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Li W, Gleeson J, Fraser MI, Ciarrochi J, Hofmann SG, Hayes SC, Sahdra B. The efficacy of personalized psychological interventions in adolescents: a scoping review and meta-analysis. Front Psychol 2024; 15:1470817. [PMID: 39309145 PMCID: PMC11413809 DOI: 10.3389/fpsyg.2024.1470817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2024] [Accepted: 08/26/2024] [Indexed: 09/25/2024] Open
Abstract
This review compared the efficacy of personalized psychological interventions to standardized interventions for adolescents. We conducted a scoping review and meta-analysis of randomized controlled trials that compared personalized interventions with standardized interventions in adolescents. Data was analyzed using Bayesian multilevel random effects meta-analysis. Eligible studies were identified through five databases: Scopus, PsycINFO, MEDLINE, Web of Science, and EMBASE. Moderation analysis was conducted to explain potential sources of effect size heterogeneity. Eight studies across 13 articles (participant N = 2,490) met inclusion criteria for the review with seven studies across 10 articles (N = 1,347) providing sufficient data for inclusion in the meta-analysis. A small but significant effect size favoring personalized interventions was found (d = 0.21, 95% CrI [0.02, 0.39]), indicating that personalized interventions are associated with superior treatment outcomes compared to standardized interventions. Moderate between-study heterogeneity was found (I2 = 53.3%). There was no evidence of publication bias. The review also found significant variation in methods of treatment personalization. This review provides evidence that personalization of adolescent psychological interventions is an effective way to improve treatment outcomes. Given the large number of adolescents worldwide who will experience some sort of mental health problem, personalization could have a significantly large impact on global mental health outcomes. Systematic review registration https://doi.org/10.17605/OSF.IO/XRNCG.
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Affiliation(s)
- William Li
- Institute for Positive Psychology and Education, Australian Catholic University, Sydney, NSW, Australia
- School of Behavioral Health Sciences, Australian Catholic University, Sydney, NSW, Australia
| | - John Gleeson
- School of Behavioral Health Sciences, Australian Catholic University, Sydney, NSW, Australia
- Healthy Brain and Mind Research Centre, Australian Catholic University, Melbourne, VIC, Australia
| | - Madeleine I. Fraser
- School of Behavioral Health Sciences, Australian Catholic University, Sydney, NSW, Australia
- Healthy Brain and Mind Research Centre, Australian Catholic University, Melbourne, VIC, Australia
| | - Joseph Ciarrochi
- Institute for Positive Psychology and Education, Australian Catholic University, Sydney, NSW, Australia
| | | | - Steven C. Hayes
- Psychology Emeritus, University of Nevada, Reno, NV, United States
- Institute for Better Health, Santa Rosa, CA, United States
| | - Baljinder Sahdra
- Institute for Positive Psychology and Education, Australian Catholic University, Sydney, NSW, Australia
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Seery C, Rushiti F, Krasniqi SP, Çarkaxhiu SI, Xhemaili VD, Limani DA, Prapashtica Q, Turjaka V, Zekaj N, Salihu M, Hjort L, Ryan J, Kaas-Petersen SH, Wang SJS. Family Therapy for Kosovar Mothers Who Experienced Conflict-Related Sexual Violence and Their Children in Postwar Times: A Pilot Randomised Waitlist-Controlled Trial. Clin Psychol Psychother 2024; 31:e3039. [PMID: 39129658 DOI: 10.1002/cpp.3039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 07/15/2024] [Accepted: 07/16/2024] [Indexed: 08/13/2024]
Abstract
Women who have experienced conflict-related sexual violence report significant long-term effects, including posttraumatic stress disorder (PTSD), depression and relationship difficulties. Research has demonstrated that maternal trauma is associated with children's behavioural difficulties and challenges in family functioning, such as impaired communication and harsh parenting. This pilot study is aimed at evaluating the preliminary effectiveness of family therapy for Kosovar mothers who experienced conflict-related sexual violence in 1998-1999 and later developed PTSD and their children in improving family functioning and reducing behavioural difficulties in postwar times. Sixty-four mothers were randomised to an intervention group or a waitlist control group. Data was collected during a screening phase, at baseline before intervention initiation, after the intervention group completed family therapy and once the waitlist control group received the intervention. Generalised linear mixed models were used to analyse group differences in family functioning and children's behaviours over time. At follow-up, mothers in the intervention group reported improved family functioning. However, mothers in the waitlist control group reported significantly fewer behavioural difficulties than mothers in the intervention group before the control group had started family therapy. There was no significant interaction between group condition and time for child-rated family functioning. Overall, this pilot study suggests that family therapy could be effective in reducing the effects of intergenerational trauma related to PTSD and conflict-related sexual violence. Future research should evaluate the long-term effects of family therapy to assess if immediate effects were maintained.
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Affiliation(s)
- Christina Seery
- UCD School of Psychology, University College Dublin, Dublin 4, Ireland
| | - Feride Rushiti
- Kosovar Rehabilitation Center for Torture Victims (KRCT), Prishtina, Kosovo
| | | | | | | | | | | | - Vesa Turjaka
- Kosovar Rehabilitation Center for Torture Victims (KRCT), Prishtina, Kosovo
| | - Nebahate Zekaj
- Kosovar Rehabilitation Center for Torture Victims (KRCT), Prishtina, Kosovo
| | - Mimoza Salihu
- Kosovar Rehabilitation Center for Torture Victims (KRCT), Prishtina, Kosovo
| | - Line Hjort
- Center for Pregnant Women with Diabetes, Dept. of Obstetrics, Rigshospitalet/Copenhagen University Hospital, Copenhagen, Denmark
- Environmental Epigenetics, Barrès Group, The Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark
| | - Joanne Ryan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Mechler J, Lindqvist K, Magnusson K, Ringström A, Krafman JD, Alvinzi P, Kassius L, Sowa J, Andersson G, Carlbring P. Guided and unguided internet-delivered psychodynamic therapy for social anxiety disorder: A randomized controlled trial. NPJ MENTAL HEALTH RESEARCH 2024; 3:21. [PMID: 38730030 PMCID: PMC11087569 DOI: 10.1038/s44184-024-00063-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 03/10/2024] [Indexed: 05/12/2024]
Abstract
Social Anxiety Disorder (SAD) is highly prevalent and debilitating disorder. Treatments exist but are not accessible and/or helpful for all patients, indicating a need for accessible treatment alternatives. The aim of the present trial was to evaluate internet-delivered psychodynamic therapy (IPDT) with and without therapist guidance, compared to a waitlist control condition, in the treatment of adults with SAD. In this randomized, clinical trial, we tested whether IPDT was superior to a waitlist control, and whether IPDT with therapeutic guidance was superior to unguided IPDT. Participants were recruited nationwide in Sweden. Eligible participants were ≥ 18 years old and scoring ≥ 60 on the Liebowitz Social Anxiety Scale self-report (LSAS-SR) whilst not fulfilling any of the exclusion criteria. Included participants were randomly assigned to IPDT with guidance (n = 60), IPDT without guidance (n = 61), or waitlist (n = 60). The IPDT intervention comprised eight self-help modules based on affect-focused dynamic therapy, delivered over 8 weeks on a secure online platform. The primary outcome was SAD symptoms severity measured weekly by the LSAS-SR. Primary analyses were calculated on an intention-to-treat sample including all participants randomly assigned. Secondary outcomes were depressive symptoms, generalized anxiety, quality of life, emotion regulation and defensive functioning. At post-treatment, both active treatments were superior to the waitlist condition with guided treatment exhibiting larger between group effects than unguided treatment (d = 1.07 95% CI [0.72, 1.43], p < .001 and d = 0.61, 95% CI [0.25, 0.98], p = .0018) on the LSAS-SR respectively. Guided IPDT lead to larger improvements than unguided IPDT (d = 0.46, 95% CI [0.11, 0.80], p < .01). At post-treatment, guided IPDT was superior to waitlist on all secondary outcome measures. Unguided IPDT was superior to waitlist on depressive symptoms and general anxiety, but not on emotion regulation, self-compassion or quality of life. Guided IPDT was superior to unguided PDT on depressive symptoms, with a trend towards superiority on a measure of generalized anxiety. At six and twelve month follow-up there were no significant differences between guided and unguided IPDT. In conclusion, IPDT shows promising effects in the treatment of SAD, with larger benefits from guided IPDT compared to non-guided, at least at post-treatment. This finding increases the range of accessible and effective treatment alternatives for adults suffering from SAD. The study was prospectively registered at ClinicalTrials (NCT05015166).
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Affiliation(s)
- Jakob Mechler
- Department of Psychology, Stockholm University, Stockholm, Sweden.
| | - Karin Lindqvist
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Kristoffer Magnusson
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockolm, Sweden
| | - Adrián Ringström
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | | | - Pär Alvinzi
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Love Kassius
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Josefine Sowa
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
- Department of Clinical Neuroscience, Karolinska Institute, Stockolm, Sweden
| | - Per Carlbring
- Department of Psychology, Stockholm University, Stockholm, Sweden
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Abramovitch A, Uwadiale A, Robinson A. A randomized clinical trial of a gamified app for the treatment of perfectionism. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2024; 63:73-91. [PMID: 37864496 DOI: 10.1111/bjc.12444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 10/03/2023] [Accepted: 10/09/2023] [Indexed: 10/23/2023]
Abstract
OBJECTIVES Perfectionism is a common transdiagnostic problem that may lead to substantial distress and functional impairments. Cognitive behavioural therapy (CBT) is an effective treatment for perfectionism. However, the existing significant barriers to access and utilization of mental health services, including among college students, demand the development of low-intensity accessible interventions. The aim of the present study was to evaluate the effectiveness of a low-intensity CBT-based self-help gamified app developed specifically for perfectionism in a sample of college students. METHODS Participants completed assessments of perfectionism, related symptoms, emotional burden and functional impairments at pretreatment, posttreatment and at one-month follow-up. RESULTS Compared with the waitlist condition (n = 35), the app condition (n = 35) demonstrated a significant and greater reduction in perfectionism, obsessive-compulsive symptoms, functional impairments and subjective ratings of emotional burden. CONCLUSIONS Results suggest that a brief, daily app-based game-like intervention targeting maladaptive perfectionistic beliefs may be a viable, low-cost alternative to traditional CBT treatments for vulnerable populations on college campuses.
