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Aggestrup AS, Martiny F, Lund Henriksen L, Davidsen AS, Martiny K. Interventions promoting recovery from depression for patients transitioning from outpatient mental health services to primary care: A scoping review. PLoS One 2024; 19:e0302229. [PMID: 38709769 PMCID: PMC11073719 DOI: 10.1371/journal.pone.0302229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 03/28/2024] [Indexed: 05/08/2024] Open
Abstract
INTRODUCTION Major Depressive Disorder (MDD) is one of the most prevalent mental disorders worldwide with significant personal and public health consequences. After an episode of MDD, the likelihood of relapse is high. Therefore, there is a need for interventions that prevent relapse of depression when outpatient mental health care treatment has ended. This scoping review aimed to systematically map the evidence and identify knowledge gaps in interventions that aimed to promote recovery from MDD for patients transitioning from outpatient mental health services to primary care. MATERIALS AND METHODS We followed the guidance by Joanna Briggs Institute in tandem with the PRISMA extension for Scoping Reviews checklist. Four electronic databases were systematically searched using controlled index-or thesaurus terms and free text terms, as well as backward and forward citation tracking of included studies. The search strategy was based on the identification of any type of intervention, whether simple, multicomponent, or complex. Three authors independently screened for eligibility and extracted data. RESULTS 18 studies were included for review. The studies had high heterogeneity in design, methods, sample size, recovery rating scales, and type of interventions. All studies used several elements in their interventions; however, the majority used cognitive behavioural therapy conducted in outpatient mental health services. No studies addressed the transitioning phase from outpatient mental health services to primary care. Most studies included patients during their outpatient mental health care treatment of MDD. CONCLUSIONS We identified several knowledge gaps. Recovery interventions for patients with MDD transitioning from outpatient mental health services to primary care are understudied. No studies addressed interventions in this transitioning phase or the patient's experience of the transitioning process. Research is needed to bridge this gap, both regarding interventions for patients transitioning from secondary to primary care, and patients' and health care professionals' experiences of the interventions and of what promotes recovery. REGISTRATION A protocol was prepared in advance and registered in Open Science Framework (https://osf.io/ah3sv), published in the medRxiv server (https://doi.org/10.1101/2022.10.06.22280499) and in PLOS ONE (https://doi.org/10.1371/journal.pone.0291559).
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Affiliation(s)
- Anne Sofie Aggestrup
- The Research Unit for Mental Health Centre Copenhagen, Copenhagen Affective Disorder Research Centre (CADIC), New Interventions in Depression (NID) Group, Mental Health Services in the Capital Region of Denmark, University of Copenhagen, Frederiksberg Hospital, Frederiksberg, Denmark
| | - Frederik Martiny
- The Research Unit for and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Center for Social Medicine, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - Line Lund Henriksen
- The Research Unit for Mental Health Centre Copenhagen, Copenhagen Affective Disorder Research Centre (CADIC), New Interventions in Depression (NID) Group, Mental Health Services in the Capital Region of Denmark, University of Copenhagen, Frederiksberg Hospital, Frederiksberg, Denmark
| | - Annette Sofie Davidsen
- The Research Unit for and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Klaus Martiny
- The Research Unit for Mental Health Centre Copenhagen, Copenhagen Affective Disorder Research Centre (CADIC), New Interventions in Depression (NID) Group, Mental Health Services in the Capital Region of Denmark, University of Copenhagen, Frederiksberg Hospital, Frederiksberg, Denmark
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Sharrad KJ, Sanwo O, Cuevas-Asturias S, Kew KM, Carson-Chahhoud KV, Pike KC. Psychological interventions for asthma in children and adolescents. Cochrane Database Syst Rev 2024; 1:CD013420. [PMID: 38205864 PMCID: PMC10782779 DOI: 10.1002/14651858.cd013420.pub2] [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] [Indexed: 01/12/2024]
Abstract
BACKGROUND Rates of asthma are high in children and adolescents, and young people with asthma generally report poorer health outcomes than those without asthma. Young people with asthma experience a range of challenges that may contribute to psychological distress. This is compounded by the social, psychological, and developmental challenges experienced by all people during this life stage. Psychological interventions (such as behavioural therapies or cognitive therapies) have the potential to reduce psychological distress and thus improve behavioural outcomes such as self-efficacy and medication adherence. In turn, this may reduce medical contacts and asthma attacks. OBJECTIVES To determine the efficacy of psychological interventions for modifying health and behavioural outcomes in children with asthma, compared with usual treatment, treatment with no psychological component, or no treatment. SEARCH METHODS We searched the Cochrane Airways Group Specialised Register (including CENTRAL, CRS, MEDLINE, Embase, PsycINFO, CINAHL EBSCO, AMED EBSCO), proceedings of major respiratory conferences, reference lists of included studies, and online clinical databases. The most recent search was conducted on 22 August 2022. SELECTION CRITERIA We included randomised controlled trials (RCTs) comparing psychological interventions of any duration with usual care, active controls, or a waiting-list control in male and female children and adolescents (aged five to 18 years) with asthma. