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Spates CR, Padalino R, Hale AC, Germain CS, Nimmo K, Kohler R. A review of web‐based technology in behavioural activation. CLIN PSYCHOL-UK 2020. [DOI: 10.1111/cp.12087] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | | | - Andrew C. Hale
- Department of Psychology, Western Michigan University, Kalamazoo, Michigan, USA,
| | - Chelsea Sage Germain
- Department of Psychology, Western Michigan University, Kalamazoo, Michigan, USA,
| | - Kelsey Nimmo
- Department of Psychology, Western Michigan University, Kalamazoo, Michigan, USA,
| | - Robert Kohler
- Department of Psychology, Western Michigan University, Kalamazoo, Michigan, USA,
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152
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Mazzucchelli TG, Kanter JW, Martell CR. A clinician's quick guide of evidence‐based approaches: Behavioural activation. CLIN PSYCHOL-UK 2020. [DOI: 10.1111/cp.12086] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Trevor G. Mazzucchelli
- School of Psychology and Speech Pathology, Curtin University, Bentley, Western Australia, Australia,
| | - Jonathan W. Kanter
- Department of Psychology, University of Washington, Seattle, Washington, USA,
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Mazzucchelli TG, Da silva M. The potential of behavioural activation for the treatment of chronic pain: An exploratory review. CLIN PSYCHOL-UK 2020. [DOI: 10.1111/cp.12088] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Trevor G. Mazzucchelli
- School of Psychology and Speech Pathology, Curtin University, Perth, Western Australia, Australia,
| | - Melissa Da silva
- School of Psychology and Speech Pathology, Curtin University, Perth, Western Australia, Australia,
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154
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Paul M, Bullock K, Bailenson J. Virtual Reality Behavioral Activation as an Intervention for Major Depressive Disorder: Case Report. JMIR Ment Health 2020; 7:e24331. [PMID: 33031046 PMCID: PMC7641650 DOI: 10.2196/24331] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 10/04/2020] [Accepted: 10/04/2020] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Major depressive disorder (MDD) is a global problem with an increasing incidence and prevalence. There has additionally been an increase in depression due to the COVID-19 pandemic. Behavioral activation is considered an evidence-based treatment for MDD. However, there are many barriers that could hinder one's ability to engage in behavioral activation, with COVID-19 "shelter-in-place" and social distancing orders being current and large impediments. Virtual reality (VR) has been successfully used to help treat a variety of mental health conditions, but it has not yet been used as a method of administering behavioral activation to a clinical population. Using VR to engage in behavioral activation could eliminate barriers that pandemic precautions place and help decrease symptoms of depression that are especially exacerbated in these times. OBJECTIVE The following case report examines the feasibility, acceptability, and tolerability of VR behavioral activation for an adult with MDD during a global pandemic. This participant was part of a larger pilot study, and the case serves as a description of the VR intervention. METHODS The participant engaged in a weekly 50-minute psychotherapy Zoom session for 4 weeks, in which a modified behavioral activation protocol was administered using a VR headset to simulate activities. Data on mood ratings, homework compliance, and headset use were obtained from the headset. Acceptability, tolerability, and depression symptoms were obtained using self-report rating scales. RESULTS The intervention was feasible, acceptable, and tolerable, as reported by this participant. The participant's depressive symptoms decreased by five-points on the Patient Health Questionnaire-9 over a month, with a beginning score of 10 (moderate depression) and a final score of 5 (mild depression). CONCLUSIONS The implications of these findings for future research are discussed. TRIAL REGISTRATION ClinicalTrials.gov NCT04268316; http://clinicaltrials.gov/ct2/show/NCT04268316.
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Affiliation(s)
- Margot Paul
- PGSP-Stanford PsyD Consortium, Palo Alto, CA, United States
| | - Kim Bullock
- Department of Psychiatry & Behavioral Sciences, Stanford School of Medicine, Stanford, CA, United States
| | - Jeremy Bailenson
- Department of Communication, Stanford University, Stanford, CA, United States
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155
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Trombello JM, South C, Sánchez A, Kahalnik F, Kennard BD, Trivedi MH. Two Trajectories of Depressive Symptom Reduction Throughout Behavioral Activation Teletherapy Among Underserved, Ethnically Diverse, Primary Care Patients: A VitalSign 6 Report. Behav Ther 2020; 51:958-971. [PMID: 33051037 DOI: 10.1016/j.beth.2020.01.002] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 01/03/2020] [Accepted: 01/05/2020] [Indexed: 12/27/2022]
Abstract
While prior research has investigated trajectories of depressive symptom change throughout psychotherapy, such work has not been conducted exclusively among underserved patients receiving brief Behavioral Activation (BA) teletherapy, intervention modifications that should reduce barriers to therapy initiation and engagement. The current project used cluster analysis to determine discrete groups of symptom change among patients receiving an 8-session BA teletherapy intervention, and analyzed whether demographic and clinical characteristics were associated with group membership. Data from 105 patients referred from charity primary care clinics and receiving at least two therapy sessions were analyzed. Patients were predominantly female and Latina. The 9-item Patient Health Questionnaire (PHQ-9) was the outcome. Two categories were determined: a larger group (N = 61) demonstrating initially less severe symptoms and experiencing a gradual recovery, and a smaller group beginning with more severe symptoms, and experiencing a steeper recovery. In both groups, a majority of participants experienced at least a 5-point drop in depressive symptoms, while in the latter group, a majority of patients achieved depressive symptom remission (PHQ-9 < 5). Monolingual Spanish speakers were more likely to be in the former group, but no other demographic or clinical characteristics were associated with group membership. In both groups, a majority of the symptom reduction occurred by sessions 4-6. Therefore, two categories of depressive symptom change, slow responders and rapid responders, occur among patients receiving a brief BA teletherapy intervention. No demographic differences aside from primary language, nor any clinical characteristics, distinguish group membership, suggesting similar patterns of symptom reduction among a primarily underserved sample.
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Working memory moderates the relation between the brain-derived neurotropic factor (BDNF) and psychotherapy outcome for depression. J Psychiatr Res 2020; 130:424-432. [PMID: 32891918 DOI: 10.1016/j.jpsychires.2020.07.045] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 07/30/2020] [Accepted: 07/31/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Insight into patient characteristics that predict response to treatment for major depressive disorder (MDD) may help to personalize treatment and improve outcomes. One mechanism that has been linked to the success of treatment for MDD is brain-derived neurotropic factor (BDNF). BDNF is implicated in learning and memory and may play a role in the effects of psychotherapy that involves changing cognitions and behaviors. In addition, only in individuals with low BDNF, low working memory capacity has been associated with increased symptoms of depression. However, the role of BDNF and working memory capacity in psychotherapy outcome is unclear. The aim of this study was to investigate the role of BDNF and its interaction with working memory capacity in psychotherapy outcomes for MDD. METHOD Adult patients with MDD were randomized to weekly or twice weekly sessions of cognitive behavioral therapy or interpersonal psychotherapy. BDNF Val66Met polymorphism (rs6265) (n = 138) was defined and serum BDNF was quantified before (n = 138) and after psychotherapy (n = 82). RESULTS Baseline serum BDNF and the Val66Met polymorphism were not associated with outcome and associations did not differ between treatment conditions. Working memory capacity significantly moderated the relation between baseline serum BDNF and outcome: high serum BDNF at baseline was related to less depressive symptoms following psychotherapy in the presence of high working memory capacity, but not low working memory capacity. DISCUSSION These findings, if replicated, might indicate that while BDNF may not be related to psychotherapy outcomes in general, they may play a role in the presence of specific learning processes such as working memory capacity.
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158
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Luo H, Lou VWQ, Chen C, Chi I. The Effectiveness of the Positive Mood and Active Life Program on Reducing Depressive Symptoms in Long-Term Care Facilities. THE GERONTOLOGIST 2020; 60:193-204. [PMID: 30295729 DOI: 10.1093/geront/gny120] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Depression is prevalent among long-term care facility (LTCF) residents. However, interventions are not normally part of the management of these residents due to a shortage of mental health professionals. On the basis of Lewinsohn's behavioral model of depression, we developed a 12-week pleasant activity scheduling intervention, the Positive Mood and Active Life (PMAL) program. This study evaluated the effectiveness of the PMAL program on reducing depressive symptoms and improving quality of life among at-risk LTCF residents. RESEARCH DESIGN AND METHODS We adopted a cluster randomized controlled trial design. Four LTCFs were randomly assigned as treatment sites and three provided care as usual. At-risk LTCF residents (N = 68) were identified using the Mood Resident Assessment Protocol from the Minimum Data Set 2.0. The PMAL program was delivered to 34 residents. The primary and secondary outcomes were depressive symptoms and quality of life, as measured by the Geriatric Depression Scale-15 (GDS-15) and the World Health Organization Quality of Life scale-BREF (WHOQoL-BREF), respectively. RESULTS After 12 weeks, the GDS-15 score in the intervention group showed a reduction from 7.59 to 5.67, with a significant treatment by time effect (p = .006), based on the mixed model analysis; the WHOQoL-BREF score also substantially increased from 69.83 to 86.61 (p = .000). DISCUSSION AND IMPLICATIONS The PMAL program is effective in reducing depressive symptoms of at-risk LTCF residents. It is a feasible intervention that requires minimum resources and can be integrated with standardized assessment systems.
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Affiliation(s)
- Hao Luo
- Department of Social Work and Social Administration, The University of Hong Kong.,Department of Computer Science, The University of Hong Kong.,Sau Po Centre on Ageing, Department of Social Work and Social Administration, The University of Hong Kong
| | - Vivian W Q Lou
- Department of Social Work and Social Administration, The University of Hong Kong.,Sau Po Centre on Ageing, Department of Social Work and Social Administration, The University of Hong Kong
| | - Chunhua Chen
- Sau Po Centre on Ageing, Department of Social Work and Social Administration, The University of Hong Kong
| | - Iris Chi
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles
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159
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Zabihi S, Lemmel FK, Orgeta V. Behavioural Activation for Depression in Informal Caregivers: A Systematic Review and Meta-Analysis of Randomised Controlled Clinical Trials. J Affect Disord 2020; 274:1173-1183. [PMID: 32663948 DOI: 10.1016/j.jad.2020.03.124] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 02/06/2020] [Accepted: 03/29/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Carers experience significant physical and psychological burden and are at increased risk of experiencing clinical depression. Although several psychological treatments have been shown to be effective for preventing and treating depression in carers, most are complex, costly, and not easily accessible to family carers. In this paper, we review evidence of effectiveness of Behavioural Activation (BA) for depressive symptoms in informal caregivers and report on its quality. METHODS We searched MEDLINE, EMBASE, PsycINFO, CINAHL, CENTRAL and Online trial registers for randomised controlled clinical trials of BA for carers. RESULTS Twelve trials met inclusion criteria and eleven were included in the meta-analyses. BA reduced depressive symptoms for carers (standardised mean difference (SMD) -0.68; confidence interval (CI) -1.14 to -0.22) at post intervention (4-14 weeks) and in the long term (l year; SMD -0.99; CI -1.26 to -0.71). BA decreased risk of a diagnosis of major depression (Odds Ratio 0.35; CI 0.19 to 0.67), and reduced negative affect (SMD -0.53; 95% CI -0.83 to -0.23), and caregiver burden (SMD -0.32; CI -0.55 to -0.09) at post-treatment. Quality of evidence was moderate and there was no evidence of publication bias. LIMITATIONS There was high heterogeneity in the studies included. CONCLUSION BA is effective in reducing depressive symptoms post-treatment and long-term (1 year) and decreases odds of a diagnosis of major depression in informal caregivers. Our review provides further evidence that BA is an effective psychological intervention, which is potentially highly scalable across many settings, populations and cultures (Registration: PROSPERO-CRD42019138860).
