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Bennebroek Evertsz' F, Bockting CL, Braamse A, van Dissel MNM, Duijvestein M, Kager LM, Kool M, Löwenberg M, Mares W, Nieuwkerk P, Sipkema HA, Young Z, Knoop H. Implementation of 'IBD-Specific Cognitive Behavioural Therapy' for Patients with Inflammatory Bowel Diseases with Poor Mental Quality of Life, Anxiety and Depression. J Clin Psychol Med Settings 2024; 31:258-278. [PMID: 38281306 DOI: 10.1007/s10880-023-09996-8] [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] [Accepted: 12/04/2023] [Indexed: 01/30/2024]
Abstract
This paper describes the implementation of inflammatory bowel disease (IBD)-specific cognitive behavioural therapy (CBT) for IBD patients with poor quality of life (QoL), anxiety and depression, in four hospitals in the Netherlands. Treatment outcomes were compared with those of a previously published randomized control trial (RCT) of 'IBD-specific CBT', following a benchmark strategy. Primary outcome was IBD-specific QoL (IBDQ) completed before and after CBT, secondary outcomes were anxiety and depressive symptoms (HADS, CES-D). Semi-structured interviews were conducted among a pilot of gastroenterologists, nurse specialists and psychologists to evaluate 'IBD-specific CBT'. 94 patients started treatment (280 screened). At follow-up, 63 participants (67% compared to 81% in the RCT benchmark) completed the IBDQ. Treatment effect sizes of the implementation study were comparable and slightly larger than those of RCT benchmark. Gastroenterologists, IBD nurses and psychologists found CBT necessary for IBD patients with poor QoL, depression and/or anxiety disorders. 'IBD-specific CBT' can be successfully implemented. Regular supervision of psychologists performing 'IBD-specific CBT' treatment is needed.
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Affiliation(s)
- Floor Bennebroek Evertsz'
- Department of Medical Psychology, Amsterdam University Medical Centers, Location AMC, University of Amsterdam, Meibergdreef 15, 1105 AZ, Amsterdam, The Netherlands.
| | - Claudi L Bockting
- Department of Psychiatry, Amsterdam University Medical Centers, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Annemarie Braamse
- Department of Medical Psychology, Amsterdam University Medical Centers, Location AMC, University of Amsterdam, Meibergdreef 15, 1105 AZ, Amsterdam, The Netherlands
| | - Mafalda N M van Dissel
- Medicine Master's Student, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Marjolijn Duijvestein
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Liesbeth M Kager
- Department of Gastroenterology and Hepatology, Noord-West Ziekenhuisgroep, Alkmaar, The Netherlands
| | - Marianne Kool
- Department of Medical Psychology, Amsterdam University Medical Centers, Location AMC, University of Amsterdam, Meibergdreef 15, 1105 AZ, Amsterdam, The Netherlands
| | - Mark Löwenberg
- Department of Gastroenterology and Hepatology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Wout Mares
- Department of Gastroenterology and Hepatology, Gelderse Vallei Hospital, Ede, The Netherlands
| | - Pythia Nieuwkerk
- Department of Medical Psychology, Amsterdam University Medical Centers, Location AMC, University of Amsterdam, Meibergdreef 15, 1105 AZ, Amsterdam, The Netherlands
| | - Houkje A Sipkema
- Department of Gastroenterology and Hepatology, Isala Hospital, Zwolle, The Netherlands
| | - Zwanet Young
- Brain and Cognitive Sciences Master's Student, University of Amsterdam, Amsterdam, The Netherlands
| | - Hans Knoop
- Department of Medical Psychology, Amsterdam University Medical Centers, Location AMC, University of Amsterdam, Meibergdreef 15, 1105 AZ, Amsterdam, The Netherlands
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Sauer-Zavala S, Southward MW, Terrill DR, Semcho SA, Stumpp NE. Mechanism engagement as a potential evidence-based approach to personalized treatment termination. Psychother Res 2024; 34:124-136. [PMID: 36669132 DOI: 10.1080/10503307.2023.2168574] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 01/10/2023] [Indexed: 01/22/2023] Open
Abstract
Objective: This study explores whether early change on a putative mechanism maintaining symptoms can serve as a proximal indicator of response to prompt discontinuation. Method: Patients (N = 70; Mage = 33.74, 67% female, 74% white) with heterogeneous anxiety and depressive disorders completed a sequential multiple assignment randomized trial (SMART). Patients received 6 sessions of skill modules from the Unified Protocol and then underwent a second-stage randomization to either receive the remaining 6 sessions (Full duration) or discontinue treatment (Brief duration). All participants completed weekly self-report measures of anxiety and depressive symptoms and distress aversion for the full 12-week treatment window. We used structural equation modeling to test (1) if distress aversion demonstrated significant variability during the first-stage randomization and (2) if distress aversion during the first-stage randomization predicted second-stage changes in anxiety and depression. Results: Participants demonstrated significant variability in first-stage distress aversion. Latent distress aversion slopes significantly predicted latent second-stage anxiety slopes, whereas latent distress aversion intercepts significantly predicted latent second-stage depression slopes. Conclusions: These results suggest that early mechanism engagement may have potential as a trigger to prompt personalized termination. Shorter courses of care may reduce patient costs and increase the mental health service system's capacity.
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Affiliation(s)
| | | | - Doug R Terrill
- Department of Psychology, University of Kentucky, Lexington, KY, USA
| | - Stephen A Semcho
- Department of Psychology, University of Kentucky, Lexington, KY, USA
| | - Nicole E Stumpp
- Department of Psychology, University of Kentucky, Lexington, KY, USA
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Sohanpal R, Pinnock H, Steed L, Heslop-Marshall K, Kelly MJ, Chan C, Wileman V, Barradell A, Dibao-Dina C, Font Gilabert P, Healey A, Hooper R, Mammoliti KM, Priebe S, Roberts M, Rowland V, Waseem S, Singh S, Smuk M, Underwood M, White P, Yaziji N, Taylor SJ. A tailored psychological intervention for anxiety and depression management in people with chronic obstructive pulmonary disease: TANDEM RCT and process evaluation. Health Technol Assess 2024; 28:1-129. [PMID: 38229579 PMCID: PMC11017633 DOI: 10.3310/pawa7221] [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: 01/18/2024] Open
Abstract
Background People with chronic obstructive pulmonary disease have high levels of anxiety and depression, which is associated with increased morbidity and poor uptake of effective treatments, such as pulmonary rehabilitation. Cognitive-behavioural therapy improves mental health of people with long-term conditions and could potentially increase uptake of pulmonary rehabilitation, enabling synergies that could enhance the mental health of people with chronic obstructive pulmonary disease. Aim Our aim was to develop and evaluate the clinical effectiveness and cost effectiveness of a tailored cognitive-behavioural approach intervention, which links into, and optimises the benefits of, routine pulmonary rehabilitation. Design We carried out a pragmatic multicentre randomised controlled trial using a 1.25 : 1 ratio (intervention : control) with a parallel process evaluation, including assessment of fidelity. Setting Twelve NHS trusts and five Clinical Commissioning Groups in England were recruited into the study. The intervention was delivered in participant's own home or at a local NHS facility, and by telephone. Participants Between July 2017 and March 2020 we recruited adults with moderate/very severe chronic obstructive pulmonary disease and mild/moderate anxiety and/or depression, meeting eligibility criteria for assessment for pulmonary rehabilitation. Carers of participants were invited to participate. Intervention The cognitive-behavioural approach intervention (i.e. six to eight 40- to 60-minute sessions plus telephone support throughout pulmonary rehabilitation) was delivered by 31 trained respiratory healthcare professionals to participants prior to commencing pulmonary rehabilitation. Usual care included routine pulmonary rehabilitation referral. Main outcome measures Co-primary outcomes were Hospital Anxiety and Depression Scale - anxiety and Hospital Anxiety and Depression Scale - depression at 6 months post randomisation. Secondary outcomes at 6 and 12 months included health-related quality of life, smoking status, uptake of pulmonary rehabilitation and healthcare use. Results We analysed results from 423 randomised participants (intervention, n = 242; control, n = 181). Forty-three carers participated. Follow-up at 6 and 12 months was 93% and 82%, respectively. Despite good fidelity for intervention delivery, mean between-group differences in Hospital Anxiety and Depression Scale at 6 months ruled out clinically important effects (Hospital Anxiety and Depression Scale - anxiety mean difference -0.60, 95% confidence interval -1.40 to 0.21; Hospital Anxiety and Depression Scale - depression mean difference -0.66, 95% confidence interval -1.39 to 0.07), with similar results at 12 months. There were no between-group differences in any of the secondary outcomes. Sensitivity analyses did not alter these conclusions. More adverse events were reported for intervention participants than for control participants, but none related to the trial. The intervention did not generate quality-of-life improvements to justify the additional cost (adjusted mean difference £770.24, 95% confidence interval -£27.91 to £1568.39) to the NHS. The intervention was well received and many participants described positive affects on their quality of life. Facilitators highlighted the complexity of participants' lives and considered the intervention to be of potential valuable; however, the intervention would be difficult to integrate within routine clinical services. Our well-powered trial delivered a theoretically designed intervention with good fidelity. The respiratory-experienced facilitators were trained to deliver a low-intensity cognitive-behavioural approach intervention, but high-intensity cognitive-behavioural therapy might have been more effective. Our broad inclusion criteria specified objectively assessed anxiety and/or depression, but participants were likely to favour talking therapies. Randomisation was concealed and blinding of outcome assessment was breached in only 15 participants. Conclusions The tailored cognitive-behavioural approach intervention delivered with fidelity by trained respiratory healthcare professionals to people with chronic obstructive pulmonary disease was neither clinically effective nor cost-effective. Alternative approaches that are integrated with routine long-term condition care are needed to address the unmet, complex clinical and psychosocial needs of this group of patients. Trial registration This trial is registered as ISRCTN59537391. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 13/146/02) and is published in full in Health Technology Assessment; Vol. 28, No. 1. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Ratna Sohanpal
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Hilary Pinnock
- Allergy and Respiratory Research Group, Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Liz Steed
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | | | - Moira J Kelly
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Claire Chan
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Vari Wileman
- School of Mental Health and Psychological Sciences, Institute of Psychiatry, King's College London, London, UK
| | - Amy Barradell
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | | | - Paulino Font Gilabert
- Health Service and Population Research Department, Institute of Psychiatry, King's College London, London, UK
| | - Andy Healey
- Health Service and Population Research Department, Institute of Psychiatry, King's College London, London, UK
| | - Richard Hooper
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Kristie-Marie Mammoliti
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Stefan Priebe
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Mike Roberts
- Safer Care Victoria, Melbourne, Melbourne, VIC, Australia
| | | | | | - Sally Singh
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Melanie Smuk
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Martin Underwood
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Patrick White
- Department of Population Health, School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Nahel Yaziji
- Health Service and Population Research Department, Institute of Psychiatry, King's College London, London, UK
| | - Stephanie Jc Taylor
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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Scott AJ, Bisby MA, Heriseanu AI, Salameh Y, Karin E, Fogliati R, Dudeney J, Gandy M, McLellan LF, Wootton B, McDonald S, Correa A, Titov N, Dear BF. Cognitive behavioral therapies for depression and anxiety in people with chronic disease: A systematic review and meta-analysis. Clin Psychol Rev 2023; 106:102353. [PMID: 37865080 DOI: 10.1016/j.cpr.2023.102353] [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: 05/25/2021] [Revised: 09/12/2023] [Accepted: 10/12/2023] [Indexed: 10/23/2023]
Abstract
OBJECTIVE Anxiety and depression in chronic disease are common and burdensome co-morbidities. There has been growing interest in cognitive and behavioral therapies (CBTs) for anxiety and depression in chronic disease, however their efficacy has not been well-established. This study examined the efficacy of CBTs for depression and/or anxiety symptoms within chronic disease and explored the moderating role of clinical and methodological characteristics. METHODS Following prospective registration, electronic databases were searched up to 2023 for randomized controlled trials (RCTs) examining CBTs for depression and/or anxiety in any adult chronic disease population. RESULTS We included 56 RCTs. The overall effect of CBTs was g = 0.61 (95% CI, 0.49, 0.72) for depression and g = 0.56 (95% CI, 0.42, 0.70) for anxiety. A range of methodological features significantly moderated the effect sizes obtained, including type of control group and the outcome measure used. Risk of Bias ratings indicated some concerns regarding RCT conduct and reporting. CONCLUSIONS CBTs lead to moderate improvements in both depression and anxiety symptoms among people with chronic disease. However, the efficacy of CBT should be interpreted considering certain study and sample characteristics. It is recommended that future studies make improvements to study methodology and reporting.