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcomes were 1. symptoms of anxiety and depression, 2. medical contacts, and 3. asthma attacks. Our secondary outcomes were 1. self-reported asthma symptoms, 2. medication use, 3. quality of life, and 4. adverse events/side effects. MAIN RESULTS We included 24 studies (1639 participants) published between 1978 and 2021. Eleven studies were set in the USA, five in China, two in Sweden, three in Iran, and one each in the Netherlands, UK, and Germany. Participants' asthma severity ranged from mild to severe. Three studies included primary school-aged participants (five to 12 years), two included secondary school-aged participants (13 to 18 years), and 18 included both age groups, while one study was unclear on the age ranges. Durations of interventions ranged from three days to eight months. One intervention was conducted online and the rest were face-to-face. Meta-analysis was not possible due to clinical heterogeneity (interventions, populations, outcome tools and definitions, and length of follow-up). We tabulated and summarised the results narratively with reference to direction, magnitude, and certainty of effects. The certainty of the evidence was very low for all outcomes. A lack of information about scale metrics and minimal clinically important differences for the scales used to measure anxiety, depression, asthma symptoms, medication use, and quality of life made it difficult to judge clinical significance. Primary outcomes Four studies (327 participants) reported beneficial or mixed effects of psychological interventions versus controls for symptoms of anxiety, and one found little to no difference between groups (104 participants). Two studies (166 participants) that evaluated symptoms of depression both reported benefits of psychological interventions compared to controls. Three small studies (92 participants) reported a reduction in medical contacts, but two larger studies (544 participants) found little or no difference between groups in this outcome. Two studies (107 participants) found that the intervention had an important beneficial effect on number of asthma attacks, and one small study (22 participants) found little or no effect of the intervention for this outcome. Secondary outcomes Eleven studies (720 participants) assessed asthma symptoms; four (322 participants) reported beneficial effects of the intervention compared to control, five (257 participants) reported mixed or unclear findings, and two (131 participants) found little or no difference between groups. Eight studies (822 participants) reported a variety of medication use measures; six of these studies (670 participants) found a positive effect of the intervention versus control, and the other two (152 participants) found little or no difference between the groups. Across six studies (653 participants) reporting measures of quality of life, the largest three (522 participants) found little or no difference between the groups. Where findings were positive or mixed, there was evidence of selective reporting (2 studies, 131 participants). No studies provided data related to adverse effects. AUTHORS' CONCLUSIONS Most studies that reported symptoms of anxiety, depression, asthma attacks, asthma symptoms, and medication use found a positive effect of psychological interventions versus control on at least one measure. However, some findings were mixed, it was difficult to judge clinical significance, and the evidence for all outcomes is very uncertain due to clinical heterogeneity, small sample sizes, incomplete reporting, and risk of bias. There is limited evidence to suggest that psychological interventions can reduce the need for medical contact or improve quality of life, and no studies reported adverse events. It was not possible to identify components of effective interventions and distinguish these from interventions showing no evidence of an effect due to substantial heterogeneity. Future investigations of evidence-based psychological techniques should consider standardising outcomes to support cross-comparison and better inform patient and policymaker decision-making.
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Affiliation(s)
- Kelsey J Sharrad
- Allied Health & Human Performance, University of South Australia, Adelaide, Australia
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Ferretti M, Lowery Walker K, Bires J, BrintzenhofeSzoc K. Building coping skills to relieve distress and physical symptoms: Findings from a quality improvement project of a five-week group psychoeducational program for cancer patients. J Psychosoc Oncol 2023; 42:256-270. [PMID: 37486181 DOI: 10.1080/07347332.2023.2238263] [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] [Indexed: 07/25/2023]
Abstract
To examine the effectiveness of Mind Over Matter (MOM), a group psychosocial intervention based on CBT, ACT, and mind-body interventions, from data collected during a quality improvement project. MOM was offered in person prior to COVID-19 and via telehealth after COVID-19 began. Distress, as measured by anxiety, depression, the severity of physical symptoms and the impact of physical symptoms on daily functioning, was measured pre- and post-MOM. The sample included 46 participants with an experience of cancer ranging in age from 31 to 75. Overall, there were significant differences in anxiety, depression, and physical symptom severity and interference pre and post MOM. The in-person intervention showed significant differences in anxiety, depression, and physical symptom interference. There were significant differences in anxiety and physical symptom severity reported in the telehealth groups. MOM may be an effective psychosocial intervention for addressing cancer-related physical and emotional challenges making it a valuable resource for institutions trying to meet needs identified by distress screenings.