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Affiliation(s)
- Sedigheh Zabihi
- Division of Psychiatry, Faculty of Brain Sciences, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, W1T 7NF London
| | - Frederike K Lemmel
- Division of Psychiatry, Faculty of Brain Sciences, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, W1T 7NF London
| | - Vasiliki Orgeta
- Division of Psychiatry, Faculty of Brain Sciences, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, W1T 7NF London.
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160
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Design and Development of a Digital Program for Training Non-Specialist Health Workers to Deliver an Evidence-Based Psychological Treatment for Depression in Primary Care in India. ACTA ACUST UNITED AC 2020; 5:402-415. [PMID: 34150992 DOI: 10.1007/s41347-020-00154-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Digital technologies hold promise for building capacity of non-specialist health workers towards scaling up depression care in low-resource settings. The purpose of this study was to describe the systematic approach to designing a digital program for training non-specialist health workers to deliver an evidence-based brief psychological treatment for depression, called the Healthy Activity Program, in primary care in rural India. Methods The design and development of the training program involved 5 steps: 1) develop program blueprint; 2) create instructional content; 3) digitize content for a smartphone app; 4) develop a platform for uploading and hosting the digital content; and 5) user-testing and refinements to ensure program functioning. This was followed by field-testing and focus group discussions with non-specialist health workers recruited from primary care facilities in Madhya Pradesh, India, to inform further modifications and improvements to the digital training program. Results Training program development occurred over 12-months, and the final digital training consisted of 16 modules with videos, role-plays, and digital content tailored to the local culture and context. Focus group discussions with 19 non-specialist health workers generated three key action items and modifications to the digital training in response to participant feedback: 1) addressing technical challenges by making the digital content available offline; 2) account for low digital literacy by including a comprehensive orientation session about navigating the smartphone app; and 3) addition of remote coaching to support participants in completing the training. Conclusions This study illustrates a step-wise approach to combine evidence-based content with iterative feedback from stakeholders to develop a digital training program tailored to the context in a low-resource setting. Further research is needed to validate this approach and to evaluate the effectiveness of the final modified digital training program, while considering whether this approach can be adopted and replicated in other settings.
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161
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Abstract
Depression is one of the most common comorbidities of many chronic medical diseases including cancer and cardiovascular, metabolic, inflammatory and neurological disorders. Indeed, the prevalence of depression in these patient groups is often substantially higher than in the general population, and depression accounts for a substantial part of the psychosocial burden of these disorders. Many factors can contribute to the occurrence of comorbid depression, such as shared genetic factors, converging biological pathways, social factors, health behaviours and psychological factors. Diagnosis of depression in patients with a medical disorder can be particularly challenging owing to symptomatic overlap. Although pharmacological and psychological treatments can be effective, adjustments may need to be made for patients with a comorbid medical disorder. In addition, symptoms or treatments of medical disorders may interfere with the treatment of depression. Conversely, symptoms of depression may decrease adherence to treatment of both disorders. Thus, comprehensive treatment plans are necessary to optimize care.
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162
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Wright J, Mazumdar P, Barua D, Lina S, Bibi H, Kanwal A, Mujeeb F, Naz Q, Safi R, Ul Haq B, Rana RZ, Nahar P, Jennings H, Sikander S, Huque R, Nizami A, Jackson C. Integrating depression care within NCD provision in Bangladesh and Pakistan: a qualitative study. Int J Ment Health Syst 2020; 14:63. [PMID: 32831905 PMCID: PMC7422526 DOI: 10.1186/s13033-020-00399-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 08/05/2020] [Indexed: 11/15/2022] Open
Abstract
Background Co-morbidity of depression with other non-communicable diseases (NCDs) worsens clinical outcomes for both conditions. Low- and middle-income countries need to strengthen mechanisms for detection and management of co-morbid depression within NCDs. The Behavioural Activation for Comorbid Depression in Non-communicable Disease (BEACON) study explored the acceptability and feasibility of integrating a brief depression intervention (behavioural activation, BA) into NCD services in healthcare facilities in Bangladesh and Pakistan. Methods Face-to-face qualitative interviews were conducted with 43 patients and 18 health workers attending or working in NCD centres in four healthcare facilities in Bangladesh and Pakistan, and with three policy makers in each country. The interviews addressed four research questions (1) how NCD care is delivered, (2) how NCD patients experience distress, (3) how depression care is integrated within NCD provision, and (4) the challenges and opportunities for integrating a brief depression intervention into usual NCD care. The data were analysed using framework analysis, organised by capability, opportunity and motivation factors, cross-synthesised across countries and participant groups. Results Patients and health workers described NCD centres as crowded and time pressured, with waiting times as long as five hours, and consultation times as short as five minutes; resulting in some patient frustration. They did not perceive direct links between their distress and their NCD conditions, instead describing worries about family and finance including affordability of NCD services. Health worker and policy maker accounts suggested these NCD centres lacked preparedness for treating depression in the absence of specific guidelines, standard screening tools, recording systems or training. Barriers and drivers to integrating a brief depression intervention reflected capability, opportunity and motivation factors for all participant groups. While generally valuing the purpose, significant challenges included the busy hospital environment, skill deficits and different conceptions of depression. Conclusions Given current resource constraints and priorities, integrating a brief psychological intervention at these NCD centres appears premature. An opportune first step calls for responding to patients’ expressed concerns on service gaps in provisioning steady and affordable NCD care. Acknowledging differences of conceptions of depression and strengthening psychologically informed NCD care will in turn be required before the introduction of a specific psychological intervention such as BA.
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Affiliation(s)
- Jerome Wright
- Department of Health Sciences, University of York, Heslington, York, YO10 5DD UK
| | - Papiya Mazumdar
- Department of Health Sciences, University of York, Heslington, York, YO10 5DD UK
| | - Deepa Barua
- ARK Foundation, House No 6, Road No 109, Gulshan 2, Dhaka, Bangladesh
| | - Silwa Lina
- ARK Foundation, House No 6, Road No 109, Gulshan 2, Dhaka, Bangladesh
| | - Humaira Bibi
- Institute of Psychiatry, Rawalpindi Medical University, Rawalpindi, 46000 Pakistan
| | - Ateeqa Kanwal
- Institute of Psychiatry, Rawalpindi Medical University, Rawalpindi, 46000 Pakistan
| | - Faiza Mujeeb
- Institute of Psychiatry, Rawalpindi Medical University, Rawalpindi, 46000 Pakistan
| | - Qirat Naz
- Institute of Psychiatry, Rawalpindi Medical University, Rawalpindi, 46000 Pakistan
| | - Rahim Safi
- Institute of Psychiatry, Rawalpindi Medical University, Rawalpindi, 46000 Pakistan
| | - Baha Ul Haq
- Institute of Psychiatry, Rawalpindi Medical University, Rawalpindi, 46000 Pakistan
| | - Rusham Zahra Rana
- Institute of Psychiatry, Rawalpindi Medical University, Rawalpindi, 46000 Pakistan
| | - Papreen Nahar
- Brighton and Sussex Medical School, Medical Research Building, University of Sussex, Falmer, Brighton, BN1 9PX UK
| | - Hannah Jennings
- Department of Health Sciences, University of York, Heslington, York, YO10 5DD UK
| | - Siham Sikander
- Health Services Academy, Islamabad, PM Health Complex, Chak Shahzad, Islamabad, 44000 Pakistan
| | - Rumana Huque
- ARK Foundation, House No 6, Road No 109, Gulshan 2, Dhaka, Bangladesh
| | - Asad Nizami
- Institute of Psychiatry, Rawalpindi Medical University, Rawalpindi, 46000 Pakistan
| | - Cath Jackson
- Valid Research Ltd, Suite 19, Sandown House, Sandbeck Way, Wetherby, LS22 7DN UK
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Uphoff E, Pires M, Barbui C, Barua D, Churchill R, Cristofalo D, Ekers D, Fottrell E, Mazumdar P, Purgato M, Rana R, Wright J, Siddiqi N. Behavioural activation therapy for depression in adults with non-communicable diseases. Cochrane Database Syst Rev 2020; 8:CD013461. [PMID: 32841367 PMCID: PMC8094508 DOI: 10.1002/14651858.cd013461.pub2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Depression is common in people with non-communicable diseases (NCDs) such as cardiovascular disease, diabetes, cancer, and chronic respiratory conditions. The co-existence of depression and NCDs may affect health behaviours, compliance with treatment, physiological factors, and quality of life. This in turn is associated with worse outcomes for both conditions. Behavioural activation is not currently indicated for the treatment of depression in this population in the UK, but is increasingly being used to treat depression in adults. OBJECTIVES To examine the effects of behavioural activation compared with any control group for the treatment of depression in adults with NCDs. To examine the effects of behavioural activation compared with each control group separately (no treatment, waiting list, other psychological therapy, pharmacological treatment, or any other type of treatment as usual) for the treatment of depression in adults with NCDs. SEARCH METHODS We searched CCMD-CTR, CENTRAL, Ovid MEDLINE, Embase, four other databases, and two trial registers on 4 October 2019 to identify randomised controlled trials (RCTs) of behavioural activation for depression in participants with NCDs, together with grey literature and reference checking. We applied no restrictions on date, language, or publication status to the searches. SELECTION CRITERIA We included RCTs of behavioural activation for the treatment of depression in adults with one of four NCDs: cardiovascular disease, diabetes, cancer, and chronic respiratory conditions. Only participants with a formal diagnosis of both depression and an NCD were eligible. Studies were included if behavioural activation was the main component of the intervention. We included studies with any comparator that was not behavioural activation, and regardless of reported outcomes. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane, including independent screening of titles/abstracts and full-text manuscripts, data extraction, and risk of bias assessments in duplicate. Where necessary, we contacted study authors for more information. MAIN RESULTS We included two studies, contributing data from 181 participants to the analyses. Both studies recruited participants from US hospital clinics; one included people who were recovering from a stroke and the other women with breast cancer. For both studies, the intervention consisted of eight weeks of face-to-face behavioural therapy, with one study comparing to poststroke treatment as usual and the other comparing to problem-solving therapy. Both studies were at risk of performance bias and potential conflict of interest arising from author involvement in the development of the intervention. For one study, risks of selection bias and reporting bias were unclear and the study was judged at high risk of attrition bias. Treatment efficacy (remission) was greater for behavioural activation than for comparators in the short term (risk ratio (RR) 1.53, 95% confidence interval (CI) 0.98 to 2.38; low-certainty evidence) and medium term (RR 1.76, 95% CI 1.01 to 3.08; moderate-certainty evidence), but these estimates lacked precision and effects were reduced in the long term (RR 1.42, 95% CI 0.91 to 2.23; moderate-certainty evidence). We found no evidence of a difference in treatment acceptability in the short term (RR 1.81, 95% CI 0.68 to 4.82) and medium term (RR 0.88, 95% CI 0.25 to 3.10) (low-certainty evidence). There was no evidence of a difference in depression symptoms between behavioural activation and comparators (short term: MD -1.15, 95% CI -2.71 to 0.41; low-certainty evidence). One study found no difference for quality of life (short term: MD 0.40, 95% CI -0.16 to 0.96; low-certainty evidence), functioning (short term: MD 2.70, 95% CI -6.99 to 12.39; low-certainty evidence), and anxiety symptoms (short term: MD -1.70, 95% CI -4.50 to 1.10; low-certainty evidence). Neither study reported data on adverse effects. AUTHORS' CONCLUSIONS Evidence from this review was not sufficient to draw conclusions on the efficacy and acceptability of behavioural activation for the treatment of depression in adults with NCDs. A future review may wish to include, or focus on, studies of people with subthreshold depression or depression symptoms without a formal diagnosis, as this may inform whether behavioural activation could be used to treat mild or undiagnosed (or both) depressive symptoms in people with NCDs. Evidence from low-resource settings including low- and middle-income countries, for which behavioural activation may offer a feasible alternative to other treatments for depression, would be of interest.
