalence for DSM-5 anxiety disorders and lifetime service utilization rates were determined by a standardized interview (DIA-X-5/CIDI). RESULTS In the present sample, 23.3 % of adolescents and young adults fulfilled DSM-5 criteria for at least one lifetime anxiety disorder. Of those, 39.1 % used any health care services, most frequently they visited an outpatient psychotherapist/psychologist (23.0 %). Individuals with agoraphobia were most likely to use any in- or outpatient specialized service (64.8 %), while individuals with a specific phobia were least likely (22.3 %). Having a comorbid disorder or being female increased the likelihood of seeking help. CONCLUSION The results showed that approximately 2/3 of adolescents and young adults suffering from an anxiety disorder did not seek help and only few report contacts with a psychotherapist. Given the adverse long-term consequences of anxiety disorders, these findings suggest to improve efforts on increasing intervention awareness and treatment possibilities for these individuals.
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166
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Hardy A, O'Driscoll C, Steel C, van der Gaag M, van den Berg D. A network analysis of post-traumatic stress and psychosis symptoms. Psychol Med 2021; 51:2485-2492. [PMID: 32419682 DOI: 10.1017/s0033291720001300] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Understanding the interplay between trauma-related psychological mechanisms and psychotic symptoms may improve the effectiveness of interventions for post-traumatic stress reactions in psychosis. Network theory assumes that mental health problems persist not because of a common latent variable, but from dynamic feedback loops between symptoms, thereby addressing the heterogeneous and overlapping nature of traumagenic and psychotic diagnoses. This is a proof-of-concept study examining interactions between post-traumatic stress symptoms, which were hypothesized to reflect trauma-related psychological mechanisms, and auditory hallucinations and delusions. METHOD Baseline data from two randomised controlled trials (N = 216) of trauma-focused therapy in people with post-traumatic stress symptoms (87.5% met diagnostic criteria for PTSD) and psychotic disorder were analysed. Reexperiencing, hyperarousal, avoidance, trauma-related beliefs, auditory hallucinations and delusional beliefs were used to estimate a Gaussian graphical model along with expected node influence and predictability (proportion of explained variance). RESULTS Trauma-related beliefs had the largest direct influence on the network and, together with hypervigilance, were implicated in the shortest paths from flashbacks to delusions and auditory hallucinations. CONCLUSIONS These findings are in contrast to previous research suggesting a central role for re-experiencing, emotional numbing and interpersonal avoidance in psychosis. Trauma-related beliefs were the psychological mechanism most associated with psychotic symptoms, although not all relevant mechanisms were measured. This work demonstrates that investigating multiple putative mediators may clarify which processes are most relevant to trauma-related psychosis. Further research should use network modelling to investigate how the spectrum of traumatic stress reactions play a role in psychotic symptoms.
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Affiliation(s)
- Amy Hardy
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, SE5 8AF, UK
- South London & Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent, BR3 3BX, UK
| | - Ciaran O'Driscoll
- Research Department of Clinical, Educational and Health Psychology, University College London, Gower Street, London, WC1E 6BT, UK
| | - Craig Steel
- The Oxford Institute of Clinical Psychology Training, Oxford, UK
| | - Mark van der Gaag
- Department of Clinical Psychology and Amsterdam Public Health Research, VU University, van der Boehorsttraat 7, 1081 BTAmsterdam, The Netherlands
- Parnassia Psychiatric Institute, Zoutkeetsingel 40, 2512 HNDen Haag, Netherlands
| | - David van den Berg
- Department of Clinical Psychology and Amsterdam Public Health Research, VU University, van der Boehorsttraat 7, 1081 BTAmsterdam, The Netherlands
- Parnassia Psychiatric Institute, Zoutkeetsingel 40, 2512 HNDen Haag, Netherlands
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167
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Stein DJ, Craske MG, Rothbaum BO, Chamberlain SR, Fineberg NA, Choi KW, de Jonge P, Baldwin DS, Maj M. The clinical characterization of the adult patient with an anxiety or related disorder aimed at personalization of management. World Psychiatry 2021; 20:336-356. [PMID: 34505377 PMCID: PMC8429350 DOI: 10.1002/wps.20919] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The clinical construct of "anxiety neurosis" was broad and poorly defined, so that the delineation of specific anxiety disorders in the DSM-III was an important advance. However, anxiety and related disorders are not only frequently comorbid, but each is also quite heterogeneous; thus diagnostic manuals provide only a first step towards formulating a management plan, and the development of additional decision support tools for the treatment of anxiety conditions is needed. This paper aims to describe systematically important domains that are relevant to the personalization of management of anxiety and related disorders in adults. For each domain, we summarize the available research evidence and review the relevant assessment instruments, paying special attention to their suitability for use in routine clinical practice. We emphasize areas where the available evidence allows the clinician to personalize the management of anxiety conditions, and we point out key unmet needs. Overall, the evidence suggests that we are becoming able to move from simply recommending that anxiety and related disorders be treated with selective serotonin reuptake inhibitors, cognitive-behavioral therapy, or their combination, to a more complex approach which emphasizes that the clinician has a broadening array of management modalities available, and that the treatment of anxiety and related disorders can already be personalized in a number of important respects.
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Affiliation(s)
- Dan J Stein
- South African Medical Research Council Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Michelle G Craske
- Department of Psychology and Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, (UCLA), Los Angeles, CA, USA
| | | | - Samuel R Chamberlain
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, and Southern Health NHS Foundation Trust, Southampton, UK
| | - Naomi A Fineberg
- School of Life and Medical Sciences, University of Hertfordshire, and Hertfordshire Partnership University NHS Foundation Trust, Hatfield, UK
- University of Cambridge Clinical Medical School, Cambridge, UK
| | - Karmel W Choi
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Peter de Jonge
- Developmental Psychology, Department of Psychology, Rijksuniversiteit Groningen, Groningen, The Netherlands
| | - David S Baldwin
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, and Southern Health NHS Foundation Trust, Southampton, UK
| | - Mario Maj
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
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Millroth P, Frey R. Fear and anxiety in the face of COVID-19: Negative dispositions towards risk and uncertainty as vulnerability factors. J Anxiety Disord 2021; 83:102454. [PMID: 34298237 PMCID: PMC8426312 DOI: 10.1016/j.janxdis.2021.102454] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 05/24/2021] [Accepted: 07/09/2021] [Indexed: 12/01/2022]
Abstract
In the face of the COVID-19 pandemic it is important to identify factors that make people particularly vulnerable of developing mental-health issues in order to provide case-specific treatments. In this article, we examine the roles of two psychological constructs - originally put forth in the behavioral decision sciences - in predicting interindividual differences in fear responses: general risk aversion (GRA) and intolerance of uncertainty (IU). We first provide a review of these constructs and illustrate why they may play important roles in shaping anxiety-related disorders. Thereafter we present an empirical study that collected survey data from 550 U.S. residents, comprising self-assessments of dispositions towards risk and uncertainty, anxiety- and depression levels, as well as demographic variables - to thus test the extent to which these psychological constructs are predictive of strong fear responses related to COVID-19 (i.e., mortal fear, racing heart). The results from Bayesian multi-model inference analyses showed that GRA and IU were more powerful predictors of fear responses than demographic variables. Moreover, the predictive power of these constructs was independent of general anxiety- and depression levels. Subsequent mediation analyses showed that the effects of GRA and IU were both direct and indirect via anxiety. We conclude by discussing possible treatment options, but also highlight that future research needs to further examine causal pathways and conceptual overlaps.
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169
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Pardiñas AF, Owen MJ, Walters JTR. Pharmacogenomics: A road ahead for precision medicine in psychiatry. Neuron 2021; 109:3914-3929. [PMID: 34619094 DOI: 10.1016/j.neuron.2021.09.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 08/05/2021] [Accepted: 09/09/2021] [Indexed: 12/11/2022]
Abstract
Psychiatric genomics is providing insights into the nature of psychiatric conditions that in time should identify new drug targets and improve patient care. Less attention has been paid to psychiatric pharmacogenomics research, despite its potential to deliver more rapid change in clinical practice and patient outcomes. The pharmacogenomics of treatment response encapsulates both pharmacokinetic ("what the body does to a drug") and pharmacodynamic ("what the drug does to the body") effects. Despite early optimism and substantial research in both these areas, they have to date made little impact on clinical management in psychiatry. A number of bottlenecks have hampered progress, including a lack of large-scale replication studies, inconsistencies in defining valid treatment outcomes across experiments, a failure to routinely incorporate adverse drug reactions and serum metabolite monitoring in study designs, and inadequate investment in the longitudinal data collections required to demonstrate clinical utility. Nonetheless, advances in genomics and health informatics present distinct opportunities for psychiatric pharmacogenomics to enter a new and productive phase of research discovery and translation.
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Affiliation(s)
- Antonio F Pardiñas
- MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University School of Medicine, Hadyn Ellis Building, Maindy Road, Cardiff CF24 4HQ, UK
| | - Michael J Owen
- MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University School of Medicine, Hadyn Ellis Building, Maindy Road, Cardiff CF24 4HQ, UK.
| | - James T R Walters
- MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University School of Medicine, Hadyn Ellis Building, Maindy Road, Cardiff CF24 4HQ, UK
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170
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Long Q, Li J, Hu X, Bai Y, Zheng Y, Gao Z. Follow-Ups on Persistent Symptoms and Pulmonary Function Among Post-Acute COVID-19 Patients: A Systematic Review and Meta-Analysis. Front Med (Lausanne) 2021; 8:702635. [PMID: 34540862 PMCID: PMC8448290 DOI: 10.3389/fmed.2021.702635] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 07/16/2021] [Indexed: 12/13/2022] Open
Abstract
Objective: As the number of recovering COVID-19 patients increases worldwide, the persistence of symptoms and signs through the post-acute phase indicates an urgent need for prolonged follow-up care. To explore existing data about post-acute COVID-19 syndrome, this meta-analysis assesses the prevalence of persistent manifestations in multiple systems and abnormalities in lung function, as well as their related risks in patients with various severities. Methods: Articles about discharged COVID-19 patients (published from January 1, 2020 to February 23, 2021) were obtained by searching four databases. Cohort studies with follow-up periods >1 month post-discharge or >2 months post-admission were included. Results: A total of 4,478 COVID-19 patients from 16 cohort studies were included in this meta-analysis. Fatigue or weakness (47%) were the most prevalent physical effects of post-acute COVID-19 syndrome, while psychosocial (28%) symptoms were the most common manifestations among several systems. Abnormalities in lung function of recovering patients, i.e., DLCO <80% (47%, 95% CI: 32–61%) persisted for long periods. Severe patients were more likely to present joint pain (OR 1.84, 95% CI: 1.11–3.04) and decreased lung functions compared with non-severe patients, with pooled ORs for abnormal TLC, FEV1, FVC, and DLCO of 3.05 (95% CI: 1.88–4.96), 2.72 (95% CI: 1.31–5.63), 2.52 (95% CI: 1.28–4.98), and 1.82 (95% CI: 1.32–2.50), respectively. Conclusions: Our research indicates that patients recovering from COVID-19 manifest long-term, multi-system symptoms, and the adverse effects on psychosocial health and lung functions were the most extensive and persistent. These findings together may facilitate much needed in-depth study of clinical treatments for long-term, post-acute phase symptoms that affect a great number of recovering COVID-19 patients.