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Affiliation(s)
- Michelle Ferretti
- Inova Life with Cancer, Inova Schar Cancer Institute, Fairfax, Virginia, USA
| | | | - Jennifer Bires
- Inova Life with Cancer, Inova Schar Cancer Institute, Fairfax, Virginia, USA
| | - Karlynn BrintzenhofeSzoc
- Kent School of Social Work and Family Sciences, University of Louisville, Louisville, Kentucky, USA
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O'Shea M, Capon H, Skvarc D, Evans S, McIver S, Harris J, Houston E, Berk M. A pragmatic preference trial of therapeutic yoga as an adjunct to group cognitive behaviour therapy versus group CBT alone for depression and anxiety. J Affect Disord 2022; 307:1-10. [PMID: 35301041 DOI: 10.1016/j.jad.2022.03.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 01/13/2022] [Accepted: 03/10/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Yoga has several mechanisms that make it a promising treatment for depression and anxiety, including physical activity, behavioural activation, and mindfulness. Following positive outcomes from adapted CBT interventions incorporating mindfulness-based practices, this study explored the effects of a therapeutic yoga program as an adjunct to group-based CBT for depression or anxiety. METHODS This was a pragmatic preference trial involving adults diagnosed with depression or anxiety in a regional primary mental healthcare service (n = 59), comparing transdiagnostic group CBT (n = 27) with transdiagnostic group CBT combined with an adjunct therapeutic yoga program (n = 32). A preference recruitment design allowed eligible participants (n = 35) to self-select into the adjunct program. The Depression Anxiety Stress Scale-21 (DASS) was assessed at baseline, post-intervention, and three-months follow up. RESULTS CBT + Yoga was an acceptable alternative to CBT alone. Significant reductions were observed in total DASS scores and the 3 subscales of the DASS for both groups, however CBT + Yoga showed significantly lower depressive and anxiety symptoms post-intervention, compared to CBT alone. CBT + Yoga also showed sustained reductions in depressive symptoms over three-months, and more rapid reductions in depressive symptoms, compared to CBT alone. LIMITATIONS These findings should be considered preliminary due to the moderate sample size, with a rigorous randomised control trial necessary to definitively support the integration of yoga within mental health care to augment the benefits and uptake of transdiagnostic CBT for depression and anxiety. CONCLUSIONS Complementing other mindfulness-based practices, therapeutic yoga shows promise as an adjunct to transdiagnostic CBT.
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Affiliation(s)
| | - Hannah Capon
- School of Psychology, Deakin University, Australia
| | - David Skvarc
- School of Psychology, Deakin University, Australia
| | | | - Shane McIver
- School of Health and Social Development, Deakin University, Australia
| | - Jill Harris
- Kyo Yoga and Healing, Ocean Grove, Australia
| | - Emma Houston
- School of Psychology, Deakin University, Australia
| | - Michael Berk
- The Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Barwon Health, Geelong, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, Florey Institute for Neuroscience and Mental Health and the Department of Psychiatry, The University of Melbourne, Melbourne, Australia
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Capon H, O'Shea M, Evans S, McIver S. Yoga complements cognitive behaviour therapy as an adjunct treatment for anxiety and depression: Qualitative findings from a mixed-methods study. Psychol Psychother 2021; 94:1015-1035. [PMID: 33834599 DOI: 10.1111/papt.12343] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 03/16/2021] [Indexed: 01/26/2023]
Abstract
OBJECTIVES Cognitive behaviour therapy (CBT) is recommended for treating anxiety and depression, demonstrating good efficacy and moderate rates of engagement. To further improve outcomes and access to evidence-based treatments, researchers have sought to enhance CBT protocols with mindfulness-based approaches, such as yoga. This study aimed to examine whether yoga is an acceptable and complementary adjunct to CBT through exploring the lived experiences of adults with anxiety and depression who engaged in an adjunct therapeutic yoga programme alongside group CBT. DESIGN Single-group qualitative design with post-intervention and follow-up timepoints. METHODS Thirty-six adults with anxiety and depression self-selected into a therapeutic yoga programme as an adjunct to group CBT. Qualitative interviews were conducted with 27 participants immediately after the eight-week programme and again three months later. Thematic analysis was used to identify common themes from the lived experiences. RESULTS Three primary themes, with nine subthemes, were identified which reflect the experiences of the combined therapies, the complementary elements, and process of engagement over time. The adjunct yoga programme was highly acceptable to adults with anxiety and depression, enhancing engagement and perceived outcomes. Yoga was identified as providing a unique combination of elements that complemented processes of CBT, such as behavioural activation and thought disputation. Yoga practices represented mental health self-management tools that are accessible and available as relapse prevention strategies. CONCLUSIONS Therapeutic yoga warrants consideration as an adjunct treatment for anxiety and depression as it offers unique and complementary elements to CBT and can enhance engagement and perceived clinical outcomes. PRACTITIONER POINTS Adults with anxiety and depression experienced a therapeutic yoga programme as a suitable and appealing adjunct that enhanced engagement with psychological treatment. Yoga offers a unique combination of elements, including a values system, body-based mindfulness practices, and breathing techniques, that complement CBT processes, such as behavioural activation, awareness of maladaptive patterns, and thought disputation. A therapeutic yoga programme provides adults with anxiety and depression with an accessible and sustainable mental health self-management tool. Therapeutic yoga can be considered for integration to models of mental health service provision to enhance engagement and clinical outcomes for adults with anxiety and depression.