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Affiliation(s)
- Amelia J Scott
- School of Psychological Sciences, Macquarie University, Australia.
| | - Madelyne A Bisby
- School of Psychological Sciences, Macquarie University, Australia
| | | | - Yalda Salameh
- School of Psychological Sciences, Macquarie University, Australia
| | - Eyal Karin
- School of Psychological Sciences, Macquarie University, Australia
| | | | - Joanne Dudeney
- School of Psychological Sciences, Macquarie University, Australia
| | - Milena Gandy
- School of Psychological Sciences, Macquarie University, Australia
| | | | - Bethany Wootton
- Discipline of Psychology, Graduate School of Health, University of Technology, Sydney, Australia
| | - Sarah McDonald
- Discipline of Psychology, Graduate School of Health, University of Technology, Sydney, Australia
| | - Ashleigh Correa
- School of Psychological Sciences, Macquarie University, Australia
| | - Nick Titov
- School of Psychological Sciences, Macquarie University, Australia; MindSpot Clinic, Macquarie University, Australia
| | - Blake F Dear
- School of Psychological Sciences, Macquarie University, Australia
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5
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Belge JB, Sabbe ACF, Sabbe BGCC. An update on pharmacotherapy for recurrent depression in 2022. Expert Opin Pharmacother 2023; 24:1387-1394. [PMID: 37300545 DOI: 10.1080/14656566.2023.2223962] [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: 01/29/2023] [Accepted: 06/06/2023] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Major depressive disorder remains a major challenge due to its biopsychosocial burden with increased morbidity and mortality. Despite successful treatment options for the acute episode, recurrence rates are high, on average four times in a life span. AREAS COVERED Both pharmacological as non-pharmacological evidence-based therapeutic options to prevent and treat recurrent depression are discussed. EXPERT OPINION Although some risk factors for recurrence are well known, better evidence is needed. Antidepressant medication should be continued after acute treatment at its full therapeutic dose for longer periods, at least 1 year. There are no clear differences between classes of antidepressant medication when treatment is focused on preventing relapse. Bupropion is the only antidepressant with a proven efficacy to prevent recurrence in seasonal affective disorder. Recent findings conclude maintenance subanesthetic ketamine and esketamine treatment can be effective in sustaining antidepressant effect following remission. Furthermore, the pharmacological approach must be integrated with lifestyle interventions, especially aerobic exercise. Finally, combining pharma- and psychotherapy seems to improve outcome. Network and complexity sciences will help to decrease the high recurrence rates of MDD by developing more integrative and personalized approaches.
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Affiliation(s)
- Jean-Baptiste Belge
- Department of Psychiatry, Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
- Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Amber C F Sabbe
- Department of Internal Medicine, University Hospital of Antwerp, Edegem, Belgium
- Campus Drie Eiken, Universiteitsplein 1, University of Antwerp, Wilrijk, Belgium
| | - Bernard G C C Sabbe
- Department of Psychiatry, Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
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Miguel C, Karyotaki E, Ciharova M, Cristea IA, Penninx BW, Cuijpers P. Psychotherapy for comorbid depression and somatic disorders: a systematic review and meta-analysis. Psychol Med 2023; 53:2503-2513. [PMID: 34792017 PMCID: PMC10123840 DOI: 10.1017/s0033291721004414] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 09/01/2021] [Accepted: 10/11/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND The treatment of depression in patients with somatic disorders is crucial, given its negative impact on quality of life (QoL), functioning, and even on the somatic disease prognosis. We aimed to examine the most updated evidence on the effects of psychotherapy in patients with depression and somatic disorders, including HIV, oncological, cardiometabolic, and neurological disorders. METHODS We conducted a meta-analysis of 75 randomized trials (8209 participants) of psychotherapy for adults with somatic disorders and a diagnosis or elevated symptoms of depression. Outcomes included depression, QoL, somatic health-related outcomes, and mortality. RESULTS Psychotherapy significantly reduced the severity of depression at post-treatment across all categories of somatic disorders (Hedges'g = 0.65; 95% CI 0.52-0.79), with sustained effects at 6-11 months (g = 0.38; 95% CI 0.22-0.53) and at 12 months follow-up or longer (g = 0.13; 95% CI 0.04-0.21). Psychotherapy also showed significant effects on QoL (g = 0.26; 95% CI 0.17-0.35), maintained up to 11 months follow-up (g = 0.25; 95% CI 0.16-0.34). No significant effects were observed on the most frequently reported somatic health-related outcomes (glycemic control, pain), and neither on mortality. Heterogeneity in most analyses was very high, and only 29 (38%) trials were rated at low risk of bias (RoB). CONCLUSIONS Psychotherapy may be an effective treatment option for patients with depression and somatic disorders, with long-term effects on depression severity and QoL. However, these results should be interpreted with caution due to heterogeneity and RoB.
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Affiliation(s)
- Clara Miguel
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, The Netherlands
| | - Eirini Karyotaki
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, The Netherlands
- WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, The Netherlands
| | - Marketa Ciharova
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, The Netherlands
| | - Ioana A. Cristea
- Department of Brain and Behavioral Sciences, University of Pavia, Italy
- IRCCS Mondino Foundation, Pavia, Italy
| | - Brenda W.J.H. Penninx
- Department of Psychiatry, Amsterdam UMC, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, The Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, The Netherlands
- WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, The Netherlands
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Zhao R, Amarnath A, Karyotaki E, Struijs SY, Cuijpers P. Effects of psychological treatment for depression among people not actively seeking help: a meta-analysis. Psychol Med 2023; 53:320-331. [PMID: 36404636 PMCID: PMC9899569 DOI: 10.1017/s0033291722003518] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 09/22/2022] [Accepted: 10/20/2022] [Indexed: 11/22/2022]
Abstract
Although psychological treatments have been found to be effective for depression in adults, many individuals with depression do not actively seek help. It is currently unclear whether psychological treatments are effective among those not actively seeking help. Besides, little is known about the proportion of patients who completed a screening questionnaire who end up in a clinical trial. Therefore, we conducted a meta-analysis of 52 randomized trials comparing psychotherapies for adults with a diagnosis or elevated symptoms of depression against control conditions (care-as-usual, waiting list, and other inactive treatment). Only studies recruiting participants who do not actively seek help (participants who have been recruited through screening instead of advertisements and clinical referrals) were included. To obtain an overall effect estimate of psychotherapy, we pooled all post-test differences with a random-effects model. We found that psychological treatments had a moderate to high effect on reducing depressive symptoms compared to control groups [g = 0.55; 95% confidence interval (CI) 0.41-0.69]. Heterogeneity was high (I2 = 75%; 95% CI 68-80). At 12 months' follow-up, the effects were small but significant (6-8 months: g = 0.33; 95% CI 0.14-0.52; 9-12 months: g = 0.24; 95% CI 0.11-0.37). As a secondary outcome, we found that 13% of patients who completed a screening questionnaire met the inclusion criteria for depression and agreed to be randomized in the trial. Based on the current evidence, psychological treatments for depression might be effective for depressed patients who are not actively seeking help.
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Affiliation(s)
- Ruiying Zhao
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Arpana Amarnath
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Eirini Karyotaki
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Sascha Y. Struijs
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Institute of Clinical Psychology, Leiden University, Leiden, The Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Karat BG, Narikuzhy S, Bonato S, Sanches M, Ahmed S, Liang L, Husain MI, Husain MO, Farooq S, Ayub M, Kidd SA, Mckenzie K, Ali F, Naeem F. The Effectiveness of Cognitive Behavioral Therapy Interventions on Depression and Anxiety in the Adult East Asian and Related Diaspora Populations: a Meta-analysis. Int J Cogn Ther 2022. [DOI: 10.1007/s41811-022-00153-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Sauer-Zavala S, Southward MW, Stumpp NE, Semcho SA, Hood CO, Garlock A, Urs A. A SMART approach to personalized care: preliminary data on how to select and sequence skills in transdiagnostic CBT. Cogn Behav Ther 2022; 51:435-455. [PMID: 35475947 PMCID: PMC9749849 DOI: 10.1080/16506073.2022.2053571] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 03/10/2022] [Indexed: 12/16/2022]
Abstract
Given that over 20 million adults each year do not receive care for their mental health difficulties, it is imperative to improve system-level capacity issues by increasing treatment efficiency. The present study aimed to collect feasibility/acceptability data on two strategies for increasing the efficiency of cognitive behavioral therapy: (1) personalized skill sequences and (2) personalized skill selections. Participants (N = 70) with anxiety and depressive disorders were enrolled in a pilot sequential multiple assignment randomized trial (SMART). Patients were randomly assigned to receive skill modules from the Unified Protocol in one of three sequencing conditions: standard, sequences that prioritized patients' relative strengths, and sequences that prioritized relative deficits. Participants also underwent a second-stage randomization to either receive 6 sessions or 12 sessions of treatment. Participants were generally satisfied with the treatment they received, though significant differences favored the Capitalization and Full duration conditions. There were no differences in trajectories of improvement as a function of sequencing condition. There were also no differences in end-of-study outcomes between brief personalized treatment and full standard treatment. Thus, it may be feasible to deliver CBT for personalized durations, though this may not substantially impact trajectories of change in anxiety or depressive symptoms.