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Affiliation(s)
- Amitai Abramovitch
- Department of Psychology, Texas State University, San Marcos, Texas, USA
| | - Akuekegbe Uwadiale
- Department of Psychology, Texas State University, San Marcos, Texas, USA
| | - Anthony Robinson
- Department of Psychology, Louisiana State University, Baton Rouge, Louisiana, USA
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Sobański JA, Klasa K, Dembińska E, Mielimąka M, Citkowska-Kisielewska A, Jęda P, Rutkowski K. Central psychological symptoms from a network analysis of patients with anxiety, somatoform or personality disorders before psychotherapy. J Affect Disord 2023; 339:1-21. [PMID: 37399849 DOI: 10.1016/j.jad.2023.06.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 03/05/2023] [Accepted: 06/20/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND Cross-sectional network analysis examines the relationships between symptoms to explain how they constitute disorders. Up to now, research focuses mostly on depression, posttraumatic stress disorder, and rarely assesses larger networks of various symptoms measured with instruments independent of classifications. Studies on large groups of psychotherapy patients are also rare. METHODS Analyzing triangulated maximally filtered graph (TMFG) networks of 62 psychological symptoms reported by 4616 consecutive nonpsychotic adults in 1980-2015. RESULTS Case-dropping and nonparametric bootstrap proved the accuracy, stability and reliability of networks in patients' sex-, age-, and time of visit divided subgroups. Feeling that others are prejudiced against the patient was the most central symptom, followed by catastrophic fears, feeling inferior and underestimated. Sadness, panic, and sex-related complaints were less central than we expected. All analysed symptoms were connected, and we found only small sex-related differences between subsamples' networks. No differences were observed for time of visit and age of patients. LIMITATION Analyses were cross-sectional and retrospective, not allowing examination of directionality or causality. Further, data are at the between-person level; thus, it is unknown whether the network remains constant for any person over time. One self-report checklist and building binary network method may bias results. Our results indicate how symptoms co-occured before psychotherapy, not longitudinally. Our sample included public university hospital patients, all White-Europeans, predominantly females and university students. CONCLUSIONS Hostile projection, catastrophic fears, feeling inferior and underestimated were the most important psychological phenomena reported before psychotherapy. Exploring these symptoms would possibly lead to enhancement of treatments.
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Affiliation(s)
- Jerzy A Sobański
- Jagiellonian University Medical College, Faculty of Medicine, Department of Psychotherapy, Poland.
| | - Katarzyna Klasa
- Jagiellonian University Medical College, Faculty of Medicine, Department of Psychotherapy, Poland
| | - Edyta Dembińska
- Jagiellonian University Medical College, Faculty of Medicine, Department of Psychotherapy, Poland
| | - Michał Mielimąka
- Jagiellonian University Medical College, Faculty of Medicine, Department of Psychotherapy, Poland
| | | | - Patrycja Jęda
- Jagiellonian University Medical College, Faculty of Medicine, Department of Psychotherapy, Poland
| | - Krzysztof Rutkowski
- Jagiellonian University Medical College, Faculty of Medicine, Department of Psychotherapy, Poland
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Pan JY. Internet-Based Cognitive Behavioral Therapy and Virtual Reality Exposure Therapy for Social Anxiety Disorder: Protocol for a Randomized Controlled Trial in Hong Kong. JMIR Res Protoc 2023; 12:e48437. [PMID: 37707944 PMCID: PMC10540030 DOI: 10.2196/48437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 08/03/2023] [Accepted: 08/04/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND Social anxiety disorder (SAD), also known as social phobia, is one of the most common mental disorders worldwide. In Hong Kong, the prevalence of SAD is high, but its treatment rate is low. SAD has immense impact on academic or work performance, social life, career development, and quality of life. One of the most effective treatments for SAD is cognitive behavioral therapy (CBT), with internet-based CBT (iCBT) and virtual reality exposure therapy (VRET) showing promise in treating SAD. However, internet interventions are underdeveloped in Chinese communities including Hong Kong. OBJECTIVE This study aims to develop an iCBT program that includes VRET, called "Ease Anxiety in Social Event Online" (Ease Online), for Hong Kong adults with SAD in a randomized controlled trial. METHODS The 14-week Ease Online program is a guided self-help iCBT program with a blended mode of service delivery. The program comprises 9 web-based modules and 5 individual counseling sessions (including 2 VRET sessions) conducted remotely or face-to-face with a therapist to provide therapist support, as guided iCBT shows superior effects than unguided iCBT. Other program components include therapist feedback on assignments, internal messages, forums, client portfolios, web-based questionnaires, reminders, and web-based bookings. The program can be accessed either through a mobile app or program website through a PC with an internet connection. The participants are openly recruited and screened using a questionnaire and through an intake interview. Eligible participants are randomized by placing them into a web-based iCBT group, app-based iCBT group, or a waitlist control (WLC) group. Participants in the WLC group are assigned to the app-based program upon completion of the service of the 2 experimental groups. Measurements of social anxiety, depression and anxiety symptoms, psychological distress, automatic thoughts, and quality of life are administered at pretest, posttest, and 3- and 6-month follow-ups. Multivariate ANOVA with repeated measures will be performed to determine the intervention effectiveness on the continuous variables over time. RESULTS Participant recruitment commenced in January 2021. As of February 2023, a total of 1811 individuals applied for the Ease Online program. In total, 401 intake interviews have been completed, and 329 eligible participants have joined the program, among whom 166 have completed the service. Data collection is still ongoing, which is expected to be completed in March 2024. CONCLUSIONS This study is the first of its kind in combining iCBT and VRET for the treatment of SAD in Hong Kong. At a theoretical level, this study contributes to the development and evaluation of internet-based psychological interventions in Hong Kong. At a practical level, the Ease Online program may serve as an alternative service option for SAD clients in Hong Kong if proven effective. TRIAL REGISTRATION ClinicalTrials.gov NCT04995913; https://clinicaltrials.gov/study/NCT04995913. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/48437.
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Affiliation(s)
- Jia-Yan Pan
- Department of Social Work, Hong Kong Baptist University, Hong Kong, China (Hong Kong)
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Høstmælingen A, Nissen-Lie HA, Wampold B, Ulvenes PG. Symptom Change during Waitlist for Medicated and Nonmedicated Patients with Chronic Depression. PSYCHOTHERAPY AND PSYCHOSOMATICS 2023; 92:340-345. [PMID: 37708855 DOI: 10.1159/000533661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 08/12/2023] [Indexed: 09/16/2023]
Abstract
INTRODUCTION Patients seeking psychotherapy often spend time on waitlist (WL), the effect of which is largely unknown. WL patients may forego alternative non-psychotherapeutic assistance and thus do more poorly than had they not been placed on a WL. The course of symptoms might also be influenced by use of antidepressant medication (ADM), an issue that remains unexplored in the literature. OBJECTIVE In a naturalistic setting, WL symptom change before inpatient psychotherapy (mean weeks of waiting = 22.6) was assessed in a sample (N = 313) of chronically depressed patients. METHODS Using the Beck Depression Inventory-II, patients' symptoms were tracked at assessment, when admitted to treatment (i.e., after WL), at posttreatment and 1-year follow-up. Multilevel growth curve analysis was used to examine waitlist change for the whole sample as well as for ADM users and nonmedicated patients. RESULTS Symptoms were reduced significantly from assessment to admittance (Cohen's d = 0.47). Symptoms reduced less for ADM users (d = 0.39) than for nonmedicated patients (d = 0.65). CONCLUSION The findings indicate that chronically depressed patients experience a decrease in symptoms during WL, quite likely due to treatment expectations. We discuss whether less symptom improvement for ADM users could be attributed to iatrogenic comorbidity and a higher degree of demoralization in this group.
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Affiliation(s)
| | | | - Bruce Wampold
- Modum Bad Research Institute, Vikersund, Norway
- Department of Counseling Psychology, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Pål G Ulvenes
- Department of Psychology, University of Oslo, Oslo, Norway
- Modum Bad Research Institute, Vikersund, Norway
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Atik E, Stricker J, Schückes M, Pittig A. Efficacy of a Brief Blended Cognitive Behavioral Therapy Program for the Treatment of Depression and Anxiety in University Students: Uncontrolled Intervention Study. JMIR Ment Health 2023; 10:e44742. [PMID: 37624631 PMCID: PMC10492172 DOI: 10.2196/44742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 05/25/2023] [Accepted: 06/25/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Blended cognitive behavioral therapy (bCBT)-the combination of cognitive behavioral therapy and digital mental health applications-has been increasingly used to treat depression and anxiety disorders. As a resource-efficient treatment approach, bCBT appears promising for addressing the growing need for mental health care services, for example, as an early intervention before the chronification of symptoms. However, further research on the efficacy and feasibility of integrated bCBT interventions is needed. OBJECTIVE This study aimed to evaluate the efficacy of a novel bCBT program comprising short (25 min), weekly face-to-face therapy sessions combined with a smartphone-based digital health app for treating mild to moderate symptoms of depression or anxiety. METHODS This prospective uncontrolled trial comprised 2 measurement points (before and after treatment) and 2 intervention groups. We recruited university students with mild to moderate symptoms of depression or anxiety. On the basis of the primary symptoms, participants were assigned to either a depression intervention group (n=67 completers) or an anxiety intervention group (n=33 completers). Participants in each group received 6 weekly individual psychotherapy sessions via videoconference and completed modules tailored to their respective symptoms in the smartphone-based digital health app. RESULTS The depression group displayed medium to large improvements in the symptoms of depression (Cohen d=-0.70 to -0.90; P<.001). The anxiety group experienced significant improvements in the symptoms of generalized anxiety assessed with the Generalized Anxiety Disorder-7 scale with a large effect size (Cohen d=-0.80; P<.001) but not in symptoms of anxiety assessed with the Beck Anxiety Inventory (Cohen d=-0.35; P=.06). In addition, both groups experienced significant improvements in their perceived self-efficacy (Cohen d=0.50; P<.001 in the depression group and Cohen d=0.71; P<.001 in the anxiety group) and quality of life related to psychological health (Cohen d=0.87; P<.001 in the depression group and Cohen d=0.40; P=.03 in the anxiety group). Work and social adjustment of patients improved significantly in the depression group (Cohen d=-0.49; P<.001) but not in the anxiety group (Cohen d=-0.06; P=.72). Patients' mental health literacy improved in the anxiety group (Cohen d=0.45; P=.02) but not in the depression group (Cohen d=0.21; P=.10). Patient satisfaction with the bCBT program and ratings of the usability of the digital app were high in both treatment groups. CONCLUSIONS This study provides preliminary evidence for the feasibility and efficacy of a novel brief bCBT intervention. The intervention effects were generalized across a broad spectrum of patient-reported outcomes. Hence, the newly developed bCBT intervention appears promising for treating mild to moderate depression and anxiety in young adults.
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Affiliation(s)
- Ece Atik
- Translational Psychotherapy, Institute of Psychology, University of Goettingen, Goettingen, Germany
| | - Johannes Stricker
- Clinical Psychology Research Group, Department of Experimental Psychology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | | | - Andre Pittig
- Translational Psychotherapy, Institute of Psychology, University of Goettingen, Goettingen, Germany
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Peipert A, Adams S, Lorenzo-Luaces L. "I would not want the mechanic to direct me to an engine repair manual": a qualitative analysis of provider perspectives on low-intensity treatments for patients on waiting lists. BMC Psychiatry 2023; 23:600. [PMID: 37592212 PMCID: PMC10436418 DOI: 10.1186/s12888-023-05055-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 07/26/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND Low-intensity treatments (LITs), such as bibliotherapy or online self-help, have the potential to reach more individuals than traditional face-to-face care by circumventing many of the common barriers to mental health treatment. Despite substantial research evidence supporting their usability and efficacy across several clinical presentations, prior work suggests that mental health providers rarely recommend LITs for patients waiting for treatment. METHODS The present study analyzed provider open responses to a prompt asking about perceived barriers, thoughts, and comments related to additional treatment resources for patients on treatment waiting lists. We surveyed 141 practicing mental health providers, 65 of whom responded to an open text box with additional thoughts on using LITs for patients on treatment waiting lists. Responses were qualitatively coded using a thematic coding process. RESULTS Qualitative outcomes yielded 11 codes: patient appropriateness, research evidence, feasibility, patient barriers, liability, patient personal contact, additional resources, positive attitudes, trust in programs, systemic problems, and downplaying distress. CONCLUSIONS Results suggest providers are predominantly concerned about the potential of suggesting a LIT that would be ultimately inappropriate for their patient due to a lack of assessment of the patient's needs. Furthermore, providers noted ambiguity around the legal and ethical liability of recommending a LIT to someone who may not yet be a patient. Guidelines and standards for recommending LITs to patients on treatment waiting lists may help address ambiguity regarding their use in routine care.
