Unguided low intensity cognitive behaviour therapy for anxiety and depression during the COVID-19 pandemic: A randomised trial

A pilot study of the perceptions and acceptability of guidance using artificial intelligence in internet cognitive behaviour therapy for perfectionism in young people

Perfectionism is a transdiagnostic process associated with a range of psychological disorders. Cognitive Behaviour Therapy for Perfectionism (CBT-P) has been demonstrated as efficacious across guided and unguided internet delivered interventions in reducing perfectionism and psychopathology. The aim of this pilot study was to understand perceptions and acceptability of an artificial intelligence supplemented CBT-P intervention (AI-CBT-P) in young people with lived experience of anxiety and depression (n = 8; age range 19-29 years, M = 24 years, SD = 3.77; 50 % female, 38 % male, 12 % non-binary). Young people reported that they were frequent users of artificial intelligence for study, work and general information, were positive about the intervention and using artificial intelligence for guidance in a self-help intervention, but also noted several concerns. Young people perceived numerous benefits to AI-CBT-P, including ease of access, low cost, lack of stigma and benefits for individuals with social anxiety. Overall, young people appear to be interested in, and have a positive view of, AI-CBT-P. Further research is now required to examine the feasibility and acceptability of the intervention.

The effects of psychosocial and behavioral interventions on depressive and anxiety symptoms during the COVID-19 pandemic: a systematic review and meta-analysis

Psychosocial and behavioral interventions have been shown to significantly reduce depressive and anxiety symptoms in different populations. Recent evidence suggests that the mental health of the general population has deteriorated significantly since the start of Coronavirus Disease 2019 (COVID-19) pandemic. We conducted a systematic review and meta-analysis of studies on the therapeutic effects of psychosocial and behavioral interventions on depression and anxiety during the COVID-19 pandemic. We systematically searched six electronic databases between December 2019 and February 2022 including PubMed, PsycINFO, Scopus, Web of Science, CNKI, and Wanfang Data. We included randomized clinical trials of psychosocial and behavioral interventions in individuals with depressive or anxiety symptoms during the COVID-19 outbreak compared to various control conditions. A total of 35 eligible studies with 5457 participants were included. The meta-analysis results showed that psychosocial and behavioral interventions had statistically significant moderate effects on depression [SMD =  - 0.73, 95% CI (- 1.01, - 0.45), I2 = 90%] and large effects on anxiety [SMD =  - 0.90, 95% CI (- 1.19, - 0.60), I2 = 92%], especially in the general population and COVID-19 survivors. Exercise and cognitive behavioral therapy were found to be the most effective treatments with moderate-to-large effect size for depression and anxiety during the outbreak of COVID-19. We also found the internet-based approach could also achieve almost equally significant effects on depression and anxiety compared with face-to-face traditional approach. Our findings suggest that cognitive behavioral therapy and physical exercise intervention are significantly effective for depression and anxiety related to the COVID-19 pandemic regardless of the delivery modes, and gender differences should be taken into consideration for better implementation of interventions in clinical and community practice.

Comorbid anxiety and depressive symptoms and the related factors among international medical students in China during COVID-19 pandemic: a cross-sectional study

BACKGROUND

The two most prevalent mental health conditions are anxiety and depression and they often coexist (comorbidity) in an individual aggravating the person's psychological or medical conditions. College students suffered from anxiety and depressive symptoms during the COVID-19 pandemic, according to numerous studies. The lack of information on the comorbidity of anxiety and depression (CAD) among international medical students, however, makes it difficult to develop effective policies or strategies to support these students.

OBJECTIVE

The present research seeks to investigate the incidence of CAD among international medical students in China and to identify the variables that may be useful in predicting CAD.

METHOD

A cross-sectional study was conducted at China Medical University in Shenyang, China, for international medical students during November 2020. A total of 519 international students provided information on their demographics, stress related to the COVID-19 pandemic, generalized anxiety disorder assessment (GAD-7), patient health questionnaire-9 (PHQ-9), simplified coping style questionnaire (SCSQ), perceived stress scale (PSS-10), the multidimensional scale of perceived social support (MSPSS), revised life orientation test (LOT-R), and resilience scale-14 (RS-14). To investigate the potential predictors of CAD, a chi-square test, a nonparametric test, and multinomial logistic regression analyses were carried out as appropriate.

RESULTS

The incidence of anxiety, depression, and CAD in the current study was 5.8%, 8.9%, and 22.7%, respectively. The predictors for students having symptoms of anxiety were observed to be the negative coping style (β = 0.662, OR = 1.938, CI:1.07-3.694) and perceived stress (β = 0.167, OR = 1.181, CI:1.076-1.297); the predictors for students having symptoms of depression were observed to be the COVID-19 pandemic-related stress (β = 0.323,OR = 1.382,CI:1.211-1.577), negative coping style (β = 0.693,OR = 2.000, CI:1.21-3.568), and perceived stress (β = 0.135,OR = 1.145,CI:1.050-1.248); whereas the predictors for students with CAD were observed to be staying up late (Yes VS No) (β = 1.028,OR = 2.794,CI:1.227-6.364), current place of residence (Other continents VS China) (β = -1.413, OR = 0.243,CI:0.065-0.910), COVID-19 pandemic-related stress (β = 0.371,OR = 1.450,CI:1.284-1.636), negative coping style (β = 1.092,OR = 2.979,CI:1.706-5.203), and perceived stress (β = 0.339,OR = 1.403,CI:1.289-1.527).