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10
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Nadort E, Schouten RW, Boeschoten RE, Smets Y, Chandie Shaw P, Vleming LJ, Dekker MJE, Westerman M, Hoogeveen EK, Bos WJW, Schouten M, Farhat K, Dekker FW, van Oppen P, Broekman BFP, Siegert CEH. Internet-based treatment for depressive symptoms in hemodialysis patients: A cluster randomized controlled trial. Gen Hosp Psychiatry 2022; 75:46-53. [PMID: 35134703 DOI: 10.1016/j.genhosppsych.2022.01.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 01/17/2022] [Accepted: 01/24/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To investigate the effectiveness of a guided internet-based self-help intervention for hemodialysis patients with depressive symptoms. METHOD Chronic hemodialysis patients from nine Dutch hospitals with a depression score on the Beck Depression Inventory - second edition (BDI-II) of ≥10, were cluster-randomized into a five modules guided internet-based self-help problem solving therapy intervention or a parallel care-as-usual control group. Clusters were based on hemodialysis shift. The primary outcome depression was measured with the BDI-II. Analysis was performed with linear mixed models. RESULTS A total of 190 hemodialysis patients were cluster-randomized to the intervention (n = 89) or control group (n = 101). Post-intervention measurement was completed by 127 patients (67%) and more than half of the patients (54%) completed the intervention. No significant differences were found on the BDI-II score between the groups (mean difference - 0.1, 95%CI -3.0; 2.7, p = 0.94). Per protocol sensitivity analysis showed comparable results. No significant differences in secondary outcomes were observed between groups. CONCLUSIONS Guided internet-based self-help problem solving therapy for hemodialysis patients with depressive symptoms does not seem to be effective in reducing these symptoms as compared to usual care. Future research should examine how to best design content and accessibility of an intervention for depressive symptoms in hemodialysis patients. TRIAL REGISTRATION Dutch Trial Register: Trial NL6648 (NTR6834) (prospectively registered 13th November 2017).
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Affiliation(s)
- Els Nadort
- Department of Psychiatry, OLVG Hospital, Jan Tooropstraat 164, 1061 AE Amsterdam, the Netherlands; Department of Psychiatry, Amsterdam University Medical Centre and GGZ inGeest, Oldenaller 1, 1081, HJ, Amsterdam, the Netherlands.
| | - Robbert W Schouten
- Department of Nephrology, OLVG hospital, Jan Tooropstraat 164, 1061 AE Amsterdam, the Netherlands.
| | - Rosa E Boeschoten
- Department of Psychiatry, Amsterdam University Medical Centre and GGZ inGeest, Oldenaller 1, 1081, HJ, Amsterdam, the Netherlands.
| | - Yves Smets
- Department of Nephrology, OLVG hospital, Jan Tooropstraat 164, 1061 AE Amsterdam, the Netherlands.
| | - Prataap Chandie Shaw
- Department of Nephrology, Haaglanden Medisch Centrum, Lijnbaan 32, 2512 VA, The Hague, the Netherlands.
| | - Louis Jean Vleming
- Department of Nephrology, HagaZiekenhuis, Els Borst-Eilersplein 275, 2545 AA The Hague, the Netherlands.
| | - Marijke J E Dekker
- Department of Nephrology, Maasstad Ziekenhuis, Maasstadweg 21, 3079 DZ, Rotterdam, the Netherlands.
| | - Michiel Westerman
- Department of Nephrology, Franciscus Gasthuis & Vlietland Ziekenhuis, Kleiweg 500, 3045 PM Rotterdam, the Netherlands.
| | - Ellen K Hoogeveen
- Department of Nephrology, Jeroen Bosch Ziekenhuis, Henri Dunantstraat 1, 5223 GZ s-Hertogenbosch, the Netherlands; Department of Clinical Epidemiology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, the Netherlands.
| | - Willem J W Bos
- Department of Internal Medicine, St. Antonius Ziekenhuis, Koekoekslaan 1, 3435 CM Nieuwegein, the Netherlands; Department of Internal Medicine, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, the Netherlands.
| | - Marcel Schouten
- Department of Nephrology, Tergooi Hospital, Van Riebeeckweg 212, 1213 XZ Hilversum, the Netherlands.
| | - Karima Farhat
- Department of Nephrology, Spaarne Gasthuis, Boerhaavelaan 22, 2035 RC Haarlem, the Netherlands.
| | - Friedo W Dekker
- Department of Clinical Epidemiology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, the Netherlands.
| | - Patricia van Oppen
- Department of Psychiatry, Amsterdam University Medical Centre and GGZ inGeest, Oldenaller 1, 1081, HJ, Amsterdam, the Netherlands.
| | - Birit F P Broekman
- Department of Psychiatry, OLVG Hospital, Jan Tooropstraat 164, 1061 AE Amsterdam, the Netherlands; Department of Psychiatry, Amsterdam University Medical Centre and GGZ inGeest, Oldenaller 1, 1081, HJ, Amsterdam, the Netherlands.
| | - Carl E H Siegert
- Department of Nephrology, OLVG hospital, Jan Tooropstraat 164, 1061 AE Amsterdam, the Netherlands.
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Tully PJ, Ang SY, Lee EJ, Bendig E, Bauereiß N, Bengel J, Baumeister H. Psychological and pharmacological interventions for depression in patients with coronary artery disease. Cochrane Database Syst Rev 2021; 12:CD008012. [PMID: 34910821 PMCID: PMC8673695 DOI: 10.1002/14651858.cd008012.pub4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Depression occurs frequently in individuals with coronary artery disease (CAD) and is associated with a poor prognosis. OBJECTIVES To determine the effects of psychological and pharmacological interventions for depression in CAD patients with comorbid depression. SEARCH METHODS We searched the CENTRAL, MEDLINE, Embase, PsycINFO, and CINAHL databases up to August 2020. We also searched three clinical trials registers in September 2021. We examined reference lists of included randomised controlled trials (RCTs) and contacted primary authors. We applied no language restrictions. SELECTION CRITERIA We included RCTs investigating psychological and pharmacological interventions for depression in adults with CAD and comorbid depression. Our primary outcomes included depression, mortality, and cardiac events. Secondary outcomes were healthcare costs and utilisation, health-related quality of life, cardiovascular vital signs, biomarkers of platelet activation, electrocardiogram wave parameters, non-cardiac adverse events, and pharmacological side effects. DATA COLLECTION AND ANALYSIS Two review authors independently examined the identified papers for inclusion and extracted data from the included studies. We performed random-effects model meta-analyses to compute overall estimates of treatment outcomes. MAIN RESULTS Thirty-seven trials fulfilled our inclusion criteria. Psychological interventions may result in a reduction in end-of-treatment depression symptoms compared to controls (standardised mean difference (SMD) -0.55, 95% confidence interval (CI) -0.92 to -0.19, I2 = 88%; low certainty evidence; 10 trials; n = 1226). No effect was evident on medium-term depression symptoms one to six months after the end of treatment (SMD -0.20, 95% CI -0.42 to 0.01, I2 = 69%; 7 trials; n = 2654). The evidence for long-term depression symptoms and depression response was sparse for this comparison. There is low certainty evidence that psychological interventions may result in little to no difference in end-of-treatment depression remission (odds ratio (OR) 2.02, 95% CI 0.78 to 5.19, I2 = 87%; low certainty evidence; 3 trials; n = 862). Based on one to two trials per outcome, no beneficial effects on mortality and cardiac events of psychological interventions versus control were consistently found. The evidence was very uncertain for end-of-treatment effects on all-cause mortality, and data were not reported for end-of-treatment cardiovascular mortality and occurrence of myocardial infarction for this comparison. In the trials examining a head-to-head comparison of varying psychological interventions or clinical management, the evidence regarding the effect on end-of-treatment depression symptoms is very uncertain for: cognitive behavioural therapy compared to supportive stress management; behaviour therapy compared to person-centred therapy; cognitive behavioural therapy and well-being therapy compared to clinical management. There is low certainty evidence from one trial that cognitive behavioural therapy may result in little to no difference in end-of-treatment depression remission compared to supportive stress management (OR 1.81, 95% CI 0.73 to 4.50; low certainty evidence; n = 83). Based on one to two trials per outcome, no beneficial effects on depression remission, depression response, mortality rates, and cardiac events were consistently found in head-to-head comparisons between psychological interventions or clinical management. The review suggests that pharmacological intervention may have a large effect on end-of-treatment depression symptoms (SMD -0.83, 95% CI -1.33 to -0.32, I2 = 90%; low certainty evidence; 8 trials; n = 750). Pharmacological interventions probably result in a moderate to large increase in depression remission (OR 2.06, 95% CI 1.47 to 2.89, I2 = 0%; moderate certainty evidence; 4 trials; n = 646). We found an effect favouring pharmacological intervention versus placebo on depression response at the end of treatment, though strength of evidence was not rated (OR 2.73, 95% CI 1.65 to 4.54, I2 = 62%; 5 trials; n = 891). Based on one to four trials per outcome, no beneficial effects regarding mortality and cardiac events were consistently found for pharmacological versus placebo trials, and the evidence was very uncertain for end-of-treatment effects on all-cause mortality and myocardial infarction. In the trials examining a head-to-head comparison of varying pharmacological agents, the evidence was very uncertain for end-of-treatment effects on depression symptoms. The evidence regarding the effects of different pharmacological agents on depression symptoms at end of treatment is very uncertain for: simvastatin versus atorvastatin; paroxetine versus fluoxetine; and escitalopram versus Bu Xin Qi. No trials were eligible for the comparison of a psychological intervention with a pharmacological intervention. AUTHORS' CONCLUSIONS In individuals with CAD and depression, there is low certainty evidence that psychological intervention may result in a reduction in depression symptoms at the end of treatment. There was also low certainty evidence that pharmacological interventions may result in a large reduction of depression symptoms at the end of treatment. Moderate certainty evidence suggests that pharmacological intervention probably results in a moderate to large increase in depression remission at the end of treatment. Evidence on maintenance effects and the durability of these short-term findings is still missing. The evidence for our primary and secondary outcomes, apart from depression symptoms at end of treatment, is still sparse due to the low number of trials per outcome and the heterogeneity of examined populations and interventions. As psychological and pharmacological interventions can seemingly have a large to only a small or no effect on depression, there is a need for research focusing on extracting those approaches able to substantially improve depression in individuals with CAD and depression.
