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Matsumoto K, Hamatani S, Shiga K, Iiboshi K, Kasai M, Kimura Y, Yokota S, Watanabe K, Kubo Y, Nakamura M. Effectiveness of Unguided Internet-Based Cognitive Behavioral Therapy for Subthreshold Social Anxiety Disorder in Adolescents and Young Adults: Multicenter Randomized Controlled Trial. JMIR Pediatr Parent 2024; 7:e55786. [PMID: 39037759 DOI: 10.2196/55786] [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: 12/24/2023] [Revised: 03/25/2024] [Accepted: 04/22/2024] [Indexed: 07/23/2024] Open
Abstract
BACKGROUND Social anxiety disorder (SAD) is a common mental disorder in adolescents and young adults. Early intervention and support could help prevent the development of full-blown SAD. Considering that adolescents with social anxiety symptoms do not prefer face-to-face sessions due to their fear of communicating with therapists, internet-based cognitive behavioral therapy (ICBT) was implemented. OBJECTIVE This study aimed to examine the effectiveness of complete self-help ICBT for subthreshold SAD in high school and college students with no history of mental disorders. METHODS A multicenter randomized controlled trial designed to demonstrate the objective was conducted from December 2022 to October 2023. Participants were students enrolled at 6 universities and 1 high school. The intervention was a complete self-help ICBT and consisted of 10 text-based sessions that taught cognitive behavioral therapy techniques for social anxiety in youths and young adults. The comparison was a no-treatment condition (control group), which was randomly assigned in a 1:1 ratio by a computer program. A total of 2 psychological scales were used to assess the severity of social anxiety, and 1 psychological scale each was used to measure symptoms of depression, general anxiety, and quality of life. RESULTS In total, 77 students were enrolled as study participants. Through the randomization procedure, 38 participants were included in the intervention group, and 39 patients were included in the control group. Results from the analysis of covariance with depression as covariates showed that the participants in the intervention group had significantly reduced symptoms of social anxiety, depression, and general anxiety compared to the control group. The response rate was 61% (19/31) in the intervention group and 24% (9/38) in the control group: odds ratio (OR) 4.97 (95% CI 1.61-16.53; P=.003) in the Fisher exact test. The recovery rate was 68% (21/31) in the intervention group and 34% (13/38) in the control group: OR 3.95 (95% CI 1.32-12.56; P=.008). The OR for the remission ratio was 2.01 (95% CI 0.64-6.60; P=.20) and for the risk of worsening was 0.23 (95% CI 0.002-1.33; P=.10), but no significant difference was observed. CONCLUSIONS The results of this randomized controlled trial show that fully unguided ICBT improves subthreshold SAD in adolescents and young adults. Interpretation of the effectiveness in preventing SAD that meets the diagnostic criteria is limited by sample size and the follow-up period. Future studies should include more extended observations and larger sample sizes in high-risk populations. TRIAL REGISTRATION UMIN-CTR UMIN000050064; https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000057035.
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Affiliation(s)
- Kazuki Matsumoto
- Division of Clinical Psychology, Kagoshima University Hospital, Research and Education Assembly Medical and Dental Sciences Area, Kagoshima University, Kagoshima, Japan
| | - Sayo Hamatani
- Research Center for Child Mental Development, University of Fukui, Fukui, Japan
- Department of Child and Adolescent Psychological Medicine, University of Fukui Hospital, Fukui, Japan
| | - Kiko Shiga
- Department of Clinical Psychology, Faculty of Human Relations, Shigakukan University, Kagoshima, Japan
| | - Kiyoko Iiboshi
- Department of Clinical Psychology, Faculty of Human Relations, Shigakukan University, Kagoshima, Japan
| | - Makiko Kasai
- Clinical Psychology Course, Naruto University of Education, Tokushima, Japan
| | - Yasuhiro Kimura
- Department of Welfare Psychology, Faculty of Welfare, Fukushima College, Fukushima, Japan
| | | | | | - Yoko Kubo
- Graduate School of Clinical Psychology, Kagoshima University, Kagoshima, Japan
| | - Masayuki Nakamura
- Department of Psychiatry, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
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Costa DLDC, Furlan Damiano R, Alcalá JÁ, Hatzinger M, Mesa F, Perna G, Purebl G, Torzsa P, Vobořilová V, Zwanzger P, Ho R, Bandelow B. How to treat subsyndromal anxiety disorder - practical recommendations for implementation in primary care. Int J Psychiatry Clin Pract 2024:1-10. [PMID: 38909282 DOI: 10.1080/13651501.2024.2362131] [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: 09/18/2023] [Accepted: 05/27/2024] [Indexed: 06/24/2024]
Abstract
BACKGROUND Anxiety is a common and disabling condition that significantly impacts quality of life. Subsyndromal anxiety (SSA) refers to anxiety symptoms that do not meet the full diagnostic criteria for an anxiety disorder but pose a risk for developing such disorders. We aimed to provide practical recommendations for the treatment of SSA in primary care settings. METHODS A narrative review was conducted to identify strategies for recognizing and treating patients with SSA. RESULTS The recommendations for treating SSA include lifestyle modifications such as exercise and stress reduction techniques, psychotherapy, and pharmacological treatments, including natural compounds like the lavender oil extract Silexan. Regular follow-up care is essential to monitor treatment response and address ongoing symptoms. Additionally, the use of the GAD-7 tool is recommended for accurately identifying patients with SSA. CONCLUSION Implementing these recommendations in primary care can lead to effective treatment of SSA, preventing the development of more severe anxiety disorders. An integrative approach, combining lifestyle modifications, psychotherapy, and pharmacotherapy, including natural compounds, offers significant benefits for managing anxiety.