CONCLUSION

Single anxiety and depressive symptoms were moderately prevalent among international medical students in China. However, CAD turned out to be the most prevalent mental health issue due to its relatively higher incidence. Negative coping style and perceived stress were the communal predictors of the three categories, whereas stress related to the COVID-19 pandemic was linked to both depression and CAD, and staying up late and in residential places were specific predictors for CAD. Study results suggest that COVID-19 pandemic-related stress was related to students' CAD and depressive symptoms, and specific intervention measures with stress reduction, proper coping strategy, and a good lifestyle might be useful in improving the international students' mental health status.

Online counterconditioning with COVID-19-relevant stimuli in lockdown: Impact on threat expectancy, fear, and persistent avoidance

BACKGROUND AND OBJECTIVES

In counterconditioning, a conditioned aversive stimulus (CS) is paired with an appetitive stimulus to reduce fear and avoidance. Findings are, however, mixed on the relative impact of counterconditioning versus standard extinction, where the CS is presented in the absence of the aversive event. This analogue treatment study investigated the impact of counterconditioning relative to standard extinction on threat expectancy, fear, and persistent avoidance with an online fear-conditioning task conducted with COVID-19-relevant appetitive stimuli during the pandemic.

METHODS

Following habituation, in which two CSs (male faces wearing face-coverings) were presented in the absence of the unconditioned stimulus (US; a loud female scream), participants (n = 123) underwent threat-conditioning where one stimulus (CS+) was followed by the US and another (CS-) was not. In avoidance learning, the US could be prevented by making a simple response in the presence of the CS+. Next, participants received either counterconditioning in which trial-unique positively rated images of scenes from before the COVID-19 pandemic and its associated restrictions (e.g., hugging others and holding hands) were presented with the CS + or no-counterconditioning (i.e., extinction). In the final test phase, avoidance was available, and all US deliveries were withheld.

RESULTS

Counterconditioning led to diminished threat expectancy and reduced avoidance relative to no-counterconditioning. Fear ratings did not differ between groups.

LIMITATIONS

No physiological measures were obtained.

CONCLUSIONS

Implemented online during the pandemic with COVID-19-relevant appetitive stimuli, counterconditioning was effective at reducing persistent avoidance and threat expectancy.

INTERNET-DELIVERED LOW-INTENSITY CBT FOR PEOPLE WITH SOCIAL ANXIETY DISORDER IN A PERIOD OF COVID-19: RESULTS OF PILOT RESEARCH

OBJECTIVE

The aim: The study aims to provide evidence of the effectiveness of online low-intensity CBT-based psychological interventions on the psychological well-being of people with social anxiety disorders and related impairments in the COVID-19 pandemic.

PATIENTS AND METHODS

Materials and methods: 222 volunteers aged 18-35 years included in study: low-intensity CBT group (n=106) and control group (n=116). To assess the mental health prob¬lems were used International Neuropsychiatric Interview (MINI) and a set of IAPT scales. Analyses considered levels of pre-post intervention effect sizes and clinically significant improvement of symptoms of social anxiety disorder, generalized anxiety disorder, depression, and distress in maintaining general and work activity scores.

RESULTS

Results: Comparisons between the low-intensity interventions group and control (self-help guide psychological care as usual) indicated more reduction in the severity of symp¬toms of social anxiety disorder and comorbid impairments associated with depression or generalized anxiety disorder. Changes for social phobia and other outcomes indicate that the odds of relapse or exacerbation of symptoms in the control group are more significant than those after a CBT-based low-intensity psychosocial care program. Analysis showed a significant interaction between outcomes scores and the number of sessions: more than five online sessions and homework with a self-help guide improved outcome.

CONCLUSION

Conclusions: This pilot trial provides initial evidence that low-intensity online interventions based on CBT result in reductions in psychological problems for persons with a social anxiety disorder during the COVID-19 pandemic.

Online psychosocial interventions for improving mental health in people during the COVID-19 pandemic: A systematic review and meta-analysis

BACKGROUND

During the COVID-19 pandemic, interventions for public mental health were mostly delivered through online modalities. Although many studies have explored the effectiveness of online psychosocial interventions through randomized controlled trials, there is a lack of quantitative synthesis of the effectiveness of online psychosocial interventions and an examination of their overall application.

OBJECTIVE

To understand the commonly used psychosocial interventions during the COVID-19 pandemic and the effectiveness of the interventions.