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Affiliation(s)
- Phillip J Tully
- School of Medicine, University of Adelaide, Adelaide, Australia
| | - Ser Yee Ang
- School of Medicine, University of Adelaide, Adelaide, Australia
| | - Emily Jl Lee
- School of Medicine, University of Adelaide, Adelaide, Australia
| | - 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
| | - Jürgen Bengel
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg, Germany
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy Institute of Psychology and Education, Ulm University, Ulm, Germany
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Orock A, Yuan T, Greenwood-Van Meerveld B. Importance of Non-pharmacological Approaches for Treating Irritable Bowel Syndrome: Mechanisms and Clinical Relevance. FRONTIERS IN PAIN RESEARCH 2021; 1:609292. [PMID: 35295688 PMCID: PMC8915633 DOI: 10.3389/fpain.2020.609292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 12/14/2020] [Indexed: 11/16/2022] Open
Abstract
Chronic visceral pain represents a major unmet clinical need with the severity of pain ranging from mild to so severe as to prevent individuals from participating in day-to-day activities and detrimentally affecting their quality of life. Although chronic visceral pain can be multifactorial with many different biological and psychological systems contributing to the onset and severity of symptoms, one of the major triggers for visceral pain is the exposure to emotional and physical stress. Chronic visceral pain that is worsened by stress is a hallmark feature of functional gastrointestinal disorders such as irritable bowel syndrome (IBS). Current pharmacological interventions for patients with chronic visceral pain generally lack efficacy and many are fraught with unwanted side effects. Cognitive behavioral therapy (CBT) has emerged as a psychotherapy that shows efficacy at ameliorating stress-induced chronic visceral pain; however, the molecular mechanisms underlying CBT remain incompletely understood. Preclinical studies in experimental models of stress-induced visceral pain employing environmental enrichment (EE) as an animal model surrogate for CBT are unraveling the mechanism by which environmental signals can lead to long-lasting changes in gene expression and behavior. Evidence suggests that EE signaling interacts with stress and nociceptive signaling. This review will (1) critically evaluate the behavioral and molecular changes that lead to chronic pain in IBS, (2) summarize the pharmacological and non-pharmacological approaches used to treat IBS patients, and (3) provide experimental evidence supporting the potential mechanisms by which CBT ameliorates stress-induced visceral pain.
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Affiliation(s)
- Albert Orock
- Oklahoma Center for Neuroscience, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Tian Yuan
- Oklahoma Center for Neuroscience, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Beverley Greenwood-Van Meerveld
- Oklahoma Center for Neuroscience, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
- Oklahoma City VA Health Care System, Oklahoma City, OK, United States
- Department of Physiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
- *Correspondence: Beverley Greenwood-Van Meerveld
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Cosci F, Mansueto G, Fava GA. Relapse prevention in recurrent major depressive disorder. A comparison of different treatment options based on clinical experience and a critical review of the literature. Int J Psychiatry Clin Pract 2020; 24:341-348. [PMID: 32716222 DOI: 10.1080/13651501.2020.1779308] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Reducing the risk of relapses is a critical component of major depressive disorders treatment. Guidelines suggest maintenance with antidepressant drugs in recurrent depression, but this solution has recently been questioned. OBJECTIVE The aim of this article is to provide a critical review of the literature of the main treatment options currently available to prevent relapse and recurrence in depression. METHODS We compared long-term antidepressant therapy (i.e., indefinite maintenance of antidepressant), intermittent antidepressant therapy (i.e., use of antidepressants mainly limited to the acute phases), use of psychotherapy in the sequential model (i.e., pharmacotherapy in the acute phase and psychotherapy in the residual phase). RESULTS We argue that the same solution may not apply to all patients and question the feasibility of a single course of treatment in the setting of complex disorders that are encountered in practice. The clinician should weigh advantages and disadvantages in the individual case. CONCLUSIONS The sequential model appears to be particularly indicated in recurrent depression. KEY POINTS Relapse is a major challenge of depressive disorders treatment Treatment options currently available include long-term antidepressants, intermittent antidepressants, addition of psychotherapy to pharmacotherapy in the sequential model Maintenance with antidepressants in recurrent depression has recently been questioned The sequential model appears to be particularly indicated in recurrent depression.
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Affiliation(s)
- Fiammetta Cosci
- Department of Health Sciences, University of Florence, Florence, Italy.,Department of Psychiatry & Neuropsychology, Maastricht University, Maastricht, the Netherlands
| | - Giovanni Mansueto
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Giovanni Andrea Fava
- Department of Psychiatry, State University of New York at Buffalo, Buffalo, NY, USA
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Abstract
BACKGROUND Interpersonal Psychotherapy (IPT) is an affect- and relationally focused, time-limited treatment supported by research spanning >4 decades. IPT focuses on stressful interpersonal experiences of loss, life changes, disputes, and social isolation. It emphasizes the role of relationships in recovery. This scoping review describes, within a historical perspective, IPT's evolution as an evidence-supported treatment of psychiatric disorders. METHODS English-language publications (n = 1119) identified via EMBASE, MEDLINE, PsycINFO, and Web of Science databases (1974-2017), augmented with manual reference searches, were coded for clinical focus, population demographics, format, setting, publication type, and research type. Quantitative and qualitative analyses identified IPT publications' characteristics and trends over four epochs of psychotherapy research. RESULTS IPT literature primarily focused on depression (n = 772 articles; 69%), eating disorders (n = 135; 12%), anxiety disorders (n = 68; 6%), and bipolar disorder (n = 44; 4%), with rising publication rates and numbers of well-conducted randomized, controlled trials over time, justifying inclusion in consensus treatment guidelines. Research trends shifted from efficacy trials to effectiveness studies and population-based dissemination initiatives. Process research examined correlates of improvement and efficacy moderators. Innovations included global initiatives, prevention trials, and digital, web-based training and treatment. CONCLUSION Sparked by clinical innovations and scientific advances, IPT has evolved as an effective treatment of psychiatric disorders across the lifespan for diverse patients, including underserved clinical populations. Future research to elucidate mechanisms of change, improve access, and adapt to changing frameworks of psychopathology and treatment planning is needed. IPT addresses the universal centrality of relationships to mental health, which is as relevant today as it was over 40 years ago.
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15
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Anderson J, O Moore K, Faraj M, Proudfoot J. Stepped care mental health service in Australian primary care: codesign and feasibility study. AUST HEALTH REV 2019; 44:873-879. [PMID: 31662177 DOI: 10.1071/ah19078] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 06/24/2019] [Indexed: 11/23/2022]
Abstract
Objective In 2015, the Australian Government introduced several mental health reforms, including the requirement that Primary Health Networks (PHNs) provide stepped care services for Australians with mental health needs such as anxiety and depression. This paper reports on the development and feasibility study of StepCare, an online stepped mental healthcare service in general practice that screens patients, provides immediate feedback to patients and general practitioners (GPs), transmits stepped treatment recommendations to GPs and monitors patients' progress, including notification of deterioration. Methods The present codesign and feasibility study in one PHN examined: (1) the acceptability and feasibility of StepCare to GPs, practice staff and patients; (2) the impact of StepCare on clinical practice; and (3) the barriers to and facilitators of implementation. Results Thirty-two GPs, 22 practice staff and 418 patients participated in the study. Overall, patients, practice staff and GPs found StepCare acceptable and feasible, commending its privacy, the mental health screening, monitoring and feedback. They also made suggestions for service improvements. GPs reported that StepCare helped with their identification and management of patients with common mental health issues. Conclusions Preliminary data suggest that StepCare may be acceptable and feasible in Australian general practice, helping GPs identify and manage common mental health problems in their patients. The study provides implications for policy and practice, and points the way to future translational research into stepped mental health care. What is known about the topic? Depression and anxiety are common illnesses in primary care and GPs are ideally placed to implement stepped care approaches enabling early detection and accessible, effective care. What does this paper add? Developed in and for general practice, StepCare is the first fully integrated stepped approach to primary mental health care in Australia. As a first step in a translational research program evaluating the effectiveness of StepCare, this paper reports data regarding the feasibility and acceptability of the service. What are the implications for practitioners? Integrated into the workflow of general practice, StepCare is an online service that helps GPs detect new cases of depression and anxiety, provide evidence-based stepped care treatments and monitor patients' progress.
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Affiliation(s)
- Josephine Anderson
- Black Dog Institute, Hospital Road, Randwick, NSW 2031, Australia. , ; and Corresponding author.
| | - Kathleen O Moore
- Black Dog Institute, Hospital Road, Randwick, NSW 2031, Australia. ,
| | - Mariam Faraj
- Central and Eastern Sydney Primary Health Network, Coward Street, Mascot, NSW, Australia.
| | - Judith Proudfoot
- Black Dog Institute, Hospital Road, Randwick, NSW 2031, Australia. ,
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van der Zweerde T, Bisdounis L, Kyle SD, Lancee J, van Straten A. Cognitive behavioral therapy for insomnia: A meta-analysis of long-term effects in controlled studies. Sleep Med Rev 2019; 48:101208. [PMID: 31491656 DOI: 10.1016/j.smrv.2019.08.002] [Citation(s) in RCA: 131] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 04/25/2019] [Accepted: 08/07/2019] [Indexed: 11/19/2022]
Abstract
Cognitive behavioral therapy for insomnia (CBT-I) is a treatment with moderate to large effects. These effects are believed to be sustained long-term, but no systematic meta-analyses of recent evidence exist. In this present meta-analysis, we investigate long-term effects in 30 randomized controlled trials (RCTs) comparing CBT-I to non-active control groups. The primary analyses (n = 29 after excluding one study which was an outlier) showed that CBT-I is effective at 3-, 6- and 12-mo compared to non-active controls: Hedges g for Insomnia severity index: 0.64 (3 m), 0.40 (6 m) and 0.25 (12 m); sleep onset latency: 0.38 (3 m), 0.29 (6 m) and 0.40 (12 m); sleep efficiency: 0.51 (3 m), 0.32 (6 m) and 0.35 (12 m). We demonstrate that although effects decline over time, CBT-I produces clinically significant effects that last up to a year after therapy.
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Affiliation(s)
- Tanja van der Zweerde
- Department of Clinical Psychology, Amsterdam Public Health, VU University, Amsterdam, the Netherlands.
| | - Lampros Bisdounis
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands
| | - Simon D Kyle
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom
| | - Jaap Lancee
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands; PsyQ Amsterdam, Amsterdam, the Netherlands
| | - Annemieke van Straten
- Department of Clinical Psychology, Amsterdam Public Health, VU University, Amsterdam, the Netherlands
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Economic Evaluations of Stepped Models of Care for Depression and Anxiety and Associated Implementation Strategies: A Review of Empiric Studies. Int J Integr Care 2019; 19:8. [PMID: 31244562 PMCID: PMC6588024 DOI: 10.5334/ijic.4157] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Since the mid-2000s stepped care, a model of integrated healthcare delivery, has been promoted for offering accessible, effective and efficient services for individuals with mental health conditions. However, adoption of the model has not been widespread warranting additional investment by way of implementation strategies to encourage uptake. These strategies also require funding and their value for money should be assessed to inform decision making and practice. We conducted a review to better understand the extent to which the cost-effectiveness of stepped care has been evaluated (review i) and also to investigate whether economic evaluation has been applied to implementation strategies of stepped care services for anxiety and depression in developed (high income) countries and to chart their methods and outcomes (review ii). The searches were conducted in six electronic databases, grey literature and relevant journals. The search strategies returned two papers for reviews (i) and a single paper for review (ii). Despite stepped care models of integrated mental health service provision being promoted as optimal, there is limited knowledge surrounding the real-world cost-effectiveness of their application and clearly a need for good quality economic evaluations of integrated care that comply with international guidelines of good practice. There is even less information pertaining to the cost-effectiveness and budget impact of strategies designed to increase the uptake of these models.