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Affiliation(s)
- Eleonora Uphoff
- Cochrane Common Mental Disorders, University of York, York, UK
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Malini Pires
- Mental Health and Addiction Research Group, Department of Health Sciences, University of York, York, UK
| | - Corrado Barbui
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | | | - Rachel Churchill
- Cochrane Common Mental Disorders, University of York, York, UK
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Doriana Cristofalo
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - David Ekers
- Mental Health and Addiction Research Group, Department of Health Sciences, University of York, York, UK
- Lanchester Road Hospital, Tees, Esk and Wear Valleys NHS Foundation Trust, Durham, UK
| | - Edward Fottrell
- Centre for Health Policy, Institute of Global Health Innovation, University College London, London, UK
| | - Papiya Mazumdar
- Mental Health and Addiction Research Group, Department of Health Sciences, University of York, York, UK
| | - Marianna Purgato
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Rusham Rana
- Institute of Psychiatry, Benazir Bhutto Hospital, Rawalpindi, Pakistan
| | - Judy Wright
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Najma Siddiqi
- Department of Health Sciences, Hull York Medical School, University of York, York, UK
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Bigot M, Alonso M, Houenou J, Sarrazin S, Dargél AA, Lledo PM, Henry C. An emotional-response model of bipolar disorders integrating recent findings on amygdala circuits. Neurosci Biobehav Rev 2020; 118:358-366. [PMID: 32739421 DOI: 10.1016/j.neubiorev.2020.07.037] [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: 11/12/2019] [Revised: 07/16/2020] [Accepted: 07/27/2020] [Indexed: 02/02/2023]
Abstract
Because of our classification system limitations for defining psychiatric disorders and understanding their physiopathology, a new research area based on dimensions has emerged. It consists of exploring domains derived from fundamental behavioral components linked to neurobiological systems. Emotional processing is among the most affected dimensions in bipolar disorders (BD), but is excluded from the definition criteria. The purpose of this review is to synthesize the emotional responses disruption during the different phases of BD, using intensity and valence as the two key characteristics of emotions. We integrate those emotional disruptions into an original, emotion-based model contrasting with the current diagnostic frame built on mood. Emotional processing is underpinned by cortico-limbic circuits involving the amygdala. Recent publications showed the crucial role of the amygdala in emotional processes triggered by stimuli of negative, but also positive valence. We show how these neuroscience data can provide physiological basis for emotional disturbances observed in BD. We conclude with translational perspectives to improve the current knowledge about neural substrates underlying altered emotional responses characterizing BD.
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Affiliation(s)
- Mathilde Bigot
- Perception and Memory Unit, Institut Pasteur, UMR3571, CNRS, Paris, France; Sorbonne Université, Collège doctoral, Paris, France
| | - Mariana Alonso
- Perception and Memory Unit, Institut Pasteur, UMR3571, CNRS, Paris, France
| | - Josselin Houenou
- Université Paris-Est, INSERM, U955, Créteil, France; NeuroSpin, Commissariat à l'Energie Atomique et aux Énergies Alternatives, Gif-sur-Yvette, France
| | - Samuel Sarrazin
- Université Paris-Est, INSERM, U955, Créteil, France; NeuroSpin, Commissariat à l'Energie Atomique et aux Énergies Alternatives, Gif-sur-Yvette, France
| | - Aroldo A Dargél
- Perception and Memory Unit, Institut Pasteur, UMR3571, CNRS, Paris, France
| | - Pierre-Marie Lledo
- Perception and Memory Unit, Institut Pasteur, UMR3571, CNRS, Paris, France
| | - Chantal Henry
- Perception and Memory Unit, Institut Pasteur, UMR3571, CNRS, Paris, France; Université de Paris, Paris, France; Department of Psychiatry, Service Hospitalo-Universitaire, GHU Paris Psychiatrie & Neurosciences, Paris, France.
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165
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Paans NPG, Bot M, Brouwer IA, Visser M, Gili M, Roca M, Hegerl U, Kohls E, Owens M, Watkins E, Penninx BWJH. Effects of food-related behavioral activation therapy on eating styles, diet quality and body weight change: Results from the MooDFOOD Randomized Clinical Trial. J Psychosom Res 2020; 137:110206. [PMID: 32798835 DOI: 10.1016/j.jpsychores.2020.110206] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 07/14/2020] [Accepted: 07/26/2020] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Depression and obesity are bi-directionally related, eating styles and diet quality are two important factors associated with both. It remains uncertain if and how these two factors can be modified. Therefore the current study aims to investigate whether food-related behavioral activation therapy (F-BA), targeting mood, dietary habits and food related behavior, can improve eating styles, and diet quality and reduce body weight in adults with overweight or obesity and subsyndromal depressive symptoms. METHODS Data were derived from the MooDFOOD prevention trial, a 2x2 factorial RCT investigating the effect of nutritional strategies on prevention of depression. Changes in emotional, uncontrolled, and cognitive restrained eating (Three Factor Eating Questionnaire Revised), Mediterranean Diet Score (MDS), and body weight were analyzed among 1025 adults who either received F-BA or no intervention for 12 months. Intervention effect was tested by longitudinal analysis of covariance using mixed model analysis. RESULTS The F-BA group showed a small decrease in emotional (β=-5.68, p<.001) and uncontrolled eating (β=-4.05, p=.03), and increase in cognitive restrained eating (β=5.53, p<.01), compared to no F-BA. The effect of the F-BA therapy on emotional and uncontrolled eating was stronger in those with higher baseline depressive symptoms (IDS-SR). The F-BA did also lead to small improvements in MDS (β=1.95, p<.001), but not to change in body weight. CONCLUSION Our trial showed no reduction in bodyweight, but provides support for the possibility to improve both unhealthy eating styles and diet quality using an intervention targeting these specifically, although effects were small [Trial registration: clinicaltrials.gov NCT02529423].
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Affiliation(s)
- Nadine P G Paans
- Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands.
| | - Mariska Bot
- Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Ingeborg A Brouwer
- Department of Health Sciences, Faculty of Science, and Amsterdam Public Health research institute, Vrije Universiteit, Amsterdam, The Netherlands
| | - Marjolein Visser
- Department of Health Sciences, Faculty of Science, and Amsterdam Public Health research institute, Vrije Universiteit, Amsterdam, The Netherlands
| | - Margalida Gili
- Institut Universitari d' Investigació en Ciències de la Salut (IUNICS/IDISBA), Rediapp, University of Balearic Islands, Carretera de Valldemosssa km 7,5, 07071 Palma de Mallorca, Spain
| | - Miquel Roca
- Institut Universitari d' Investigació en Ciències de la Salut (IUNICS/IDISBA), Rediapp, University of Balearic Islands, Carretera de Valldemosssa km 7,5, 07071 Palma de Mallorca, Spain
| | - Ulrich Hegerl
- Department of Psychiatry, Psychosomatic and Psychotherapy, Senckenberg Distinguished Professorship, Goethe-University Frankfurt, Frankfurt A.M., Germany
| | - Elisabeth Kohls
- Department of Psychiatry and Psychotherapy, University Leipzig, Medical Faculty, Leipzig, Germany
| | - Matthew Owens
- Department of Psychology, University of Exeter, Exeter, UK
| | - Ed Watkins
- Department of Psychology, University of Exeter, Exeter, UK
| | - Brenda W J H Penninx
- Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
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Howell J, Anderson R, Egan S, McEvoy P. One factor? Two factor? Bi-factor? A psychometric evaluation of the Frost Multidimensional Scale and the Clinical Perfectionism Questionnaire. Cogn Behav Ther 2020; 49:518-530. [DOI: 10.1080/16506073.2020.1790645] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Joel Howell
- School of Psychology, Curtin University, Perth, WA, Australia
| | | | - Sarah Egan
- School of Psychology, Curtin University, Perth, WA, Australia
| | - Peter McEvoy
- School of Psychology, Curtin University, Perth, WA, Australia
- Centre for Clinical Interventions, Perth, WA, Australia
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Uphoff E, Ekers D, Robertson L, Dawson S, Sanger E, South E, Samaan Z, Richards D, Meader N, Churchill R. Behavioural activation therapy for depression in adults. Cochrane Database Syst Rev 2020; 7:CD013305. [PMID: 32628293 PMCID: PMC7390059 DOI: 10.1002/14651858.cd013305.pub2] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Behavioural activation is a brief psychotherapeutic approach that seeks to change the way a person interacts with their environment. Behavioural activation is increasingly receiving attention as a potentially cost-effective intervention for depression, which may require less resources and may be easier to deliver and implement than other types of psychotherapy. OBJECTIVES To examine the effects of behavioural activation compared with other psychological therapies for depression in adults. To examine the effects of behavioural activation compared with medication for depression in adults. To examine the effects of behavioural activation compared with treatment as usual/waiting list/placebo no treatment for depression in adults. SEARCH METHODS We searched CCMD-CTR (all available years), CENTRAL (current issue), Ovid MEDLINE (1946 onwards), Ovid EMBASE (1980 onwards), and Ovid PsycINFO (1806 onwards) on the 17 January 2020 to identify randomised controlled trials (RCTs) of 'behavioural activation', or the main elements of behavioural activation for depression in participants with clinically diagnosed depression or subthreshold depression. We did not apply any restrictions on date, language or publication status to the searches. We searched international trials registries via the World Health Organization's trials portal (ICTRP) and ClinicalTrials.gov to identify unpublished or ongoing trials. SELECTION CRITERIA We included randomised controlled trials (RCTs) of behavioural activation for the treatment of depression or symptoms of depression in adults aged 18 or over. We excluded RCTs conducted in inpatient settings and with trial participants selected because of a physical comorbidity. Studies were included regardless of reported outcomes. DATA COLLECTION AND ANALYSIS Two review authors independently screened all titles/abstracts and full-text manuscripts for inclusion. Data extraction and 'Risk of bias' assessments were also performed by two review authors in duplicate. Where necessary, we contacted study authors for more information. MAIN RESULTS Fifty-three studies with 5495 participants were included; 51 parallel group RCTs and two cluster-RCTs. We found moderate-certainty evidence that behavioural activation had greater short-term efficacy than treatment as usual (risk ratio (RR) 1.40, 95% confidence interval (CI) 1.10 to 1.78; 7 RCTs, 1533 participants), although this difference was no longer evident in sensitivity analyses using a worst-case or intention-to-treat scenario. Compared with waiting list, behavioural activation may be more effective, but there were fewer data in this comparison and evidence was of low certainty (RR 2.14, 95% CI 0.90 to 5.09; 1 RCT, 26 participants). No evidence on treatment efficacy was available for behavioural activation versus placebo and behavioural activation versus no treatment. We found moderate-certainty evidence suggesting no evidence of a difference in short-term treatment efficacy between behavioural activation and CBT (RR 0.99, 95% CI 0.92 to 1.07; 5 RCTs, 601 participants). Fewer data were available for other comparators. No evidence of a difference in short term-efficacy was found between behavioural activation and third-wave CBT (RR 1.10, 95% CI 0.91 to 1.33; 2 RCTs, 98 participants; low certainty), and psychodynamic therapy (RR 1.21, 95% CI 0.74 to 1.99; 1 RCT,60 participants; very low certainty). Behavioural activation was more effective than humanistic therapy (RR 1.84, 95% CI 1.15 to 2.95; 2 RCTs, 46 participants; low certainty) and medication (RR 1.77, 95% CI 1.14 to 2.76; 1 RCT; 141 participants; moderate certainty), but both of these results were based on a small number of trials and participants. No evidence on treatment efficacy was available for comparisons between behavioural activation versus interpersonal, cognitive analytic, and integrative therapies. There was moderate-certainty evidence that behavioural activation might have lower treatment acceptability (based on dropout rate) than treatment as usual in the short term, although the data did not confirm a difference and results lacked precision (RR 1.64, 95% CI 0.81 to 3.31; 14 RCTs, 2518 participants). Moderate-certainty evidence did not suggest any difference in short-term acceptability between behavioural activation and waiting list (RR 1.17, 95% CI 0.70 to 1.93; 8 RCTs. 359 participants), no treatment (RR 0.97, 95% CI 0.45 to 2.09; 3 RCTs, 187 participants), medication (RR 0.52, 95% CI 0.23 to 1.16; 2 RCTs, 243 participants), or placebo (RR 0.72, 95% CI 0.31 to 1.67; 1 RCT; 96 participants; low-certainty evidence). No evidence on treatment acceptability was available comparing behavioural activation versus psychodynamic therapy. Low-certainty evidence did not show a difference in short-term treatment acceptability (dropout rate) between behavioural activation and CBT (RR 1.03, 95% CI 0.85 to 1.25; 12 RCTs, 1195 participants), third-wave CBT (RR 0.84, 95% CI 0.33 to 2.10; 3 RCTs, 147 participants); humanistic therapy (RR 1.06, 95% CI 0.20 to 5.55; 2 RCTs, 96 participants) (very low certainty), and interpersonal, cognitive analytic, and integrative therapy (RR 0.84, 95% CI 0.32 to 2.20; 4 RCTs, 123 participants). Results from medium- and long-term primary outcomes, secondary outcomes, subgroup analyses, and sensitivity analyses are summarised in the text. AUTHORS' CONCLUSIONS This systematic review suggests that behavioural activation may be more effective than humanistic therapy, medication, and treatment as usual, and that it may be no less effective than CBT, psychodynamic therapy, or being placed on a waiting list. However, our confidence in these findings is limited due to concerns about the certainty of the evidence. We found no evidence of a difference in short-term treatment acceptability (based on dropouts) between behavioural activation and most comparison groups (CBT, humanistic therapy, waiting list, placebo, medication, no treatment or treatment as usual). Again, our confidence in all these findings is limited due to concerns about the certainty of the evidence. No data were available about the efficacy of behaioural activation compared with placebo, or about treatment acceptability comparing behavioural activation and psychodynamic therapy, interpersonal, cognitive analytic and integrative therapies. The evidence could be strengthened by better reporting and better quality RCTs of behavioural activation and by assessing working mechanisms of behavioural activation.