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Affiliation(s)
- Daniel Lucas da Conceição Costa
- Department and Institute of Psychiatry, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Rodolfo Furlan Damiano
- Department and Institute of Psychiatry, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - José Ángel Alcalá
- Clinical Unit of Mental Health. Reina Sofia University Hospital, Cordoba, Spain
| | - Martin Hatzinger
- Psychiatric Services Solothurn, and Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Francisco Mesa
- Health Economy Unit, National Institute of Mental Health, Mexico City, Mexico
| | - Giampaolo Perna
- Department of Biological Sciences, Humanitas University, Milan, Italy
| | - György Purebl
- Institute of Behavioural Sciences, Semmelweis University, Budapest, Hungary
| | - Péter Torzsa
- Department of Family Medicine, Semmelweis University, Budapest, Hungary
| | - Věra Vobořilová
- Faculty of Health Care Studies, University of West Bohemia, Pilsen, The Czech Republic
| | - Peter Zwanzger
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-Universität München, Munich, Germany; kbo-Inn-Salzach-Klinikum, Clinical Center for Psychiatry, Psychotherapy, Psychosomatic Medicine, Geriatrics and Neurology, Wasserburg am Inn, Germany
| | - Roger Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Borwin Bandelow
- Department of Psychiatry and Psychotherapy, University of Göttingen, Göttin-gen, Germany
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Bisby MA, Dear BF, Karin E, Fogliati R, Dudeney J, Ryan K, Fararoui A, Nielssen O, Staples LG, Kayrouz R, Cross S, Titov N. An open trial of the Things You Do Questionnaire: Changes in daily actions during internet-delivered treatment for depressive and anxiety symptoms. J Affect Disord 2023; 329:483-492. [PMID: 36863469 DOI: 10.1016/j.jad.2023.02.117] [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: 02/13/2022] [Revised: 02/12/2023] [Accepted: 02/22/2023] [Indexed: 03/04/2023]
Abstract
Many psychological treatments aim to reduce symptoms of depression and anxiety by modifying maladaptive patterns of cognitions, behavior, and other actions. The Things You Do Questionnaire (TYDQ) was developed to measure the frequency of actions that are associated with psychological health in a reliable and valid manner. The present study examined treatment-related change in the frequency of actions measured by the TYDQ. Using an uncontrolled single-group design, 409 participants with self-reported symptoms of depression, anxiety, or both received access to an 8-week internet-delivered treatment course based on cognitive behavior therapy. Most (77 %) participants completed the treatment, completed questionnaires at post-treatment (83 %), and obtained significant reductions in symptoms of depression (d = 0.88) and anxiety at post-treatment (d = 0.97), as well as improvement in a measure of satisfaction with life (d = 0.36). Factor analyses supported the five-factor structure of the TYDQ, including Realistic Thinking, Meaningful Activities, Goals and Plans, Healthy Habits, and Social Connections. Those participants who, on average, engaged in the identified actions on the TYDQ at least half the days of the week reported lower symptoms of depression and anxiety at post-treatment. The psychometric properties of both a longer 60-item (TYDQ-60) and shorter 21-item (TYDQ-21) version were acceptable. These findings provide further evidence that there are modifiable activities that are strongly associated with psychological health. Future studies will test the replicability to these results in in a broader range of samples, including those seeking psychological treatment.