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Affiliation(s)
- Qiuyue Long
- Department of Respiratory, Critical Care and Sleep Medicine, Xiang'an Hospital of Xiamen University, Xiamen, China.,School of Medicine, Xiamen University, Xiamen, China
| | - Jiwei Li
- Department of Respiratory, Critical Care and Sleep Medicine, Xiang'an Hospital of Xiamen University, Xiamen, China.,School of Medicine, Xiamen University, Xiamen, China
| | - Xiaoyi Hu
- Department of Respiratory, Critical Care and Sleep Medicine, Xiang'an Hospital of Xiamen University, Xiamen, China.,School of Medicine, Xiamen University, Xiamen, China
| | - Yangyuyan Bai
- Department of Respiratory, Critical Care and Sleep Medicine, Xiang'an Hospital of Xiamen University, Xiamen, China.,School of Medicine, Xiamen University, Xiamen, China
| | - Yali Zheng
- Department of Respiratory, Critical Care and Sleep Medicine, Xiang'an Hospital of Xiamen University, Xiamen, China
| | - Zhancheng Gao
- Department of Respiratory, Critical Care and Sleep Medicine, Xiang'an Hospital of Xiamen University, Xiamen, China.,Department of Respiratory Medicine, Peking University People's Hospital, Beijing, China
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171
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Dreier M, Baumgardt J, Bock T, Härter M, Liebherz S. Development of an online suicide prevention program involving people with lived experience: ideas and challenges. RESEARCH INVOLVEMENT AND ENGAGEMENT 2021; 7:60. [PMID: 34496972 PMCID: PMC8424946 DOI: 10.1186/s40900-021-00307-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 08/26/2021] [Indexed: 05/14/2023]
Abstract
BACKGROUND Fear of stigmatization, self-stigmatization, and insufficient information can lead to secrecy, reduced help-seeking, lower self-esteem, and lower self-efficacy among people affected by suicidality or suicide. Therefore, we developed an online suicide prevention program aiming to improve knowledge about suicidality and suicide stigma. METHODS Inspired by the Australian program The Ripple Effect, a German team comprising people with lived experience of suicide, researchers, and clinicians was established for developing an online suicide prevention program. Therefore, we oriented on guidelines for evidence-based health information, for reporting on suicide, and on dealing with suicidality. The lived experience team discussed and developed concept, structure, and content of the program. This manuscript presents summaries of protocols from 16 team meetings and 3 written text reviews to outline the program development process. A summative evaluation 3 years after program development began was qualitatively analyzed based on thematic analysis. RESULTS Between 2018 und 2021, the lived experience team (n = 10) discussed possibilities of support in suicidal crises, attitudes towards suicide, content, and design of the online program. In a structured process, six members of the lived experience team reviewed the content. Eight persons shared their lived experience of suicide in video reports by focusing on constructive ways of dealing with suicidality or a loss by suicide, conveying hope and encouraging people to continue living. Team members recommended greater public and patient involvement from the application stage, as well as more financial and personnel resources. CONCLUSIONS Through contributions to discussions and text reviews, the lived experience team shaped decisions in the program development process. While involving persons with lived experiences of suicide, it is important to consider that suicidality is 1. emotionally challenging, 2. a stigmatized issue, and 3. that the aspect of safety must be a priority. A distinction must be made between the duty of care based on actual risk and inappropriate overprotection. Hereby, transparency, autonomy, and a clear structure appeared to be helpful. For further research, we recommend a structured formative review process of the development of the program. Additionally, we recommend discussing the purpose and the specific design of the evaluation with a lived experience team in advance. Trial registration German Clinical Trial RegisterDRKS00015071 on August 6, 2018.
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Affiliation(s)
- Mareike Dreier
- Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Johanna Baumgardt
- Department of Psychiatry and Psychotherapy, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Vivantes Hospital Am Urban and Vivantes Hospital Im Friedrichshain, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Thomas Bock
- Department of Psychiatry and Psychotherapy, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Härter
- Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sarah Liebherz
- Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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172
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Identifying and integrating active ingredients for mental health. Lancet Psychiatry 2021; 8:741-743. [PMID: 34419174 DOI: 10.1016/s2215-0366(21)00283-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 07/08/2021] [Indexed: 12/24/2022]
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Andersson E, Ljótsson B, Hedman-Lagerlöf M, Nygren L, Persson M, Rosengren K, Gezelius A, Andersson L, Sundquist T, Ivanov VZ, Bjureberg J, Hedman-Lagerlöf E. Targeting excessive worry with internet-based extinction therapy: a randomised controlled trial with mediation analysis and economical evaluation. Psychol Med 2021; 51:2023-2033. [PMID: 32340638 PMCID: PMC8426147 DOI: 10.1017/s0033291720000781] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 12/19/2019] [Accepted: 03/17/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Excessive worry is a common phenomenon. Our research group has previously developed an online intervention for excessive worry based on operant principles of extinction (IbET; internet-based extinction therapy) and tested it against a waiting-list. The aim of this study was to evaluate IbET against an active control comparator (CTRL). METHODS A 10-week parallel participant blind randomised controlled trial with health-economical evaluation and mediation analyses. Participants (N = 311) were randomised (ratio 4.5:4.5:1) to IbET, to CTRL (an internet-based stress-management training program) or to waiting-list. The nation-wide trial included self-referred adults with excessive worry. The primary outcome was change in worry assessed with the Penn State Worry Questionnaire from baseline to 10 weeks. RESULTS IbET had greater reductions in worry compared to CTRL [-3.6 point difference, (95% CI -2.4 to -4.9)] and also a significantly larger degree of treatment responders [63% v. 51%; risk ratio = 1.24 (95% CI 1.01-1.53)]. Both IbET and CTRL made large reductions in worry compared to waiting-list and effects were sustained up to 1 year. Treatment credibility, therapist attention, compliance and working alliance were equal between IbET and CTRL. Data attrition was 4% at the primary endpoint. The effects of IbET were mediated by the hypothesized causal mechanism (reduced thought suppression) but not by competing mediators. Health-economical evaluation indicated that IbET had a 99% chance of being cost-effective compared to CTRL given societal willingness to pay of 1000€. CONCLUSIONS IbET is more effective than active comparator to treat excessive worry. Replication and extensions to real-world setting are warranted.
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Affiliation(s)
- Erik Andersson
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Brjánn Ljótsson
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Maria Hedman-Lagerlöf
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Linn Nygren
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Malin Persson
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Karin Rosengren
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Anton Gezelius
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Louise Andersson
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Tove Sundquist
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Volen Z. Ivanov
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Johan Bjureberg
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Erik Hedman-Lagerlöf
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
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Pile V, Williamson G, Saunders A, Holmes EA, Lau JYF. Harnessing emotional mental imagery to reduce anxiety and depression in young people: an integrative review of progress and promise. Lancet Psychiatry 2021; 8:836-852. [PMID: 34419188 DOI: 10.1016/s2215-0366(21)00195-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 04/23/2021] [Accepted: 05/12/2021] [Indexed: 11/15/2022]
Abstract
Emotional mental imagery is a powerful part of our mental landscape. Given its capacity to depict, process, and generate emotional events, mental imagery could have an important role in psychological therapies. This Series paper explores whether harnessing emotional mental imagery is meaningful to young people; ways in which interventions use emotional mental imagery; contextual and individual factors influencing intervention effectiveness; and mechanisms underpinning imagery techniques. We completed a systematic review of imagery interventions and consulted young people with lived experience (n=10) and leading international experts (n=7). The systematic search identified 86 papers covering a diverse range of imagery interventions. Across the seven categories of techniques reviewed, imagery rescripting for aversive memories, techniques targeting positive imagery, and imagery-enhanced protocols indicated the most potential. The report suggests that harnessing emotional mental imagery in psychological interventions could be a promising approach to reduce anxiety and depression and that mental health science could inform the development of new interventions and help to maximise intervention effectiveness.