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Affiliation(s)
- Allison Peipert
- Department of Psychological and Brain Sciences, Indiana University Bloomington, 1101 E 10th Street, Bloomington, IN, 47405, USA
| | - Sydney Adams
- Department of Psychological and Brain Sciences, Indiana University Bloomington, 1101 E 10th Street, Bloomington, IN, 47405, USA
| | - Lorenzo Lorenzo-Luaces
- Department of Psychological and Brain Sciences, Indiana University Bloomington, 1101 E 10th Street, Bloomington, IN, 47405, USA.
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Ugarte Pérez C, Cruzat-Mandich C, Quiñones Bergeret Á, Díaz-Tendero D, Gallegos M, Gil AA, Cepeda-Benito A. Comparative efficacy of remotely delivered mindfulness-based eating awareness training versus behavioral-weight loss counseling during COVID-19. Front Psychol 2023; 14:1101120. [PMID: 37265953 PMCID: PMC10229895 DOI: 10.3389/fpsyg.2023.1101120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 04/21/2023] [Indexed: 06/03/2023] Open
Abstract
Introduction Dysregulated eating (emotional eating, cue-elicited eating, and dietary restraint and restriction) has been linked to being overweight or obese. The present investigation used a random controlled trial (RCT) to test the differential efficacy of remotely delivered Mindfulness-Based Eating Awareness Training (MB-EAT) and Behavioral Weight Loss (BWL) counseling. Methods The sample was recruited through advertisements that offered help to people "with problems controlling their eating" or "interested in improving their relationship with food" (n = 135). Results Retention was low in both groups (42%), but not dissimilar to retention rates reported in related clinical trials delivered "in person." Among the participants who completed treatment, we found no between-group differences in any of the treatment outcomes, but participants in both groups experienced significant increases in eating-related mindfulness [Mindful Eating Questionnaire (MEQ) and awareness [Multidimensional Assessment of Interoceptive Awareness (MAIA), and significant decreases in unhealthy eating patterns [Dutch Eating Behavior Questionnaire (DEBQ); Binge Eating Scale (BES), and weight over the course of treatment. Participants in both groups also experienced increases in self-reported depression and anxiety symptoms [Hospital Anxiety and Depression Scale (HADS)], although these increases likely reflected normative changes observed in the population at large during COVID-19. Discussion Overall, the results suggest that dysregulated eating and weight loss intervention delivered remotely via teleconference can be effective.
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Affiliation(s)
- Carla Ugarte Pérez
- Centro de Estudios de la Conducta Alimentaria (CECA), Escuela de Psicología, Universidad Adolfo Ibáñez, Peñalolén, Chile
| | - Claudia Cruzat-Mandich
- Centro de Estudios de la Conducta Alimentaria (CECA), Escuela de Psicología, Universidad Adolfo Ibáñez, Peñalolén, Chile
| | | | - Dafne Díaz-Tendero
- Centro de Estudios de la Conducta Alimentaria (CECA), Escuela de Psicología, Universidad Adolfo Ibáñez, Peñalolén, Chile
| | - Marcela Gallegos
- Departamento de Nutrición y Bariátrica, Clinica Las Condes, Santiago, Chile
| | - Aurora A. Gil
- Eating Disorders Unit, Psychiatry Department, Faculty of Medicine, Pontificia Universidad Católica, Santiago, Chile
| | - Antonio Cepeda-Benito
- Department of Psychological Science, University of Vermont, Burlington, VT, United States
- Departamento de Psicología, Personalidad y Tratamiento, Universidad de Jaén, Jaén, Spain
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Endhoven B, De Cort K, Matthijssen SJMA, de Jongh A, van Minnen A, Duits P, Schruers KRJ, van Dis EAM, Krypotos AM, Gerritsen L, Engelhard IM. Eye movement desensitization and reprocessing (EMDR) therapy or supportive counseling prior to exposure therapy in patients with panic disorder: study protocol for a multicenter randomized controlled trial (IMPROVE). BMC Psychiatry 2023; 23:157. [PMID: 36918861 PMCID: PMC10011792 DOI: 10.1186/s12888-022-04320-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 10/18/2022] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Exposure-based therapy is the treatment of choice for anxiety disorders, but many patients do not benefit sufficiently from it. Distressing images of threat related to the future or past may maintain the anxiety symptomatology or impede exposure therapy. An intervention that targets threat-related imagery is eye movement desensitization and reprocessing (EMDR) therapy. The main goal of this multicenter randomized controlled trial is to investigate whether EMDR therapy plus exposure therapy, relative to supportive counseling plus exposure therapy, improves treatment efficacy, tolerability, and adherence in patients with panic disorder. In addition, we will examine potential predictors of optimal treatment allocation, mechanisms of change as well as the long term effects of treatment. Finally, we will assess cost-effectiveness. METHODS A multicenter randomized controlled trial mixed design will be conducted. Participants will be 50 patients, aged ≥ 18, diagnosed with a panic disorder. They will be randomly assigned to one of two conditions: EMDR therapy (i.e., flashforward strategy) or supportive counseling (each consisting of four weekly sessions of 90 min each) prior to exposure therapy (consisting of eight weekly sessions of 90 min each). Assessments will be made pre-treatment (T1), between-treatments (T2), post-treatment (T3), one month post-treatment (FU1) and six months post-treatment (FU2) by an assessor blind to treatment condition. The primary outcome measure is severity of panic-related symptoms. Secondary outcome measures are: tolerability of exposure therapy (initial avoidance, willingness to start exposure therapy, considered drop-out; no-show and drop-out), related symptomatology (generalized anxiety, depression), and functional impairment. DISCUSSION The primary goals of this research are to compare the efficacy, tolerability, and adherence of EMDR therapy plus exposure therapy and supportive counseling plus exposure therapy and to identify predictors, moderators, and mediators for treatment success. This multi-center research aims to make a significant contribution to our understanding as to how treatment for patients with anxiety disorders can be optimized, and elucidate who can benefit most from this novel approach. TRIAL REGISTRATION ISRCTN-ISRCTN29668369: Improving anxiety treatment by modifying emotional memories before real-life exposure. Registered 27 June 2022-retrospectively registered. ISRCTN-ISRCTN29668369.
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Affiliation(s)
- Bart Endhoven
- Department of Clinical Psychology, Utrecht University, PO Box 80140, 3508 TC, Utrecht, The Netherlands.
- Altrecht Academic Anxiety Center, Nieuwe, Houtenseweg 12, 3524 SH, Utrecht, The Netherlands.
| | - Klara De Cort
- Academic Anxiety Center, Mondriaan/PsyQ, Oranjeplein 10, 6624 KD, Maastricht, The Netherlands
- Department of Psychiatry and Neuropsychology, Maastricht University, PO Box 616, 6200MD, Maastricht, The Netherlands
| | - Suzy J M A Matthijssen
- Department of Clinical Psychology, Utrecht University, PO Box 80140, 3508 TC, Utrecht, The Netherlands
- Altrecht Academic Anxiety Center, Nieuwe, Houtenseweg 12, 3524 SH, Utrecht, The Netherlands
| | - Ad de Jongh
- PSYTREC, Professor Bronkhorstlaan 2, 3723 MB, Bilthoven, The Netherlands
- Academic Centre for Dentistry Amsterdam, University of Amsterdam and VU University Amsterdam), Gustav Mahlerlaan 3004, 1081 LA, Amsterdam, The Netherlands
| | - Agnes van Minnen
- PSYTREC, Professor Bronkhorstlaan 2, 3723 MB, Bilthoven, The Netherlands
- Behavioural Science Institute, Radboud University, PO Box 9104, 6500HE, Nijmegen, The Netherlands
| | - Puck Duits
- Altrecht Academic Anxiety Center, Nieuwe, Houtenseweg 12, 3524 SH, Utrecht, The Netherlands
| | - Koen R J Schruers
- Academic Anxiety Center, Mondriaan/PsyQ, Oranjeplein 10, 6624 KD, Maastricht, The Netherlands
- Department of Psychiatry and Neuropsychology, Maastricht University, PO Box 616, 6200MD, Maastricht, The Netherlands
- Research Group Health Psychology, PO Box 3726, 3000, Leuven, KU, Belgium
| | - Eva A M van Dis
- Department of Clinical Psychology, Utrecht University, PO Box 80140, 3508 TC, Utrecht, The Netherlands
| | - Angelos M Krypotos
- Department of Clinical Psychology, Utrecht University, PO Box 80140, 3508 TC, Utrecht, The Netherlands
- Research Group Health Psychology, PO Box 3726, 3000, Leuven, KU, Belgium
| | - Lotte Gerritsen
- Department of Clinical Psychology, Utrecht University, PO Box 80140, 3508 TC, Utrecht, The Netherlands
| | - Iris M Engelhard
- Department of Clinical Psychology, Utrecht University, PO Box 80140, 3508 TC, Utrecht, The Netherlands
- Altrecht Academic Anxiety Center, Nieuwe, Houtenseweg 12, 3524 SH, Utrecht, The Netherlands
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12
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Henke RM. Knowing Well, Being Well: well-being born of understanding: The COVID-19 Pandemic and Children: Implications for Future Health. Am J Health Promot 2023; 37:263-288. [PMID: 36646664 DOI: 10.1177/08901171221140641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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13
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Nadeem E, R Van Meter A. The Impact of the COVID-19 Pandemic on Adolescents: An Opportunity to Build Resilient Systems. Am J Health Promot 2023; 37:274-281. [PMID: 36646661 DOI: 10.1177/08901171221140641d] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The impact of the COVID-19 pandemic on adolescents is significant. Educational progress and mental health, in particular, have been negatively affected. Among youth from vulnerable communities, pre-existing academic and health disparities have been exacerbated. Youth outcomes are often attributed to individual resilience - or lack thereof; in this paper, we describe how failure to adapt and effectively cope at the system level (ie, lack of system resilience) is implicated in the current dual educational and mental crisis. We describe opportunities to make our systems more nimble and better-equipped to support youth moving forward.
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Affiliation(s)
- Erum Nadeem
- Graduate School of Applied and Professional Psychology, Rutgers University, USA
| | - Anna R Van Meter
- Department of Child and Adolescent Psychiatry, New York University Grossman School of Medicine, USA
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Melkonian M, McDonald S, Scott A, Karin E, Dear BF, Wootton BM. Symptom improvement and remission in untreated adults seeking treatment for obsessive-compulsive disorder: A systematic review and meta-analysis. J Affect Disord 2022; 318:175-184. [PMID: 36030999 DOI: 10.1016/j.jad.2022.08.037] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 08/09/2022] [Accepted: 08/18/2022] [Indexed: 11/26/2022]
Abstract
Obsessive-compulsive disorder (OCD) is a common psychiatric condition that results in significant distress and impairment, and high societal costs. OCD is widely considered to be a chronic condition, however, our understanding of the chronicity of the disorder, and the incidence of spontaneous remission, has largely relied on longitudinal studies of individuals who have received treatment. The aim of the current study is to examine symptom improvement and rate of spontaneous remission in individuals with OCD who were assigned to a no-treatment control group within a randomized controlled trial using a meta-analytic approach. Twelve studies (n = 282; mean age = 35.52; 60.03 % female) were included in the meta-analysis. The pooled within-group effect size was negligible (g = -0.14; 95 % CI [-0.25, -0.04]) and only 4 % of participants demonstrated spontaneous remission across an average of 10.92 weeks (event rate = 0.04; [95 % CI: 0.01, 0.11]). Sample size and duration of OCD symptoms significantly moderated the effect size for symptom change. No moderators were found for symptom remission. The findings add to the small body of literature demonstrating that OCD has a chronic and unremitting course without treatment.