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Affiliation(s)
- Madelyne A Bisby
- eCentreClinic, School of Psychological Sciences, Macquarie University, Sydney, Australia.
| | - Blake F Dear
- eCentreClinic, School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Eyal Karin
- eCentreClinic, School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Rhiannon Fogliati
- eCentreClinic, School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Joanne Dudeney
- eCentreClinic, School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Katie Ryan
- eCentreClinic, School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Ashleigh Fararoui
- eCentreClinic, School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Olav Nielssen
- eCentreClinic, School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Lauren G Staples
- eCentreClinic, School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Rony Kayrouz
- eCentreClinic, School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Shane Cross
- eCentreClinic, School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Nickolai Titov
- eCentreClinic, School of Psychological Sciences, Macquarie University, Sydney, Australia
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Titov N, Dear BF, Bisby MA, Nielssen O, Staples LG, Kayrouz R, Cross S, Karin E. Measures of Daily Activities Associated With Mental Health (Things You Do Questionnaire): Development of a Preliminary Psychometric Study and Replication Study. JMIR Form Res 2022; 6:e38837. [PMID: 35788101 PMCID: PMC9297144 DOI: 10.2196/38837] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 05/31/2022] [Accepted: 06/01/2022] [Indexed: 01/07/2023] Open
Abstract
Background A large body of research has identified modifiable cognitions and behaviors (actions) associated with psychological health. However, little is known regarding the actions that are most strongly associated with psychological health or the frequency with which they should be performed. Objective This paper described 2 studies that used survey methodology to create the Things You Do Questionnaire (TYDQ), which aims to identify and rank actions (items) and domains of actions (factors) most strongly associated with psychological health. Methods We used digital marketing strategies to recruit Australian adult participants, who were asked to complete 2 web-based surveys comprising versions of the TYDQ; validated measures of depression, anxiety, and satisfaction with life; and demographic questions. In study 1, a total of 3040 participants rated how often they performed each of the 96 items comprising the TYDQ. This design was replicated in study 2, in which a 59-item version of the TYDQ was completed by 3160 participants. In both studies, the factor structure and validity were examined, as were the associations between individual TYDQ items and 3 mental health outcomes: depression, anxiety, and satisfaction with life. Results In study 1, factor analyses revealed that a 5-factor model comprising 27 items achieved an optimum balance between brevity and variance and accounted for 38.1%, 31.4%, and 33.2% of the variance in scores on measures of depression, anxiety, and satisfaction with life, respectively. The factors were interpreted as realistic thinking, meaningful activities, goals and plans, healthy habits, and social connections. These 5 factors were more strongly associated with psychological health than those such as practicing kindness, exercising gratitude, and practicing spirituality. This pattern of results was replicated across gender, age groups, and depression severity. The 5-factor solution found in study 1 was replicated in study 2. Analyses revealed that a 21-item version accounted for 46.8%, 38.2%, and 38.1% of the variance in scores on measures of depression, anxiety, and satisfaction with life, respectively. Conclusions These findings indicate that some actions are more strongly associated with psychological health than others and that these activities fall within 5 broad domains, which represent skills often taught in psychological treatments. Subsequent studies are planned to explore the reliability of these items and results in other samples and to examine patterns of change in scores during treatment for anxiety and depression. If replicated, these efforts will assist in the development of new psychological interventions and provide an evidence base for public mental health campaigns designed to promote good mental health and prevent the emergence of common mental disorders.
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Affiliation(s)
- Nickolai Titov
- eCentreClinic, School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Blake F Dear
- eCentreClinic, School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Madelyne A Bisby
- eCentreClinic, School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Olav Nielssen
- eCentreClinic, School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Lauren G Staples
- eCentreClinic, School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Rony Kayrouz
- eCentreClinic, School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Shane Cross
- eCentreClinic, School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Eyal Karin
- eCentreClinic, School of Psychological Sciences, Macquarie University, Sydney, Australia
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Batsikoura M, Zyga S, Tzavella F, Sachlas A, Rojas Gil AP. Anxiety Status and Coping Strategies in Association with Sociodemographic Factors, Dietary and Lifestyle Habits in Greece. Clin Pract Epidemiol Ment Health 2021; 17:152-160. [PMID: 34880927 PMCID: PMC8595982 DOI: 10.2174/1745017902117010152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 07/24/2021] [Accepted: 08/09/2021] [Indexed: 11/22/2022]
Abstract
Aim: The aim of this study was to investigate the relationship between nutritional habits, lifestyle, anxiety, and coping strategies. Background: Anxiety is an underestimated and often undiagnosed subclinical disorder that burdens the general public of modern societies and increases illness suscentibility. Methods: The study group consisted of 693 individuals living in Peloponnese, Greece. A standardized questionnaire that consists of the dietary habits and lifestyle questionnaire, the trait Anxiety STAI-X-2 questionnaire and the brief-COPE questionnaire, was used. Principal components analysis identified the factors from the questionnaires, and stepwise multivariate regression analysis investigated their relationships. Results: Weekly consumption of fruits, tomatoes, salads and lettuce, together with Εmotional/Ιnstrumental support, Denial/Behavioural disengagement, substance use and self-blame, was the most important predictors of anxiety scores. Positive reframing/Humour and Acceptance/Planning are also associated with the Positive STAI factor and decreased anxiety scores. Conclusion: Healthy nutritional habits, comprised of consumption of salads and fruits, together with adaptive coping strategies, such as Positive reframing/Humour and Active problem solving, may provide the most profound improvement in the anxiety levels of a healthy population in Peloponnese, Greece.