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Feasibility and impact of a guided symptom exposure augmented cognitive behavior therapy protocol to prevent symptoms of pharmacologically induced depression: A pilot study. COGNITIVE THERAPY AND RESEARCH 2019; 43:679-692. [PMID: 31777409 DOI: 10.1007/s10608-018-09990-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Depression is the leading cause of disability and a major cause of morbidity worldwide, with societal costs now upwards of 1 trillion dollars across the globe. Hence, extending current efforts to augment prevention outcomes is consistent with global public health interests. Although many prevention programs have been developed and have demonstrated efficacy, studies have yet to demonstrate that CBT is effective in preventing symptoms in populations at risk for developing depression induced by pharmacological substances. Using a randomized, controlled design, this pilot study reports on the feasibility and preliminary effects of a novel, guided symptom exposure augmented cognitive behavioral prevention intervention (GSE-CBT) in a sample diagnosed with Hepatitis C at risk for developing medication induced depression. Results demonstrated that the guided symptom exposure augmented CBT (GSE-CBT) was feasible in this population and was delivered with high integrity. Although not statistically different, we observed a pattern of lower depression levels in the GSE-CBT group versus those in the control group throughout. This pilot study demonstrates that a psychosocial prevention intervention is feasible for use in patients at risk for developing pharmacologically induced depression and that a guided symptom exposure augmented CBT protocol has the potential to prevent symptoms of depression that develop as a side effect to taking these medications. Results are preliminary and future studies should use larger samples and test the intervention in other populations.
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The effects of psychological meaning-centered therapies on quality of life and psychological stress: A metaanalysis. Palliat Support Care 2018; 16:608-632. [PMID: 30246682 DOI: 10.1017/s1478951517000931] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
ABSTRACTObjective:Many psychotherapists speak with clients about meaning in life. Meaning is an neutral evidence-based term for a subjective sense of purpose, values, understanding, self-worth, action-directed goals, and self-regulation. Since little is known about its effectiveness, our study aimed to determine the effects of meaning-centered therapies (MCTs) on improving quality of life and reducing psychological stress. METHOD Independent researchers selected and scored articles in multiple languages in multiple search engines. Weighted pooled mean effects were calculated following a random-effects model. Sensitivity analyses included moderators, study and sample characteristics, risk of bias, randomization, types of MCT, control condition, and outcome instruments. RESULTS Some 52,220 citations included 60 trials (total sample N = 3,713), of which 26 were randomized controlled trials (N = 1,975), 15 nonrandomized controlled trials (N = 709), and 19 nonrandomized noncontrolled trials with pre/post measurements (N = 1,029). Overall analyses showed large improvements from baseline to immediate posttreatment and follow-up on quality of life (Hedges' g = 1.13, SE = 0.12; g = 0.99, SE = 0.20) and psychological stress (g = 1.21, SE = 0.10; g = 0.67, SE = 0.20). As effects varied between studies, further analyses focused only on controlled trials: MCT had large effect sizes compared to control groups, both immediate and at follow-up, on quality of life (g = 1.02, SE = 0.06; g = 1.06, SE = 0.12) and psychological stress (g = 0.94, SE = 0.07, p < 0.01; g = 0.84, SE = 0.10). Immediate effects were larger for general quality of life (g = 1.37, SE = 0.12) than for meaning in life (g = 1.18, SE = 0.08), hope and optimism (g = 0.80, SE = 0.13), self-efficacy (g = 0.89, SE = 0.14), and social well-being (g = 0.81, SE = 13). The homogeneity of these results was validated by the lack of significance of moderators and alternative ways of selecting studies. Metaregression analyses showed that increases in meaning in life predicted decreases in psychological stress (β = -0.56, p < 0.001). SIGNIFICANCE OF RESULTS MCT strongly improves quality of life and reduces psychological stress. MCT should be made more widely available, particularly to individuals in transitional moments in life or with a chronic or life-threatening physical illness as they explicitly report meaning-centered concerns.
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Onuigbo LN, Eseadi C, Ebifa S, Ugwu UC, Onyishi CN, Oyeoku EK. Effect of Rational Emotive Behavior Therapy Program on Depressive Symptoms Among University Students with Blindness in Nigeria. JOURNAL OF RATIONAL-EMOTIVE AND COGNITIVE-BEHAVIOR THERAPY 2018. [DOI: 10.1007/s10942-018-0297-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Prothero L, Barley E, Galloway J, Georgopoulou S, Sturt J. The evidence base for psychological interventions for rheumatoid arthritis: A systematic review of reviews. Int J Nurs Stud 2018; 82:20-29. [PMID: 29573593 DOI: 10.1016/j.ijnurstu.2018.03.008] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 03/04/2018] [Accepted: 03/09/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Psychological interventions are an important but often overlooked adjunctive treatment option for patients with rheumatoid arthritis. Findings from systematic reviews of psychological interventions for this patient group are conflicting. A systematic review of reviews can explain inconsistencies between studies and provide a clearer understanding of the effects of interventions. OBJECTIVES To: 1) determine the effectiveness of psychological interventions in improving biopsychosocial outcomes for adults with rheumatoid arthritis, 2) determine the relationship between the intensity of the psychological interventions (number of sessions, duration of sessions, duration of intervention) on outcomes, and 3) assess the impact of comparator group (usual care, education only) on outcomes. DESIGN We conducted a systematic review of reviews using the following inclusion criteria: 1) randomised controlled trials of psychological interventions (including cognitive behavioural therapy, supportive counselling, psychotherapy, self-regulatory techniques, mindfulness-based cognitive therapy and disclosure therapy) provided as an adjunct to medication, 2) included rheumatoid arthritis patients aged ≥ 18 years, 3) reported findings for at least 1 of the primary outcomes: pain, fatigue, psychological status, functional disability and disease activity and 4) were published in English between January 2000 and March 2015 (updated January 2018). DATA SOURCES We searched in MEDLINE, EMBASE, CINAHL, PsycINFO, the Cochrane Database of Systematic Reviews and the Database of Abstracts of Reviews of Effects. Reference lists were searched for additional reviews. REVIEW METHODS Study selection and 50% of the quality assessments were performed by two independent reviewers. Methodological quality was measured using the Assessment of Multiple Systematic Reviews checklist. Data extraction was conducted by one reviewer using a predesigned data extraction form. RESULTS Eight systematic reviews met inclusion criteria (one review was excluded due to its low-quality score). Small post intervention improvements in patient global assessment, functional disability, pain, fatigue, anxiety and depression were observed. The effect on coping, self-efficacy and physical activity was greater. Improvements in depression, coping and physical activity were maintained (8.5-14 months). Interventions delivered over a longer period with a maintenance component appeared more effective. Attention, education, and placebo control groups produced some improvements but not as large as those produced by the psychological interventions. CONCLUSIONS Psychological interventions result in small to moderate improvements in biopsychosocial outcomes for patients with rheumatoid arthritis in addition to those achieved by standard care. Several priorities for future research were identified, including determining the cost effectiveness of non-psychologically trained health professionals delivering psychological interventions.
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Affiliation(s)
- Louise Prothero
- Department of Inflammation Biology, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, 10 Cutcombe Road, Denmark Hill, London, SE5 9RJ, UK; Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, 57 Waterloo Road, London, SE1 8WA, UK.
| | - Elizabeth Barley
- College of Nursing, Midwifery and Healthcare, University of West London, Boston Manor Road, Brentford, Middlesex, TW8 9GA, UK.
| | - James Galloway
- Department of Inflammation Biology, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, 10 Cutcombe Road, Denmark Hill, London, SE5 9RJ, UK.
| | - Sofia Georgopoulou
- Department of Inflammation Biology, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, 10 Cutcombe Road, Denmark Hill, London, SE5 9RJ, UK; School of Psychology, University of East London, Water Lane, London, E15 4LZ, UK.
| | - Jackie Sturt
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, 57 Waterloo Road, London, SE1 8WA, UK.
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Osma J, Suso-Ribera C, García-Palacios A, Crespo-Delgado E, Robert-Flor C, Sánchez-Guerrero A, Ferreres-Galan V, Pérez-Ayerra L, Malea-Fernández A, Torres-Alfosea MÁ. Efficacy of the unified protocol for the treatment of emotional disorders in the Spanish public mental health system using a group format: study protocol for a multicenter, randomized, non-inferiority controlled trial. Health Qual Life Outcomes 2018. [PMID: 29530035 PMCID: PMC5848595 DOI: 10.1186/s12955-018-0866-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Background Emotional disorders, which include both anxiety and depressive disorders, are the most prevalent psychological disorders according to recent epidemiological studies. Consequently, public costs associated with their treatment have become a matter of concern for public health systems, which face long waiting lists. Because of their high prevalence in the population, finding an effective treatment for emotional disorders has become a key goal of today’s clinical psychology. The Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders might serve the aforementioned purpose, as it can be applied to a variety of disorders simultaneously and it can be easily performed in a group format. Methods The study is a multicenter, randomized, non-inferiority controlled clinical trial. Participants will be 220 individuals with emotional disorders, who are randomized to either a treatment as usual (individual cognitive behavioral therapy) or to a Unified Protocol condition in group format. Depression, anxiety, and diagnostic criteria are the primary outcome measures. Secondary measures include the assessment of positive and negative affect, anxiety control, personality traits, overall adjustment, and quality of life. An analysis of treatment satisfaction is also conducted. Assessment points include baseline, post-treatment, and three follow-ups at 3, 6, and 12 months. To control for missing data and possible biases, intention-to-treat and per-protocol analyses will be performed. Discussion This is the first randomized, controlled clinical trial to test the effectiveness of a transdiagnostic intervention in a group format for the treatment of emotional disorders in public settings in Spain. Results obtained from this study may have important clinical, social, and economic implications for public mental health settings in Spain. Trial registration Retrospectively registered at https://clinicaltrials.gov/. Trial NCT03064477 (March 10, 2017). The trial is active and recruitment is ongoing. Recruitment is expected to finish by January 2020.