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Affiliation(s)
- Hannah Capon
- School of Psychology, Deakin University, Geelong, Victoria, Australia
| | - Melissa O'Shea
- School of Psychology, Deakin University, Geelong, Victoria, Australia
| | - Subhadra Evans
- School of Psychology, Deakin University, Geelong, Victoria, Australia
| | - Shane McIver
- School of Health and Social Development, Deakin University, Burwood, Victoria, Australia
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O Donnell R, Savaglio M, Vicary D, Skouteris H. Effect of community mental health care programs in Australia: a systematic review. Aust J Prim Health 2020; 26:443-451. [PMID: 33038938 DOI: 10.1071/py20147] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 09/08/2020] [Indexed: 11/23/2022]
Abstract
Although numerous studies have examined the effects of community-based mental health care programs in Australia, no synthesis of this literature exists. This systematic review of peer-reviewed and grey literature described the types of community-based mental health care programs delivered and evaluated in Australia in the past 20 years, and evaluated their impact in improving outcomes for those with a serious mental illness (SMI). Articles were included if they evaluated the extent to which the programs delivered in Australia improved individual outcomes, including hospitalisations, psychiatric symptoms, substance misuse or psychosocial outcomes, for individuals with an SMI. Forty studies were included. Community-based mental health care programs were categorised into three types: case management (n=23), therapeutic (n=11) and lifestyle (n=6). Therapeutic programs were most effective in reducing psychiatric symptoms. Case management approaches yielded significant improvements in psychosocial outcomes. Lifestyle programs were inconclusive in improving individual outcomes. This review provides support for the implementation of community-based mental health care programs that are informed by both therapeutic and case management principles. A multidisciplinary team that can facilitate the provision of therapeutic and psychosocial support may be most beneficial for those with an SMI within the Australian community.
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Affiliation(s)
- Renee O Donnell
- Monash Centre for Health Research and Implementation, Monash University, Level 1, 43-51 Kanooka Grove, Locked Bag 29, Clayton, Vic. 3168, Australia
| | - Melissa Savaglio
- Monash Centre for Health Research and Implementation, Monash University, Level 1, 43-51 Kanooka Grove, Locked Bag 29, Clayton, Vic. 3168, Australia
| | - Dave Vicary
- Baptcare, Level 1/1193 Toorak Road, Camberwell, Vic. 3124, Australia
| | - Helen Skouteris
- Monash Centre for Health Research and Implementation, Monash University, Level 1, 43-51 Kanooka Grove, Locked Bag 29, Clayton, Vic. 3168, Australia; and Warwick Business School, University of Warwick, Scarman Road, Coventry CV4 7AL, UK; and Corresponding author.
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Schneider RA, Grasso JR, Chen SY, Chen C, Reilly ED, Kocher B. Beyond the Lab: Empirically Supported Treatments in the Real World. Front Psychol 2020; 11:1969. [PMID: 32849153 PMCID: PMC7432146 DOI: 10.3389/fpsyg.2020.01969] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 07/16/2020] [Indexed: 11/13/2022] Open
Abstract
Laboratory studies of empirically supported treatments (ESTs) for mental health problems achieve much higher rates of clinical improvement than has been observed following treatment in the community. This discrepancy is likely to due to limited reliance on ESTs by therapists outside of academia. Concerns about the generalizability of ESTs to patients in the community, who may have comorbid problems, likely limit rates of adoption. The present study examined the impact of ESTs delivered in the real-world for 1,256 adults who received services through an employee assistance program specializing in the delivery of ESTs. Rates of anxiety and depression decreased significantly, following treatment with an EST, and 898 (71.5%) patients demonstrated reliable improvement. Even among patients comorbid for depression and anxiety at baseline, over half reported reliable improvement in both disorders. Findings suggest ESTs can be effectively delivered outside of academic RCTs. However, additional research is needed to understand and overcome barriers to disseminating ESTs to the broader community.