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Affiliation(s)
- Victoria Pile
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Department of Psychology, Royal Holloway, University of London, Egham, UK.
| | - Grace Williamson
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Aleks Saunders
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Emily A Holmes
- Department of Psychology, Uppsala University, Uppsala, Sweden; Division of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Jennifer Y F Lau
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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175
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Malik K, Michelson D, Doyle AM, Weiss HA, Greco G, Sahu R, E. J. J, Mathur S, Sudhir P, King M, Cuijpers P, Chorpita B, Fairburn CG, Patel V. Effectiveness and costs associated with a lay counselor-delivered, brief problem-solving mental health intervention for adolescents in urban, low-income schools in India: 12-month outcomes of a randomized controlled trial. PLoS Med 2021; 18:e1003778. [PMID: 34582460 PMCID: PMC8478208 DOI: 10.1371/journal.pmed.1003778] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 08/20/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Psychosocial interventions for adolescent mental health problems are effective, but evidence on their longer-term outcomes is scarce, especially in low-resource settings. We report on the 12-month sustained effectiveness and costs of scaling up a lay counselor-delivered, transdiagnostic problem-solving intervention for common adolescent mental health problems in low-income schools in New Delhi, India. METHODS AND FINDINGS Participants in the original trial were 250 school-going adolescents (mean [M] age = 15.61 years, standard deviation [SD] = 1.68), including 174 (69.6%) who identified as male. Participants were recruited from 6 government schools over a period of 4 months (August 20 to December 14, 2018) and were selected on the basis of elevated mental health symptoms and distress/functional impairment. A 2-arm, randomized controlled trial design was used to examine the effectiveness of a lay counselor-delivered, problem-solving intervention (4 to 5 sessions over 3 weeks) with supporting printed booklets (intervention arm) in comparison with problem solving delivered via printed booklets alone (control arm), at the original endpoints of 6 and 12 weeks. The protocol was modified, as per the recommendation of the Trial Steering Committee, to include a post hoc extension of the follow-up period to 12 months. Primary outcomes were adolescent-reported psychosocial problems (Youth Top Problems [YTP]) and mental health symptoms (Strengths and Difficulties Questionnaire [SDQ] Total Difficulties scale). Other self-reported outcomes included SDQ subscales, perceived stress, well-being, and remission. The sustained effects of the intervention were estimated at the 12-month endpoint and over 12 months (the latter assumed a constant effect across 3 follow-up points) using a linear mixed model for repeated measures and involving complete case analysis. Sensitivity analyses examined the effect of missing data using multiple imputations. Costs were estimated for delivering the intervention during the trial and from modeling a scale-up scenario, using a retrospective ingredients approach. Out of the 250 original trial participants, 176 (70.4%) adolescents participated in the 12-month follow-up assessment. One adverse event was identified during follow-up and deemed unrelated to the intervention. Evidence was found for intervention effects on both SDQ Total Difficulties and YTP at 12 months (YTP: adjusted mean difference [AMD] = -0.75, 95% confidence interval [CI] = -1.47, -0.03, p = 0.04; SDQ Total Difficulties: AMD = -1.73, 95% CI = -3.47, 0.02, p = 0.05), with stronger effects over 12 months (YTP: AMD = -0.98, 95% CI = -1.51, -0.45, p < 0.001; SDQ Total Difficulties: AMD = -1.23, 95% CI = -2.37, -0.09; p = 0.03). There was also evidence for intervention effects on internalizing symptoms, impairment, perceived stress, and well-being over 12 months. The intervention effect was stable for most outcomes on sensitivity analyses adjusting for missing data; however, for SDQ Total Difficulties and impairment, the effect was slightly attenuated. The per-student cost of delivering the intervention during the trial was $3 United States dollars (USD; or $158 USD per case) and for scaling up the intervention in the modeled scenario was $4 USD (or $23 USD per case). The scaling up cost accounted for 0.4% of the per-student school budget in New Delhi. The main limitations of the study's methodology were the lack of sample size calculations powered for 12-month follow-up and the absence of cost-effectiveness analyses using the primary outcomes. CONCLUSIONS In this study, we observed that a lay counselor-delivered, brief transdiagnostic problem-solving intervention had sustained effects on psychosocial problems and mental health symptoms over the 12-month follow-up period. Scaling up this resource-efficient intervention is an affordable policy goal for improving adolescents' access to mental health care in low-resource settings. The findings need to be interpreted with caution, as this study was a post hoc extension, and thus, the sample size calculations did not take into account the relatively high attrition rate observed during the long-term follow-up. TRIAL REGISTRATION ClinicalTrials.gov NCT03630471.
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Affiliation(s)
| | - Daniel Michelson
- School of Psychology, University of Sussex, Brighton, United Kingdom
| | - Aoife M. Doyle
- Medical Research Council International Statistics & Epidemiology Group, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Helen A. Weiss
- Medical Research Council International Statistics & Epidemiology Group, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Giulia Greco
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | | | | | - Paulomi Sudhir
- Department of Clinical Psychology, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
| | - Michael King
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, United Kingdom
| | - Pim Cuijpers
- Department of Clinical Psychology, Vrije Universiteit, Amsterdam, the Netherlands
| | - Bruce Chorpita
- Department of Psychology, University of California, Los Angeles, United States of America
| | | | - Vikram Patel
- Sangath, New Delhi, India
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, United States of America
- Harvard TH Chan School of Public Health, Boston, United States of America
- * E-mail:
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Maurer LF, Espie CA, Omlin X, Emsley R, Kyle SD. The effect of sleep restriction therapy for insomnia on sleep pressure and arousal: a randomised controlled mechanistic trial. Sleep 2021; 45:6360382. [PMID: 34463762 DOI: 10.1093/sleep/zsab223] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 08/10/2021] [Indexed: 11/13/2022] Open
Abstract
STUDY OBJECTIVES Sleep restriction therapy (SRT) effectively treats insomnia but mechanisms are poorly understood. Theoretical models suggest that potentiation of sleep pressure and reduction of arousal are key mechanisms of action. To our knowledge this has never been directly tested. We designed a randomised controlled trial with embedded mechanistic measurement to investigate if SRT causally modifies multidimensional assessments of sleep pressure and arousal. METHODS Participants aged 25-55 who met DSM-5 diagnostic criteria for insomnia disorder were randomised to four weeks of SRT or time in bed regularisation (TBR), a control intervention that involves prescription of a regular but not reduced time in bed. Sleep pressure was assessed through daily diary appraisal of morning and evening sleepiness, weekly Epworth sleepiness scale (ESS) scores, psychomotor vigilance, and NREM delta power (0.75-4.5Hz) from ambulatory polysomnographic recordings. Arousal was assessed through daily diary appraisal of cognitive arousal, the pre-sleep arousal scale (PSAS), and NREM beta power (15-32Hz). Outcomes were assessed at baseline (2-week period prior to randomisation), during the intervention phase (1-4 weeks post-randomisation), and at 12-week follow-up. We performed intention-to-treat analyses using linear mixed models. For continuous daily measures, the treatment period was split into early (weeks 1-2) and late (weeks 3-4) treatment. RESULTS Fifty-six participants (39 females, mean age=40.78±9.08) were assigned to SRT (n=27) or TBR (n=29). The SRT group showed enhanced sleep pressure relative to TBR, reflected in (1) enhanced sleepiness in the evening during early (d=1.17) and late treatment (d=0.92), and in the morning during early treatment (d=0.47); (2) higher daytime sleepiness on the ESS at weeks-1 and -2 (d=0.54, d=0.45); and (3) reduced psychomotor vigilance at week-1 (d=0.34). The SRT group also showed reduced arousal relative to TBR, reflected in lower levels of daily-monitored cognitive arousal during early treatment (d=0.53) and decreased PSAS total score at week-4 and week-12 (ds≥0.39). Power spectral analysis of all night NREM sleep revealed an increase in relative, but not absolute, EEG delta power at week-1 and week-4 (ds≥0.52) and a decrease of relative EEG beta power at week-4 (d=0.11). CONCLUSION For the first time we show that SRT increases sleep pressure and decreases arousal during acute implementation, providing support for mechanism-of-action.
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Affiliation(s)
- Leonie F Maurer
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neuroscience, University of Oxford, Sir William Dunn School of Pathology, Oxford, United Kingdom
| | - Colin A Espie
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neuroscience, University of Oxford, Sir William Dunn School of Pathology, Oxford, United Kingdom.,Big Health Inc., San Francisco, USA.,Big Health Inc., London, UK
| | - Ximena Omlin
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neuroscience, University of Oxford, Sir William Dunn School of Pathology, Oxford, United Kingdom
| | - Richard Emsley
- King's College London, Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, United Kingdom
| | - Simon D Kyle
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neuroscience, University of Oxford, Sir William Dunn School of Pathology, Oxford, United Kingdom
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177
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Ji JL, Geiles D, Saulsman LM. Mental imagery-based episodic simulation amplifies motivation and behavioural engagement in planned reward activities. Behav Res Ther 2021; 145:103947. [PMID: 34433114 DOI: 10.1016/j.brat.2021.103947] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 07/27/2021] [Accepted: 08/10/2021] [Indexed: 11/18/2022]
Abstract
Preliminary evidence suggests mental imagery-based episodic simulation of planned reward activities may amplify motivation and promote greater behavioural engagement, particularly for activities with high motivational barriers (Renner, Murphy, Ji, Manly, & Holmes, 2019). This study conducted a conceptual replication and extension of Renner et al. (2019). N = 81 first-year university students self-selected and scheduled two reward activities (one hedonic, one mastery) for the following week before being randomly allocated to either an Imagery-Experiential elaboration condition (n = 27), a Verbal-Reasoning elaboration condition (n = 28), or a Scheduling-only Control condition (n = 26). Following the lab session, all participants received standardized daily prompts to complete daily activity diaries online for seven days. The Imagery-Experiential condition reported greater increases in anticipatory pleasure (state mood), anticipated pleasure, and self-reported motivation compared to the Scheduling-only Control condition, and greater increases in anticipatory pleasure (state mood), but not anticipated pleasure or motivation, relative to the Verbal-Reasoning condition. Consistent with Renner et al. (2019), the Imagery-Experiential condition, but not the Verbal-Reasoning condition, reported more frequent engagement in high motivational barrier activities than the Scheduling-only Control condition. Exploratory mediational analyses suggested that mental imagery may exert unique motivational impacts via its impact on anticipatory pleasure (state mood), although indirect effects were only observed for self-reported motivation change in the lab, with real world behavioural effects falling short of statistical significance.
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Affiliation(s)
- Julie L Ji
- School of Psychological Science, University of Western Australia, Australia.
| | - Dylan Geiles
- School of Psychological Science, University of Western Australia, Australia
| | - Lisa M Saulsman
- School of Psychological Science, University of Western Australia, Australia
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178
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Spanhel K, Balci S, Feldhahn F, Bengel J, Baumeister H, Sander LB. Cultural adaptation of internet- and mobile-based interventions for mental disorders: a systematic review. NPJ Digit Med 2021; 4:128. [PMID: 34433875 PMCID: PMC8387403 DOI: 10.1038/s41746-021-00498-1] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 08/03/2021] [Indexed: 02/07/2023] Open
Abstract
Providing accessible and effective healthcare solutions for people living in low- and middle-income countries, migrants, and indigenous people is central to reduce the global mental health treatment gap. Internet- and mobile-based interventions (IMI) are considered scalable psychological interventions to reduce the burden of mental disorders and are culturally adapted for implementation in these target groups. In October 2020, the databases PsycInfo, MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Web of Science were systematically searched for studies that culturally adapted IMI for mental disorders. Among 9438 screened records, we identified 55 eligible articles. We extracted 17 content, methodological, and procedural components of culturally adapting IMI, aiming to consider specific situations and perspectives of the target populations. Adherence and effectiveness of the adapted IMI seemed similar to the original IMI; yet, no included study conducted a direct comparison. The presented taxonomy of cultural adaptation of IMI for mental disorders provides a basis for future studies investigating the relevance and necessity of their cultural adaptation.PROSPERO registration number: CRD42019142320.