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Affiliation(s)
- Maral Melkonian
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology, Sydney, NSW, Australia
| | - Sarah McDonald
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology, Sydney, NSW, Australia
| | - Amelia Scott
- Department of Psychology, Faculty of Medicine, Health and Human Sciences, Macquarie University, North Ryde, NSW, Australia
| | - Eyal Karin
- Department of Psychology, Faculty of Medicine, Health and Human Sciences, Macquarie University, North Ryde, NSW, Australia
| | - Blake F Dear
- Department of Psychology, Faculty of Medicine, Health and Human Sciences, Macquarie University, North Ryde, NSW, Australia
| | - Bethany M Wootton
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology, Sydney, NSW, Australia; Department of Psychology, Faculty of Medicine, Health and Human Sciences, Macquarie University, North Ryde, NSW, Australia.
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15
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Peipert A, Krendl AC, Lorenzo-Luaces L. Waiting Lists for Psychotherapy and Provider Attitudes Toward Low-Intensity Treatments as Potential Interventions: Survey Study. JMIR Form Res 2022; 6:e39787. [PMID: 36112400 PMCID: PMC9526124 DOI: 10.2196/39787] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/19/2022] [Accepted: 08/22/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Common mental disorders, including depression and anxiety, are leading causes of disability worldwide. Digital mental health interventions, such as web-based self-help and other low-intensity treatments (LITs) that are not digital (eg, bibliotherapy), have the potential to reach many individuals by circumventing common barriers present in traditional mental health care. It is unclear how often LITs are used in clinical practice, or whether providers would be interested in their use for treatment waiting lists. OBJECTIVE The aims of this study were to (1) describe current practices for treatment waiting lists, (2) describe providers' attitudes toward digital and nondigital LITs for patients on a waiting list, and (3) explore providers' willingness to use digital and nondigital LITs and their decisions to learn about them. METHODS We surveyed 141 practicing mental health care providers (eg, therapists and psychologists) and provided an opportunity for them to learn about LITs. RESULTS Most participants reported keeping a waiting list. Few participants reported currently recommending digital or nondigital LITs, though most were willing to use at least one for patients on their waiting list. Attitudes toward digital and nondigital LITs were neutral to positive. Guided digital and nondigital LITs were generally perceived to be more effective but less accessible, and unguided interventions were perceived to be less effective but more accessible. Most participants selected to access additional information on LITs, with the most popular being web-based self-help. CONCLUSIONS Results suggest providers are currently not recommending LITs for patients on treatment waiting lists but would be willing to recommend them. Future work should explore barriers and facilitators to implementing digital and nondigital LITs for patients on treatment waiting lists.
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Affiliation(s)
- Allison Peipert
- Department of Psychological and Brain Sciences, Indiana University Bloomington, Bloomington, IN, United States
| | - Anne C Krendl
- Department of Psychological and Brain Sciences, Indiana University Bloomington, Bloomington, IN, United States
| | - Lorenzo Lorenzo-Luaces
- Department of Psychological and Brain Sciences, Indiana University Bloomington, Bloomington, IN, United States
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16
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Chen R, Zheng J, Li T, Zhang Q, Li C, Cui L. Cognitive bias modification of interpretation training for Chinese undergraduates with depressive symptoms. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-020-01094-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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17
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McEvoy PM, Hyett MP, Bank SR, Erceg-Hurn DM, Johnson AR, Kyron MJ, Saulsman LM, Moulds ML, Grisham JR, Holmes EA, Moscovitch DA, Lipp OV, Campbell BNC, Rapee RM. Imagery-enhanced v. verbally-based group cognitive behavior therapy for social anxiety disorder: a randomized clinical trial. Psychol Med 2022; 52:1277-1286. [PMID: 32912351 DOI: 10.1017/s0033291720003001] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Cognitive behavior therapy (CBT) is effective for most patients with a social anxiety disorder (SAD) but a substantial proportion fails to remit. Experimental and clinical research suggests that enhancing CBT using imagery-based techniques could improve outcomes. It was hypothesized that imagery-enhanced CBT (IE-CBT) would be superior to verbally-based CBT (VB-CBT) on pre-registered outcomes. METHODS A randomized controlled trial of IE-CBT v. VB-CBT for social anxiety was completed in a community mental health clinic setting. Participants were randomized to IE (n = 53) or VB (n = 54) CBT, with 1-month (primary end point) and 6-month follow-up assessments. Participants completed 12, 2-hour, weekly sessions of IE-CBT or VB-CBT plus 1-month follow-up. RESULTS Intention to treat analyses showed very large within-treatment effect sizes on the social interaction anxiety at all time points (ds = 2.09-2.62), with no between-treatment differences on this outcome or clinician-rated severity [1-month OR = 1.45 (0.45, 4.62), p = 0.53; 6-month OR = 1.31 (0.42, 4.08), p = 0.65], SAD remission (1-month: IE = 61.04%, VB = 55.09%, p = 0.59); 6-month: IE = 58.73%, VB = 61.89%, p = 0.77), or secondary outcomes. Three adverse events were noted (substance abuse, n = 1 in IE-CBT; temporary increase in suicide risk, n = 1 in each condition, with one being withdrawn at 1-month follow-up). CONCLUSIONS Group IE-CBT and VB-CBT were safe and there were no significant differences in outcomes. Both treatments were associated with very large within-group effect sizes and the majority of patients remitted following treatment.
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Affiliation(s)
- Peter M McEvoy
- School of Psychology, Curtin University, Perth, Australia
- Centre for Clinical Interventions, Perth, Australia
| | | | - Samantha R Bank
- School of Psychology, Curtin University, Perth, Australia
- Centre for Clinical Interventions, Perth, Australia
| | - David M Erceg-Hurn
- School of Psychology, Curtin University, Perth, Australia
- Centre for Clinical Interventions, Perth, Australia
| | | | | | - Lisa M Saulsman
- School of Psychological Science, University of Western Australia, Perth, Australia
| | - Michelle L Moulds
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Jessica R Grisham
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Emily A Holmes
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - David A Moscovitch
- Department of Psychology, Centre for Mental Health Research and Treatment, University of Waterloo, Waterloo, Canada
| | - Ottmar V Lipp
- School of Psychology, Curtin University, Perth, Australia
| | | | - Ronald M Rapee
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, Australia
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18
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Boecking B, Rausch L, Psatha S, Nyamaa A, Dettling-Papargyris J, Funk C, Brueggemann P, Rose M, Mazurek B. Hearing Therapy Improves Tinnitus-Related Distress in Mildly Distressed Patients with Chronic Tinnitus and Mild-to-Moderate Hearing Loss: A Randomized-Controlled Cross-Over Design. J Clin Med 2022; 11:jcm11071764. [PMID: 35407372 PMCID: PMC9000020 DOI: 10.3390/jcm11071764] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/14/2022] [Accepted: 03/17/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The psychological effects of hearing aids and auditory training are underinvestigated. OBJECTIVE To assess the short- and long-term effects of an industry-developed auditory training on tinnitus-related distress, perceived stress, and psychological epiphenomena in patients with chronic tinnitus and mild-to-moderate hearing loss. METHOD One-hundred-seventy-seven gender-stratified patients were randomized to an immediate [IIG] or delayed [DIG] intervention group. Following binaural hearing aid fitting, participants completed a CD-enhanced 14-days self-study program. Applying a randomized-controlled cross-over design, psychological measures were obtained at four times: pre-treatment/wait [IIG: t1; DIG: wait], post-treatment/pre-treatment [IIG: t2; DIG: t1], follow-up/post-treatment [IIG: t3; DIG: t2], and follow-up [DIG: t3]. Between- and within-group analyses investigated treatment-related effects and their stability at a 70-day follow-up. RESULTS Overall, distress symptom severity was mild. Unlike the DIG, the IIG showed significant improvements in tinnitus-related distress. Some psychological epiphenomena, notably anxiety, slightly improved in both groups. Within-group analyses demonstrated the stability of the tinnitus-distress-related effects, alongside uncontrolled improvements of perceived stress and mood-related symptoms at follow-up. CONCLUSIONS The investigated hearing therapy lastingly improves tinnitus-related distress in mildly distressed patients with chronic tinnitus and mild-to-moderate hearing loss. Beneficial psychological knock-on effects deserve further investigation.
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Affiliation(s)
- Benjamin Boecking
- Tinnitus Centre, Charité—Universitätsmedizin Berlin, 10117 Berlin, Germany; (B.B.); (L.R.); (S.P.); (A.N.); (P.B.)
| | - Leonie Rausch
- Tinnitus Centre, Charité—Universitätsmedizin Berlin, 10117 Berlin, Germany; (B.B.); (L.R.); (S.P.); (A.N.); (P.B.)
| | - Stamatina Psatha
- Tinnitus Centre, Charité—Universitätsmedizin Berlin, 10117 Berlin, Germany; (B.B.); (L.R.); (S.P.); (A.N.); (P.B.)
| | - Amarjargal Nyamaa
- Tinnitus Centre, Charité—Universitätsmedizin Berlin, 10117 Berlin, Germany; (B.B.); (L.R.); (S.P.); (A.N.); (P.B.)
| | | | - Christine Funk
- Terzo Institute, ISMA AG, 96515 Sonneberg, Germany; (J.D.-P.); (C.F.)
| | - Petra Brueggemann
- Tinnitus Centre, Charité—Universitätsmedizin Berlin, 10117 Berlin, Germany; (B.B.); (L.R.); (S.P.); (A.N.); (P.B.)
| | - Matthias Rose
- Medical Department, Division of Psychosomatic Medicine, Charité—Universitätsmedizin Berlin, 10117 Berlin, Germany;
| | - Birgit Mazurek
- Tinnitus Centre, Charité—Universitätsmedizin Berlin, 10117 Berlin, Germany; (B.B.); (L.R.); (S.P.); (A.N.); (P.B.)