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Affiliation(s)
| | | | | | - Connie Chen
- Lyra Health, Burlingame, CA, United States.,Department of General Internal Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Erin D Reilly
- Department of Psychiatry, University of Massachusetts System, Boston, MA, United States
| | - Bob Kocher
- Lyra Health, Burlingame, CA, United States.,School of Medicine, Stanford University, Stanford, CA, United States
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Whiston A, Bockting CLH, Semkovska M. Towards personalising treatment: a systematic review and meta-analysis of face-to-face efficacy moderators of cognitive-behavioral therapy and interpersonal psychotherapy for major depressive disorder. Psychol Med 2019; 49:2657-2668. [PMID: 31615583 DOI: 10.1017/s0033291719002812] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Consistent evidence suggests that face-to-face cognitive-behavioural therapy (CBT) and interpersonal psychotherapy (IPT) may be equally effective depression treatments. Current clinical research focuses on detecting the best predictors-moderators of efficacy to guide treatment personalisation. However, individual moderator studies show inconsistent findings. This systematic review and meta-analysis aimed to compare the efficacy of CBT and IPT, including combined treatment with antidepressants for depression, and evaluate the predictive power of demographic, clinical presentation and treatment characteristics moderators for both therapies. METHODS PsycArticles, PsycINFO, PubMed and Cochrane Library were systematically searched through December 2017 for studies that have assessed individuals with major depression receiving either CBT or IPT in a face-to-face format both at pre- and post-treatment. Random-effects moderator meta-analyses were conducted. RESULTS In total 168 samples from 137 studies including 11 374 participants qualified for the meta-analytic review. CBT and IPT were equally effective across all but one prespecified moderators. For psychotherapy delivered without concomitant antidepressant treatment [antidepressant medications (ADMs)], CBT was superior to IPT (g = 1.68, Qbetweenp = 0.037). Within-CBT moderator analyses showed that increased CBT efficacy was associated with lower age, high initial depression severity, individual format of administration and no adjunctive ADMs. Within-IPT analyses showed comparable efficacy across all moderators. CONCLUSIONS Clinical guidance around combined treatment (psychotherapy plus ADMs) should be reconsidered. CBT alone is superior to IPT alone and to combined treatment, while IPT alone is non-inferior to combined treatment. More research is needed to assess the moderating effect of older age and number of previous episodes on IPT efficacy.
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Affiliation(s)
- Aoife Whiston
- Department of Psychology, University of Limerick, Limerick, Ireland
| | - Claudi L H Bockting
- Department of Psychiatry, Academic Medical Centre, University of Amsterdam, Amsterdam, Netherlands
| | - Maria Semkovska
- Department of Psychology, University of Limerick, Limerick, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
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Sharrad KJ, Sanwo O, Carson-Chahhoud KV, Pike KC. Psychological interventions for asthma in children and adolescents. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2019. [DOI: 10.1002/14651858.cd013420] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Kelsey J Sharrad
- University of South Australia; School of Health Sciences; Adelaide Australia
| | - Olatokunbo Sanwo
- William Harvey Hospital; East Kent Hospitals University NHS Foundation Trust; Ashford UK
| | | | - Katharine C Pike
- UCL Great Ormond Street Institute of Child Health; Respiratory, Critical Care & Anaesthesia; London UK
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Hofmann SG, Curtiss J, Carpenter JK, Kind S. Effect of treatments for depression on quality of life: a meta-analysis. Cogn Behav Ther 2017; 46:265-286. [PMID: 28440699 DOI: 10.1080/16506073.2017.1304445] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Cognitive-behavioral therapy (CBT) and selective serotonin reuptake inhibitors (SSRIs) are the two first-line treatments for depression, but little is known about their effects on quality of life (QOL). A meta-analysis was conducted to examine changes in QOL in adults with major depressive disorder who received CBT (24 studies examining 1969 patients) or SSRI treatment (13 studies examining 4286 patients) for their depression. Moderate improvements in QOL from pre to post-treatment were observed in both CBT (Hedges' g = .63) and SSRI (Hedges' g = .79) treatments. The effect size remained stable over the course of the follow-up period for CBT. No data were available to examine follow-ups in the SSRI group. QOL effect sizes decreased linearly with publication year, and greater improvements in depression were significantly associated with greater improvements in QOL for CBT, but not for SSRIs. CBT and SSRIs for depression were both associated with moderate improvements in QOL, but are possibly caused by different mechanisms.