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Affiliation(s)
- Kerstin Spanhel
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg, Germany.
| | - Sumeyye Balci
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Felicitas Feldhahn
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg, Germany
| | - Juergen Bengel
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg, Germany
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Lasse B Sander
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg, Germany
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179
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Nazari N, Safitri S, Usak M, Arabmarkadeh A, Griffiths MD. Psychometric Validation of the Indonesian Version of the Fear of COVID-19 Scale: Personality Traits Predict the Fear of COVID-19. Int J Ment Health Addict 2021; 21:1-17. [PMID: 34456653 PMCID: PMC8382103 DOI: 10.1007/s11469-021-00593-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/12/2021] [Indexed: 02/08/2023] Open
Abstract
The coronavirus disease-2019 (COVID-19) pandemic is a global health crisis that has generated fear and negative psychological consequences. The present study evaluated the validity and factor structure of Fear of COVID-19 Scale (FCV-19S) among a sample from the general Indonesian population. The English version of the FCV-19S was translated and back-translated into Indonesian language, followed by a pilot study. Using convenience sampling method, a total of 728 participants completed an online survey distributed on various social media platforms. The survey included the FCV-19S, personality traits (neuroticism and extraversion), Positive and Negative Affect Scale (PANAS), Generalized Anxiety Disorder Scale (GAD-7), and the nine-item Patient Health Questionnaire (PHQ-9). The Indonesian FCV-19S had very good internal consistency (Cronbach's alpha and McDonald's omega) and composite reliability (alpha = 0.88, omega = .86, composite reliability = .87). Maximum likelihood confirmatory factor analysis (CFA) was conducted to test construct validity (χ 2/df = 2.51, CFI = .984, SRMR = .028, PCLOSE = .15 > .05, RMSEA = .06, 90% CI [.03, .09]). As for criterion-related validity, the FCV-19S score positively correlated with the score on PHQ-9, GAD-7, negative affect, and neuroticism and negatively correlated with extraversion. Negative affect was identified as the most important predictor of the fear of COVID-19. Personality traits also predicted the fear of COVID-19. The findings provide evidence that the FCV-19S is a reliable and valid instrument for assessing fear generated by COVID-19 among a healthy Indonesian-speaking population.
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Affiliation(s)
- Nabi Nazari
- Department of Psychology, Faculty of Human Sciences, Lorestan University, Khorramabad, Iran
| | - Shahnaz Safitri
- Department of Educational Psychology, Faculty of Psychology, Universitas Indonesia, West Java, Indonesia
| | - Muhammet Usak
- Kazan (Volga region) Federal University, Kazan, Russia
| | - Arman Arabmarkadeh
- Faculty of Mathematics and Statistics, University of Isfahan, Isfahan, Iran
| | - Mark D. Griffiths
- International Gaming Research Unit, Psychology Division, Nottingham Trent University, Nottingham, UK
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180
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Beames JR, Kikas K, Werner-Seidler A. Prevention and early intervention of depression in young people: an integrated narrative review of affective awareness and Ecological Momentary Assessment. BMC Psychol 2021; 9:113. [PMID: 34392830 PMCID: PMC8365890 DOI: 10.1186/s40359-021-00614-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 06/21/2021] [Indexed: 01/03/2023] Open
Abstract
Depression has a devastating impact on young people around the world. This impact is pervasive and long-long lasting, still causing havoc as young people transition into adulthood. Prevention and timely early intervention efforts are necessary to lessen the disease burden of depression in young people. There is some evidence for the effectiveness of existing prevention and early intervention programs when delivered early. However, there is no consensus on what the active ingredients of these programs are. Identifying these ingredients is important because focusing on those that have maximal benefit will help to minimise the costs and resourcing of (already intensive) therapeutic approaches. We explored whether, and in what circumstances, affective awareness (i.e., knowing how one feels) is a candidate for protecting against and decreasing vulnerability to depression in young people. We specifically looked at how Ecological Momentary Assessment methods (EMA) were used to measure and/or increase affective awareness. We integrated three streams of data, including narrative review findings, perspectives from young people and psychologists, and publicly available information online (e.g., discussion forums). Across data sources, we found converging evidence that affective awareness is important in the prevention and early intervention of depression although there were considerable gaps in knowledge. More work needs to be done with young people and their health care teams to build affective awareness in the right way, at the right time, with individual differences in mind. The identification of how EMA can be best incorporated into young people's lives to facilitate these outcomes is also needed.
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Affiliation(s)
- Joanne R Beames
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia.
| | - Katarina Kikas
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
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Terpstra JA, van der Vaart R, Ding HJ, Kloppenburg M, Evers AW. Guided internet-based cognitive-behavioral therapy for patients with rheumatic conditions: A systematic review. Internet Interv 2021; 26:100444. [PMID: 34485094 PMCID: PMC8391057 DOI: 10.1016/j.invent.2021.100444] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 08/02/2021] [Accepted: 08/09/2021] [Indexed: 11/28/2022] Open
Abstract
CONTEXT Rheumatic conditions have a large impact on both patients and society. Many patients experience adjustment problems, such as symptoms of anxiety and depression and sleep problems, contributing to high healthcare costs. Internet-based cognitive-behavioral therapy (iCBT) has shown to support patients with somatic conditions in coping with their disease, with therapist-guided iCBT usually showing larger effects than unguided iCBT. However, the specific relevance of guided iCBT for rheumatic conditions has not been reviewed yet, which could have important implications for implementation. OBJECTIVES The objective of our review was to give an overview of evaluations of guided iCBT for rheumatic conditions, including physical, psychological, and impact on daily life outcomes. METHODS This review is registered with PROSPERO with registration number CRD42020154911. The review followed PRISMA guidelines and included an assessment of risk of bias. PubMed, PsycINFO, Embase, Cochrane Library, Web of Science, and Emcare were searched until 5 October 2020. Inclusion criteria were: patients ≥18 years old with a rheumatic condition, randomized controlled trial, accessible full-text English article, original data, inclusion of psychological, and/or physical and/or impact outcomes, and therapist-guided iCBT. Study and sample characteristics, as well as clinical variables were extracted. RESULTS A systematic search identified 6089 studies, of which 8 trials were included, comprising of 1707 participants in total. Significant medium to large between-group effects were found for psychological outcomes (depression, anxiety, catastrophizing, self-efficacy) and impact on daily life outcomes (impact on daily life, quality of life), whilst results for physical outcomes (pain intensity, fatigue) were mixed. CONCLUSION Whilst more research is warranted, for instance regarding physical outcomes, cost-effectiveness, safety of the intervention, and moderators of iCBT success, our results show that guided iCBT could be an important addition to medical treatment for rheumatic conditions. Guided iCBT can improve psychological and impact on daily life outcomes in patients with rheumatic conditions, which is promising for iCBT implementation in clinical practice.
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Affiliation(s)
- Jessy A. Terpstra
- Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, PO Box 9555, 2300 RB Leiden, the Netherlands,Leiden University Medical Center, Department of Rheumatology, C1-R, PO Box 9600, 2300 RC Leiden, the Netherlands,Corresponding author at: Leiden University, Dpt. of Health, Medical, and Neuropsychology, PO Box 9555, 2300 RB Leiden, the Netherlands.
| | - Rosalie van der Vaart
- Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, PO Box 9555, 2300 RB Leiden, the Netherlands
| | - He Jie Ding
- Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, PO Box 9555, 2300 RB Leiden, the Netherlands
| | - Margreet Kloppenburg
- Leiden University Medical Center, Department of Rheumatology, C1-R, PO Box 9600, 2300 RC Leiden, the Netherlands
| | - Andrea W.M. Evers
- Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, PO Box 9555, 2300 RB Leiden, the Netherlands,Leiden University Medical Center, Department of Psychiatry, B1-P, PO Box 9600, 2300 RC Leiden, the Netherlands
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182
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De Nadai AS, Etherton JL. Beyond Efficacy and Effectiveness: Clinical Efficiency Is Necessary for Dissemination. J Cogn Psychother 2021; 35:221-231. [PMID: 34362861 DOI: 10.1891/jcpsy-d-20-00034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Nearly all patients interact with critical gatekeepers-insurance companies or centralized healthcare systems. For mental health dissemination efforts to be successful, these gatekeepers must refer patients to evidence-based care. To make these referral decisions, they require evidence about the amount of resources expended to achieve therapeutic gains. Without this information, a bottleneck to widespread dissemination of evidence-based care will remain. To address this need for information, we introduce a new perspective, clinical efficiency. This approach directly ties resource usage to clinical outcomes. We highlight how cost-effectiveness approaches and other strategies can address clinical efficiency, and we also introduce a related new metric, the incremental time efficiency ratio (ITER). The ITER is particularly useful for quantifying the benefits of low-intensity and concentrated interventions, as well as stepped-care approaches. Given that stakeholders are increasingly requiring information on resource utilization, the ITER is a metric that can be estimated for past and future clinical trials. As a result, the ITER can allow researchers to better communicate desirable aspects of treatment, and an increased focus on clinical efficiency can improve our ability to deliver high-quality treatment to more patients in need.
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183
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Agren T, Hoppe JM, Singh L, Holmes EA, Rosén J. The neural basis of Tetris gameplay: implicating the role of visuospatial processing. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-021-02081-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AbstractTetris is not only a widely used entertaining computer game, but has been used as a component in emerging psychological interventions targeting dysfunctional mental imagery, e.g., intrusive memories and imagery-based cravings. However, little is known about the neurobiological mechanisms underlying these interventions. Tetris gameplay has been hypothesized to disrupt dysfunctional mental imagery (e.g., imagery-based intrusive memories of adverse events) and cravings (e.g., substance use) by taxing visuospatial working memory. In line with this, the present study aimed to characterize brain areas involved in the visuospatial aspects of Tetris gameplay, by controlling for motor activity (button presses) and using gameplay instructions emphasizing mental rotation. Participants (N = 28) received mental rotation instructions and thereafter either played Tetris, or only pressed buttons as if playing Tetris (motor activity), while undergoing functional magnetic resonance imaging. Tetris gameplay (when using mental rotation instructions and controlling for motor activity) robustly activated brain areas located in the ventral and dorsal stream, with maximum peak activation in the inferior and mid temporal gyrus. To the best of our knowledge, this is the first study to characterize brain areas specifically associated with the visuospatial aspects of Tetris gameplay, by controlling for motor activity and when using mental rotation instructions. Results demonstrate that engaging in Tetris gameplay recruits an extensive brain circuitry previously tied to visuospatial processing. Thus, findings are consistent with the use of Tetris as an imagery-competing task as one of several components of emerging interventions targeting dysfunctional mental imagery.