- Correspondence:
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MacKinnon AL, Silang K, Penner K, Zalewski M, Tomfohr-Madsen L, Roos LE. Promoting Mental Health in Parents of Young Children Using eHealth Interventions: A Systematic Review and Meta-analysis. Clin Child Fam Psychol Rev 2022; 25:413-434. [PMID: 35184262 PMCID: PMC8858396 DOI: 10.1007/s10567-022-00385-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2022] [Indexed: 12/11/2022]
Abstract
Parent stress and mental health problems negatively impact early child development. This study aimed to systematically review and meta-analyze the effect of eHealth interventions on parent stress and mental health outcomes, and identify family- and program-level factors that may moderate treatment effects. A search of PsycINFO, Medline, CINAHL, Cochrane and Embase databases was conducted from their inception dates to July 2020. English-language controlled and open trials were included if they reported: (a) administration of an eHealth intervention, and (b) stress or mental health outcomes such as self-report or clinical diagnosis of anxiety and depression, among (c) parents of children who were aged 1–5 years old. Non-human studies, case reports, reviews, editorials, letters, dissertations, and books were excluded. Risk of bias was assessed using the National Institutes of Health (NIH) Study Quality Assessment Tools. Random-effects meta-analyses of standardized mean differences (SMD) were conducted and meta-regressions tested potential moderators. 38 studies were included (N = 4360 parents), from 13 countries (47.4% USA). Meta-analyses indicated eHealth interventions were associated with better self-reported mental health among parents (overall SMD = .368, 95% CI 0.228, 0.509), regardless of study design (k = 30 controlled, k = 8 pre-post) and across most outcomes (k = 17 anxiety, k = 19 depression, k = 12 parenting stress), with small to medium effect sizes. No significant family- or program-level moderators emerged. Despite different types and targets, eHealth interventions offer a promising and accessible option to promote mental health among parents of young children. Further research is needed on moderators and the long-term outcomes of eHealth interventions. Prospero Registration: CRD42020190719.
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Affiliation(s)
- Anna L MacKinnon
- Department of Psychology, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute (ACHRI), Calgary, AB, Canada
| | - Katherine Silang
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - Kailey Penner
- Department of Psychology, University of Manitoba, 66 Chancellors Cir., Winnipeg, MB, R3T 2N2, Canada
| | | | - Lianne Tomfohr-Madsen
- Department of Psychology, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute (ACHRI), Calgary, AB, Canada
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - Leslie E Roos
- Department of Psychology, University of Manitoba, 66 Chancellors Cir., Winnipeg, MB, R3T 2N2, Canada.
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20
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Burgos-Julián FA, Ruiz-Íñiguez R, Peña-Ibáñez F, Montero AC, Germán MAS. Mindfulness-based and mindfulness-informed interventions in bipolar disorder: a meta-analysis based on Becker's method. Clin Psychol Psychother 2022; 29:1172-1185. [PMID: 35102640 DOI: 10.1002/cpp.2717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 12/31/2021] [Accepted: 01/25/2022] [Indexed: 11/10/2022]
Abstract
Bipolar disorder is a highly disruptive and debilitating problem. Mindfulness-based and mindfulness-informed interventions have exponentially emerged as third-generation therapies, applied to a wide spectrum of disorders, including bipolar disorder. However, the reviews and meta-analyses published to date are limited in their conclusions, as they are based on single-group pretest-posttest cohort designs and mostly focused on mindfulness-based interventions. The present review and meta-analysis try to address these limitations, including studies on informed mindfulness, controlled and single group designs. It used a specific meta-analytical procedure that allows an imputation procedure in those designs lacking a comparison group, by means of separate omnibus tests for the experimental and control group. A total of 13 studies (N = 331) were selected. The results showed an absence of effects on depression (g = 0.21) and mania (g = -0.13), but significant moderate effect on anxiety (g = 0.53). In conclusion, both mindfulness interventions showed robust evidence on anxiety symptoms in pretest-posttest periods compared to control groups. Few studies and lack of evidence of follow-up periods were the main limitations found.
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Affiliation(s)
| | - Raquel Ruiz-Íñiguez
- Faculty of Psychology, Universidad Nacional de Educación a Distancia (UNED), Madrid, Spain
| | - Fernando Peña-Ibáñez
- Alpedrete Local Clinic. Health Center Villalba Estación (Madrid). Plaza de la Tauromaquia, s/n. 28430 Alpedrete, Madrid
| | - Ana Carralero Montero
- Faculty of Medicine and Health Sciences, Universidad de Alcalá de Henares (UAH). Ctra. Madrid- Barcelona, Alcalá de Henares, (Madrid)
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Mekonen T, Ford S, Chan GCK, Hides L, Connor JP, Leung J. What is the short-term remission rate for people with untreated depression? A systematic review and meta-analysis. J Affect Disord 2022; 296:17-25. [PMID: 34583099 DOI: 10.1016/j.jad.2021.09.046] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 09/12/2021] [Accepted: 09/14/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Depression is one of the prevalent mental illnesses and leading cause of global disease burden. However, most people with depression do not access treatment. Remission without treatment may occur in some cases of depression. This study aimed to estimate the short-term remission (natural recovery) from untreated depression. METHODS A systematic review and meta-analysis was registered on PROSPERO and conducted following PRISMA guidelines. EMBASE, PsycINFO, and PubMed were searched, supplemented with an additional hand search to identify studies reporting natural recovery from untreated depression. Study selection and screening were carried out by three independent reviewers. Methodological quality assessment of the included studies was conducted. Remission was defined as no longer meeting the diagnostic criteria or scoring below the cut off points of the validated tools as reported by the included studies. The data were synthesized using narrative summary and random-effects meta-analysis. RESULTS Sixteen waitlist-controlled trial studies were included in the systematic review and meta-analysis. The duration of follow-up ranged from 4 to 12 weeks with a median duration of 8 weeks. The overall pooled remission from untreated depression was 12.5%, 95% confidence interval (7.8, 18.0%). Due to lack of published data, we were unable to determine if the severity of depression symptoms was associated with remission rates. CONCLUSIONS Short-term remission from depression without treatment is uncommon. Across studies, 8 - 18% of people remitted without treatment within 12 weeks. Waitlist control groups may not represent all persons with depression.
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Affiliation(s)
- Tesfa Mekonen
- School of Psychology, The University of Queensland, Australia; Psychiatry Department, Bahir Dar University, Ethiopia; National Centre for Youth Substance Use Research, The University of Queensland, Australia.
| | - Sarah Ford
- School of Psychology, The University of Queensland, Australia
| | - Gary C K Chan
- National Centre for Youth Substance Use Research, The University of Queensland, Australia
| | - Leanne Hides
- School of Psychology, The University of Queensland, Australia; National Centre for Youth Substance Use Research, The University of Queensland, Australia
| | - Jason P Connor
- National Centre for Youth Substance Use Research, The University of Queensland, Australia; Discipline of Psychiatry, The University of Queensland, Australia
| | - Janni Leung
- School of Psychology, The University of Queensland, Australia; National Centre for Youth Substance Use Research, The University of Queensland, Australia
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22
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Sezer D, de Leeuw M, Netzer C, Dieterle M, Meyer A, Buergler S, Locher C, Ruppen W, Gaab J, Schneider T. Open-Label Placebo Treatment for Acute Postoperative Pain (OLP-POP Study): Study Protocol of a Randomized Controlled Trial. Front Med (Lausanne) 2021; 8:687398. [PMID: 34805194 PMCID: PMC8602681 DOI: 10.3389/fmed.2021.687398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 10/07/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Open-label placebos have been proposed as way of using long recognized analgesic placebo effects in an ethical manner. Recent evidence shows efficacy of open-label placebos for clinical conditions, but there is need for more research on open-label placebos in acute pain. In the treatment of acute postoperative pain, minimization of opioid related side effects remains one of the key challenges. Therefore, this study aims at investigating the potential of adding unconditioned open-label placebos to treatment as usual as a means of reducing opioid consumption and its related side effects in patients with acute postoperative pain. Methods and Analysis: This is the protocol of an ongoing single site randomized controlled trial. The first patient was enrolled in May 2020. In total, 70 patients suffering from acute postoperative pain following dorsal lumbar interbody fusion are randomized to either a treatment as usual group or an experimental intervention group. The treatment as usual group consists of participants receiving a patient-controlled morphine pump. On day 1 and 2 post-surgery, patients in the intervention group receive, in addition to treatment as usual, two open-label placebo injections per day along with an evidence-based treatment rationale explaining the mechanisms of placebos. The primary outcome is measured by means of self-administered morphine during day 1 and 2 post-surgery. Several other outcome measures including pain intensity and adverse events as well as potential predictors of placebo response are assessed. Analysis of covariance will be used to answer the primary research question and additional statistical techniques such as generalized linear mixed models will be applied to model the temporal course of morphine consumption. Discussion: This study will provide valuable insights into the efficacy of open-label placebos in acute pain and will potentially constitute an important step toward the implementation of open-label placebos in the clinical management of acute postoperative pain. In addition, it will shed light on a cost-efficient and patient-centered strategy to reduce opioid consumption and its related side effects, without any loss in pain management efficacy. Ethics and Dissemination: The "Ethikkommission Nordwest- und Zentralschweiz" (BASEC2020-00099) approved the study protocol. Results of the analysis will be submitted for publication in a peer-reviewed journal. Clinical Trial Registration: The study is registered at ClinicalTrials.gov (NCT04339023) and is listed in the Swiss national registry at kofam.ch (SNCTP000003720).
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Affiliation(s)
- Dilan Sezer
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Matthijs de Leeuw
- Pain Unit, Department of Anesthesiology, University Hospital of Basel, Basel, Switzerland
| | - Cordula Netzer
- Department of Spine Surgery, University Hospital of Basel, Basel, Switzerland
| | - Markus Dieterle
- Pain Unit, Department of Anesthesiology, University Hospital of Basel, Basel, Switzerland
| | - Andrea Meyer
- Division of Clinical Psychology and Epidemiology, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Sarah Buergler
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Cosima Locher
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland.,Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Wilhelm Ruppen
- Pain Unit, Department of Anesthesiology, University Hospital of Basel, Basel, Switzerland
| | - Jens Gaab
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Tobias Schneider
- Pain Unit, Department of Anesthesiology, University Hospital of Basel, Basel, Switzerland
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Anand L, Sadowski I, Per M, Khoury B. Mindful parenting: a Meta-analytic review of intrapersonal and interpersonal parental outcomes. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-021-02111-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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24
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Bendig E, Bauereiss N, Schmitt A, Albus P, Baumeister H. ACTonDiabetes-a guided psychological internet intervention based on Acceptance and Commitment Therapy (ACT) for adults living with type 1 or 2 diabetes: results of a randomised controlled feasibility trial. BMJ Open 2021; 11:e049238. [PMID: 34244277 PMCID: PMC8273455 DOI: 10.1136/bmjopen-2021-049238] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 06/02/2021] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES This two-group randomised controlled trial evaluates the feasibility of an Acceptance and Commitment Therapy (ACT)-based internet intervention for diabetes distress in people with diabetes type 1 or type 2. Participants were assigned to a guided self-help intervention (EG) or waitlist control group (CG). SETTING Recruitment took place following an open recruitment strategy including different diabetes centres, self-help groups and social media platforms. PARTICIPANTS Eligibility criteria comprised being 18 years of age or older, self-reported diagnosis of type 1 or type 2 diabetes, internet access, sufficient German language skills and written informed consent. INTERVENTION ACTonDiabetes is an internet-based and mobile-based intervention and comprises an introduction and seven modules (one module per week, processing time about 45-60 min). Intervention contents are based on ACT. PRIMARY AND SECONDARY OUTCOME MEASURES Participants were assessed before and 8 weeks after randomisation. Primary outcome was feasibility (trial recruitment, acceptability). Potential group differences in diabetes distress and other outcomes at follow-up were analysed using linear regression models with baseline values as predictors. All analyses were based on an intention-to-treat principle, potential negative effects were analysed on per-protocol basis. RESULTS From October 2017 to April 2018, N=42 people with diabetes consented and were randomised (EG n=21, CG n=21). Forty-three per cent of the EG completed all treatment modules within 8 weeks. Across modules, formative user feedback revealed that contents could be optimised regarding comprehensibility (34%), individualisation (20%) and text amount (21%). Overall, 57% of participants dropped out prior to full treatment completion. There were reductions of diabetes distress in the EG (d=0.65, p=0.042). CONCLUSIONS Modifications of the intervention content according to the user feedback will be performed to further improve acceptability. Mechanisms to foster intervention adherence should be considered for lowering the attrition rate. ACTonDiabetes is feasible for the implementation in a confirmatory trial. TRIAL REGISTRATION NUMBER WHO International Clinical Trials Registry Platform via the German Clinical Trials Register (DRKS) (DRKS00013193).