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Affiliation(s)
- Stefan G Hofmann
- a Department of Psychological and Brain Sciences , Boston University , 648 Beacon Street, 6th Floor, Boston , MA 02215 , USA
| | - Joshua Curtiss
- a Department of Psychological and Brain Sciences , Boston University , 648 Beacon Street, 6th Floor, Boston , MA 02215 , USA
| | - Joseph K Carpenter
- a Department of Psychological and Brain Sciences , Boston University , 648 Beacon Street, 6th Floor, Boston , MA 02215 , USA
| | - Shelley Kind
- a Department of Psychological and Brain Sciences , Boston University , 648 Beacon Street, 6th Floor, Boston , MA 02215 , USA.,b Psychology Department , Suffolk University , 73 Tremont Street, 8th Floor, Boston , MA 02108 , USA
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Beard C, Stein AT, Hearon BA, Lee J, Hsu KJ, Björgvinsson T. Predictors of Depression Treatment Response in an Intensive CBT Partial Hospital. J Clin Psychol 2016; 72:297-310. [DOI: 10.1002/jclp.22269] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 10/26/2015] [Accepted: 12/31/2015] [Indexed: 11/12/2022]
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Gudmundsdottir RM, Thome M. Evaluation of the effects of individual and group cognitive behavioural therapy and of psychiatric rehabilitation on hopelessness of depressed adults: a comparative analysis. J Psychiatr Ment Health Nurs 2014; 21:866-72. [PMID: 24842124 DOI: 10.1111/jpm.12157] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/29/2014] [Indexed: 11/30/2022]
Abstract
The aim of this study is to evaluate the effects of individual and group cognitive behavioural therapy (CBT) and of psychiatric rehabilitation (PR) on hopelessness for depressed patients in a rehabilitation setting. Three groups of patients who underwent PR were allocated to individual CBT combined with PR (n = 43), group CBT combined with PR (n = 52) or PR only (n = 22). Hopelessness was assessed by the Beck Hopelessness Scale (BHS). The majority of the patients (68.4%) suffered from moderate to severe hopelessness before treatment (score ≥ 9-20). Results showed that the pretest mean score on the BHS decreased from 11. 57 (SD = 5.58) to 7.46 (SD = 5.20) at posttest. The mean scores on the BHS decreased in all groups under nine. The combination of individual CBT and PR was significantly more effective in reducing hopelessness than group CBT with PR or PR only. Group CBT combined with PR was not significantly more effective than PR only. It is concluded that individual CBT combined with PR is more effective in alleviating hopelessness among depressed patients than group CBT with PR or PR only. CBT can be delivered by an interdisciplinary team including advanced psychiatric nurses.
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Garvik M, Idsoe T, Bru E. Effectiveness study of a CBT-based adolescent coping with depression course. EMOTIONAL AND BEHAVIOURAL DIFFICULTIES 2013. [DOI: 10.1080/13632752.2013.840959] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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14
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Yamadera W, Sato M, Harada D, Iwashita M, Aoki R, Obuchi K, Ozone M, Itoh H, Nakayama K. Comparisons of short-term efficacy between individual and group cognitive behavioral therapy for primary insomnia. Sleep Biol Rhythms 2013; 11:176-184. [PMID: 24098091 PMCID: PMC3787783 DOI: 10.1111/sbr.12019] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2013] [Indexed: 02/04/2023]
Abstract
The purpose of this study was to compare the efficacy of individual and group cognitive behavioral therapy for insomnia (CBT-I) in outpatients with primary insomnia diagnosed by DSM-IV-TR. The participants were 20 individually treated (I-CBT-I) and 25 treated in a group therapy format (three to five patients per group) (G-CBT-I), which showed no significant difference regarding demographic variables between groups. The same components of CBT-I stimulus control therapy, sleep restriction therapy, cognitive therapy, and sleep hygiene education were applied on both groups. The short-term outcome (4 weeks after treatment) was measured by sleep logs, actigraphy, the Pittsburgh Sleep Quality Index (PSQI), and the Dysfunctional Beliefs and Attitudes about Sleep Scale (DBAS), and was compared between I-CBT-I and G-CBT-I. The results indicated that CBT-I was effective in improving subjective and objective sleep parameters and subjective sleep evaluations for both individual and group treatment. However, I-CBT-I resulted in significantly better improvements over G-CBT-I, in (i) objective and subjective sleep onset latency time, (ii) objective sleep efficacy and moving time during sleeping, (iii) overall sleep quality and duration of actual sleep time in PSQI, (iv) consequences of insomnia, control and predictability of sleep, sleep requirement expectation, and sleep-promoting practices in DBAS. The present study suggested the superiority of I-CBT-I over G-CBT-I in clinical settings, and further evaluations are necessary.