METHODS

Risk bias was assessed in the included studies according to the Cochrane Collaboration criteria, and data from post-test and follow-up were combined for standardized mean differences using Stata 16.0 software, and sources of heterogeneity were explored by subgroup analysis, and risk bias was assessed in the included studies using Review Manager 5.4 software. The study was written in strict accordance with PRISMA specifications, and registration was completed on the PROSPERO platform (CRD42022302917).

RESULTS

The online psychosocial intervention had an ameliorating effect on anxiety (SMD = -0.78), depression (SMD = -0.80), and insomnia (SMD = -0.19) in the public during the COVID-19 pandemic, was ineffective for the intervention on stress, and the effectiveness of the intervention on depression continued at follow-up. Subgroup analyses showed that the type of intervention, intervention form, Duration of intervention, and setting of the control group influenced the trial results to some extent, with cognitive behavioral therapy being the most effective intervention for anxiety and depressive symptoms, self-help interventions being more effective than interventions with therapist interventions, and 1-4 week interventions being more effective than 5-8 week interventions. Due to the limited number of studies included in the analysis and variability in quality, more randomized controlled trials are needed to test the findings.

CONCLUSION

Online psychosocial interventions can be effective in improving symptoms of anxiety, depression, stress, and insomnia in the public during the COVID-19 pandemic. However, additional randomized controlled trial studies are needed to determine which types of interventions are more appropriate for which populations and how they can be implemented to achieve better intervention outcomes.

The effect of cognitive behavior therapy on anxiety and depression during COVID-19 pandemic: a systematic review and meta-analysis

BACKGROUND

The global spread of coronavirus has caused many physical and mental health problems throughout the world. Depression and anxiety are among the issues that people are experiencing abundantly, along with other mental health disorders, during this period. Cognitive behavior therapy (CBT) is one of the approaches that is effective on improving most of the psychological issues including depression and anxiety. The objective of this systematic review and meta-analysis was to assess the effects of CBT on depression and anxiety during COVID-19 pandemic period.

METHODS

English databases such as Cochrane, PubMed, Google Scholar, Web of Science and Persian databases such as SID, MagIran and IranDoc were searched with a time limit of 2019 to 2022. Two researchers independently evaluated the quality of the entered studies based on Cochrane handbook. Subgroup analysis was conducted separately on the basis of being infected with coronavirus, not being infected with coronavirus, and having a history of depression or anxiety before the intervention and internet-based CBT for depression and anxiety. Meta-analysis results were reported using standardized mean difference (SMD) and 95% confidence interval (95% CI). Heterogeneity of studies was analyzed by means of I² index; and in the case of heterogeneity presence, random effects model was used instead of fixed effects model. Grading of Recommendations Assessment, Development and Evaluation (GRADE) was used for evaluating the quality of evidence.

RESULTS

Totally, 2015 articles were analyzed of which 11 articles entered meta-analysis. The overall results of meta-analysis showed that mean score of anxiety in the group receiving CBT was significantly lower than the control group (SMD: - 0.95, 95% CI - 1.29 to - 0.62; P < 0.00001, I² = 94%). In addition, mean score of depression in the intervention group was significantly lower than the control group (SMD: - 0.58; 95% CI - 1.00 to - 0.16, P < 0.00001, I² = 94%). In addition, the results of subgroup meta-analysis showed that internet-based CBT was effective in reducing of depression (SMD - 0.35; 95% CI - 0.50 to - 0.20; P < 0.00001; I² = 0%) and anxiety (SMD - 0.90; 95%CI - 1.47 to - 0.33; P = 0.002; I² = 94%). The evidence about the effectiveness of CBT on depression and anxiety compared with control group on the basis of GRADE approach had low quality.

CONCLUSIONS

Meta-analysis results showed that CBT reduced the mean scores of anxiety and depression significantly during COVID-19 pandemic period. Due to the low quality of evidence, conducting more randomized controlled trials with rigorous design is suggested. Prospero registration This systematic review has been registered in Prospero (ID: CRD42021277213).

A protocol for unguided internet self-help cognitive behaviour therapy for perfectionism in adolescents at-risk of eating disorders

Perfectionism has a strong association with eating disorders, anxiety and depression. Unguided internet cognitive behaviour therapy for perfectionism has demonstrated efficacy in female adolescents without elevated eating disorder symptoms. No research to date has examined unguided internet cognitive behaviour therapy for perfectionism for adolescents with elevated eating disorder symptoms as an indicated prevention for eating disorders and co-occurring symptoms of anxiety and depression. The protocol outlines the plan for a randomised controlled trial of a co-designed, unguided internet cognitive behaviour therapy for perfectionism with female adolescents with elevated symptoms of eating disorders. The intervention will be a 4-week programme compared to a waitlist control. Outcomes on eating disorder symptoms, anxiety and depression will be measured pre and post intervention and follow-up.

TRIAL REGISTRATION

This trial was registered on 23 September 2020 with the Australian New Zealand Clinical Trials Registry (ACTRN12620000951954P).