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Affiliation(s)
- Eleonora Uphoff
- Cochrane Common Mental Disorders, University of York, York, UK
- Centre for Reviews and Dissemination, University of York, York, UK
| | - David Ekers
- Lanchester Road Hospital, Tees, Esk and Wear Valleys NHS Foundation Trust, Durham, UK
- Mental Health and Addiction Research Group, Department of Health Sciences, University of York, York, UK
| | - Lindsay Robertson
- Cochrane Common Mental Disorders, University of York, York, UK
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Sarah Dawson
- Cochrane Common Mental Disorders, University of York, York, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Emily Sanger
- Cochrane Common Mental Disorders, University of York, York, UK
| | - Emily South
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Zainab Samaan
- Psychiatry, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | | | - Nicholas Meader
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Rachel Churchill
- Cochrane Common Mental Disorders, University of York, York, UK
- Centre for Reviews and Dissemination, University of York, York, UK
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Blanchet V, Provencher MD. Évaluation des effets de l’activation comportementale de groupe pour le traitement de la dépression sévère en milieu clinique. SANTE MENTALE AU QUEBEC 2020. [DOI: 10.7202/1070239ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Bien que l’efficacité de la thérapie d’activation comportementale (AC) pour le traitement de la dépression ait été établie à travers de nombreux essais aléatoires et contrôlés, les études ayant évalué l’efficacité de l’AC, lorsqu’implantée dans les établissements du réseau de la santé, sont rares et les données la supportant sont insuffisantes. Cette étude s’intéresse à l’AC appliquée de manière à tenir compte de la réalité clinique des milieux et des patients. Elle évalue les effets de l’AC de groupe pour le traitement de la dépression sévère en milieu clinique auprès d’une population hétérogène en termes de diagnostic (dépression unipolaire et bipolaire) et de comorbidité (Axes I et II). Les 45 participants souffrant de dépression sévère ont été recrutés en milieu hospitalier et ont reçu une intervention de groupe d’AC de 10 séances. Des questionnaires ont été administrés afin d’obtenir des données prétraitement, posttraitement et 4 semaines suivant la fin du traitement. Les résultats soutiennent les effets de l’AC de groupe pour le traitement de la dépression sévère en milieu clinique auprès d’une population hétérogène, de même que pour le maintien des acquis à court terme. Les effets de l’AC ont également été observés sur l’ensemble des mesures d’activation comportementale, de renforcement, d’anxiété, d’adaptation sociale et de qualité de vie ainsi que sur les symptômes de dépression bipolaire.
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Affiliation(s)
| | - Martin D. Provencher
- Ph. D., Professeur titulaire, École de psychologie, Université Laval ; Chercheur régulier, Centre de recherche sur les soins et les services de première ligne de l’Université Laval et Centre de recherche CERVO
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169
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Li SH, Graham BM. Progesterone levels predict reductions in behavioral avoidance following cognitive restructuring in women with spider phobia. J Affect Disord 2020; 270:1-8. [PMID: 32275214 DOI: 10.1016/j.jad.2020.03.039] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 03/19/2020] [Accepted: 03/20/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Ovarian hormones have been implicated as a potential source of variability in the effectiveness of exposure therapy for anxiety disorders in women. Additionally, preclinical studies in healthy women indicate that ovarian hormones are related to cognitive modes of emotion regulation, like cognitive restructuring. The purpose of the current study was to determine whether a relationship exists between endogenous ovarian hormones and the outcomes of cognitive restructuring in clinically anxious women. METHODS Ninety women with spider phobia received training in cognitive restructuring or a control task and provided a blood sample for the measurement of serum estradiol and progesterone levels. Behavioral avoidance, using a behavioral approach task with a live spider, and self-reported fear of spiders were measured at baseline and 1-week post-treatment. RESULTS The results indicated that heightened levels of progesterone, but not estradiol, at the time of cognitive restructuring predicted greater post-treatment reductions in behavioral avoidance, but not self-reported fear, amongst women who received cognitive restructuring but not those in the control group. LIMITATIONS As menstrual cycle phase was not assessed; the present study provides information regarding how the benefits of cognitive therapy are predicted by between-person individual differences in absolute hormone levels, but does not examine the relationship between within-person fluctuations in hormone levels and outcomes. CONCLUSIONS These results suggest the effectiveness of cognitive therapy for anxiety disorders in women may differ depending on endogenous levels of progesterone, and raise the possibility that progesterone could be a useful pharmacological adjunct to cognitive therapy.
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Affiliation(s)
- Sophie H Li
- School of Psychology, The University of New South Wales Australia, Sydney, New South Wales, 2052, Australia.
| | - Bronwyn M Graham
- School of Psychology, The University of New South Wales Australia, Sydney, New South Wales, 2052, Australia
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170
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Duell N, Steinberg L. Differential Correlates of Positive and Negative Risk Taking in Adolescence. J Youth Adolesc 2020; 49:1162-1178. [PMID: 32335842 PMCID: PMC7242164 DOI: 10.1007/s10964-020-01237-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 03/31/2020] [Indexed: 10/24/2022]
Abstract
Positive risks benefit adolescent development without posing the same public safety concerns as negative risks, but little is understood about the psychological characteristics of positive risk taking. This study explored the shared and unique correlates of positive and negative risk taking in 223 adolescents (48% female) ages 16-20 years (M = 18.1; SD = 0.81). Positive and negative risk taking were both associated with higher sensation seeking. Unlike negative risk taking, positive risk taking was not associated with impulsivity or risk taking on experimental tasks. Further, positive risk taking was associated with lower reward sensitivity, higher punishment sensitivity, and greater school engagement than negative risk taking. The findings offer new insights for prevailing models of adolescent risk behavior and suggest positive risk taking may be particularly beneficial in the school context.
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Affiliation(s)
- Natasha Duell
- Department of Psychology and Neuroscience and Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Laurence Steinberg
- Department of Psychology, Temple University, Philadelphia, PA, USA
- Department of Psychology, King Abdulaziz University, Jeddah, Saudi Arabia
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171
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Attention and affect in dysphoria: Insights from startle reflex modulation and cardiac deceleration. Behav Res Ther 2020; 131:103626. [PMID: 32387705 DOI: 10.1016/j.brat.2020.103626] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 02/28/2020] [Accepted: 04/22/2020] [Indexed: 02/08/2023]
Abstract
The present study investigated the interplay between attention and affective disposition during emotional processing in dysphoria. Attentional and affective startle modulation and cardiac deceleration were assessed during the viewing of emotional pictures in 38 individuals with dysphoria and in 52 controls. Startle probes during picture viewing were presented at 300, 1500, 3500, 4500 ms after picture onset. Whereas controls showed the expected startle potentiation to unpleasant stimuli as compared to neutral and pleasant ones, individuals with dysphoria did not show any significant increase in startle reflex amplitude in response to unpleasant stimuli. Of note, startle potentiation during the viewing of unpleasant stimuli was significantly attenuated in the group with dysphoria relative to controls. Conversely, no significant effect concerning attentional startle modulation was noted. However, whereas individuals with dysphoria showed a prolonged cardiac deceleration when viewing unpleasant compared to neutral stimuli, the same effect was observed in controls only in the initial stage of stimuli processing. This study suggests that dysphoria is characterized by underactivation of the defensive motivational system and by prolonged attentional allocation to unpleasant stimuli. The assessment of affective startle modulation and cardiac deceleration is a valuable paradigm for unraveling dysfunctions in affective disposition and attention in dysphoria.
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172
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Bilbrey AC, Laidlaw K, Cassidy-Eagle E, Thompson LW, Gallagher-Thompson D. Cognitive Behavioral Therapy for Late-Life Depression: Evidence, Issues, and Recommendations. COGNITIVE AND BEHAVIORAL PRACTICE 2020. [DOI: 10.1016/j.cbpra.2020.02.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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173
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Sibalija J, Savundranayagam MY, Orange JB, Kloseck M. Social support, social participation, & depression among caregivers and non-caregivers in Canada: a population health perspective. Aging Ment Health 2020; 24:765-773. [PMID: 30521370 DOI: 10.1080/13607863.2018.1544223] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objectives: The study used data from the Canadian Longitudinal Study on Aging to investigate the relationships among social support (measured as affectionate support, emotional/informational support, positive social interaction, tangible support), social participation and depression in caregivers and non-caregivers.Method: Hierarchical multiple regression was used to investigate relationships among social support, social participation, and depression. Analyses of variance were used to examine differences in the means of social support, social participation, and depression between the two participant groups.Results: Higher levels of affectionate support, positive social interaction, and social participation were associated with lower depression scores. Social participation was a significant mediator of the relationship between caregiver status and depression. Caregivers reported significantly higher levels of affectionate support, emotional/informational support, positive social interaction, and social participation than non-caregivers. There were no between-group difference in depression scores.Discussion: The study provides support for the beneficial role of social participation in preserving caregiver mental health. Results are discussed in the context of policy and practice implications for caregivers in Canada.