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Affiliation(s)
- Jorge Osma
- University of Zaragoza, Teruel, Spain. .,Instituto de Investigación Sanitaria de Aragón, Zaragoza, Spain. .,Facultad de Ciencias Sociales y Humanas, Universidad de Zaragoza, C/ Ciudad Escolar s/n, 44003, Teruel, Spain.
| | - Carlos Suso-Ribera
- Universitat Jaume I. Edificio de Investigación II, Av. Vicente SosBaynat s/n, 12006, Castellón, Spain
| | - Azucena García-Palacios
- CIBER of Physiopathology of Obesity and Nutrition CIBERobn, CB06/03 Instituto de Salud Carlos III, Castellón, Spain
| | - Elena Crespo-Delgado
- Universitat Jaume I. Edificio de Investigación II, Av. Vicente SosBaynat s/n, 12006, Castellón, Spain
| | - Cristina Robert-Flor
- Unidad de Salud Mental La Fuente de San Luís, C/ Arabista Ambrosio Huici, 30, 46013, Valencia, Spain
| | - Ana Sánchez-Guerrero
- Unidad de Salud Mental La Fuente de San Luís, C/ Arabista Ambrosio Huici, 30, 46013, Valencia, Spain
| | - Vanesa Ferreres-Galan
- Hospital Comarcal de Vinaròs, Avinguda Gil d'Atrosillo, s/n, 12500, Castellón, Spain
| | - Luisa Pérez-Ayerra
- Centro de Salud Mental La Milagrosa, C/ Julián Gayarre, 1A, 31005, Pamplona, Spain
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Cuijpers P, de Wit L, Kleiboer A, Karyotaki E, Ebert DD. Problem-solving therapy for adult depression: An updated meta-analysis. Eur Psychiatry 2018; 48:27-37. [PMID: 29331596 DOI: 10.1016/j.eurpsy.2017.11.006] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 11/08/2017] [Accepted: 11/09/2017] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Problem-solving therapy (PST) is one of the best examined types of psychotherapy for adult depression. No recent meta-analysis has examined the effects of PST compared to control groups or to other treatments. We wanted to verify whether PST is effective, whether effects are comparable to those of other treatments, and whether we could identify the possible sources of high heterogeneity that was found in earlier meta-analyses. METHODS We conducted systematic searches in bibliographical databases, including PubMed, PsycInfo, Embase and the Cochrane database of randomized trials. RESULTS We included 30 randomized controlled trials on PST (with 3530 patients), in which PST was compared to control conditions, with other therapies, and with pharmacotherapy. We could compare these 30 trials on PST also with 259 trials on other psychotherapies for adult depression. The effect size of PST versus control groups was g=0.79 (0.57-1.01) with very high heterogeneity (I2=84; 95% CI: 77-88). The effect size from the 9 studies with low risk of bias was g=0.34 (95% CI: 0.22-0.46) with low heterogeneity (I2=32; 95% CI: 0-68), which is comparable to the effects of other psychotherapies. PST was a little more effective than other therapies in direct comparisons, but that may be explained by the considerable number of studies with researcher allegiance towards PST. In meta-regression analyses of all controlled studies, no significant difference between PST and other therapies was found. CONCLUSION PST is probably an effective treatment for depression, with effect sizes that are small, but comparable to those found for other psychological treatments of depression.
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Affiliation(s)
- Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, The Netherlands.
| | - Leonore de Wit
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, The Netherlands
| | - Annet Kleiboer
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, The Netherlands
| | - Eirini Karyotaki
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, The Netherlands
| | - David D Ebert
- Clinical Psychology and Psychotherapy, Institute for Psychology, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
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van Luenen S, Garnefski N, Spinhoven P, Spaan P, Dusseldorp E, Kraaij V. The Benefits of Psychosocial Interventions for Mental Health in People Living with HIV: A Systematic Review and Meta-analysis. AIDS Behav 2018; 22:9-42. [PMID: 28361453 PMCID: PMC5758656 DOI: 10.1007/s10461-017-1757-y] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
In this systematic review and meta-analysis we investigated the effectiveness of different psychosocial treatments for people living with HIV (PLWH) and mental health problems. Additionally, characteristics that may influence the effectiveness of a treatment (e.g., treatment duration) were studied. PubMed, PsycINFO and Embase were searched for randomized controlled trials on psychosocial interventions for PLWH. Depression, anxiety, quality of life, and psychological well-being were investigated as treatment outcome measures. Sixty-two studies were included in the meta-analysis. It was found that psychosocial interventions for PLWH had a small positive effect on mental health (ĝ = 0.19, 95% CI [0.13, 0.25]). Furthermore, there was evidence for publication bias. Six characteristics influenced the effectiveness of a treatment for depression. For example, larger effects were found for studies with psychologists as treatment providers. To conclude, this systematic review and meta-analysis suggests that psychosocial interventions have a beneficial effect for PLWH with mental health problems.
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Affiliation(s)
- Sanne van Luenen
- Section of Clinical Psychology, Institute of Psychology, Faculty of Social and Behavioural Sciences, Leiden University, P.O. Box 9555, 2300 RB, Leiden, The Netherlands.
| | - Nadia Garnefski
- Section of Clinical Psychology, Institute of Psychology, Faculty of Social and Behavioural Sciences, Leiden University, P.O. Box 9555, 2300 RB, Leiden, The Netherlands
| | - Philip Spinhoven
- Section of Clinical Psychology, Institute of Psychology, Faculty of Social and Behavioural Sciences, Leiden University, P.O. Box 9555, 2300 RB, Leiden, The Netherlands
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
| | - Pascalle Spaan
- Section of Clinical Psychology, Institute of Psychology, Faculty of Social and Behavioural Sciences, Leiden University, P.O. Box 9555, 2300 RB, Leiden, The Netherlands
| | - Elise Dusseldorp
- Section of Methodology and Statistics, Institute of Psychology, Leiden University, Leiden, The Netherlands
| | - Vivian Kraaij
- Section of Clinical Psychology, Institute of Psychology, Faculty of Social and Behavioural Sciences, Leiden University, P.O. Box 9555, 2300 RB, Leiden, The Netherlands
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Cuijpers P, Gentili C. Psychological treatments are as effective as pharmacotherapies in the treatment of adult depression: a summary from Randomized Clinical Trials and neuroscience evidence. ACTA ACUST UNITED AC 2017; 20:273. [PMID: 32913741 PMCID: PMC7451304 DOI: 10.4081/ripppo.2017.273] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 06/28/2017] [Accepted: 06/28/2017] [Indexed: 11/25/2022]
Affiliation(s)
- Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, the Netherlands
| | - Claudio Gentili
- Department of General Psychology, University of Padua, Italy
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Cordero-Andrés P, González-Blanch C, Umaran-Alfageme O, Muñoz-Navarro R, Ruíz-Rodríguez P, Medrano LA, Hernández-de Hita F, Pérez-Poo T, Cano-Vindel A. Tratamiento psicológico de los trastornos emocionales en atención primaria: fundamentos teóricos y empíricos del estudio PsicAP. ANSIEDAD Y ESTRÉS 2017. [DOI: 10.1016/j.anyes.2017.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Madsen MT, Isbrand A, Andersen UO, Andersen LJ, Taskiran M, Simonsen E, Gögenur I. The effect of MElatonin on Depressive symptoms, Anxiety, CIrcadian and Sleep disturbances in patients after acute coronary syndrome (MEDACIS): study protocol for a randomized controlled trial. Trials 2017; 18:81. [PMID: 28228148 PMCID: PMC5322602 DOI: 10.1186/s13063-017-1806-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 01/20/2017] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Depression following acute coronary syndrome (ACS) constitutes a serious and debilitating problem. Approximately one in five patients will develop significant depression following ACS and less severe depressive symptoms are even more frequent. Furthermore, anxiety symptoms and sleep-wake disturbances are frequent. The objective of the MEDACIS trial is to investigate whether prophylactic treatment with melatonin has a preventive effect on depression, depressive and anxiety symptoms, sleep, and circadian disturbances following ACS. METHODS/DESIGN "The effect of MElatonin and Depressive symptoms, Anxiety, CIrcadian and Sleep disturbances in patients after acute coronary syndrome" trial (MEDACIS) is a multicenter, double-blinded, placebo-controlled, randomized clinical trial. A total of 240 patients with ACS and no depressive symptoms will be included in the trial for treatment with either 25 mg melatonin or placebo for a 12-week period. Development and severity of depressive symptoms will be evaluated using Major Depression Inventory every 2 weeks with the purpose of investigating the potential preventive effect of melatonin on depressive symptoms. DISCUSSION Previously, only selective serotonin reuptake inhibitors (SSRIs) have been investigated in a primary preventive setup in patients following ACS. However, SSRIs are associated with several side effects. An ideal intervention would constitute the highest degree of prevention of depressive symptoms with the lowest risk of side effects. In this regard, melatonin may have advantages due to its low toxicity as well as its proven anxiolytic and hypnotic effects. TRIAL REGISTRATION ClinicalTrials.gov, Identifier: NCT02451293 . Registered on 12 May 2015. EudraCT nr. 2015-002116-32.
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Affiliation(s)
- Michael Tvilling Madsen
- Department of Surgery, Zealand University Hospital, University of Copenhagen, Lykkebaekvej 1, 4600 Koege, Denmark
- Department of Cardiology, Zealand University Hospital, Lykkebaekvej 1, 4600 Koege, Denmark
- Department of Cardiology, Holbaek Hospital, Smedelundsgade 60, 4300 Holbaek, Denmark
- Department of Cardiology, Zealand University Hospital, Roskilde, Koegevej 7-13, 4000 Roskilde, Denmark
- Psychiatric Research Unit, Region Zealand, Faelledvej 6, Bygning 3, 4. Sal., 4200 Slagelse, Denmark
| | - Anders Isbrand
- Department of Cardiology, Zealand University Hospital, Lykkebaekvej 1, 4600 Koege, Denmark
| | | | - Lars Juel Andersen
- Department of Cardiology, Zealand University Hospital, Roskilde, Koegevej 7-13, 4000 Roskilde, Denmark
| | - Mustafa Taskiran
- Department of Cardiology, Zealand University Hospital, Lykkebaekvej 1, 4600 Koege, Denmark
| | - Erik Simonsen
- Psychiatric Research Unit, Region Zealand, Faelledvej 6, Bygning 3, 4. Sal., 4200 Slagelse, Denmark
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ismail Gögenur
- Department of Surgery, Zealand University Hospital, University of Copenhagen, Lykkebaekvej 1, 4600 Koege, Denmark
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Syunyakov TS, Neznamov GG. [Evaluation of the therapeutic efficacy and safety of the selective anxiolytic afobazole in generalized anxiety disorder and adjustment disorders: Results of a multicenter randomized comparative study of diazepam]. TERAPEVT ARKH 2017; 88:73-86. [PMID: 27636931 DOI: 10.17116/terarkh201688873-86] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
AIM to summarize the previously published results of a multicenter randomized clinical research phase III study trial of afobazole (INN: fabomotizole) versus diazepam in the treatment of patients with generalized anxiety disorder (GAD) and adjustment disorders (AD). SUBJECTS AND METHODS Five investigating centers included 150 patients aged 18 to 60 years (60 patients with GAD and 90 with AD) a simple structure of anxiety disorders without concurrent mental, neurological or somatic disorders. Patients were randomized to take afobazole (30 mg/day; n=100) or diazepam (30 mg/day; n=50) for 30 days. Prior to drug administration, patients susceptible to placebo were excluded according to the results of its 7-day use. Withdrawal syndrome was evaluated within 10 days after completion of active therapy. The primary efficacy endpoint was the change of Hamilton Anxiety Rating Scale (HAMA) total score. The scores of the Clinical Global Impression (CGI) Scale and the Sheehan Scale as secondary efficacy endpoints were analyzed. Drug safety was evaluated by assessment of adverse events. RESULTS Afobazole and diazepam caused a significant reduction of HAMA total score. In the afobazole group, the reduction of anxiety exceeded that in the diazepam group (the difference in the total score changes was 2.93 [0.67; 5.19]; p=0,01).The proportion of patients with reduction of disease severity was 72% in the afobazole group and 58% in the diazepam group. After therapy completion, the proportion of patients with no or mild disorder in the afobazole group was significantly higher than that in the diazepam group (69 and 44%, respectively; χ2=12.46; p=0,014). There was a trend toward a higher subjective patient-rated estimate of the afobazole effect using the Sheehan scale. There were a total of 15 and 199 adverse events in the afobazole and diazepam groups, respectively. No manifestations of afobazole withdrawal syndrome were found. Diazepam withdrawal syndrome was observed in 34 (68%) patients. CONCLUSION Afobazole is an effective and safe drug to treat patients with GAD and AD and non-inferior than diazepam in the treatment of these disorders, however it is superior in terms of several variables, including the safety profile.