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Affiliation(s)
- Maria Batsikoura
- Department of Nursing, Laboratory of Biology and Biochemistry, Faculty of Health Sciences, University of Peloponnese, Tripoli, Greece
| | - Sofia Zyga
- Department of Nursing, Laboratory of Basic Nursing, Faculty of Health Sciences, University of Peloponnese, Tripoli, Greece
| | - Foteini Tzavella
- Department of Nursing, Laboratory of Integrated Health Care, Faculty of Health Sciences, University of Peloponnese, Tripoli, Greece
| | - Athanasios Sachlas
- Department of Statistics and Insurance Science, University of Piraeus, Athens, Greece
| | - Andrea Paola Rojas Gil
- Department of Nursing, Laboratory of Biology and Biochemistry, Faculty of Health Sciences, University of Peloponnese, Tripoli, Greece
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Pilkington K, Wieland LS. Self-care for anxiety and depression: a comparison of evidence from Cochrane reviews and practice to inform decision-making and priority-setting. BMC Complement Med Ther 2020; 20:247. [PMID: 32778171 PMCID: PMC7418416 DOI: 10.1186/s12906-020-03038-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 07/27/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Self-care refers to a range of activities and approaches undertaken by an individual to maintain health and manage ill-health which may include various complementary or alternative approaches. The purpose of this study was to identify the self-care approaches used by the general public for depression and anxiety, assess the usefulness of Cochrane reviews for informing decisions on self-care and highlight any gaps in the evidence. METHODS Searches were carried out for surveys of self-care for anxiety and/or depression and for Cochrane reviews and protocols of interventions with potential for use in self-care. Data was extracted from each review and Plain Language Summaries assessed for content, consistency and readability. Interventions reported in surveys and in Cochrane reviews were compared and effectiveness of each assessed. RESULTS Surveys from 10 countries reported a variety of self-care interventions, 17 of which appeared in 2 or more surveys and which included dietary supplements, herbal medicines, mind-body therapies and various forms of exercise. Twenty-two reviews and 5 protocols on potential self-care interventions were identified, the majority in depression. Twelve interventions were judged effective or promising, most with small effect sizes. Readability of summaries was highly variable: half were written at college/university level. Several commonly used approaches were not covered by Cochrane reviews. CONCLUSIONS This study has revealed the interventions currently used by the general public which are judged effective or promising based on Cochrane reviews. Some disparity is highlighted between interventions used in practice and the availability of reliable evidence, and in the presentation of effectiveness and safety. Being able to direct patients to reliable, accessible information is a positive step in ensuring effective patient-centered, evidence-informed care. Addressing gaps, ensuring consistency and increasing usability of evidence intended for the general public will support this goal.
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Affiliation(s)
- Karen Pilkington
- School of Health and Care Professions, University of Portsmouth, James Watson West, 2 King Richard 1st Road, Portsmouth, P01 2FR, UK.
| | - Lisa Susan Wieland
- Center for Integrative Medicine, University of Maryland School of Medicine, 520 West Lombard Street, East Hall, Baltimore, MD, 21201, USA
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Digital Marketing Actions That Achieve a Better Attraction and Loyalty of Users: An Analytical Study. FUTURE INTERNET 2019. [DOI: 10.3390/fi11060130] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Currently, the digital economy contributes decisively to an increase in competitiveness, especially as a digital transformation involves migrating to new technological models where digital marketing is a key part of growth and user loyalty strategies. Internet and Digital Marketing have become important factors in campaigns, which attract and retain Internet users. This study aims to identify the main ways in which users can be gained and retained by using Digital Marketing. The Delphi method with in-depth interviews was the methodology used in this study. The results of the research show the most important actions for achieving user recruitment and loyalty with Digital Marketing from the opinions of consulted experts. The limitations of this study are those related to the number of experts included in the study, and the number of research papers consulted in the literature review. The literature review and the results of this research are used to propose new solid research with a consolidated critical methodology. This research deals with a new approach that will optimize web technologies for the evolution of user trends, and therefore, will be of academic and professional use for marketing managers and web solution developers. The conclusions of the investigation show the key factors, discarding others that do not affect the optimization of conversions in B2C businesses such as the duration of the session and the rebound percentage. Likewise, the results of the research identify the specific actions that must be carried out to attract and retain users in B2C companies that use the Digital Marketing ecosystem on the Internet. The requirements for companies that wish to implement a model to optimize conversions using the current digital economy are also shown.
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