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Affiliation(s)
- Eileen Bendig
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Natalie Bauereiss
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Andreas Schmitt
- Research Institute of the Diabetes Academy Mergentheim, Diabetes Academy Bad Mergentheim, Bad Mergentheim, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Patrick Albus
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
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25
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Dobias ML, Sugarman MB, Mullarkey MC, Schleider JL. Predicting Mental Health Treatment Access Among Adolescents With Elevated Depressive Symptoms: Machine Learning Approaches. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 49:88-103. [PMID: 34213666 DOI: 10.1007/s10488-021-01146-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2021] [Indexed: 11/26/2022]
Abstract
A large proportion of adolescents experiencing depression never access treatment. To increase access to effective mental health care, it is critical to understand factors associated with increased versus decreased odds of adolescent treatment access. This study used individual depression symptoms and sociodemographic variables to predict whether and where adolescents with depression accessed mental health treatments. We performed a pre-registered, secondary analysis of data from the 2017 National Survey of Drug Use and Health (NSDUH), a nationally representative sample of non-institutionalized civilians in the United States. Using four cross-validated random forest models, we predicted whether adolescents with elevated past-year depressive symptoms (N = 1,671; ages 12-17 years) accessed specific mental health treatments in the previous 12 months ("yes/no" for inpatient, outpatient, school, any). 53.38% of adolescents with elevated depressive symptoms accessed treatment of any kind. Even with depressive symptoms and sociodemographic factors included as predictors, pre-registered random forests explained < 0.00% of pseudo out-of-sample deviance in adolescent access to inpatient, outpatient, school, or overall treatments. Exploratory elastic net models explained 0.80-2.50% of pseudo out-of-sample deviance in adolescent treatment access across all four treatment types. Neither individual depressive symptoms nor any socioeconomic variables meaningfully predicted specific or overall mental health treatment access in adolescents with elevated past-year symptoms. This study highlights substantial limitations in our capacity to predict whether and where adolescents access mental health treatment and underscores the broader need for more accessible, scalable adolescent depression treatments.
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Affiliation(s)
- Mallory L Dobias
- Department of Psychology, Stony Brook University, Stony Brook, NY, 11794-2500, USA.
| | - Michael B Sugarman
- Department of Psychology, Stony Brook University, Stony Brook, NY, 11794-2500, USA
| | - Michael C Mullarkey
- Department of Psychology, Stony Brook University, Stony Brook, NY, 11794-2500, USA
| | - Jessica L Schleider
- Department of Psychology, Stony Brook University, Stony Brook, NY, 11794-2500, USA
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26
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Nielsen P, Christensen M, Henderson C, Liddle HA, Croquette-Krokar M, Favez N, Rigter H. Multidimensional family therapy reduces problematic gaming in adolescents: A randomised controlled trial. J Behav Addict 2021; 10:234-243. [PMID: 33905350 PMCID: PMC8996793 DOI: 10.1556/2006.2021.00022] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 12/06/2020] [Accepted: 03/23/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND AND AIMS Social variables including parental and family factors may serve as risk factors for Internet Gaming Disorder (IGD) in adolescents. An IGD treatment programme should address these factors. We assessed two family therapies - multidimensional family therapy (MDFT) and family therapy as usual (FTAU) - on their impact on the prevalence of IGD and IGD symptoms. METHODS Eligible for this randomised controlled trial comparing MDFT (N = 12) with FTAU (N = 30) were adolescents of 12-19 years old meeting at least 5 of the 9 DSM-5 IGD criteria and with at least one parent willing to participate in the study. The youths were recruited from the Centre Phénix-Mail, which offers outpatient adolescent addiction care in Geneva. Assessments occurred at baseline and 6 and 12 months. RESULTS Both family therapies decreased the prevalence of IGD across the one-year period. Both therapies also lowered the number of IGD criteria met, with MDFT outperforming FTAU. There was no effect on the amount of time spent on gaming. At baseline, parents judged their child's gaming problems to be important whereas the adolescents thought these problems were minimal. This discrepancy in judgment diminished across the study period as parents became milder in rating problem severity. MDFT better retained families in treatment than FTAU. DISCUSSION AND CONCLUSIONS Family therapy, especially MDFT, was effective in treating adolescent IGD. Improvements in family relationships may contribute to the treatment success. Our findings are promising but need to be replicated in larger study. TRIAL REGISTRATION NUMBER ISRCTN 11142726.
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Affiliation(s)
- Philip Nielsen
- Fondation Phénix, Geneva, Switzerland,Unité de psychologie clinique des relations interpersonnelles, FPSE, University of Geneva, Geneva, Switzerland,Corresponding author. E-mail:
| | - Maxwell Christensen
- Department of Psychology and Philosophy, Sam Houston State University, Huntsville, TX, USA
| | - Craig Henderson
- Department of Psychology and Philosophy, Sam Houston State University, Huntsville, TX, USA
| | - Howard A Liddle
- Departments of Public Health Sciences and Psychology, University of Miami Miller School of Medicine, Miami, USA
| | | | - Nicolas Favez
- Unité de psychologie clinique des relations interpersonnelles, FPSE, University of Geneva, Geneva, Switzerland
| | - Henk Rigter
- Department of Child and Adolescent Psychiatry, Leiden University Medical Centre (LUMC), Leiden, the Netherlands
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Sima AP, Stromberg KA, Kreutzer JS. An adaptive method for assigning clinical trials wait-times for controls. Contemp Clin Trials Commun 2021; 21:100727. [PMID: 33604487 PMCID: PMC7872975 DOI: 10.1016/j.conctc.2021.100727] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 10/16/2020] [Accepted: 01/11/2021] [Indexed: 11/30/2022] Open
Abstract
Wait-list control clinical trials are popular among psychologists and rehabilitation specialists partly because all participants receive the intervention. In 2 arm wait-list control trials, individuals randomized to the treatment group receive immediate treatment whereas individuals randomized to the control group wait a fixed amount of time before intervention is initiated. For interventions that have varying durations, careful consideration must be given to the period that participants in the control group have a delay until treatment begins, as incongruent wait times compared to the intervention durations of the treatment group may introduce confounding into the evaluation of the treatment differences. To alleviate this issue, we propose to adaptively assign wait times to individuals randomized to the control group based on the intervention duration of those in the treatment group. Simulations demonstrate the that our method not only results in similar timing distributions between participants in the treatment and control groups, but also allows participants in the control group to initiate treatment earlier than the traditional design. The latter characteristic may reduce dropout and result in more efficient study enrollment.
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Affiliation(s)
- Adam P. Sima
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, USA
| | | | - Jeffrey S. Kreutzer
- Departments of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, USA
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28
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Engels A, König HH, Magaard JL, Härter M, Hawighorst-Knapstein S, Chaudhuri A, Brettschneider C. Depression treatment in Germany - using claims data to compare a collaborative mental health care program to the general practitioner program and usual care in terms of guideline adherence and need-oriented access to psychotherapy. BMC Psychiatry 2020; 20:591. [PMID: 33317480 PMCID: PMC7737360 DOI: 10.1186/s12888-020-02995-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 12/03/2020] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Societies strive for fast-delivered, evidence-based and need-oriented depression treatment within budget constraints. To explore potential improvements, selective contracts can be implemented. Here, we evaluate if the German collaborative psychiatry-neurology-psychotherapy contract (PNP), which extends the gatekeeping-based general practitioner (GP) program, improved guideline adherence or need-oriented and timely access to psychotherapy compared to usual care (UC). METHODS We conducted a retrospective observational cohort study based on health insurance claims data. After we identified patients with depression who were on sick leave due to a mental disorder in 2015, we applied entropy balancing to adjust for selection effects and employed chi-squared tests to compare guideline adherence of the received treatment between PNP, the GP program and UC. Subsequently, we applied an extended cox regression to assess need-orientation by comparing the relationship between accumulated sick leave days and waiting times for psychotherapy across health plans. RESULTS N = 23,245 patients were included. Regarding guideline adherence, we found no significant differences for most severity subgroups; except that patients with a first moderate depressive episode received antidepressants or psychotherapy more often in UC. Regarding need-orientation, we observed that the effect of each additional month of sick leave on the likelihood of starting psychotherapy was increased by 6% in PNP compared to UC. Irrespective of the health plan, we found that within the first 12 months only between 24.3 and 39.7% (depending on depression severity) received at least 10 psychotherapy sessions or adequate pharmacotherapy. CONCLUSIONS The PNP contract strengthens the relationship between sick leave days and the delay until the beginning of psychotherapy, which suggests improvements in terms of need-oriented access to care. However, we found no indication for increased guideline adherence and - independent of the health plan - a gap in sufficient utilization of adequate treatment options.
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Affiliation(s)
- Alexander Engels
- Department of Health Economics and Health Services Research, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Building W37, 20246, Hamburg, Germany.
| | - Hans-Helmut König
- grid.13648.380000 0001 2180 3484Department of Health Economics and Health Services Research, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Building W37, 20246 Hamburg, Germany
| | - Julia Luise Magaard
- grid.13648.380000 0001 2180 3484Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Härter
- grid.13648.380000 0001 2180 3484Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Ariane Chaudhuri
- grid.491710.a0000 0001 0339 5982AOK Baden-Württemberg, Stuttgart, Germany
| | - Christian Brettschneider
- grid.13648.380000 0001 2180 3484Department of Health Economics and Health Services Research, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Building W37, 20246 Hamburg, Germany
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29
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Johnson AR, Bank SR, Summers M, Hyett MP, Erceg-Hurn DM, Kyron MJ, McEvoy PM. A longitudinal assessment of the bivalent fear of evaluation model with social interaction anxiety in social anxiety disorder. Depress Anxiety 2020; 37:1253-1260. [PMID: 33001532 DOI: 10.1002/da.23099] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 07/28/2020] [Accepted: 09/09/2020] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The Bivalent Fear of Evaluation Model proposes that the fears of positive and negative evaluation each uniquely contribute to social anxiety severity. However, the debate continues as to whether these are distinct constructs, and, if so, the degree of influence each has on social anxiety severity. This study used a longitudinal evaluation of these relationships in a clinical sample to identify whether the two fears differentially change over time and differentially relate to social anxiety severity. METHODS Individuals with a social anxiety disorder (N = 105) completed measures of fears of negative and positive evaluation weekly, and social interaction anxiety monthly, for 12 weeks. Temporal relationships were assessed using residual dynamic structural equation modeling. RESULTS Fears of positive and negative evaluation both predicted the future status of the other (ϕ = 0.18, 95% credibility interval [0.10-0.28] and ϕ = 0.22 [0.12-0.35], respectively). Fear of negative evaluation (ϕ = 0.16 [0.05-0.28]) but not positive evaluation (ϕ < 0.01 [-0.09 to 0.10]) directly predicted future social anxiety severity. Fear of positive evaluation only indirectly predicted anxiety severity via fear of negative evaluation. CONCLUSIONS Previous fears of negative evaluation could not fully explain future fears of positive evaluation (or vice-versa), which is consistent with the two constructs being likely distinct in social anxiety disorder. Given its more direct relationship with social anxiety severity, fear of negative evaluation should be targeted in treatment, as this could both directly reduce social anxiety severity and minimize the indirect impact of fear of positive evaluation.