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Affiliation(s)
- T S Syunyakov
- V.V. Zakusov Research Institute of Pharmacology, Moscow, Russia
| | - G G Neznamov
- V.V. Zakusov Research Institute of Pharmacology, Moscow, Russia
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29
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Li M, Kennedy EB, Byrne N, Gérin-Lajoie C, Katz MR, Keshavarz H, Sellick S, Green E. Systematic review and meta-analysis of collaborative care interventions for depression in patients with cancer. Psychooncology 2016; 26:573-587. [PMID: 27643388 DOI: 10.1002/pon.4286] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 08/17/2016] [Accepted: 09/15/2016] [Indexed: 01/06/2023]
Abstract
BACKGROUND Previous systematic reviews have found limited evidence for the effectiveness of pharmacological and psychological interventions for the management of depression in patients with cancer. This paper provides the first meta-analysis of newer collaborative care interventions, which may include both types of treatment, as well as integrated delivery and follow-up. Meta-analyses of pharmacological and psychological interventions are included as a comparison. METHODS A search of MEDLINE, EMBASE, PsycINFO, and the Cochrane Library from July 2005 to January 2015 for randomized controlled trials of depression treatments for cancer patients diagnosed with a major depressive disorder, or who met a threshold on a validated depression rating scale was conducted. Meta-analyses were conducted using summary data. RESULTS Key findings included eight reports of four collaborative care interventions, eight pharmacological, and nine psychological trials. A meta-analysis demonstrated that collaborative care interventions were significantly more effective than usual care (standardized mean difference = -0.49, p = 0.003), and depression reduction was maintained at 12 months. By comparison, short-term (up to 12 weeks), but not longer-term effectiveness was demonstrated for both pharmacological and psychological interventions. CONCLUSIONS Collaborative care interventions have newly emerged as multidisciplinary care delivery models, which may result in more long-term depression remission. This review also updates previous findings of modest evidence for the effectiveness of both pharmacological and psychological interventions for threshold depression in cancer patients. Research designs focusing on combined treatments and delivery systems may best further the limited evidence-base for the management of depression in cancer.
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Affiliation(s)
- Madeline Li
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Erin B Kennedy
- Cancer Care Ontario, Program in Evidence-based Care/McMaster University, Hamilton, Ontario, Canada
| | - Nelson Byrne
- Trillium Health Partners, Mississauga Halton-Central West Regional Cancer Program, Mississauga, Ontario, Canada
| | | | - Mark R Katz
- Stronach Regional Cancer Centre, Southlake Regional Health Centre, Ontario, Canada
| | - Homa Keshavarz
- Cancer Care Ontario, Program in Evidence-based Care/McMaster University, Hamilton, Ontario, Canada
| | - Scott Sellick
- Thunder Bay Regional Health Sciences Centre, Thunder Bay, Ontario, Canada
| | - Esther Green
- Nursing and Psychosocial Oncology, Cancer Care Ontario, Toronto, Ontario, Canada
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Boeschoten RE, Dekker J, Uitdehaag BMJ, Beekman ATF, Hoogendoorn AW, Collette EH, Cuijpers P, Nieuwenhuis MM, van Oppen P. Internet-based treatment for depression in multiple sclerosis: A randomized controlled trial. Mult Scler 2016; 23:1112-1122. [DOI: 10.1177/1352458516671820] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Depression in multiple sclerosis (MS) patients is common but may stay untreated. Physical limitations impede face-to-face treatment. Internet-based treatment is therefore a promising tool for treating depression in MS. Objectives: To investigate effectiveness of a guided Internet-based problem-solving treatment (IPST) for depressed MS patients. Methods: MS patients with moderate or severe depressive symptoms were randomly assigned to IPST or a wait list control. Primary outcome was the change in depressive symptoms defined by a change in sum score on the Beck Depression Inventory Second Edition (BDI-II). Assessments took place at baseline (T0), within a week after the intervention (T1), and at 4 months follow-up (T2). Analyses were based on the intention-to-treat principle. Results: A total of 171 patients were randomized to IPST ( n = 85) or a wait list control ( n = 86). T1 was completed by 152 (89%) and T2 by 131 patients (77%). The IPST group and wait list control showed large significant improvements in depressive symptoms, but no differences were found between groups at T1 ( d = 0.23; 95% confidence interval (CI) = (−4.03, 1.08); p = 0.259) and T2 ( d = 0.01; 95% CI = (−2.80, 2.98); p = 0.953). Conclusion: We found no indication that IPST for MS patients with moderate or severe depression is effective in reducing depressive symptoms compared to a waiting list. Large improvements in the wait list control were unexpected and are discussed.
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Affiliation(s)
- Rosa E Boeschoten
- EMGO+ Institute for Mental Health and Care Research/Department of Psychiatry, VU University Medical Center/GGZinGeest, Amsterdam, The Netherlands
| | - Joost Dekker
- Department of Psychiatry, VU University Medical Center/GGZinGeest, Amsterdam, The Netherlands/EMGO+ Institute for Mental Health and Care Research, VU University, Amsterdam, The Netherlands; Department of Rehabilitation Medicine, VU University Medical Center Amsterdam, The Netherlands
| | - Bernard MJ Uitdehaag
- Department of Neurology, Multiple Sclerosis Center, VU University Medical Center, Amsterdam, The Netherlands
| | - Aartjan TF Beekman
- EMGO+ Institute for Mental Health and Care Research/Department of Psychiatry, VU University Medical Center/GGZinGeest, Amsterdam, The Netherlands
| | - Adriaan W Hoogendoorn
- EMGO+ Institute for Mental Health and Care Research/Department of Psychiatry, VU University Medical Center/GGZinGeest, Amsterdam, The Netherlands
| | - Emma H Collette
- Department of Medical Psychology, VU University Medical Center, Amsterdam, The Netherlands
| | - Pim Cuijpers
- EMGO+ Institute for Mental Health and Care Research, VU University, Amsterdam, The Netherlands/Department of Clinical, Neuro & Developmental Psychology, VU University, Amsterdam, The Netherlands
| | - Magdalena M Nieuwenhuis
- EMGO+ Institute for Mental Health and Care Research/Department of Psychiatry, VU University Medical Center/GGZinGeest, Amsterdam, The Netherlands
| | - Patricia van Oppen
- EMGO+ Institute for Mental Health and Care Research/Department of Psychiatry, VU University Medical Center/GGZinGeest, Amsterdam, The Netherlands
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Li M, Kennedy EB, Byrne N, Gérin-Lajoie C, Katz MR, Keshavarz H, Sellick S, Green E. Management of Depression in Patients With Cancer: A Clinical Practice Guideline. J Oncol Pract 2016; 12:747-56. [PMID: 27382000 DOI: 10.1200/jop.2016.011072] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
PURPOSE This report updates the Cancer Care Ontario Program in Evidence-Based Care guideline for the management of depression in adult patients with cancer. This guideline covers pharmacologic, psychological, and collaborative care interventions, with a focus on integrating practical management tools to assist clinicians in delivering appropriate treatments for depression in patients with cancer. METHODS Recommendations were developed by synthesizing information from extant guidelines and reviews and searching for randomized controlled trials from the date of database inception (1964 for MEDLINE and 1974 for EMBASE) to January 2015. Quality assessment of guidelines and systematic reviews were conducted by using the Appraisal of Guidelines for Research and Evaluation II (AGREE II), Assessment of Multiple Systematic Reviews (AMSTAR), and Cochrane Risk of Bias tools. Final recommendations were developed through a standardized Program in Evidence-Based Care multidisciplinary expert and knowledge user review process. RESULTS Two high-quality relevant clinical practice guidelines, eight pharmacologic trials, nine psychological trials, and eight collaborative care intervention trials composed the evidence base upon which the recommendations were developed. Eight specific recommendations were made to establish a standard of care for the management of depression in patients with cancer. The recommendations and practical management tools were reviewed as being well organized and helpful, although systemic barriers to implementation were identified. CONCLUSION This updated guideline supports the previous general recommendation that patients with cancer who have depression may benefit from psychological and/or pharmacologic interventions, without evidence for the superiority of any specific treatment over another. New recommendations for a collaborative care model that incorporates a stepped care approach suggest that multidisciplinary mental health care restructuring may be required for optimal management of depression.