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Affiliation(s)
- Wataru Yamadera
- Department of Psychiatry, Jikei University School of MedicineTokyo, Japan
| | - Miki Sato
- Department of Psychiatry, Jikei University School of MedicineTokyo, Japan
| | - Daisuke Harada
- Department of Psychiatry, Jikei University School of MedicineTokyo, Japan
| | - Masayuki Iwashita
- Department of Psychiatry, Jikei University School of MedicineTokyo, Japan
| | - Ryo Aoki
- Department of Psychiatry, Jikei University School of MedicineTokyo, Japan
| | - Keita Obuchi
- Department of Psychiatry, Jikei University School of MedicineTokyo, Japan
| | - Motohiro Ozone
- Department of Psychiatry, Jikei University School of MedicineTokyo, Japan
| | - Hiroshi Itoh
- Department of Psychiatry, Jikei University School of MedicineTokyo, Japan
| | - Kazuhiko Nakayama
- Department of Psychiatry, Jikei University School of MedicineTokyo, Japan
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15
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Shaurya Prakash R, De Leon AA, Klatt M, Malarkey W, Patterson B. Mindfulness disposition and default-mode network connectivity in older adults. Soc Cogn Affect Neurosci 2012; 8:112-7. [PMID: 23051900 DOI: 10.1093/scan/nss115] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
An extensive body of research defines the default-mode network (DMN) to be one of the critical networks of the human brain, playing a pivotal functional role in processes of internal mentation. Alterations in the connectivity of this network as a function of aging have been found, with reductions associated with functional ramifications for the elderly population. This study examined associations between integrity of the DMN and trait levels of mindfulness disposition, defined by our ability to exert attentional and emotional control in the present moment, and, thereby, bring awareness to immediate experiences. Twenty-five older adults participated in the study and underwent a brief functional magnetic resonance imaging session and filled out questionnaires related to their overall health and mindfulness disposition. Mindfulness disposition was associated with greater connectivity of the DMN, specifically, in the dorsal posterior cingulate cortex and the precuneus. Mindfulness disposition, thus, explains variance in the connectivity of one of the more intrinsic networks of the human brain, known to be critical for promoting self-relevant mental explorations and building cognitive and affective control.
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Affiliation(s)
- Ruchika Shaurya Prakash
- Department of Psychology, The Ohio State University, 1835 Neil Avenue, Columbus, OH 43210, USA.
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Abstract
BACKGROUND Cognitive impairment and depression are common and disabling non-motor symptoms of Parkinson's disease (PD). Previous studies have shown associations between them but the nature of the relationship remains unclear. In chronic illness, problem- or task-oriented coping strategies are associated with better outcome but often require higher level cognitive functioning. The present study investigated, in a sample of patients with PD, the relationships between cognitive function, choice of coping strategies, and a broad index of outcome including depression, anxiety, and health-related quality of life (QoL). It was hypothesized that the coping strategy used could mediate the association between cognition and outcome. METHODS 347 participants completed the Coping Inventory for Stressful Situations, the Hospital Anxiety and Depression Scale, the Parkinson's Disease Questionnaire-8, the Unified Parkinson's Disease Rating Scale, and the Addenbrooke's Cognitive Examination-Revised. Structural Equation Modeling was used to test the hypothesized model of cognition, coping, and outcome based on a direct association between cognition and outcome and an indirect association mediated by coping. RESULTS Overall, poorer cognition predicted less use of task-oriented coping, which predicted worse outcome (a latent variable comprised of higher depression and anxiety and lower QoL). The analyses suggested a small indirect effect of cognition on outcome mediated by coping. CONCLUSIONS The findings suggest that patients who fail to employ task-oriented coping strategies may be at greater risk of depression, anxiety, and poor health-related QoL. Even mild to moderate cognitive impairment may contribute to reduced use of task-oriented coping. Suitably adapted cognitive-behavioral approaches may be useful to enable the use of adaptive coping strategies in such patients.
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Hiller W, Schindler AC, Lambert MJ. Defining response and remission in psychotherapy research: A comparison of the RCI and the method of percent improvement. Psychother Res 2012; 22:1-11. [DOI: 10.1080/10503307.2011.616237] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Schindler AC, Hiller W, Witthöft M. Benchmarking of cognitive-behavioral therapy for depression in efficacy and effectiveness studies—How do exclusion criteria affect treatment outcome? Psychother Res 2011; 21:644-57. [DOI: 10.1080/10503307.2011.602750] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Robb SL, Burns DS, Carpenter JS. Reporting Guidelines for Music-based Interventions. MUSIC AND MEDICINE 2011; 3:271-279. [PMID: 23646227 PMCID: PMC3641897 DOI: 10.1177/1943862111420539] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Music-based interventions are used to address a variety of problems experienced by individuals across the developmental lifespan (infants to elderly adults). In order to improve the transparency and specificity of reporting music-based interventions, a set of specific reporting guidelines is recommended. Recommendations pertain to reporting seven different components of music-based interventions including intervention theory, intervention content, intervention delivery schedule, interventionist, treatment fidelity, setting, and unit of delivery. Recommendations are intended to support CONSORT and TREND statements for transparent reporting of interventions while taking into account the variety, complexity, and uniqueness of music-based interventions.