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184
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Are Changes in Beliefs About Rumination and in Emotion Regulation Skills Mediators of the Effects of Internet-Delivered Cognitive-Behavioral Therapy for Depression and Anxiety? Results from a Randomized Controlled Trial. COGNITIVE THERAPY AND RESEARCH 2021. [DOI: 10.1007/s10608-020-10200-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Abstract
Background
Internet-delivered cognitive behavior therapy (iCBT) is effective in treating anxiety and depression. Research on how these interventions operate is scarce. This study explored whether emotion regulation skills and positive beliefs about rumination were affected by iCBT and if these constructs mediated changes in depression and anxiety.
Methods
This is a secondary analysis of a pragmatic randomized waitlist-controlled trial testing the effectiveness of supported iCBT. Adults with at least mild symptoms of depression or anxiety were included. Depression (PHQ-9), anxiety (GAD-7), positive beliefs about rumination (PBRS-A) and two emotion regulation skills: cognitive reappraisal (ERQ-A) and expressive suppression (ERQ-S), were measured at baseline and 8-weeks post-treatment.
Results
The analyses included 358 participants, 71% were female. Median age was 29. Linear mixed models showed statistically significant differences along ERQ-A in favor of the iCBT group (b = 1.83, SE = 0.82, p = .026). Mediation analyses showed reductions in depression (b = 0.31, SE = 0.15, p = 0.043) and anxiety symptoms (b = 0.27, SE = 0.14, p = 0.057) were partially mediated by gains in ERQ-A. No effects were observed for PBRS-A and ERQ-S.
Conclusions
These results align with findings from face-to-face therapy and add to the scarce literature on mediators of effects of iCBT, contributing to the understanding of how these interventions operate. Since mediator and outcome variables were measured at the same time, partial mediation results should be interpreted with caution since the study design did not account for temporality and therefore causality effects cannot be confirmed.
Trial Registration
ISRCTN91967124.
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185
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Zhang X, Jiang X, Ni P, Li H, Li C, Zhou Q, Ou Z, Guo Y, Cao J. Association between resilience and burnout of front-line nurses at the peak of the COVID-19 pandemic: Positive and negative affect as mediators in Wuhan. Int J Ment Health Nurs 2021; 30:939-954. [PMID: 33893718 PMCID: PMC8251287 DOI: 10.1111/inm.12847] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 12/31/2020] [Accepted: 01/22/2021] [Indexed: 12/13/2022]
Abstract
The outbreak of coronavirus disease 2019 (COVID-19) is having a dramatic effect on the mental health of healthcare workers (HCWs). Upon the emergence of the COVID-19 pandemic, the Chinese government dispatched about 42 000 HCWs to Wuhan City and Hubei Province to fight this pandemic. This study briefly examines front-line nurses who experienced burnout, with the main objective of investigating the mediating roles of positive and negative affect in the relationship between resilience and burnout in Wuhan hospitals at the peak of the COVID-19 pandemic. A total of 180 front-line nurses voluntarily participated via a social media group. They completed the online questionnaires, including the Maslach Burnout Inventory-General Survey (MBI-GS), the Positive and Negative Affect Schedule (PANAS), the Connor-Davidson Resilience Scale (CD-RISC), demographics, and work-related characteristics. Structural equation modelling (SEM) analysis was used to examine the mediating effect of positive and negative affect on the relationship between resilience and burnout. The total prevalence of burnout was 51.7%, of which 15.0% were severe burnout. These preliminary results revealed that positive and negative affect fully mediated the effects of resilience on burnout, emotional exhaustion, depersonalization, and reduced personal accomplishment of front-line nurses. It is necessary to know the impact of resilience on HCWs with burnout through the positive and negative affect of individual backgrounds and situations, and how policymakers can deploy resilience interventions to support front-line HCWs.
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Affiliation(s)
- Xiaoning Zhang
- School of Nursing, Xuzhou Medical University, Xuzhou, China.,School of Nursing, Capital Medical University, Beijing, China.,Department of Neonatology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.,Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, China.,Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology, Xuzhou Medical University, Xuzhou, China
| | - Xue Jiang
- School of Nursing, Xuzhou Medical University, Xuzhou, China
| | - Pingping Ni
- School of Nursing, Xuzhou Medical University, Xuzhou, China.,Department of Neonatology, Suqian First Hospital, Suqian, China
| | - Haiyang Li
- Development Planning Office, Xuzhou Medical University, Xuzhou, China
| | - Chong Li
- Graduate School, Xuzhou Medical University, Xuzhou, China
| | - Qiong Zhou
- School of Nursing, Xuzhou Medical University, Xuzhou, China
| | - Zhengyan Ou
- School of Nursing, Xuzhou Medical University, Xuzhou, China
| | - Yuqing Guo
- School of Nursing, Xuzhou Medical University, Xuzhou, China
| | - Junli Cao
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, China.,Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology, Xuzhou Medical University, Xuzhou, China
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186
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Nieto I, Vazquez C. 'Relearning how to think': A brief online intervention to modify biased interpretations in emotional disorders-study protocol for a randomised controlled trial. Trials 2021; 22:510. [PMID: 34332616 PMCID: PMC8325786 DOI: 10.1186/s13063-021-05459-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 07/15/2021] [Indexed: 11/18/2022] Open
Abstract
Background Cognitive biases play an important role in the development and maintenance of emotional disorders, such as depression and anxiety. Novel procedures, known as Cognitive Bias Modification (CBM), aim to reduce these dysfunctional information processing modes. This study develops a brief clinically based online intervention programme to modify biased interpretations in depression and anxiety (CBM-IClin), overcoming some methodological issues that have been addressed in previous literature. Methods Volunteer participants will be recruited via social media and posters at the university. They will be randomly assigned to an experimental group or a waiting list control group. Both groups will complete two assessment sessions (before and after the intervention) consisting of questionnaires measuring cognitive and emotional variables as well as experimental tasks measuring cognitive biases (i.e. attention, memory, and interpretation). After the first assessment session, only participants in the experimental group will receive a link to follow the four CBM-IClin sessions at home. All participants will receive, via email, follow-up questionnaires 2 weeks and 3 months after the second assessment. Discussion This study will test the 'Relearning how to think', an online programme potentially beneficial to modify cognitive biases in emotional disorders. Several limitations of previous CBM procedures are addressed, and the impact of the programme both on objective cognitive bias tasks and clinical symptoms will be explored. Trial registration ClinicalTrials.gov NCT03987477. Prospectively registered on June 17, 2019
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Affiliation(s)
- Inés Nieto
- Department of Clinical Psychology, School of Psychology, Complutense University of Madrid, 28223, Madrid, Spain.
| | - Carmelo Vazquez
- Department of Clinical Psychology, School of Psychology, Complutense University of Madrid, 28223, Madrid, Spain
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187
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D'Agostini M, Burger AM, Franssen M, Claes N, Weymar M, von Leupoldt A, Van Diest I. Effects of transcutaneous auricular vagus nerve stimulation on reversal learning, tonic pupil size, salivary alpha-amylase, and cortisol. Psychophysiology 2021; 58:e13885. [PMID: 34245461 DOI: 10.1111/psyp.13885] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 04/26/2021] [Accepted: 05/25/2021] [Indexed: 12/11/2022]
Abstract
This study investigated whether transcutaneous auricular vagus nerve stimulation (taVNS) enhances reversal learning and augments noradrenergic biomarkers (i.e., pupil size, cortisol, and salivary alpha-amylase [sAA]). We also explored the effect of taVNS on respiratory rate and cardiac vagal activity (CVA). Seventy-one participants received stimulation of either the cymba concha (taVNS) or the earlobe (sham) of the left ear. After learning a series of cue-outcome associations, the stimulation was applied before and throughout a reversal phase in which cue-outcome associations were changed for some (reversal), but not for other (distractor) cues. Tonic pupil size, salivary cortisol, sAA, respiratory rate, and CVA were assessed at different time points. Contrary to our hypothesis, taVNS was not associated with an overall improvement in performance on the reversal task. Compared to sham, the taVNS group performed worse for distractor than reversal cues. taVNS did not increase tonic pupil size and sAA. Only post hoc analyses indicated that the cortisol decline was steeper in the sham compared to the taVNS group. Exploratory analyses showed that taVNS decreased respiratory rate but did not affect CVA. The weak and unexpected effects found in this study might relate to the lack of parameters optimization for taVNS and invite to further investigate the effect of taVNS on cortisol and respiratory rate.