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Affiliation(s)
| | - Samantha R Bank
- School of Psychology, Curtin University, Perth, Australia.,Centre for Clinical Interventions, North Metro Health Service, Perth, Australia
| | - Mark Summers
- Centre for Clinical Interventions, North Metro Health Service, Perth, Australia
| | | | - David M Erceg-Hurn
- Centre for Clinical Interventions, North Metro Health Service, Perth, Australia
| | | | - Peter M McEvoy
- School of Psychology, Curtin University, Perth, Australia.,Centre for Clinical Interventions, North Metro Health Service, Perth, Australia
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30
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Raghuraman S, Stuttard N, Hunt N. Evaluating narrative exposure therapy for post-traumatic stress disorder and depression symptoms: A meta-analysis of the evidence base. Clin Psychol Psychother 2020; 28:1-23. [PMID: 32525597 DOI: 10.1002/cpp.2486] [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: 02/13/2020] [Revised: 05/20/2020] [Accepted: 06/03/2020] [Indexed: 11/07/2022]
Abstract
Narrative exposure therapy (NET) is an intervention for trauma spectrum disorders. Originally developed to treat refugee populations, NET has since been tested for efficacy across different settings. In this review, the NET evidence base is examined through a retrieval, synthesis and appraisal of randomized controlled trials (RCTs) published since 2002. Two independent reviewers (S. R. and N. S.) searched online databases including EMBASE, PsycINFO and PubMed. Twenty-four RCTs were selected for a meta-analysis of three outcomes: post-traumatic stress disorder (PTSD) diagnosis and PTSD and depression symptoms. All outcomes were analysed at short-term (3-4 months), midterm (6-7 months) and long-term (≥12 months) data points. A random-effects model was applied to yield standardized mean differences (SMDs) and odds ratios (ORs) as indicators of NET treatment effect. Subgroup analyses for type of trauma and type of control groups were conducted to examine potential heterogeneity. For the NET group, moderate effect sizes for PTSD symptom severity were observed at midterm and long term and at midterm for depression symptom severity. The number of PTSD diagnoses decreased significantly in the short term for the NET condition, but this was not sustained at the long term. Caution must be exercised when interpreting these results due to high heterogeneity estimates and low quality of evidence across trials. Potential small-study effects further complicate the interpretation of the findings. Recommendations are made for augmenting statistical significance research with qualitative analyses of NET efficacy to better inform clinical practice.
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Affiliation(s)
- Shruti Raghuraman
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Nathan Stuttard
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Nigel Hunt
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
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31
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Rozen N, Aderka IM. Do depressive symptoms affect the outcome of treatments for SAD? A meta analysis of randomized controlled trials. Clin Psychol Rev 2020; 80:101874. [PMID: 32653699 DOI: 10.1016/j.cpr.2020.101874] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 05/17/2020] [Accepted: 05/30/2020] [Indexed: 01/05/2023]
Abstract
Individuals with social anxiety disorder (SAD) typically have elevated depressive symptoms. In the present meta-analysis, we reviewed the treatment outcome literature in SAD and examined whether depressive symptoms predict treatment outcome. We focused on randomized controlled trials of cognitive behavior therapy (individual face-to-face, group format, and internet-delivered format) and randomized controlled trials of pharmacotherapy. After implementing exclusion criteria, 108 studies with 133 treatment conditions (n = 12,913 participants) were included in the meta-analysis. Our findings indicated that treatments for SAD were efficacious and significantly reduced social anxiety symptoms across all treatment modalities. Exclusion of individuals with MDD or high levels of depression did not affect outcome at post-treatment or at follow-up. However, we found that elevated depressive symptoms were associated with greater reductions in social anxiety symptoms from pre-treatment to post-treatment. Importantly, this effect was above and beyond pre-treatment levels of social anxiety. Finally, analyzing treatment modalities separately, we found that depressive symptoms were associated with better post-treatment outcomes in individual face-to-face CBT but not in other modalities. Clinical and research implications of these findings are discussed.
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Affiliation(s)
- Naama Rozen
- School of Psychological Sciences, University of Haifa, Israel
| | - Idan M Aderka
- School of Psychological Sciences, University of Haifa, Israel.
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32
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Lindegaard T, Hesslow T, Nilsson M, Johansson R, Carlbring P, Lilliengren P, Andersson G. Internet-based psychodynamic therapy vs cognitive behavioural therapy for social anxiety disorder: A preference study. Internet Interv 2020; 20:100316. [PMID: 32257826 PMCID: PMC7118309 DOI: 10.1016/j.invent.2020.100316] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 03/16/2020] [Accepted: 03/17/2020] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Both Internet-delivered cognitive behavioural therapy (ICBT) and Internet-delivered psychodynamic psychotherapy (IPDT) have shown promise in the treatment of social anxiety disorder (SAD). However, little is known about client preferences and what predicts treatment outcome. The objective of the present pilot study was to examine preference for ICBT versus IPDT in the treatment of SAD and whether participants' preference strength and therapeutic alliance predicted treatment response. Further, we also investigated the effect of the two treatments, including 6-months follow-up. METHOD Thirty-six participants were instructed to choose between either IPDT or ICBT based on a brief description. Both treatments were 10 weeks long. Liebowitz Social Anxiety Scale - Self Report was used as the primary outcome measure. RESULTS IPDT (N = 23; 63.9%) was preferred more often than ICBT (N = 13; 36.1%), but the difference did not reach statistical significance (p = .10). Preference strength did not predict the treatment effect but therapeutic alliance did. The observed within-group effects for the treatment period were d = 0.40 [-0.21, 0.99] for the IPDT group and d = 0.53 [-0.29, 1.31] for the ICBT group. An intention-to-treat (ITT) analysis revealed no significant difference between the two treatments on any outcome measure at either post-treatment or at six months follow-up. CONCLUSION The present pilot study did not find a difference in preference for IPDT or ICBT in the treatment of SAD and both treatments resulted in small to moderate improvements in symptoms of SAD. Preference strength might not predict treatment effect, but this needs to be tested in larger studies.
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Affiliation(s)
- Tomas Lindegaard
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden,Corresponding author at: Department of Behavioural Sciences and Learning, Linköping University, SE-581 83 Linköping, Sweden.
| | - Thomas Hesslow
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Maja Nilsson
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Robert Johansson
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Per Carlbring
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | | | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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The effect of a brief online self-compassion versus cognitive restructuring intervention on trait social anxiety. Behav Res Ther 2019; 123:103492. [DOI: 10.1016/j.brat.2019.103492] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 09/24/2019] [Accepted: 10/01/2019] [Indexed: 11/23/2022]
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34
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Increase value and reduce waste in research on psychological therapies. Behav Res Ther 2019; 123:103479. [PMID: 31639527 DOI: 10.1016/j.brat.2019.103479] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 07/25/2019] [Accepted: 09/09/2019] [Indexed: 12/27/2022]
Abstract
A seminal Lancet series focused on increasing value and reducing waste in biomedical research, providing a transferrable template to diagnose problems in research. Our goal was to document how some of these sources of waste apply to mental health and particularly psychological treatments research. We synthesize and critically evaluate empirical findings in relation to four major sources: i) defining research priorities; ii) research design, methods and analysis; iii) accessibility of research information; iv) accuracy and usability of research reports. We demonstrate that each source of waste considered is well-represented and amply documented within this field. We describe hype and insufficient consideration of what is known in defining research priorities, persistent risk of bias, particularly due to selective outcome reporting, for psychotherapy trials across mental disorders, intellectual and financial biases, direct and indirect evidence of publication bias, largely inexistent adoption of data sharing, issues of multiplicity and fragmentation of data and findings, and insufficient adoption of reporting guidelines. We expand on a few general solutions, including supporting meta-research, properly testing interventions to increase research quality, placing open science at the center of psychological treatment research and remaining vigilant particularly regarding the strains of research currently prioritized, such as experimental psychopathology.
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Green SM, Donegan E, Frey BN, Fedorkow DM, Key BL, Streiner DL, McCabe RE. Cognitive behavior therapy for menopausal symptoms (CBT-Meno): a randomized controlled trial. Menopause 2019; 26:972-980. [PMID: 31453958 DOI: 10.1097/gme.0000000000001363] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of cognitive behavioral therapy for menopausal symptoms (CBT-Meno) compared with a waitlist condition (no active intervention). A randomized controlled trial was conducted with 71 perimenopausal or postmenopausal women who were seeking treatment for menopausal symptoms. METHODS Blind assessments were conducted at baseline, 12 weeks postbaseline, and 3 months post-treatment. An intention-to-treat analysis was conducted. CBT-Meno sessions included psychoeducation, and cognitive and behavioral strategies for vasomotor and depressive symptoms, anxiety, sleep difficulties, and sexual concerns. Primary outcomes were scores on the Hot Flash Related Daily Interference Scale (HFRDIS) and Beck Depression Inventory (BDI-II). Secondary outcomes were scores assessing vasomotor and sexual concerns on the Greene Climacteric Scale (GCS-vm, GCS-sex), the Montgomery-Åsberg Depression Rating Scale (MADRS), Hamilton Anxiety Rating Scale (HAM-A), Pittsburgh Sleep Quality Index (PSQI), and the Female Sexual Function Index (FSFI). RESULTS There were significantly greater improvements in CBT-Meno compared with waitlist in vasomotor symptom interference (HFRDIS; P < 0.001, ηP = 0.21) and "bothersomeness" (GCS-vm; P = 0.04, ηP = 0.06), depressive symptoms (BDI-II; P = 0.001, ηP = 0.15), sleep difficulties (PSQI; P = 0.001, ηP = 0.17), and sexual concerns (GCS-sex; P = 0.03, ηP = 0.07). These results were found even when controlling for menopausal staging and medication use. Gains were maintained at 3 months post-treatment. CONCLUSIONS CBT-Meno was particularly effective in improving self-reported vasomotor symptoms, depressive symptoms, sleep difficulties, and sexual concerns. Although future studies will be needed to confirm the impact of CBT-Meno on anxiety symptoms, these results suggest that this protocol is effective in targeting commonly reported menopausal symptoms. : Video Summary: Supplemental Digiatl Content 1, http://links.lww.com/MENO/A416.