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Abstract
Music-based interventions are used to address a variety of problems experienced by individuals across the developmental lifespan (infants to elderly adults). In order to improve the transparency and specificity of reporting music-based interventions, a set of specific reporting guidelines is recommended. Recommendations pertain to seven different components of music-based interventions, including theory, content, delivery schedule, interventionist, treatment fidelity, setting, and unit of delivery. Recommendations are intended to support Consolidated Standards for Reporting Trials (CONSORT) and Transparent Reporting of Evaluations with Non-randomized Designs (TREND) statements for transparent reporting of interventions while taking into account the variety, complexity, and uniqueness of music-based interventions.
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Linde JA, Simon GE, Ludman EJ, Ichikawa LE, Operskalski BH, Arterburn D, Rohde P, Finch EA, Jeffery RW. A randomized controlled trial of behavioral weight loss treatment versus combined weight loss/depression treatment among women with comorbid obesity and depression. Ann Behav Med 2011; 41:119-30. [PMID: 20878292 PMCID: PMC3033656 DOI: 10.1007/s12160-010-9232-2] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Obesity is associated with clinical depression among women. However, depressed women are often excluded from weight loss trials. PURPOSE This study examined treatment outcomes among women with comorbid obesity and depression. METHODS Two hundred three (203) women were randomized to behavioral weight loss (n = 102) or behavioral weight loss combined with cognitive-behavioral depression management (n = 101). RESULTS Average participant age was 52 years; mean baseline body mass index was 39 kg/m(2). Mean Patient Health Questionnaire and Hopkins Symptom Checklist (SCL-20) scores indicated moderate to severe baseline depression. Weight loss and SCL-20 changes did not differ between groups at 6 or 12 months in intent-to-treat analyses (p = 0.26 and 0.55 for weight, p = 0.70 and 0.25 for depressive symptoms). CONCLUSIONS Depressed obese women lost weight and demonstrated improved mood in both treatment programs. Future weight loss trials are encouraged to enroll depressed women.
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Jarrett RB, Thase ME. Comparative efficacy and durability of continuation phase cognitive therapy for preventing recurrent depression: design of a double-blinded, fluoxetine- and pill placebo-controlled, randomized trial with 2-year follow-up. Contemp Clin Trials 2010; 31:355-77. [PMID: 20451668 PMCID: PMC2936266 DOI: 10.1016/j.cct.2010.04.004] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2009] [Revised: 04/22/2010] [Accepted: 04/25/2010] [Indexed: 01/14/2023]
Abstract
BACKGROUND Major Depressive Disorder (MDD) is highly prevalent and associated with disability and chronicity. Although cognitive therapy (CT) is an effective short-term treatment for MDD, a significant proportion of responders subsequently suffer relapses or recurrences. PURPOSE This design prospectively evaluates: 1) a method to discriminate CT-treated responders at lower vs. higher risk for relapse; and 2) the subsequent durability of 8-month continuation phase therapies in randomized higher risk responders followed for an additional 24 months. The primary prediction is: after protocol treatments are stopped, higher risk patients randomly assigned to continuation phase CT (C-CT) will have a lower risk of relapse/recurrence than those randomized to fluoxetine (FLX). METHODS Outpatients, aged 18 to 70 years, with recurrent MDD received 12-14 weeks of CT provided by 15 experienced therapists from two sites. Responders (i.e., no MDD and 17-item Hamilton Rating Scale for Depression RESULTS The trial began in 2000. Enrollment is complete (n=523). The follow-up continues. CONCLUSIONS The trial evaluates the preventive effects and durability of acute and continuation phase treatments in the largest known sample of CT responders collected worldwide.
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Affiliation(s)
- Robin B. Jarrett
- Department of Psychiatry, The University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Boulevard, Dallas, TX, 75390-9149, United States of America; 214-648-5345; fax 214-648-5340
| | - Michael E. Thase
- The University of Pennsylvania School of Medicine, 3535 Market Street, Suite 670, Philadelphia, PA, 19104, United States of America. Philadelphia, Veterans Affairs Medical Center and University of Pittsburgh Medical Center
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