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Affiliation(s)
| | - Andreas M Burger
- Research Group Health Psychology, KU Leuven, Leuven, Belgium.,Laboratory for Biological Psychology, KU Leuven, Leuven, Belgium
| | | | - Nathalie Claes
- Research Group Health Psychology, KU Leuven, Leuven, Belgium
| | - Mathias Weymar
- Department of Biological Psychology and Affective Science, Faculty of Human Sciences, University of Potsdam, Potsdam, Germany.,Faculty of Health Sciences Brandenburg, University of Potsdam, Potsdam, Germany
| | | | - Ilse Van Diest
- Research Group Health Psychology, KU Leuven, Leuven, Belgium
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188
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Nordh M, Wahlund T, Jolstedt M, Sahlin H, Bjureberg J, Ahlen J, Lalouni M, Salomonsson S, Vigerland S, Lavner M, Öst LG, Lenhard F, Hesser H, Mataix-Cols D, Högström J, Serlachius E. Therapist-Guided Internet-Delivered Cognitive Behavioral Therapy vs Internet-Delivered Supportive Therapy for Children and Adolescents With Social Anxiety Disorder: A Randomized Clinical Trial. JAMA Psychiatry 2021; 78:705-713. [PMID: 33978699 PMCID: PMC8117054 DOI: 10.1001/jamapsychiatry.2021.0469] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
IMPORTANCE Social anxiety disorder (SAD) is a prevalent childhood-onset disorder associated with lifelong adversity and high costs for the individual and society at large. Cognitive behavioral therapy (CBT) is an established evidence-based treatment for SAD, but its availability is limited. OBJECTIVE To assess the efficacy and cost-effectiveness of therapist-guided internet-delivered cognitive behavioral therapy (ICBT) for SAD in youths vs an active comparator, internet-delivered supportive therapy (ISUPPORT). DESIGN, SETTING, AND PARTICIPANTS This single-masked, superiority randomized clinical trial enrolled participants at a clinical research unit integrated within the child and adolescent mental health services in Stockholm, Sweden, from September 1, 2017, to October 31, 2018. The final participant reached the 3-month follow-up (primary end point) in May 2019. Children and adolescents 10 to 17 years of age with a principal diagnosis of SAD and their parents were included in the study. INTERVENTIONS ICBT and ISUPPORT, both including 10 online modules, 5 separate parental modules, and 3 video call sessions with a therapist. MAIN OUTCOMES AND MEASURES The Clinician Severity Rating (CSR), derived from the Anxiety Disorder Interview Schedule, rated by masked assessors 3 months after the end of treatment. The CSR ranges from 0 to 8, with scores of 4 or higher indicating caseness. Secondary outcomes included masked assessor-rated diagnostic status of SAD and global functioning, child- and parent-reported social anxiety and depressive symptoms, and health-related costs. RESULTS Of the 307 youths assessed for eligibility, 103 were randomized to 10 weeks of therapist-guided ICBT (n = 51) or therapist-guided ISUPPORT (n = 52) for SAD. The sample consisted of 103 youths (mean [SD] age, 14.1 [2.1] years; 79 [77%] female). Internet-delivered cognitive behavioral therapy was significantly more efficacious than ISUPPORT in reducing the severity of SAD symptoms. Mean (SD) CSR scores for ICBT at baseline and at the 3-month follow-up were 5.06 (0.95) and 3.96 (1.46), respectively, compared with 4.94 (0.94) and 4.48 (1.30) for ISUPPORT. There was a significant between-group effect size of d = 0.67 (95% CI, 0.21-1.12) at the 3-month follow-up. Similarly, all of the secondary outcome measures demonstrated significant differences with small to large effect sizes, except for child-rated quality of life (nonsignificant). The cost-effectiveness analyses indicated cost savings associated with ICBT compared with ISUPPORT, with the main drivers of the savings being lower medication costs (z = 2.38, P = .02) and increased school productivity (z = 1.99, P = .047) in the ICBT group. There was 1 suicide attempt in the ISUPPORT group; no other serious adverse events occurred in either group. CONCLUSIONS AND RELEVANCE In this randomized clinical trial, internet-delivered cognitive behavioral therapy was an efficacious and cost-effective intervention for children and adolescents with SAD. Implementation in clinical practice could markedly increase the availability of effective interventions for SAD. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03247075.
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Affiliation(s)
- Martina Nordh
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Tove Wahlund
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Maral Jolstedt
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Hanna Sahlin
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Johan Bjureberg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Johan Ahlen
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden,Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Maria Lalouni
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden,Division of Neuro, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Sigrid Salomonsson
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Sarah Vigerland
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Malin Lavner
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Lars-Göran Öst
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Fabian Lenhard
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Hugo Hesser
- Center for Health and Medical Psychology, Örebro University, Örebro, Sweden,Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden
| | - David Mataix-Cols
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Jens Högström
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Eva Serlachius
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
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189
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Mans K, Kettner H, Erritzoe D, Haijen ECHM, Kaelen M, Carhart-Harris RL. Sustained, Multifaceted Improvements in Mental Well-Being Following Psychedelic Experiences in a Prospective Opportunity Sample. Front Psychiatry 2021; 12:647909. [PMID: 34267683 PMCID: PMC8277190 DOI: 10.3389/fpsyt.2021.647909] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 05/31/2021] [Indexed: 12/20/2022] Open
Abstract
In the last 15 years, psychedelic substances, such as LSD and psilocybin, have regained legitimacy in clinical research. In the general population as well as across various psychiatric populations, mental well-being has been found to significantly improve after a psychedelic experience. Mental well-being has large socioeconomic relevance, but it is a complex, multifaceted construct. In this naturalistic observational study, a comprehensive approach was taken to assessing well-being before and after a taking a psychedelic compound to induce a "psychedelic experience." Fourteen measures of well-being related constructs were included in order to examine the breadth and specificity of change in well-being. This change was then analysed to examine clusters of measures changing together. Survey data was collected from volunteers that intended to take a psychedelic. Four key time points were analysed: 1 week before and 2 weeks, 4 weeks, and 2 years after the experience (N = 654, N = 315, N = 212, and N = 64, respectively). Change on the included measures was found to cluster into three factors which we labelled: 1) "Being well", 2) "Staying well," and 3) "Spirituality." Repeated Measures Multivariate Analysis of Variance revealed all but the spirituality factor to be improved in the weeks following the psychedelic experience. Additional Mixed model analyses revealed selective increases in Being Well and Staying Well (but not Spirituality) that remained statistically significant up to 2 years post-experience, albeit with high attrition rates. Post-hoc examination suggested that attrition was not due to differential acute experiences or mental-health changes in those who dropped out vs. those who did not. These findings suggest that psychedelics can have a broad, robust and sustained positive impact on mental well-being in those that have a prior intention to use a psychedelic compound. Public policy implications are discussed.
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Affiliation(s)
- Keri Mans
- Centre for Psychedelic Research, Division of Psychiatry, Department of Brain Sciences, Imperial College London, London, United Kingdom
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190
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Pile V, Winstanley A, Oliver A, Bennett E, Lau JYF. Targeting image-based autobiographical memory in childhood to prevent emotional disorders: Intervention development and a feasibility randomised controlled trial. Behav Res Ther 2021; 144:103913. [PMID: 34214822 DOI: 10.1016/j.brat.2021.103913] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 03/15/2021] [Accepted: 06/08/2021] [Indexed: 11/18/2022]
Abstract
Maladaptive cognitive styles confer vulnerability for emotional disorders and may emerge in childhood. In three phases, we developed and evaluated a novel parent-led intervention (My Memory Forest) to target overgeneral memory and avoidance of negative memories. In phase 1, the intervention was co-designed using two focus groups (n = 30 children) and consultation with teachers and parents. The acceptability, feasibility, and clinical potential of My Memory Forest was initially evaluated in phase two (n = 12 children aged 6 to 9) and then in a feasibility randomised controlled trial in phase three, against an active control (n = 56 aged 6 to 9). Acceptability and engagement were good, and no harm was reported by parents or participants. Phase 2 identified decreases in self-reported anxiety (d = 1.08), depression (d = 0.51) and vividness of negative events (d = 0.53). There was little change in parent-reported symptoms. In phase 3, recruitment was highly feasible and participant retention excellent (100%) but parent retention poor (55%). Descriptive statistics indicated similar changes in anxiety and depression for both groups. Changes between Phases 2 and 3 (e.g. methods of recruitment) could explain the discrepancy between results. Further development is necessary before proceeding to another trial. TRIAL REGISTRATION: ISRCTN13142918.
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Affiliation(s)
- Victoria Pile
- Department of Psychology, Institute of Psychiatry, King's College London, London, UK
| | - Ali Winstanley
- Cultural Institute, King's College London, Artist, Illustrator and Arts and Wellbeing Project Producer, Lewes, East Sussex, UK
| | - Abigail Oliver
- Department of Psychology, Institute of Psychiatry, King's College London, London, UK
| | - Eleanor Bennett
- Department of Psychology, Institute of Psychiatry, King's College London, London, UK
| | - Jennifer Y F Lau
- Department of Psychology, Institute of Psychiatry, King's College London, London, UK.
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191
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Eysenbach G, Nazari N, Griffiths MD. Using Fear and Anxiety Related to COVID-19 to Predict Cyberchondria: Cross-sectional Survey Study. J Med Internet Res 2021; 23:e26285. [PMID: 34014833 PMCID: PMC8191728 DOI: 10.2196/26285] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 02/18/2021] [Accepted: 05/03/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Studies have highlighted that fear and anxiety generated by COVID-19 are important psychological factors that affect all populations. There currently remains a lack of research on specific amplification factors regarding fear and anxiety in the context of the COVID-19 pandemic. Despite established associations between anxiety sensitivity, intolerance of uncertainty, and cyberchondria, empirical data investigating the associations between these three variables, particularly in the context of the COVID-19 pandemic, are currently lacking. Urgent research is needed to better understand the role of repeated media consumption concerning COVID-19 in amplifying fear and anxiety related to COVID-19. OBJECTIVE This study investigated the associations between fear of COVID-19, COVID-19 anxiety, and cyberchondria. METHODS Convenience sampling was used to recruit respondents to participate in an online survey. The survey, which was distributed via social media and academic forums, comprised the Cyberchondria Severity Scale, Fear of COVID-19 Scale, Coronavirus Anxiety Scale, Anxiety Sensitivity Index, and Intolerance of Uncertainty Scale. Multiple mediation analyses were conducted using structural equation modeling. RESULTS A total of 694 respondents (males: n=343, females: n=351) completed the online survey. The results showed that fear and anxiety generated by COVID-19 predicted cyberchondria (fear: β=.39, SE 0.04, P<.001, t=11.16, 95% CI 0.31-0.45; anxiety: β=.25, SE 0.03, P<.001, t=7.67, 95% CI 0.19-0.32). In addition, intolerance of uncertainty and anxiety sensitivity mediated the relationship between fear and anxiety generated by COVID-19 with cyberchondria. In a reciprocal model, the standardized total effects of cyberchondria on fear of COVID-19 (β=.45, SE 0.04, P<.001, t=15.31, 95% CI 0.39-0.51) and COVID-19 anxiety (β=.36, SE 0.03, P<.001, t=11.29, 95% CI 0.30-0.41) were statistically significant, with moderate effect sizes. Compared to males, females obtained significantly higher scores for cyberchondria (t1,692=-2.85, P=.004, Cohen d=0.22), COVID-19 anxiety (t1,692=-3.32, P<.001, Cohen d=0.26), and anxiety sensitivity (t1,692=-3.69, P<.001, Cohen d=0.29). CONCLUSIONS The findings provide a better understanding of the role of COVID-19 in amplifying cyberchondria. Based on these results, cyberchondria must be viewed as a significant public health issue. Importantly, increasing awareness about cyberchondria and online behavior at both the individual and collective levels must be prioritized to enhance preparedness and to reduce the adverse effects of current and future medical crises.