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Affiliation(s)
- Sheryl M Green
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Ontario, Canada
| | - Eleanor Donegan
- Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Ontario, Canada
| | - Benicio N Frey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Ontario, Canada
- Mood Disorders Program, St. Joseph's Healthcare Hamilton, Ontario, Canada
| | - Donna M Fedorkow
- Department of Obstetrics & Gynecology, McMaster University, Hamilton, Ontario, Canada
| | - Brenda L Key
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Mood Disorders Program, St. Joseph's Healthcare Hamilton, Ontario, Canada
- Anxiety Treatment and Research Clinic, St. Joseph's Healthcare Hamilton, Ontario, Canada
| | - David L Streiner
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Randi E McCabe
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Anxiety Treatment and Research Clinic, St. Joseph's Healthcare Hamilton, Ontario, Canada
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Steinert C, Kruse J, Leweke F, Leichsenring F. Psychosomatic inpatient treatment: Real-world effectiveness, response rates and the helping alliance. J Psychosom Res 2019; 124:109743. [PMID: 31443812 DOI: 10.1016/j.jpsychores.2019.109743] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 06/13/2019] [Accepted: 06/14/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE While inpatient mental health treatments in real-world settings have shown to be generally effective with moderate to large pre-post effects, little is known about rates of response in inpatients. METHODS Inpatients routinely treated at a university hospital for psychosomatics and psychotherapy in Germany were assessed before and after receiving a psychodynamically oriented multimodal treatment. As primary outcome response rates based on the Symptom Checklist-90-Revised (SCL-90-R) were used. As secondary outcomes, pre-post effect sizes on measures of symptoms and stress (SCL-90-R, Hospital anxiety and depression scale, Perceived stress questionnaire) as well as interpersonal problems (IIP) were determined. Additionally, the relationship of the helping alliance to outcome was examined. RESULTS A total of 709 patients with various primary diagnoses and high mental (72.4%) and physical (61%) comorbidity, receiving on average 7.9 weeks of treatment, were included. The response rate based on the SCL-90-R global severity index was 62.9% at posttreatment and 60.4% at short-term follow up. Pre-post effect sizes on symptom and stress measures were large (Cohen's d ≥ 1.0) while change regarding interpersonal problems was small (d = 0.34). For patients responding to treatment a significantly better helping alliance was found, corresponding to a large effect (d = 0.84). CONCLUSIONS A majority of patients benefitted considerably from a psychosomatic inpatient treatment in terms of response and pre-post effects. Response was significantly related to the quality of the therapeutic alliance. Monitoring and improving alliance may enhance treatment outcome.
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Affiliation(s)
- Christiane Steinert
- MSB Medical School Berlin, Department of Psychology, Calandrellistr. 1-9, 12247 Berlin, Germany; Justus-Liebig-University Giessen, Clinic for Psychosomatic Medicine and Psychotherapy, Ludwigstr. 76, 35392 Giessen, Germany.
| | - Johannes Kruse
- Justus-Liebig-University Giessen, Clinic for Psychosomatic Medicine and Psychotherapy, Ludwigstr. 76, 35392 Giessen, Germany; Philipps University of Marburg, Clinic for Psychosomatic Medicine and Psychotherapy, Baldingerstr., 35043 Marburg, Germany
| | - Frank Leweke
- Justus-Liebig-University Giessen, Clinic for Psychosomatic Medicine and Psychotherapy, Ludwigstr. 76, 35392 Giessen, Germany
| | - Falk Leichsenring
- Justus-Liebig-University Giessen, Clinic for Psychosomatic Medicine and Psychotherapy, Ludwigstr. 76, 35392 Giessen, Germany
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Broglia E, Millings A, Barkham M. Counseling With Guided Use of a Mobile Well-Being App for Students Experiencing Anxiety or Depression: Clinical Outcomes of a Feasibility Trial Embedded in a Student Counseling Service. JMIR Mhealth Uhealth 2019; 7:e14318. [PMID: 31418424 PMCID: PMC6714497 DOI: 10.2196/14318] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 07/09/2019] [Accepted: 07/19/2019] [Indexed: 11/13/2022] Open
Abstract
Background Anxiety and depression continue to be prominent experiences of students approaching their university counseling service. These services face unique challenges to ensure that they continue to offer quality support with fewer resources to a growing student population. The convenience and availability of mobile phone apps offer innovative solutions to address therapeutic challenges and expand the reach of traditional support. Objective The primary aim of this study was to establish the feasibility of a trial in which guided use of a mobile phone well-being app was introduced into a student counseling service and offered as an adjunct to face-to-face counseling. Methods The feasibility trial used a two-arm, parallel nonrandomized design comparing counseling alone (treatment as usual, or TAU) versus counseling supplemented with guided use of a mobile phone well-being app (intervention) for 38 university students experiencing moderate anxiety or depression. Students in both conditions received up to 6 sessions of face-to-face counseling within a 3-month period. Students who approached the counseling service and were accepted for counseling were invited to join the trial. Feasibility factors evaluated include recruitment duration, treatment preference, randomization acceptability, and intervention fidelity. Clinical outcomes and clinical change were assessed with routine clinical outcome measures administered every counseling session and follow-up phases at 3 and 6 months after recruitment. Results Both groups demonstrated reduced clinical severity by the end of counseling. This was particularly noticeable for depression, social anxiety, and hostility, whereby clients moved from elevated clinical to low clinical or from low clinical to nonclinical by the end of the intervention. By the 6-month follow-up, TAU clients’ (n=18) anxiety had increased whereas intervention clients’ (n=20) anxiety continued to decrease, and this group difference was significant (Generalized Anxiety Disorder–7: t22=3.46, P=.002). This group difference was not replicated for levels of depression: students in both groups continued to decrease their levels of depression by a similar amount at the 6-month follow-up (Physical Health Questionnaire–9: t22=1.30, P=.21). Conclusion Supplementing face-to-face counseling with guided use of a well-being app is a feasible and acceptable treatment option for university students experiencing moderate anxiety or depression. The feasibility trial was successfully embedded into a university counseling service without denying access to treatment and with minimal disruption to the service. This study provides preliminary evidence for using a well-being app to maintain clinical improvements for anxiety following the completion of counseling. The design of the feasibility trial provides the groundwork for the development of future pilot trials and definitive trials embedded in a student counseling service. Trial registration ISRCTN registry ISRCTN55102899; http://www.isrctn.com/ISRCTN55102899
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Affiliation(s)
- Emma Broglia
- Research Department, British Association for Counselling and Psychotherapy, Leicestershire, United Kingdom.,Department of Psychology, University of Sheffield, Sheffield, United Kingdom
| | - Abigail Millings
- Department of Psychology, University of Sheffield, Sheffield, United Kingdom
| | - Michael Barkham
- Department of Psychology, University of Sheffield, Sheffield, United Kingdom
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Trial-Based Cognitive Therapy: Efficacy of a New CBT Approach for Treating Social Anxiety Disorder with Comorbid Depression. Int J Cogn Ther 2018. [DOI: 10.1007/s41811-018-0028-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Nordgreen T, Gjestad R, Andersson G, Carlbring P, Havik OE. The effectiveness of guided internet-based cognitive behavioral therapy for social anxiety disorder in a routine care setting. Internet Interv 2018; 13:24-29. [PMID: 30206515 PMCID: PMC6112093 DOI: 10.1016/j.invent.2018.05.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 05/28/2018] [Accepted: 05/29/2018] [Indexed: 11/30/2022] Open
Abstract
Social anxiety disorder (SAD) is a common mental disorder with high persistence when untreated. As access to effective treatment is limited, guided internet-based cognitive behavioral therapy (ICBT) has been proposed as an effective alternative to face-to-face treatment. In this study, we examined the effectiveness of a 14-week therapist-guided ICBT program for patients with SAD undergoing routine care. From 2014 to 2017, 169 patients were included in the study, of which 145 started the treatment. The sample was all general practitioner-referred and had a lower educational level and higher rate of work absence compared to similar effectiveness studies. Regarding social anxiety symptoms, we identified significant within-group effect sizes (post-treatment: d = 1.00-1.10; six-month follow-up: d = 1.03-1.55). We also found significant effects on secondary depression symptoms (d = 0.67). Clinically significant improvement was reported by 66.2% of the participants, and 16.6% had a significant deterioration. Clinical implications of the current study are that guided ICBT for SAD is an effective treatment for the majority of the patients undergoing routine care. Future studies should explore interventions targeting non-responders and deteriorated patients.
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Affiliation(s)
- Tine Nordgreen
- eMeistring, Bjørgvin DPS, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Psychology, Faculty of Psychology, University of Bergen, Norway
| | - Rolf Gjestad
- Research Department, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Linköping University, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Sweden
| | - Per Carlbring
- Department of Psychology, Stockholm University, Sweden
- Department of Psychology, University of Southern Denmark, Denmark
| | - Odd E. Havik
- Department of Clinical Psychology, Faculty of Psychology, University of Bergen, Norway
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Maladaptive Self-Beliefs During Cognitive Behavioural Therapy for Social Anxiety Disorder: A Test of Temporal Precedence. COGNITIVE THERAPY AND RESEARCH 2018. [DOI: 10.1007/s10608-017-9882-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Phillips JS, McFerran DJ, Hall DA, Hoare DJ. The natural history of subjective tinnitus in adults: A systematic review and meta-analysis of no-intervention periods in controlled trials. Laryngoscope 2017; 128:217-227. [PMID: 28425615 DOI: 10.1002/lary.26607] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2017] [Indexed: 01/23/2023]
Abstract
OBJECTIVES Tinnitus is a prevalent condition, but little has been published regarding the natural history of the condition. One technique for evaluating the long-term progression of the disease is to examine what happens to participants in the no-intervention control arm of a clinical trial. The aim of this study was to examine no-intervention or waiting-list data reported in trials, in which participants on the active arm received any form of tinnitus intervention. DATA SOURCES CINAHL, PsychINFO, EMBASE, ASSIA, PubMed, Web of Science, Science Direct, EBSCO Host, and Cochrane. METHODS Inclusion criteria followed the PICOS principles: Participants, adults with tinnitus; Intervention, none; Control, any intervention for alleviating tinnitus; Outcomes, a measure assessing tinnitus symptoms using a multi-item patient-reported tinnitus questionnaire. Secondary outcome measures included multi-item patient-reported questionnaires of mood and health-related quality of life and measures that quantified change in tinnitus loudness; Study design, randomized controlled trials or observational studies utilizing a no-intervention or waiting-list control group. Data were extracted and standardized mean difference was calculated for each study to enable meta-analysis. RESULTS The evidence strongly favored a statistically significant decrease in the impact of tinnitus over time, though there was significant heterogeneity and clinical significance cannot be interpreted. Outcome data regarding secondary measures did not demonstrate any clinically significant change. CONCLUSIONS Participants allocated to the no-intervention or waiting-list control arm of clinical trials for a tinnitus intervention show a small but significant improvement in self-reported measures of tinnitus with time; the clinical significance of this finding is unknown. There is, however, considerable variation across individuals. These findings support previous work and can cautiously be used when counseling patients. Laryngoscope, 128:217-227, 2018.
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Affiliation(s)
- John S Phillips
- Department of Otolaryngology, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, United Kingdom
| | - Don J McFerran
- Colchester Hospital University National Health Service Foundation Trust, Colchester, United Kingdom
| | - Deborah A Hall
- Nottingham Hearing Biomedical Research Unit, National Institute for Health Research, Nottingham, United Kingdom.,Otology and Hearing Group, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Derek J Hoare
- Nottingham Hearing Biomedical Research Unit, National Institute for Health Research, Nottingham, United Kingdom.,Otology and Hearing Group, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, United Kingdom
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Edwards KR, Specht M. A Review of the Literature Regarding Behavioral Therapy for Chronic Tic Disorders (CTDs): Where Do We Go from Here? CURRENT DEVELOPMENTAL DISORDERS REPORTS 2016. [DOI: 10.1007/s40474-016-0100-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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