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Affiliation(s)
- Jovana Sibalija
- Health and Rehabilitation Sciences, Western University, London, Canada
| | | | - J B Orange
- School of Communication Sciences and Disorders, Western University, London, Canada
| | - Marita Kloseck
- Faculty of Health Sciences, Western University, London, Canada
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175
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Dobkin RD, Mann SL, Gara MA, Interian A, Rodriguez KM, Menza M. Telephone-based cognitive behavioral therapy for depression in Parkinson disease: A randomized controlled trial. Neurology 2020; 94:e1764-e1773. [PMID: 32238507 PMCID: PMC7282876 DOI: 10.1212/wnl.0000000000009292] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 11/18/2019] [Indexed: 01/23/2023] Open
Abstract
Objective To determine whether, for patients with depression and Parkinson disease (PD), telephone-based cognitive-behavioral treatment (T-CBT) alleviates depressive symptoms significantly more than treatment as usual (TAU), we conducted a randomized controlled trial to evaluate the efficacy of a 10-session T-CBT intervention for depression in PD, compared to TAU. Methods Seventy-two people with PD (PWP) were randomized to T-CBT + TAU or TAU only. T-CBT tailored to PWPs’ unique needs was provided weekly for 3 months, then monthly during 6-month follow-up. CBT targeted negative thoughts (e.g., “I have no control”; “I am helpless”) and behaviors (e.g., social withdrawal, excessive worry). It also trained care partners to help PWP practice healthy habits. Blind raters assessed outcomes at baseline, midtreatment, treatment end, and 1 and 6 months post-treatment. Analyses were intent to treat. Results T-CBT outperformed TAU on all depression, anxiety, and quality of life measures. The primary outcome (Hamilton Depression Rating Scale score) improved significantly in T-CBT compared to TAU by treatment end. Mean improvement from baseline was 6.53 points for T-CBT and −0.27 points for TAU (p < 0.0001); gains persisted over 6-month follow-up (p < 0.0001). Improvements were moderated by a reduction in negative thoughts in the T-CBT group only, reflecting treatment target engagement. Conclusions T-CBT may be an effective depression intervention that addresses a significant unmet PD treatment need and bypasses access barriers to multidisciplinary, evidence-based care. Clinicaltrials.gov identifier NCT02505737. Classification of evidence This study provides Class I evidence that for patients with depression and PD, T-CBT significantly alleviated depressive symptoms compared to usual care.
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Affiliation(s)
- Roseanne D Dobkin
- From the Departments of Psychiatry (R.D.D., M.A.G., K.M.R., M.M.) and Neurology (M.M.), Rutgers-Robert Wood Johnson Medical School, Piscataway; and VA New Jersey Health Care System (R.D.D., S.L.M., A.I.), Lyons.
| | - Sarah L Mann
- From the Departments of Psychiatry (R.D.D., M.A.G., K.M.R., M.M.) and Neurology (M.M.), Rutgers-Robert Wood Johnson Medical School, Piscataway; and VA New Jersey Health Care System (R.D.D., S.L.M., A.I.), Lyons
| | - Michael A Gara
- From the Departments of Psychiatry (R.D.D., M.A.G., K.M.R., M.M.) and Neurology (M.M.), Rutgers-Robert Wood Johnson Medical School, Piscataway; and VA New Jersey Health Care System (R.D.D., S.L.M., A.I.), Lyons
| | - Alejandro Interian
- From the Departments of Psychiatry (R.D.D., M.A.G., K.M.R., M.M.) and Neurology (M.M.), Rutgers-Robert Wood Johnson Medical School, Piscataway; and VA New Jersey Health Care System (R.D.D., S.L.M., A.I.), Lyons
| | - Kailyn M Rodriguez
- From the Departments of Psychiatry (R.D.D., M.A.G., K.M.R., M.M.) and Neurology (M.M.), Rutgers-Robert Wood Johnson Medical School, Piscataway; and VA New Jersey Health Care System (R.D.D., S.L.M., A.I.), Lyons
| | - Matthew Menza
- From the Departments of Psychiatry (R.D.D., M.A.G., K.M.R., M.M.) and Neurology (M.M.), Rutgers-Robert Wood Johnson Medical School, Piscataway; and VA New Jersey Health Care System (R.D.D., S.L.M., A.I.), Lyons
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Harris B, Stevens CJ. Practicing mind-body medicine before Freud: John G. Gehring, the "Wizard of the Androscoggin". JOURNAL OF THE HISTORY OF THE BEHAVIORAL SCIENCES 2020; 56:75-98. [PMID: 31612511 DOI: 10.1002/jhbs.22012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This article describes the psychotherapy practice of physician John G. Gehring and places it in historical context. Forgotten today, Gehring was a highly sought-after therapist from the 1890s to the 1920s by prominent figures in the arts, sciences, business, and law. He practiced a combination of work therapy, suggestion, and autosuggestion that has similarities to Cognitive Behavior Therapy and Behavioral Activation. Using biographies, memoirs, and archival records, the details of Gehring's work are reconstructed and the reasons for its success are analyzed. His invisibility in the history of psychiatry is attributed to the later dominance of Freudianism within the field.
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Affiliation(s)
- Ben Harris
- Department of Psychology, University of New Hampshire, Durham, NH
| | - Courtney J Stevens
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH
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Nair A, Rutledge RB, Mason L. Under the Hood: Using Computational Psychiatry to Make Psychological Therapies More Mechanism-Focused. Front Psychiatry 2020; 11:140. [PMID: 32256395 PMCID: PMC7093344 DOI: 10.3389/fpsyt.2020.00140] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 02/14/2020] [Indexed: 12/21/2022] Open
Abstract
Psychological therapies, such as CBT, are an important part of the treatment of a range of psychiatric disorders such as depression and anxiety. There is a growing desire to understand the mechanisms by which such therapies effect change so as to improve treatment outcomes. Here we argue that adopting a computational framework may be one such approach. Computational psychiatry aims to provide a theoretical framework for moving between higher-level psychological states (like emotions, decisions and beliefs) to neural circuits, by modeling these constructs mathematically. These models are explicit hypotheses that contain quantifiable variables and parameters derived from each individual's behavior. This approach has two advantages. Firstly, some of the variables described by these models appears to reflect the neural activity of specific brain regions. Secondly, the parameters estimated by these models may offer a unique description of a patient's symptoms which can be used to both tailor therapy and track its effect. In doing so this approach may offer some additional granularity in understanding how psychological therapies, such as CBT, are working. Although this field shows significant promise, we also highlight several of the key hurdles that must first be overcome before clinical translation of computational insights can be realized.
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Affiliation(s)
- Akshay Nair
- Department of Neurodegenerative Disease, UCL Institute of Neurology, University College London, London, United Kingdom
| | - Robb B. Rutledge
- Max Planck UCL Centre for Computational Psychiatry and Ageing Research, Berlin, Germany
- Wellcome Centre for Human Neuroimaging, University College London, London, United Kingdom
| | - Liam Mason
- Max Planck UCL Centre for Computational Psychiatry and Ageing Research, Berlin, Germany
- Wellcome Centre for Human Neuroimaging, University College London, London, United Kingdom
- Research Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
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178
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Flint DD, Ferrell EL, Engelman J. Clinical research on behavioral activation as treatment for post‐traumatic stress disorder: A brief review and meta‐analysis. BEHAVIORAL INTERVENTIONS 2020. [DOI: 10.1002/bin.1712] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Daniel D. Flint
- Department of PsychologyBowling Green State University Bowling Green Ohio USA
| | - Emily L. Ferrell
- Department of PsychologyBowling Green State University Bowling Green Ohio USA
| | - Joel Engelman
- Department of PsychologyBowling Green State University Bowling Green Ohio USA
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179
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Martínez-Vispo C, López-Durán A, Senra C, Rodríguez-Cano R, Fernández Del Río E, Becoña E. Behavioral activation and smoking cessation outcomes: The role of depressive symptoms. Addict Behav 2020; 102:106183. [PMID: 31809878 DOI: 10.1016/j.addbeh.2019.106183] [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: 06/20/2019] [Revised: 09/13/2019] [Accepted: 10/14/2019] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Depressive symptoms are related to smoking cessation outcomes. We examined the effects of behavioral activation (BA), as part of a cognitive behavioral intervention to quit smoking, in terms of abstinence rates according to depressive symptom level. We also analyzed whether BA could differentially benefit participants with higher versus lower anhedonia. METHODS The sample was composed of 183 smokers (Mage = 45.3; 62.8% female) who participated in a randomized clinical trial assessing the effects of a BA intervention compared to a standard intervention. Smoking outcomes were biochemically confirmed point prevalence abstinence, and abstinence days after treatment during one year follow-up. The intensity of depressive symptomatology and anhedonic symptoms were assessed using the Beck Depression Inventory-II. RESULTS No differences in abstinence rates were found in relation to depressive symptom level. The BA condition (vs. standard condition) predicted greater abstinence rates (OR = 1.91) in participants with lower scores on depressive symptoms, whereas in participants with higher scores, it did not (OR = 1.17). Moreover, the BA condition predicted greater abstinence rates in participants with lower scores on anhedonia. When examining days of abstinence during the one-year follow-up period, a significant interaction was found between depressive symptoms and treatment condition, favoring the BA condition. CONCLUSION BA implemented as part of a cognitive behavioral intervention to quit smoking improves long-term abstinence rates, especially among those with fewer depressive symptoms.
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Affiliation(s)
- Carmela Martínez-Vispo
- Smoking Cessation and Addictive Disorders Unit, Faculty of Psychology, University of Santiago de Compostela, Galicia, Spain.
| | - Ana López-Durán
- Smoking Cessation and Addictive Disorders Unit, Faculty of Psychology, University of Santiago de Compostela, Galicia, Spain; Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Santiago de Compostela, Galicia, Spain
| | - Carmen Senra
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Santiago de Compostela, Galicia, Spain
| | - Rubén Rodríguez-Cano
- Smoking Cessation and Addictive Disorders Unit, Faculty of Psychology, University of Santiago de Compostela, Galicia, Spain
| | | | - Elisardo Becoña
- Smoking Cessation and Addictive Disorders Unit, Faculty of Psychology, University of Santiago de Compostela, Galicia, Spain; Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Santiago de Compostela, Galicia, Spain
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180
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Price RB, Duman R. Neuroplasticity in cognitive and psychological mechanisms of depression: an integrative model. Mol Psychiatry 2020; 25:530-543. [PMID: 31801966 PMCID: PMC7047599 DOI: 10.1038/s41380-019-0615-x] [Citation(s) in RCA: 269] [Impact Index Per Article: 67.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 11/18/2019] [Accepted: 11/19/2019] [Indexed: 12/13/2022]
Abstract
Chronic stress and depressive-like behaviors in basic neuroscience research have been associated with impairments of neuroplasticity, such as neuronal atrophy and synaptic loss in the medial prefrontal cortex (mPFC) and hippocampus. The current review presents a novel integrative model of neuroplasticity as a multi-domain neurobiological, cognitive, and psychological construct relevant in depression and other related disorders of negative affect (e.g., anxiety). We delineate a working conceptual model in which synaptic plasticity deficits described in animal models are integrated and conceptually linked with human patient findings from cognitive science and clinical psychology. We review relevant reports including neuroimaging findings (e.g., decreased functional connectivity in prefrontal-limbic circuits), cognitive deficits (e.g., executive function and memory impairments), affective information processing patterns (e.g., rigid, negative biases in attention, memory, interpretations, and self-associations), and patient-reported symptoms (perseverative, inflexible thought patterns; inflexible and maladaptive behaviors). Finally, we incorporate discussion of integrative research methods capable of building additional direct empirical support, including using rapid-acting treatments (e.g., ketamine) as a means to test this integrative model by attempting to simultaneously reverse these deficits across levels of analysis.
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Affiliation(s)
- Rebecca B. Price
- Departments of Psychiatry and Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ronald Duman
- Department of Psychiatry, Yale University, New Haven, CT
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181
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Elhai JD, Rozgonjuk D, Liu T, Yang H. Fear of missing out predicts repeated measurements of greater negative affect using experience sampling methodology. J Affect Disord 2020; 262:298-303. [PMID: 31733919 DOI: 10.1016/j.jad.2019.11.026] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 09/13/2019] [Accepted: 11/08/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Fear of missing out (FOMO) has been increasingly researched recently, especially in relation to negative affectivity constructs. Our aim was to examine relations between FOMO and repeated measurements of negative affect over one week. METHOD We investigated associations between FOMO and prospectively-measured negative affect over one week in an experience sampling study of 93 undergraduate students. Participants completed an initial web survey assessing depression, anxiety and FOMO. Over the week, participants responded to daily text messages, assessing negative affect from earlier in the day. RESULTS On a bivariate basis, FOMO, depression and anxiety severity were related to daily negative affect assessments. Using multivariate growth modeling, higher initial negative affect was related to decreasing negative affect over the week. Female sex and higher anxiety related to higher initial negative affect ratings. Higher FOMO levels related to increasing negative affect over the week. LIMITATIONS Findings were based on self-report methodology, using university students and only one week of measurement. CONCLUSIONS Results suggest that women and more anxious individuals had higher initial negative affect, while FOMO predicted increasing negative affect over the week. Results advance understanding of FOMO in relation to psychopathology, and are discussed in the context of Self-Determination Theory.