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Affiliation(s)
| | - Nabi Nazari
- Department of Psychology, Faculty of Literature and Human Sciences, Lorestan University, Khorramabad, Iran
| | - Mark D Griffiths
- International Gaming Research Unit, Psychology Division, Nottingham Trent University, Nottingham, United Kingdom
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192
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Wu X, Nazari N, Griffiths MD. Using Fear and Anxiety Related to COVID-19 to Predict Cyberchondria: Cross-sectional Survey Study. J Med Internet Res 2021. [DOI: doi.org/10.2196/26285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Background
Studies have highlighted that fear and anxiety generated by COVID-19 are important psychological factors that affect all populations. There currently remains a lack of research on specific amplification factors regarding fear and anxiety in the context of the COVID-19 pandemic. Despite established associations between anxiety sensitivity, intolerance of uncertainty, and cyberchondria, empirical data investigating the associations between these three variables, particularly in the context of the COVID-19 pandemic, are currently lacking. Urgent research is needed to better understand the role of repeated media consumption concerning COVID-19 in amplifying fear and anxiety related to COVID-19.
Objective
This study investigated the associations between fear of COVID-19, COVID-19 anxiety, and cyberchondria.
Methods
Convenience sampling was used to recruit respondents to participate in an online survey. The survey, which was distributed via social media and academic forums, comprised the Cyberchondria Severity Scale, Fear of COVID-19 Scale, Coronavirus Anxiety Scale, Anxiety Sensitivity Index, and Intolerance of Uncertainty Scale. Multiple mediation analyses were conducted using structural equation modeling.
Results
A total of 694 respondents (males: n=343, females: n=351) completed the online survey. The results showed that fear and anxiety generated by COVID-19 predicted cyberchondria (fear: β=.39, SE 0.04, P<.001, t=11.16, 95% CI 0.31-0.45; anxiety: β=.25, SE 0.03, P<.001, t=7.67, 95% CI 0.19-0.32). In addition, intolerance of uncertainty and anxiety sensitivity mediated the relationship between fear and anxiety generated by COVID-19 with cyberchondria. In a reciprocal model, the standardized total effects of cyberchondria on fear of COVID-19 (β=.45, SE 0.04, P<.001, t=15.31, 95% CI 0.39-0.51) and COVID-19 anxiety (β=.36, SE 0.03, P<.001, t=11.29, 95% CI 0.30-0.41) were statistically significant, with moderate effect sizes. Compared to males, females obtained significantly higher scores for cyberchondria (t1,692=–2.85, P=.004, Cohen d=0.22), COVID-19 anxiety (t1,692=–3.32, P<.001, Cohen d=0.26), and anxiety sensitivity (t1,692=–3.69, P<.001, Cohen d=0.29).
Conclusions
The findings provide a better understanding of the role of COVID-19 in amplifying cyberchondria. Based on these results, cyberchondria must be viewed as a significant public health issue. Importantly, increasing awareness about cyberchondria and online behavior at both the individual and collective levels must be prioritized to enhance preparedness and to reduce the adverse effects of current and future medical crises.
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Cardinale EM, Naim R, Haller SP, German R, Botz-Zapp C, Bezek J, Jangraw DC, Brotman MA. Rationale and validation of a novel mobile application probing motor inhibition: Proof of concept of CALM-IT. PLoS One 2021; 16:e0252245. [PMID: 34086728 PMCID: PMC8177631 DOI: 10.1371/journal.pone.0252245] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 05/02/2021] [Indexed: 12/02/2022] Open
Abstract
Identification of behavioral mechanisms underlying psychopathology is essential for the development of novel targeted therapeutics. However, this work relies on rigorous, time-intensive, clinic-based laboratory research, making it difficult to translate research paradigms into tools that can be used by clinicians in the community. The broad adoption of smartphone technology provides a promising opportunity to bridge the gap between the mechanisms identified in the laboratory and the clinical interventions targeting them in the community. The goal of the current study is to develop a developmentally appropriate, engaging, novel mobile application called CALM-IT that probes a narrow biologically informed process, inhibitory control. We aim to leverage the rigorous and robust methods traditionally used in laboratory settings to validate this novel mechanism-driven but easily disseminatable tool that can be used by clinicians to probe inhibitory control in the community. The development of CALM-IT has significant implications for the ability to screen for inhibitory control deficits in the community by both clinicians and researchers. By facilitating assessment of inhibitory control outside of the laboratory setting, researchers could have access to larger and more diverse samples. Additionally, in the clinical setting, CALM-IT represents a novel clinical screening measure that could be used to determine personalized courses of treatment based on the presence of inhibitory control deficits.
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Affiliation(s)
- Elise M. Cardinale
- Emotion & Development Branch, National Institute of Mental Health, Bethesda, MD, United States of America
| | - Reut Naim
- Emotion & Development Branch, National Institute of Mental Health, Bethesda, MD, United States of America
| | - Simone P. Haller
- Emotion & Development Branch, National Institute of Mental Health, Bethesda, MD, United States of America
| | - Ramaris German
- Emotion & Development Branch, National Institute of Mental Health, Bethesda, MD, United States of America
| | - Christian Botz-Zapp
- Emotion & Development Branch, National Institute of Mental Health, Bethesda, MD, United States of America
| | - Jessica Bezek
- Emotion & Development Branch, National Institute of Mental Health, Bethesda, MD, United States of America
| | - David C. Jangraw
- Department of Electrical and Biomedical Engineering, University of Vermont, Burlington, VT, United States of America
| | - Melissa A. Brotman
- Emotion & Development Branch, National Institute of Mental Health, Bethesda, MD, United States of America
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194
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Bø R, Kraft B, Jonassen R, Harmer CJ, Hilland E, Stiles TC, Haaland VØ, Aspesletten MEB, Sletvold H, Landrø NI. Symptom severity moderates the outcome of attention bias modification for depression: An exploratory study. J Psychiatr Res 2021; 138:528-534. [PMID: 33984807 DOI: 10.1016/j.jpsychires.2021.04.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 04/12/2021] [Accepted: 04/25/2021] [Indexed: 10/21/2022]
Abstract
A recent meta-analysis has questioned the relevance of attention bias modification (ABM) for depression outcomes. However, there might be patient characteristics not yet accounted for, that are relevant to the outcome. In the context of personalized treatment, the lack of moderator studies have limited the potential for matching ABM-treatment to individual patient characteristics. Subjects (N = 301) were randomly assigned 1:1 to receive either active or placebo Attention Bias Modification (ABM) twice daily for 14 days in a double-blind design (placebo n = 148; ABM n = 153). The outcome was change in symptoms based on the Hamilton Depression Rating Scale (HDRS). Moderator variables were self-reported depression (Beck Depression Inventory-II; BDI-II), anxiety (Beck Anxiety Inventory; BAI) and attentional bias (AB) assessed at baseline. This trial was registered with ClinicalTrials.gov, number NCT02658682. Only BAI (p for interaction = .01, Bootstrap 95% CI [0.046, 0.337]) moderated the effects of ABM on change in clinician rated depressive symptoms. Interactions were significant for BAI scores ≥8. The relative effect of the intervention increased with the highest symptom load. ABM was not effective in patients with the lowest symptom load. Future research should validate this finding and continue investigating moderators of the ABM-intervention to further enhance personalization of treatment to individual symptom characteristics.
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Affiliation(s)
- Ragnhild Bø
- Clinical Neuroscience Research Group, Department of Psychology, University of Oslo, Oslo, Norway.
| | - Brage Kraft
- Clinical Neuroscience Research Group, Department of Psychology, University of Oslo, Oslo, Norway; Division of Psychiatry, Diakonhjemmet Hospital, Oslo, Norway
| | - Rune Jonassen
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Catherine J Harmer
- Clinical Neuroscience Research Group, Department of Psychology, University of Oslo, Oslo, Norway; Psychopharmacology and Emotional Research Lab (PERL), Department of Psychiatry, University of Oxford, Oxford, UK; Oxford Health NHS Foundation Trust, Warenford Hospital, Oxfordshire, UK
| | - Eva Hilland
- Norwegian Centre for Mental Disorders Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Tore C Stiles
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Vegard Ø Haaland
- Clinical Neuroscience Research Group, Department of Psychology, University of Oslo, Oslo, Norway; Division of Mental Health, Sørlandet Hospital, Norway
| | - Maria E B Aspesletten
- Clinical Neuroscience Research Group, Department of Psychology, University of Oslo, Oslo, Norway
| | - Hanna Sletvold
- Clinical Neuroscience Research Group, Department of Psychology, University of Oslo, Oslo, Norway
| | - Nils Inge Landrø
- Clinical Neuroscience Research Group, Department of Psychology, University of Oslo, Oslo, Norway; Division of Psychiatry, Diakonhjemmet Hospital, Oslo, Norway
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195
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Naslund JA, Karyotaki E. Reducing psychological distress and depression in humanitarian emergencies: An essential role for nonspecialists. PLoS Med 2021; 18:e1003625. [PMID: 34138878 PMCID: PMC8211261 DOI: 10.1371/journal.pmed.1003625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
John Naslund and Eirini Karyotaki discuss Mark Jordans and colleagues' accompanying research study on therapy for people with psychological distress in Nepal.