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Affiliation(s)
- Jon D Elhai
- Academy of Psychology and Behavior, Tianjin Normal University, No. 57-1 Wujiayao Street, Hexi District, Tianjin, 300074, China; Department of Psychology, University of Toledo, 2801 West Bancroft Street, Toledo, Ohio, 43606, USA; Department of Psychiatry, University of Toledo, 3000 Arlington Avenue, Toledo, Ohio, 43614, USA.
| | - Dmitri Rozgonjuk
- Institute of Psychology, University of Tartu, Näituse 2, Tartu 50409, Estonia; Center of IT Impact Studies, Johann Skytte Institute for Political Studies, University of Tartu, Lossi 36, Tartu 51003, Estonia
| | - Tour Liu
- Academy of Psychology and Behavior, Tianjin Normal University, No. 57-1 Wujiayao Street, Hexi District, Tianjin, 300074, China
| | - Haibo Yang
- Academy of Psychology and Behavior, Tianjin Normal University, No. 57-1 Wujiayao Street, Hexi District, Tianjin, 300074, China
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182
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Singla DR, Hollon SD, Velleman R, Weobong B, Nadkarni A, Fairburn CG, Bhat B, Gurav M, Anand A, McCambridge J, Dimidjian S, Patel V. Temporal pathways of change in two randomized controlled trials for depression and harmful drinking in Goa, India. Psychol Med 2020; 50:68-76. [PMID: 30616698 PMCID: PMC6945322 DOI: 10.1017/s0033291718003963] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 11/24/2018] [Accepted: 12/04/2018] [Indexed: 11/09/2022]
Abstract
BACKGROUND The current study explored the temporal pathways of change within two treatments, the Healthy Activity Program (HAP) for depression and the Counselling for Alcohol Problems (CAP) Program for harmful drinking. METHODS The study took place in the context of two parallel randomized controlled trials in Goa, India. N = 50 random participants who met a priori criteria were selected from each treatment trial and examined for potential direct and mediational pathways. In HAP, we examined the predictive roles of therapy quality and patient-reported activation, assessing whether activation mediated the effects of therapy quality on depression (Patient Health Questionnaire-9) outcomes. In CAP, we examined the predictive roles of therapy quality and patient change- and counter-change-talk, assessing whether change- or counter-change-talk mediated the effects of therapy quality on daily alcohol consumption. RESULTS In HAP, therapy quality (both general and treatment-specific skills) was associated with patient activation; patient activation but not therapy quality significantly predicted depression outcomes, and patient activation mediated the effects of higher general skills on subsequent clinical outcomes [a × b = -2.555, 95% confidence interval (CI) -5.811 to -0.142]. In CAP, higher treatment-specific skills, but not general skills, were directly associated with drinking outcomes, and reduced levels of counter-change talk both independently predicted, and mediated the effects of higher general skills on, reduced alcohol consumption (a × b = -24.515, 95% CI -41.190 to -11.060). Change talk did not predict alcohol consumption and was not correlated with counter-change talk. CONCLUSION These findings suggest that therapy quality in early sessions operated through increased patient activation and reduced counter-change talk to reduce depression and harmful drinking respectively.
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Affiliation(s)
- Daisy R. Singla
- Department of Psychiatry, University of Toronto and Sinai Health System, Toronto, Canada
| | - Steven D. Hollon
- Department of Psychology, Vanderbilt University, Nashville, Tennessee, USA
| | - Richard Velleman
- Department of Psychology, University of Bath, Bath, UK
- Sangath, Alto Porvorim, Goa, India
| | - Benedict Weobong
- Sangath, Alto Porvorim, Goa, India
- Centre for Global Mental Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
- Department of Social & Behavioral Sciences, School of Public Health, University of Ghana, Accra, Ghana
| | - Abhijit Nadkarni
- Sangath, Alto Porvorim, Goa, India
- Centre for Global Mental Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | | | | | | | - Sona Dimidjian
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, Colorado, USA
| | - Vikram Patel
- Sangath, Alto Porvorim, Goa, India
- Department of Global Health & Social Medicine, Harvard Medical School, Cambridge, USA
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA
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183
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Effect of Three Types of Activities on Improving Mood and Enjoyment in a Brief Online Depression Study. DEPRESSION RESEARCH AND TREATMENT 2020; 2020:1387832. [PMID: 32411455 PMCID: PMC7204385 DOI: 10.1155/2020/1387832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 10/23/2019] [Accepted: 10/30/2019] [Indexed: 11/30/2022]
Abstract
The goal of this study is to determine whether different types of activities have a differential effect on mood and enjoyment. Methods. A secondary analysis of the data of 754 participants (M age = 35.8 years, SD age = 12.6; M PHQ-9 = 7.6, SD PHQ-9 = 7.0) who were recruited via Amazon Mechanical Turk (AMT) to participate in a brief online study. Participants completed an activity log and reported retrospectively about three types of activities (Pleasant, Meaningful, and Mastery) at baseline and one week follow-up. A mixed effects ANOVA was used to analyze the effect of weekly activities on mood, and a temporal analysis model was used to test for the effect of daily activities on enjoyment. Results. Participants who reported higher number of Mastery activities for the week had higher mood ratings at follow-up (F (1, 39) = 4.89, p < .05), regardless of depression status at baseline. Pleasant and Meaningful activities did not have a significant effect on mood. Daily engagement in any of the three activity types increased enjoyment of that day (Pleasant: b = 0.312, t (1811) = 46.73, p < .001; Meaningful: b = 0.254, t (1814) = 11.65, p < .001; Mastery: b = 0.290, t (1816) = 13.07, p < .001]. Conclusions. These findings contribute to the understanding on how brief behavioral activation interventions delivered online may influence participants' mood and enjoyment, and can inform clinicians' recommendations about types of activities.
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184
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Watkins ER, Newbold A. Factorial Designs Help to Understand How Psychological Therapy Works. Front Psychiatry 2020; 11:429. [PMID: 32477195 PMCID: PMC7240021 DOI: 10.3389/fpsyt.2020.00429] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 04/27/2020] [Indexed: 11/13/2022] Open
Abstract
A large amount of research time and resources are spent trying to develop or improve psychological therapies. However, treatment development is challenging and time-consuming, and the typical research process followed-a series of standard randomized controlled trials-is inefficient and sub-optimal for answering many important clinical research questions. In other areas of health research, recognition of these challenges has led to the development of sophisticated designs tailored to increase research efficiency and answer more targeted research questions about treatment mechanisms or optimal delivery. However, these innovations have largely not permeated into psychological treatment development research. There is a recognition of the need to understand how treatments work and what their active ingredients might be, and a call for the use of innovative trial designs to support such discovery. One approach to unpack the active ingredients and mechanisms of therapy is the factorial design as exemplified in the Multiphase Optimization Strategy (MOST) approach. The MOST design allows identification of the active components of a complex multi-component intervention (such as CBT) using a sophisticated factorial design, allowing the development of more efficient interventions and elucidating their mechanisms of action. The rationale, design, and potential advantages of this approach will be illustrated with reference to the IMPROVE-2 study, which conducts a fractional factorial design to investigate which elements (e.g., thought challenging, activity scheduling, compassion, relaxation, concreteness, functional analysis) within therapist-supported internet-delivered CBT are most effective at reducing symptoms of depression in 767 adults with major depression. By using this innovative approach, we can first begin to work out what components within the overall treatment package are most efficacious on average allowing us to build an overall more streamlined and potent therapy. This approach also has potential to distinguish the role of specific versus non-specific common treatment components within treatment.
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Affiliation(s)
- Edward R Watkins
- College of Life and Environmental Sciences, University of Exeter, Exeter, United Kingdom
| | - Alexandra Newbold
- College of Life and Environmental Sciences, University of Exeter, Exeter, United Kingdom
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185
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Yasinski C, Hayes AM, Ready CB, Abel A, Görg N, Kuyken W. Processes of change in cognitive behavioral therapy for treatment-resistant depression: psychological flexibility, rumination, avoidance, and emotional processing. Psychother Res 2019; 30:983-997. [PMID: 31822203 DOI: 10.1080/10503307.2019.1699972] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Recent clinical research suggests that facilitating psychological flexibility and emotional processing and decreasing rumination and avoidance are important tasks of treatment for disorders characterized by entrenched patterns of psychopathology, such as major depressive disorder. The current study examined these processes as predictors of treatment outcomes in a subsample of depressed adult patients (n = 49) who had not fully responded to antidepressant medication and were randomized to receive cognitive-behavioral therapy (CBT). Target variables were coded from session recordings at baseline and in the vicinity of two therapeutic transition points: a sudden gain (improvement) and a transient spike in depression symptoms, or at similar periods for those without such transitions. Results indicated that psychological flexibility during the pre-sudden gain period predicted less depression at 12-month follow-up, beyond baseline symptoms and other co-occurring processes. Interaction analyses revealed that when flexibility was low during the post-spike period, avoidance and rumination predicted higher depressive symptoms, whereas emotional processing predicted lower symptoms at the 12-month follow-up. When flexibility was high, none of these variables were associated with outcome. Together, these findings highlight psychological flexibility as a key therapeutic target in CBT for treatment-resistant depression and might have implications for relapse prevention.
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Affiliation(s)
- Carly Yasinski
- Department of Psychological and Brain Sciences, University of Delaware, Newark, DE, USA
| | - Adele M Hayes
- Department of Psychological and Brain Sciences, University of Delaware, Newark, DE, USA
| | - C Beth Ready
- Department of Psychological and Brain Sciences, University of Delaware, Newark, DE, USA
| | - Anna Abel
- Mood Disorders Centre, University of Exeter, Exeter, UK
| | - Nora Görg
- Mood Disorders Centre, University of Exeter, Exeter, UK
| | - Willem Kuyken
- Mood Disorders Centre, University of Exeter, Exeter, UK
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186
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Patel AR, Weobong B, Patel VH, Singla DR. Psychological treatments for depression among women experiencing intimate partner violence: findings from a randomized controlled trial for behavioral activation in Goa, India. Arch Womens Ment Health 2019; 22:779-789. [PMID: 31363925 PMCID: PMC6841649 DOI: 10.1007/s00737-019-00992-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 07/11/2019] [Indexed: 12/03/2022]
Abstract
Intimate partner violence (IPV) strongly predicts depression, but it is unknown if women experiencing IPV can benefit from depression treatments in contexts where depression and IPV are prevalent. This study explored whether women experiencing IPV in Goa, India, can benefit from the Healthy Activity Program (HAP), a culturally adapted behavioral activation treatment, compared with enhanced usual care (EUC). Cross-sectional and longitudinal analyses were performed on data from a clinical trial. Measures assessed at baseline and 3 and 12 months included depressive symptoms. Measures assessed at 3 and 12 months included activation and IPV. Independent t tests were conducted to assess if participants experiencing IPV had higher depressive symptoms and lower activation at 3 and 12 months; hierarchical linear regression was conducted to determine if 3-month IPV predicted 12-month depressive symptoms across trial arms (Hypothesis 1). Hierarchical linear regression was then conducted to examine if the relationship between 3-month activation and 12-month depressive symptoms was moderated by 3-month IPV within each trial arm (Hypothesis 2). As expected, participants experiencing IPV had significantly lower activation levels and higher depressive symptoms compared with participants who did not experience IPV at 3 and 12 months in cross-sectional analyses. Similarly, IPV endorsed at 3 months significantly predicted depressive symptoms at 12 months. However, activation was significantly associated with less severe depressive symptoms at 12 months, irrespective of IPV endorsement among HAP participants. For EUC participants, IPV remained the only significant predictor of depressive symptoms at 12 months. Results suggest that women experiencing IPV can still benefit from behavioral activation.