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Affiliation(s)
- John A. Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Eirini Karyotaki
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Clinical, Neuro- and Development Psychology, Section Clinical Psychology, Vrije Universiteit, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Faculty of Behavioural and Movement Sciences, Vrije Universiteit, Amsterdam, the Netherlands
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Nakimuli‐Mpungu E, Musisi S, Smith CM, Von Isenburg M, Akimana B, Shakarishvili A, Nachega JB, Mills EJ, Chibanda D, Ribeiro M, V Williams A, Joska JA. Mental health interventions for persons living with HIV in low- and middle-income countries: a systematic review. J Int AIDS Soc 2021; 24 Suppl 2:e25722. [PMID: 34164926 PMCID: PMC8222847 DOI: 10.1002/jia2.25722] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 03/23/2021] [Accepted: 03/26/2021] [Indexed: 01/23/2023] Open
Abstract
INTRODUCTION Addressing the intersection between mental health and HIV is critical for the wellbeing of persons living with HIV (PLWH). This systematic review synthesized the literature on mental health interventions for PLWH in low- and middle-income countries (LMICs) to determine intervention components and explore their relationship with intervention effectiveness. METHODS We included only controlled clinical trials of interventions aiming to improve the mental health of PLWH. We conducted a search in the following databases: PubMed, CINAHL, PsycINFO and EMBASE for eligible studies describing the evaluation of interventions for mental health problems among PLWH in LMICs published through August 2020. Two reviewers independently screened references in two successive stages of title/abstract screening and then full-text screening for references meeting title/abstract criteria. RESULTS We identified a total of 30 eligible articles representing 6477 PLWH who were assigned to either the intervention arm (n = 3182) or control arm (n = 3346). The mental health interventions evaluated were psychological (n = 17, 56.67%), pharmacological (n = 6, 20.00%), combined psychological and pharmacological (n = 1, 3.33%) and complementary/alternative treatments (n = 6, 20.00%). The mental health problems targeted were depression (n = 22, 73.33 %), multiple psychological symptoms (n = 1, 3.33%), alcohol and substance use problems (n = 4, 13.33%), post-traumatic stress disorder (n = 1, 3.33%) and HIV-related neuro-cognitive impairment (n = 2, 6.67%). Studies of interventions with significant effects had significantly a higher number of active ingredients than those without significant effects [3.41 (2.24) vs. 1.84 (1.46) Mean (SD)] [Mean difference = -1.56, 95% CI = -3.03 to -0.09, p = 0.037]. CONCLUSIONS There continue to be advances in mental health interventions for PLWH with mental illness in LMICs. However, more research is needed to elucidate how intervention components lead to intervention effectiveness. We recommend scale up of culturally appropriate interventions that have been successfully evaluated in low- and middle-income countries.
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Affiliation(s)
| | - Seggane Musisi
- Department of PsychiatryCollege of Health SciencesMakerere UniversityKampalaUganda
| | - Colin M Smith
- Department of Psychiatry and Behavioral SciencesDuke University Medical CenterDurhamNCUSA
- Department of MedicineDuke University Medical CenterDurhamNCUSA
| | - Megan Von Isenburg
- Duke University Medical Center LibraryDuke University Medical CenterDurhamNCUSA
| | - Benedict Akimana
- The Butabika National Referral HospitalMinistry of HealthKampalaUganda
| | | | - Jean B Nachega
- Department of International Health, Bloomberg's School of Public HealthJohns Hopkins UniversityBaltimoreMDUSA
- Department of EpidemiologyPittsburgh Graduate School of Public HealthUniversity of PittsburghPittsburghPAUSA
- Stellenbosch Center for Infectious DiseaseDepartment of MedicineStellenbosch UniversityStellenboschSouth Africa
| | - Edward J Mills
- Department of Clinical Epidemiology & BiostatisticsMcMaster UniversityHamiltonONCanada
| | - Dixon Chibanda
- Zimbabwe AIDS Prevention ProjectDepartment of Community MedicineUniversity of ZimbabweHarareZimbabwe
| | - Marcelo Ribeiro
- Reference Center for Alcohol, Tobacco and Other Drugs (CRATOD)São Paulo State Secretary of HealthSão PauloBrazil
| | - Anna V Williams
- National Addiction CentreInstitute of Psychiatry, Psychology and NeuroscienceKing's College LondonUK
| | - John A Joska
- HIV Mental Health Research UnitDepartment of PsychiatryNeuroscience InstituteUniversity of Cape TownCape TownSouth Africa
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Cristea IA, Vecchi T, Cuijpers P. Top-down and Bottom-up Pathways to Developing Psychological Interventions. JAMA Psychiatry 2021; 78:593-594. [PMID: 33688937 DOI: 10.1001/jamapsychiatry.2020.4793] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Ioana A Cristea
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,IRCCS Mondino Foundation, Pavia, Italy
| | - Tomaso Vecchi
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,IRCCS Mondino Foundation, Pavia, Italy
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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198
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Storytelling increases oxytocin and positive emotions and decreases cortisol and pain in hospitalized children. Proc Natl Acad Sci U S A 2021; 118:2018409118. [PMID: 34031240 PMCID: PMC8179166 DOI: 10.1073/pnas.2018409118] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Storytelling is a unique human skill, yet we know little about its physiological and psychological impact. This study provides evidence of the biomarker changes and beneficial effects of storytelling in children admitted to an intensive care unit. We found that, compared with an active control condition, one storytelling session with hospitalized children leads to an increase in oxytocin, a reduction in cortisol and pain, and positive emotional shifts during a free-association task. These multimodal findings support evolutionary theories of storytelling and demonstrate its physiological and psychological effects under naturalistic stress conditions. These important clinical implications affirm storytelling as a low-cost and humanized intervention that can improve the well-being of hospitalized children. Storytelling is a distinctive human characteristic that may have played a fundamental role in humans’ ability to bond and navigate challenging social settings throughout our evolution. However, the potential impact of storytelling on regulating physiological and psychological functions has received little attention. We investigated whether listening to narratives from a storyteller can provide beneficial effects for children admitted to intensive care units. Biomarkers (oxytocin and cortisol), pain scores, and psycholinguistic associations were collected immediately before and after storytelling and an active control intervention (solving riddles that also involved social interaction but lacked the immersive narrative aspect). Compared with the control group, children in the storytelling group showed a marked increase in oxytocin combined with a decrease in cortisol in saliva after the 30-min intervention. They also reported less pain and used more positive lexical markers when describing their time in hospital. Our findings provide a psychophysiological basis for the short-term benefits of storytelling and suggest that a simple and inexpensive intervention may help alleviate the physical and psychological pain of hospitalized children on the day of the intervention.
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Hedman-Lagerlöf E, Fust J, Axelsson E, Bonnert M, Lalouni M, Molander O, Agrell P, Bergman A, Lindefors N, Bradley M. Internet-Delivered Cognitive Behavior Therapy for Atopic Dermatitis: A Randomized Clinical Trial. JAMA Dermatol 2021; 157:796-804. [PMID: 34009282 DOI: 10.1001/jamadermatol.2021.1450] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Atopic dermatitis is a common and debilitating skin condition characterized by intense itching and chronic inflammation. Research on behavioral treatments with high accessibility is needed. Objective To investigate the efficacy of a highly scalable internet-delivered cognitive behavior therapy (CBT) for adults with atopic dermatitis. Design, Setting, and Participants This randomized clinical trial from a medical university in Stockholm, Sweden, included 102 adults with atopic dermatitis, recruited from across Sweden, who received 12 weeks of internet-delivered CBT (March 29, 2017, to February 16, 2018). The first participant provided screening data on November 27, 2016, and the last 1-year follow-up assessment was conducted on June 28, 2019. Interventions Participants were randomized in a 1:1 ratio to 12 weeks of therapist-guided internet-delivered CBT (n = 51) or a control condition (n = 51) that gave instructions about standard care. Main Outcomes and Measures The primary outcome was the between-group difference in mean reduction of atopic dermatitis symptoms as measured by the Patient-Oriented Eczema Measure and modeled intention to treat during the 12-week treatment period. Results A total of 102 participants (mean [SD] age, 37 [11] years; 83 [81%] female) were recruited and randomized. The primary analysis indicated that participants receiving internet-delivered CBT, relative to the controls, had a significantly larger mean weekly reduction in symptoms of atopic dermatitis as measured with the Patient-Oriented Eczema Measure (B = 0.32; 95% CI, 0.14-0.49; P < .001), with a moderate to large, controlled effect size after treatment (d = 0.75; 95% CI, 0.32-1.16). Secondary analyses indicated that internet-delivered CBT also produced significantly larger reductions in itch intensity, perceived stress, sleep problems, and depression. Gains were sustained at 12 months of follow-up. Treatment satisfaction was high, and therapists spent a mean (SD) of 39.7 (34.7) minutes per treated patient providing internet-delivered CBT. Conclusions and Relevance Internet-delivered CBT appears to be efficacious for reducing symptoms of atopic dermatitis, despite requiring minimal therapist resources. Thus, internet-delivered CBT has the potential to increase access to effective adjunct behavioral treatment for patients with this common skin condition. Trial Registration ClinicalTrials.gov Identifier: NCT03051958.
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Affiliation(s)
| | - Jens Fust
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Erland Axelsson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Marianne Bonnert
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Maria Lalouni
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Olof Molander
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Petter Agrell
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Anna Bergman
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Nils Lindefors
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Maria Bradley
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
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Britton WB, Lindahl JR, Cooper DJ, Canby NK, Palitsky R. Defining and measuring meditation-related adverse effects in mindfulness-based programs. Clin Psychol Sci 2021; 9:1185-1204. [PMID: 35174010 PMCID: PMC8845498 DOI: 10.1177/2167702621996340] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
BACKGROUND Research on the adverse effects of mindfulness-based programs (MBPs) has been sparse and hindered by methodological imprecision. METHODS The 44-item Meditation Experiences Interview (MedEx-I) was used by an independent assessor to measure meditation-related side effects (MRSE) following three variants of an 8-week program of mindfulness-based cognitive therapy (n = 96). Each item was queried for occurrence, causal link to mindfulness meditation practice, duration, valence, and impact on functioning. RESULTS Eighty-three percent of the MBP sample reported at least one MRSE. Meditation-related adverse effects (MRAEs) with negative valences or negative impacts on functioning occurred in 58% and 37% of the sample, respectively. Lasting bad effects occurred in 6-14% of the sample and were associated with signs of dysregulated arousal (hyperarousal and dissociation). CONCLUSION Meditation practice in MBPs is associated with transient distress and negative impacts at similar rates to other psychological treatments.
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Affiliation(s)
- Willoughby B. Britton
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School at Brown University
| | | | - David J. Cooper
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School at Brown University
| | - Nicholas K. Canby
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School at Brown University
| | - Roman Palitsky
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School at Brown University
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