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Affiliation(s)
- Anushka Rajesh Patel
- Department of Psychology, The University of Tulsa, 800 S. Tucker Drive, Tulsa, OK, 74104, USA
| | - Benedict Weobong
- School of Public Health, Department of Social and Behavioural Sciences, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Vikram Harshad Patel
- Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA
- Sangath, H No 451 (168), Bhatkar Waddo, Socorro, Bardez, Porvorim, Goa, 403501, India
| | - Daisy Radha Singla
- Department of Psychiatry, University of Toronto and Sinai Health System, 600 University Ave, Rm914A, Toronto, Ontario, M5T 1R8, Canada.
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187
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Abstract
This paper summarizes a course of psychotherapy in which the therapist integrated concepts and strategies from psychoanalytic and cognitive-behavioral orientations in treating a gay man with HIV-associated neurocognitive disorder and a history of sexual abuse. The article highlights the psychologically protective function that deception served in the treatment of this patient, and how the therapist navigated the fragility of these inner fictions. Further, it illustrates the way in which the therapist-patient dynamic was colored by a psychoanalytic process known as projective identification.
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Affiliation(s)
- Liat S Graber
- Teachers College, Columbia University, New York City, New York
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188
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Abstract
PURPOSE OF REVIEW We give an overview of recent developments on psychological treatments of depression in primary care. RECENT FINDINGS In recent years, it has become clear that psychotherapies can effectively be delivered through e-health applications. Furthermore, several studies in low and middle income countries have shown that lay health counselors can effectively deliver psychological therapies. Behavioral activation, a relatively simple form of therapy, has been found to be as effective as cognitive behavior therapy. Treatment of subthreshold depression has been found to not only reduce depressive symptoms but also prevent the onset of major depression. In addition, therapies are effective in older adults, patients with general medical disorders and in perinatal depression. Psychological therapies are effective in the treatment of depression in primary care, have longer lasting effects than drugs, are preferred by the majority of patients, and can be applied flexibly with different formats and across different target groups.
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Affiliation(s)
- Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7-9, 1081 BT, Amsterdam, The Netherlands.
| | - Soledad Quero
- Department of Basic, Clinical Psychology and Psychobiology, Universitat Jaume I, Castellón, Spain
| | - Christopher Dowrick
- Department of Health Services Research, University of Liverpool, Liverpool, UK
| | - Bruce Arroll
- Department of General Practice and Primary Health Care, University of Auckland, Auckland, New Zealand
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189
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Brouwer ME, Williams AD, Kennis M, Fu Z, Klein NS, Cuijpers P, Bockting CLH. Psychological theories of depressive relapse and recurrence: A systematic review and meta-analysis of prospective studies. Clin Psychol Rev 2019; 74:101773. [PMID: 31756681 DOI: 10.1016/j.cpr.2019.101773] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 05/18/2019] [Accepted: 09/14/2019] [Indexed: 01/05/2023]
Abstract
Psychological factors hypothesized to account for relapse of major depressive disorder (MDD) roughly originate from five main theories: Cognitive, diathesis-stress, behavioural, psychodynamic, and personality-based. In a meta-analysis we investigated prospective, longitudinal evidence for these leading psychological theories and their factors in relation to depressive relapse. Included studies needed to establish history of MDD and prospective depressive relapse through a clinical interview, have a longitudinal and prospective design, and measure at least one theory-derived factor before relapse. We identified 66 eligible articles out of 43,586 records published up to November 2018. Pooled odds ratios (OR) indicated a significant relationship between the cognitive, behavioural, and personality-based theories and depressive relapse (cognitive: k = 17, OR = 1.24, 95% CI = 1.10-1.40; behavioural, k = 8, OR = 1.15, 95% CI = 1.05-1.25; personality: k = 12, OR = 1.26, 95% CI = 1.02-1.54), but not for the psychodynamic theories (k = 4, OR = 1.29, 95% CI = 0.83-1.99). Pooled hazard ratios of the theories were not significant. There were no articles identified for the diathesis-stress theories. To conclude, there is a restricted number of prospective studies, and some evidence that the cognitive, behavioural, and personality-based theories indeed partially account for depressive relapse.
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Affiliation(s)
- Marlies E Brouwer
- Department of Psychiatry, Amsterdam University Medical Centres, location AMC, University of Amsterdam, Amsterdam, the Netherlands; Department of Clinical Psychology, Utrecht University, Utrecht, the Netherlands.
| | - Alishia D Williams
- Department of Clinical Psychology, Utrecht University, Utrecht, the Netherlands; Faculty of Science, School of Psychology, The University of New South Wales, Sydney, Australia.
| | - Mitzy Kennis
- Department of Clinical Psychology, Utrecht University, Utrecht, the Netherlands.
| | - Zhongfang Fu
- Department of Psychiatry, Amsterdam University Medical Centres, location AMC, University of Amsterdam, Amsterdam, the Netherlands; Department of Clinical Psychology, Utrecht University, Utrecht, the Netherlands.
| | - Nicola S Klein
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, the Netherlands; Department of Early Detection and Intervention in Psychosis, GGZ Drenthe, Assen, the Netherlands.
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
| | - Claudi L H Bockting
- Department of Psychiatry, Amsterdam University Medical Centres, location AMC, University of Amsterdam, Amsterdam, the Netherlands; Institute for Advanced Study, University of Amsterdam, Netherlands Institute for Advanced Study in the Humanities and Social Sciences, Royal Netherlands Academy of Arts and Sciences, Amsterdam, the Netherlands.
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190
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Raue PJ, Sirey JA, Dawson A, Berman J, Bruce ML. Lay-delivered behavioral activation for depressed senior center clients: Pilot RCT. Int J Geriatr Psychiatry 2019; 34:1715-1723. [PMID: 31368583 PMCID: PMC6803033 DOI: 10.1002/gps.5186] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 07/28/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVE We describe the development of a lay-delivered behavioral intervention ("Do More, Feel Better") for depressed senior center clients, and we present preliminary data from a pilot randomized controlled trial (RCT) on (a) the feasibility of training lay volunteers to fidelity and (b) the acceptability, impact, and safety of the intervention. METHODS We trained 11 volunteers at two aging service settings in "Do More, Feel Better" and randomized 18 depressed clients to receive the intervention or referral to mental health services. RESULTS Pilot data indicated that we can successfully train and certify 64% of older volunteers and that depressed clients receiving the intervention reported high levels of session attendance and satisfaction. While there were no significant differences in 12-week reduction in Hamilton Depression Rating Scale scores between groups, intervention clients showed an 8-point reduction in comparison with a 0-point reduction among referral clients. CONCLUSIONS "Do More, Feel Better" has the potential of transferring evidence-based behavioral interventions to the hands of supervised lay volunteers and can address the insufficient workforce providing geriatric mental health services.
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191
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Santos MM, Ullman J, Leonard RC, Puspitasari AJ, Cook J, Riemann BC. Behavioral Activation as a Mechanism of Change in Residential Treatment for Mood Problems: A Growth Curve Model Analysis. Behav Ther 2019; 50:1087-1097. [PMID: 31735244 DOI: 10.1016/j.beth.2019.05.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 03/22/2019] [Accepted: 05/07/2019] [Indexed: 11/17/2022]
Abstract
Research on the efficacy, effectiveness, and dissemination potential of behavioral activation (BA)-focused interventions for depression and comorbid disorders has expanded rapidly. However, research that examines how BA interventions work has seen less growth. A primary purported mechanism of BA is activation, which reflects a person's meaningful (re)engagement in life. BA theory posits that depression will decrease as activation increases, and that changes in the mechanism variable will lead to changes in outcome. The current study aims to investigate activation as a potential mechanism of change in the context of a BA-focused residential treatment intervention for mood problems using repeated measures of self-reported activation and depression from a large comorbid sample (N = 578). Growth curve modeling was used to examine between-person differences in within-person change over time. Findings suggest that self-reported activation increases and depression decreases over time. Moreover, results show both linear and quadratic growth and that the rate of change in activation predicts the rate of change of depression. BA-focused residential treatment may facilitate activation, which exerts an effect on depression among residents with diagnostically complex presentations.
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Topooco N, Byléhn S, Dahlström Nysäter E, Holmlund J, Lindegaard J, Johansson S, Åberg L, Bergman Nordgren L, Zetterqvist M, Andersson G. Evaluating the Efficacy of Internet-Delivered Cognitive Behavioral Therapy Blended With Synchronous Chat Sessions to Treat Adolescent Depression: Randomized Controlled Trial. J Med Internet Res 2019; 21:e13393. [PMID: 31682572 PMCID: PMC6858617 DOI: 10.2196/13393] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 07/17/2019] [Accepted: 07/28/2019] [Indexed: 01/17/2023] Open
Abstract
Background Depression is a common and serious problem among adolescents, but few seek or have access to therapy. Internet-delivered cognitive behavioral therapies (ICBTs), developed to increase treatment access, show promise in reducing depression. The inclusion of coach support in treatment is desired and may be needed. Objective The aim of this study was to determine the efficacy of an ICBT protocol blended with weekly real-time therapist sessions via chat; blended treatment, for adolescent depression, including major depressive episode (MDE). The protocol has previously been evaluated in a controlled study. Methods In a two-arm randomized controlled trial, adolescents 15 to 19 years of age were recruited through a community setting at the national level in Sweden (n=70) and allocated to either 8 weeks of treatment or to minimal attention control. Depression was assessed at baseline, at posttreatment, and at 12 months following treatment (in the intervention group). The primary outcome was self-reported depression level as measured with the Beck Depression Inventory II at posttreatment. The intervention was offered without the need for parental consent. Results Over two weeks, 162 adolescents registered and completed the baseline screening. Eligible participants (n=70) were on average 17.5 years of age (SD 1.15), female (96%, 67/70), suffered from MDE (76%, 53/70), had no previous treatment experience (64%, 45/70), and reported guardian(s) to be aware about their depression state (71%, 50/70). The average intervention completion was 74% (11.8 of 16 modules and sessions). Following the treatment, ICBT participants demonstrated a significant decrease in depression symptoms compared with controls (P<.001), corresponding to a large between-group effect (intention-to-treat analysis: d=0.86, 95% CI 0.37-1.35; of completer analysis: d=0.99, 95% CI 0.48-1.51). A significant between-group effect was observed in the secondary depression outcome (P=.003); clinically significant improvement was found in 46% (16/35) of ICBT participants compared with 11% (4/35) in the control group (P=.001). Conclusions The results are in line with our previous study, further demonstrating that adolescents with depression can successfully be engaged in and experience significant improvement following ICBT blended with therapist chat sessions. Findings on participants’ age and baseline depression severity are of interest in relation to used study methods. Trial Registration ClinicalTrials.gov NCT02363205; https://clinicaltrials.gov/ct2/show/NCT02363205
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Affiliation(s)
- Naira Topooco
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.,Center for m2Health, Palo Alto, CA, United States
| | - Sandra Byléhn
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | | | - Jenny Holmlund
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Johanna Lindegaard
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Sanna Johansson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Linnea Åberg
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Lise Bergman Nordgren
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Maria Zetterqvist
- Center for Social and Affective Neuroscience, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.,Department of Child and Adolescent Psychiatry, Region Östergötland, Linköping, Sweden
| | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.,Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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193
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Lindner P, Hamilton W, Miloff A, Carlbring P. How to Treat Depression With Low-Intensity Virtual Reality Interventions: Perspectives on Translating Cognitive Behavioral Techniques Into the Virtual Reality Modality and How to Make Anti-Depressive Use of Virtual Reality-Unique Experiences. Front Psychiatry 2019; 10:792. [PMID: 31736809 PMCID: PMC6836923 DOI: 10.3389/fpsyt.2019.00792] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 10/04/2019] [Indexed: 01/05/2023] Open
Abstract
Depression is a common mental disorder with a large treatment gap. Low-intensity, automated virtual reality (VR) interventions (not requiring a therapist) is a scalable and promising solution now that VR is an accessible and mature, consumer technology. Yet unlike with phobias, there have been few attempts at translating evidence-based cognitive behavioral therapeutic (CBT) techniques for depression into the VR modality. In this paper, we discuss how specific CBT techniques can be made into VR experiences, including psychoeducation, behavioral activation, cognitive restructuring, and social skills training. We also discuss how VR-unique experiences, such as alternative embodiment and virtual pet interactions, can be made therapeutic. Creating a pre-clinical and clinical evidence base for these types of novel interventions should be considered a research priority, and high-quality development on par with other consumer VR applications will be essential to the success of any consumer-targeted intervention. If this is achieved, low-intensity VR interventions for depression have great potential to make an impact on public mental health.
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Affiliation(s)
- Philip Lindner
- Department of Psychology, Stockholm University, Stockholm, Sweden
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
- Center for Dependency Disorders, Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | | | - Alexander Miloff
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Per Carlbring
- Department of Psychology, Stockholm University, Stockholm, Sweden
- Department of Psychology, University of Southern Denmark, Odense, Denmark
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194
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Uphoff E, Pires M, Barbui C, Barua D, Churchill R, Ekers D, Fottrell E, Mazumdar P, Purgato M, Rana R, Wright J, Siddiqi N. Behavioural activation therapies for depression in adults with non-communicable diseases. Hippokratia 2019. [DOI: 10.1002/14651858.cd013461] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Eleonora Uphoff
- University of York; Cochrane Common Mental Disorders; Heslington York - None - UK YO10 5DD
- University of York; Centre for Reviews and Dissemination; York UK
| | - Malini Pires
- University of York; Mental Health and Addiction Research Group, Department of Health Sciences; York UK
| | - Corrado Barbui
- University of Verona; Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry; Verona Italy
| | | | - Rachel Churchill
- University of York; Cochrane Common Mental Disorders; Heslington York - None - UK YO10 5DD
- University of York; Centre for Reviews and Dissemination; York UK
| | - David Ekers
- University of York; Mental Health and Addiction Research Group, Department of Health Sciences; York UK
- Tees, Esk and Wear Valleys NHS Foundation Trust; Lanchester Road Hospital; Durham UK
| | - Edward Fottrell
- University College London; Centre for Health Policy, Institute of Global Health Innovation; London UK
| | - Papiya Mazumdar
- University of York; Mental Health and Addiction Research Group, Department of Health Sciences; York UK
| | - Marianna Purgato
- University of Verona; Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry; Verona Italy
| | - Rusham Rana
- Benazir Bhutto Hospital; Institute of Psychiatry; Rawalpindi Pakistan
| | - Judy Wright
- University of Leeds; Leeds Institute of Health Sciences; Leeds UK
| | - Najma Siddiqi
- Hull York Medical School, University of York; Department of Health Sciences; Heslington York North Yorkshire UK Y010 5DD
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195
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Wasil AR, Venturo-Conerly KE, Shingleton RM, Weisz JR. A review of popular smartphone apps for depression and anxiety: Assessing the inclusion of evidence-based content. Behav Res Ther 2019; 123:103498. [PMID: 31707224 DOI: 10.1016/j.brat.2019.103498] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 10/10/2019] [Accepted: 10/21/2019] [Indexed: 12/18/2022]
Abstract
Smartphone applications for the treatment of depression and anxiety have acquired millions of users, yet little is known about whether they include evidence-based therapeutic content. We examined the extent to which popular mental health applications (MH apps) for depression and anxiety contain treatment elements found in empirically supported psychotherapy protocols (i.e., "common elements"). Of the 27 MH apps reviewed, 23 included at least one common element, with a median of three elements. Psychoeducation (in 52% of apps), relaxation (44%), meditation (41%), mindfulness (37%), and assessment (37%) were the most frequent elements, whereas several elements (e.g., problem solving) were not found in any apps. We also identified gaps between app content and empirically supported treatments. Cognitive restructuring was more common in depression protocols than in depression apps (75% of protocols vs. 31% of apps), as was problem solving (34% vs. 0%). For anxiety, exposure (85%, 12%), cognitive restructuring (60%, 12%), and problem solving (25%, 0%) were more common in protocols than apps. Overall, our findings highlight empirically supported treatment elements that are poorly represented in current MH apps. The absence of several core treatment elements underscores the need for future research, including randomized trials testing the effectiveness of popular MH apps.
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Affiliation(s)
- Akash R Wasil
- Department of Psychology, Harvard University, 33 Kirkland Street, Cambridge, MA, 02138, USA.
| | | | - Rebecca M Shingleton
- Department of Psychology, Harvard University, 33 Kirkland Street, Cambridge, MA, 02138, USA
| | - John R Weisz
- Department of Psychology, Harvard University, 33 Kirkland Street, Cambridge, MA, 02138, USA
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196
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Acceptability and feasibility of digital technology for training community health workers to deliver brief psychological treatment for depression in rural India. Asian J Psychiatr 2019; 45:99-106. [PMID: 31557716 PMCID: PMC6810794 DOI: 10.1016/j.ajp.2019.09.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 09/04/2019] [Accepted: 09/05/2019] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Digital technology offers opportunities to train community health workers to deliver psychological treatments towards closing the gap in existing mental health services in low-resource settings. This study explored the acceptability and feasibility of using digital technology for training community health workers to deliver evidence-based brief psychological treatment for depression in rural India. METHODS This study consisted of two sequential evaluations of digital training prototypes using focus group discussions to explore community health worker perspectives about the digital training platform and the program content. Through an iterative design process, feedback was collected about the first prototype to inform modifications to the second prototype. Qualitative data was analyzed using a framework analysis approach. RESULTS Thirty-two community health workers participated in three separate focus group discussions. Five overarching themes related to acceptability and feasibility of digital training revealed that training on detection and treatment of depression was considered important by study participants for addressing 'stress' and 'tension' within their communities, while the digital platform was viewed as useful and convenient despite limited familiarity with using digital technology. Moreover, participants suggested simple language for the program and use of interactive content and images to increase interest and improve engagement. DISCUSSION Digital technology appears acceptable and feasible for supporting training of community health workers to deliver evidence-based depression care in rural India. These findings can inform use of technology as a tool for developing the clinical skills of community health workers for treating depression in low-resource settings.
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197
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Irie T, Yokomitsu K, Sakano Y. Relationship between cognitive behavioral variables and mental health status among university students: A meta-analysis. PLoS One 2019; 14:e0223310. [PMID: 31560719 PMCID: PMC6764683 DOI: 10.1371/journal.pone.0223310] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 09/18/2019] [Indexed: 01/07/2023] Open
Abstract
Cognitive behavioral therapy is an effective treatment for improving mental health problems among university students. However, intervention components have different effects on mental health problems. This paper is a meta-analysis of the data concerning the relationship between cognitive behavioral variables and mental health status among university students. A total of five electronic databases were reviewed, and 876 articles met the initial selection criteria. Reviewers applied standardized coding schemes to extract the correlational relationship between cognitive behavioral variables and mental health status. A total of 55 articles were included in the meta-analysis. Correlations were found for three cognitive behavioral variables (attention, thought, and behavior) across nine mental health domains (negative affect, positive affect, happiness, social function, stress response, psychological symptom, quality of life, well-being, and general health). Across each cognitive behavioral process and all mental health domains, the estimated mean correlation was medium (r = .32 - .46), and varied by the domain of mental health.
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Affiliation(s)
- Tomonari Irie
- School of Education and Culture, Hokusho University, Hokkaido, Japan
- Graduate School of Psychological Science, Health Sciences University of Hokkaido, Hokkaido, Japan
| | - Kengo Yokomitsu
- College of Comprehensive Psychology, Ritsumeikan University, Osaka, Japan
| | - Yuji Sakano
- School of Psychological Science, Health Sciences University of Hokkaido, Hokkaido, Japan
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198
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The role of avoidance motivation in the relationship between reward sensitivity and depression symptoms in adolescents: An ERP study. Psychiatry Res 2019; 279:345-349. [PMID: 30857881 PMCID: PMC6713598 DOI: 10.1016/j.psychres.2019.03.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 03/05/2019] [Accepted: 03/06/2019] [Indexed: 01/23/2023]
Abstract
Blunted neural responses to reward in an EEG paradigm (RewP) are associated with vulnerability to depression, but the pathways linking this biomarker to depressive symptoms are unclear. We examined whether the relationship between reward response (RewP mean amplitude and latency) and depression was in part explained by approach-motivated behaviors in adolescents with varying levels of depression. EEG was collected during a game rigged to provide win/loss trials. Longer RewP latency was associated with depression symptoms only when scores on a measure of avoidance motivation were included. These results suggest that treatments targeting avoidance may decrease vulnerability to depressive episodes.
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199
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Simmonds-Buckley M, Kellett S, Waller G. Acceptability and Efficacy of Group Behavioral Activation for Depression Among Adults: A Meta-Analysis. Behav Ther 2019; 50:864-885. [PMID: 31422844 DOI: 10.1016/j.beth.2019.01.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 11/29/2018] [Accepted: 01/09/2019] [Indexed: 10/27/2022]
Abstract
The evidence base for behavioral activation (BA) as a front-line treatment for depression is grounded in individual delivery. No valid previous meta-analytic reviews of BA delivered in groups have been conducted. This study therefore examined the efficacy and acceptability of group BA drawn from clinical trial evidence. Randomized controlled trials of group BA were identified using a comprehensive literature search. Depression outcomes at posttreatment/follow-up, recovery and dropout rates were extracted and analyzed using a random-effects meta-analysis. Treatment moderators were analyzed using meta-regression and subgroup analyses. Nineteen trials were quantitatively synthesized. Depression outcomes postgroup BA treatment were superior to controls (SMD 0.72, CI 0.34 to 1.10, k=13, N=461) and were equivalent to other active therapies (SMD 0.14, CI -0.18 to 0.46, k=15, N=526). Outcomes were maintained at follow-up for group BA and moderators of treatment outcome were limited. The dropout rate for group BA (14%) was no different from other active treatments for depression (17%). Further research is required to refine the conditions for optimum delivery of group BA and define robust moderators and mediators of outcome. However, BA delivered in groups produces a moderate to large effect on depressive symptoms and should be considered an appropriate front-line treatment option.
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Affiliation(s)
| | - Stephen Kellett
- University of Sheffield, and Sheffield Health and Social Care NHS Foundation Trust
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200
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Values-Based Behavioral Activation for Chronic Pain in Primary Care: A Pilot Study. J Clin Psychol Med Settings 2019; 27:633-642. [PMID: 31456124 DOI: 10.1007/s10880-019-09655-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Chronic pain is prevalent and can be complex to manage in primary care. Encouraging patients with chronic pain to engage in valued activities has been associated with reduced disability and distress. This single-arm, mixed methods pilot study examined whether adding a values-based behavioral activation intervention to a chronic pain protocol is feasible and acceptable in an urban, underserved family medicine residency clinic. Patients (N = 30) living with chronic pain completed a values assessment and co-created a plan with a psychologist to engage in values-based activities. Patients completed self-report measures of psychological health and functioning pre- and post-intervention and a qualitative interview at the follow-up visit. The intervention was considered feasible and acceptable. Patients reported high levels of satisfaction and enjoyment of the intervention and significantly less pain interference at follow-up compared to baseline. Values-based behavioral activation for chronic pain may be implemented as part of behavioral health practice in primary care.
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