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Affiliation(s)
- Madeline Li
- Princess Margaret Cancer Centre, University Health Network; Cancer Care Ontario; and University of Toronto, Toronto; Cancer Care Ontario Program in Evidence-Based Care, McMaster University, Hamilton; Trillium Health Partners, Mississauga Halton-Central West Regional Cancer Program, Mississauga; Ottawa Hospital Cancer Centre, Ottawa; Stronach Regional Cancer Centre and Southlake Regional Health Centre, Newmarket; and Thunder Bay Regional Health Sciences Centre, Thunder Bay, Ontario, Canada
| | - Erin B Kennedy
- Princess Margaret Cancer Centre, University Health Network; Cancer Care Ontario; and University of Toronto, Toronto; Cancer Care Ontario Program in Evidence-Based Care, McMaster University, Hamilton; Trillium Health Partners, Mississauga Halton-Central West Regional Cancer Program, Mississauga; Ottawa Hospital Cancer Centre, Ottawa; Stronach Regional Cancer Centre and Southlake Regional Health Centre, Newmarket; and Thunder Bay Regional Health Sciences Centre, Thunder Bay, Ontario, Canada
| | - Nelson Byrne
- Princess Margaret Cancer Centre, University Health Network; Cancer Care Ontario; and University of Toronto, Toronto; Cancer Care Ontario Program in Evidence-Based Care, McMaster University, Hamilton; Trillium Health Partners, Mississauga Halton-Central West Regional Cancer Program, Mississauga; Ottawa Hospital Cancer Centre, Ottawa; Stronach Regional Cancer Centre and Southlake Regional Health Centre, Newmarket; and Thunder Bay Regional Health Sciences Centre, Thunder Bay, Ontario, Canada
| | - Caroline Gérin-Lajoie
- Princess Margaret Cancer Centre, University Health Network; Cancer Care Ontario; and University of Toronto, Toronto; Cancer Care Ontario Program in Evidence-Based Care, McMaster University, Hamilton; Trillium Health Partners, Mississauga Halton-Central West Regional Cancer Program, Mississauga; Ottawa Hospital Cancer Centre, Ottawa; Stronach Regional Cancer Centre and Southlake Regional Health Centre, Newmarket; and Thunder Bay Regional Health Sciences Centre, Thunder Bay, Ontario, Canada
| | - Mark R Katz
- Princess Margaret Cancer Centre, University Health Network; Cancer Care Ontario; and University of Toronto, Toronto; Cancer Care Ontario Program in Evidence-Based Care, McMaster University, Hamilton; Trillium Health Partners, Mississauga Halton-Central West Regional Cancer Program, Mississauga; Ottawa Hospital Cancer Centre, Ottawa; Stronach Regional Cancer Centre and Southlake Regional Health Centre, Newmarket; and Thunder Bay Regional Health Sciences Centre, Thunder Bay, Ontario, Canada
| | - Homa Keshavarz
- Princess Margaret Cancer Centre, University Health Network; Cancer Care Ontario; and University of Toronto, Toronto; Cancer Care Ontario Program in Evidence-Based Care, McMaster University, Hamilton; Trillium Health Partners, Mississauga Halton-Central West Regional Cancer Program, Mississauga; Ottawa Hospital Cancer Centre, Ottawa; Stronach Regional Cancer Centre and Southlake Regional Health Centre, Newmarket; and Thunder Bay Regional Health Sciences Centre, Thunder Bay, Ontario, Canada
| | - Scott Sellick
- Princess Margaret Cancer Centre, University Health Network; Cancer Care Ontario; and University of Toronto, Toronto; Cancer Care Ontario Program in Evidence-Based Care, McMaster University, Hamilton; Trillium Health Partners, Mississauga Halton-Central West Regional Cancer Program, Mississauga; Ottawa Hospital Cancer Centre, Ottawa; Stronach Regional Cancer Centre and Southlake Regional Health Centre, Newmarket; and Thunder Bay Regional Health Sciences Centre, Thunder Bay, Ontario, Canada
| | - Esther Green
- Princess Margaret Cancer Centre, University Health Network; Cancer Care Ontario; and University of Toronto, Toronto; Cancer Care Ontario Program in Evidence-Based Care, McMaster University, Hamilton; Trillium Health Partners, Mississauga Halton-Central West Regional Cancer Program, Mississauga; Ottawa Hospital Cancer Centre, Ottawa; Stronach Regional Cancer Centre and Southlake Regional Health Centre, Newmarket; and Thunder Bay Regional Health Sciences Centre, Thunder Bay, Ontario, Canada
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Carletto S, Borghi M, Francone D, Scavelli F, Bertino G, Cavallo M, Malucchi S, Bertolotto A, Oliva F, Ostacoli L. The efficacy of a Mindfulness Based Intervention for depressive symptoms in patients with Multiple Sclerosis and their caregivers: study protocol for a randomized controlled clinical trial. BMC Neurol 2016; 16:7. [PMID: 26757728 PMCID: PMC4711056 DOI: 10.1186/s12883-016-0528-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 01/05/2016] [Indexed: 12/02/2022] Open
Abstract
Background Multiple Sclerosis has a great impact on psychological functioning of patients and can be associated with various mental health disorders and symptoms. The most prevalent one is depression, which ranges from 15 to 47 %. Mindfulness Based Interventions are a relatively brief and cost-effective program that has been studied in patients with several chronic diseases and recently also in patients with Multiple Sclerosis. Mindfulness Based Interventions are based on the assumption that a non-judgmental awareness and acceptance of one’s moment-to-moment experience can have a positive effect on the adaptation to the disease, reducing the psychological burden and improving patients’ quality of life. Several studies concluded that Mindfulness Based Interventions can be beneficial in terms of improving both psychological and psychical aspects of Multiple Sclerosis, but none of them compared the intervention with an active control group. The primary objective of the study is to evaluate the efficacy of a group-based Mindfulness Based Intervention on depressive symptoms in patients with Multiple Sclerosis, as compared with an active control group. Methods The study design is a randomized controlled clinical trial. Eighty-eight patients with Multiple Sclerosis and depressive symptoms will be recruited and randomized to either Mindfulness Based Intervention or an active control group. The latter is designed to control for non-specific elements of the intervention and it comprises psycho-education and relaxation techniques. The primary outcome is the reduction of depressive symptoms as measured via the Beck Depressive Inventory-II. Secondary outcome measures are level of quality of life, anxiety, perceived stress, illness perception, fatigue and quality of interpersonal relationship. Outcomes will be assessed at baseline, after treatment and 6 months after the end of the treatment. Caregivers will participate in groups together with patients. Discussion As far as we know this trial will be the first randomized controlled trial testing the efficacy of group-based Mindfulness Based Intervention for patients with Multiple Sclerosis with a comparison with an active control group with a specific focus on depressive symptoms. Trial registration NCT02611401.
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Affiliation(s)
- Sara Carletto
- Clinical Psychology and Psychosomatics Service, A.O.U. San Luigi Gonzaga, University of Turin, Regione Gonzole 10, Orbassano, TO, 10043, Italy. .,Clinical and Biological Sciences Department, University of Turin, A.O.U. San Luigi Gonzaga, Regione Gonzole 10, Orbassano, TO, 10043, Italy.
| | - Martina Borghi
- Clinical Psychology and Psychosomatics Service, A.O.U. San Luigi Gonzaga, University of Turin, Regione Gonzole 10, Orbassano, TO, 10043, Italy. .,Neurologia 2-CRESM (Centro Riferimento Regionale Sclerosi Multipla), AOU San Luigi, Regione Gonzole 10, Orbassano, TO, 10043, Italy.
| | - Diana Francone
- Clinical Psychology and Psychosomatics Service, A.O.U. San Luigi Gonzaga, University of Turin, Regione Gonzole 10, Orbassano, TO, 10043, Italy.
| | - Francesco Scavelli
- Clinical Psychology and Psychosomatics Service, A.O.U. San Luigi Gonzaga, University of Turin, Regione Gonzole 10, Orbassano, TO, 10043, Italy. .,Neurologia 2-CRESM (Centro Riferimento Regionale Sclerosi Multipla), AOU San Luigi, Regione Gonzole 10, Orbassano, TO, 10043, Italy.
| | - Gabriella Bertino
- Clinical Psychology and Psychosomatics Service, A.O.U. San Luigi Gonzaga, University of Turin, Regione Gonzole 10, Orbassano, TO, 10043, Italy.
| | - Marco Cavallo
- eCampus University, Via Isimbardi, Novedrate, Como, 10-22060, Italy. .,Department of Mental Health, Azienda Sanitaria Locale Torino 3, Via Martiri XXX Aprile, Collegno, Torino, 30-10093, Italy.
| | - Simona Malucchi
- Neurologia 2-CRESM (Centro Riferimento Regionale Sclerosi Multipla), AOU San Luigi, Regione Gonzole 10, Orbassano, TO, 10043, Italy.
| | - Antonio Bertolotto
- Neurologia 2-CRESM (Centro Riferimento Regionale Sclerosi Multipla), AOU San Luigi, Regione Gonzole 10, Orbassano, TO, 10043, Italy.
| | - Francesco Oliva
- Clinical and Biological Sciences Department, University of Turin, A.O.U. San Luigi Gonzaga, Regione Gonzole 10, Orbassano, TO, 10043, Italy.
| | - Luca Ostacoli
- Clinical Psychology and Psychosomatics Service, A.O.U. San Luigi Gonzaga, University of Turin, Regione Gonzole 10, Orbassano, TO, 10043, Italy. .,Clinical and Biological Sciences Department, University of Turin, A.O.U. San Luigi Gonzaga, Regione Gonzole 10, Orbassano, TO, 10043, Italy.
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Fiest K, Walker J, Bernstein C, Graff L, Zarychanski R, Abou-Setta A, Patten S, Sareen J, Bolton J, Marriott J, Fisk J, Singer A, Marrie R. Systematic review and meta-analysis of interventions for depression and anxiety in persons with multiple sclerosis. Mult Scler Relat Disord 2016; 5:12-26. [DOI: 10.1016/j.msard.2015.10.004] [Citation(s) in RCA: 99] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Revised: 10/09/2015] [Accepted: 10/16/2015] [Indexed: 11/24/2022]
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Psychosocial interventions for people with diabetes and co-morbid depression. A systematic review. Int J Nurs Stud 2015; 52:1625-39. [DOI: 10.1016/j.ijnurstu.2015.05.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 04/07/2015] [Accepted: 05/29/2015] [Indexed: 12/14/2022]
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Evaluating the Outcome of Cultural Adaptations of Cognitive-Behavioural Therapy for Adult Depression: a Meta-Analysis of Treatment Studies in Developing Countries. INTERNATIONAL JOURNAL FOR THE ADVANCEMENT OF COUNSELLING 2015. [DOI: 10.1007/s10447-015-9244-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Abstract
Abstract
Background:
The stepped care program Bridging Intervention in Anesthesiology (BRIA) aims at motivating and supporting surgical patients with comorbid mental disorders to engage in psychosocial mental healthcare options. This study examined the efficacy of BRIA.
Methods:
This randomized, parallel-group, open-label, controlled trial was conducted in the preoperative anesthesiological assessment clinics and surgical wards of a large university hospital in Germany. A total of 220 surgical patients with comorbid mental disorders were randomized by using the computer-generated lists to one of two intervention groups: BRIA psychotherapy sessions up to 3 months postoperatively (BRIA) versus no psychotherapy/computerized brief written advice (BWA) only. Primary outcome was participation in psychosocial mental healthcare options at month 6. Secondary outcome was change of self-reported general psychological distress (Global Severity Index of the Brief Symptom Inventory) between baseline and month 6.
Results:
At 6-month follow-up, the rate of patients who engaged in psychosocial mental healthcare options was 30% (33 of 110) in BRIA compared with 11.8% (13 of 110) in BWA (P = 0.001). Number needed to treat and relative risk reduction were 6 (95% CI, 4 to 13) and 0.21 (0.09 to 0.31), respectively. In BRIA, Global Severity Index decreased between baseline and month 6 (P < 0.001), whereas it did not change significantly in BWA (P = 0.197).
Conclusions:
Among surgical patients with comorbid mental disorders, BRIA results in an increased engagement in subsequent therapy options and a decrease of general psychological distress. These data suggest that it is reasonable to integrate innovative psychotherapy programs into the context of interdisciplinary surgical care.
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McMain S, Newman MG, Segal ZV, DeRubeis RJ. Cognitive behavioral therapy: Current status and future research directions. Psychother Res 2015; 25:321-9. [DOI: 10.1080/10503307.2014.1002440] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Pearce MJ, Koenig HG, Robins CJ, Nelson B, Shaw SF, Cohen HJ, King MB. Religiously integrated cognitive behavioral therapy: a new method of treatment for major depression in patients with chronic medical illness. ACTA ACUST UNITED AC 2014; 52:56-66. [PMID: 25365155 DOI: 10.1037/a0036448] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Intervention studies have found that psychotherapeutic interventions that explicitly integrate clients' spiritual and religious beliefs in therapy are as effective, if not more so, in reducing depression than those that do not for religious clients. However, few empirical studies have examined the effectiveness of religiously (vs. spiritually) integrated psychotherapy, and no manualized mental health intervention had been developed for the medically ill with religious beliefs. To address this gap, we developed and implemented a novel religiously integrated adaptation of cognitive-behavioral therapy (CBT) for the treatment of depression in individuals with chronic medical illness. This article describes the development and implementation of the intervention. First, we provide a brief overview of CBT. Next, we describe how religious beliefs and behaviors can be integrated into a CBT framework. Finally, we describe Religiously Integrated Cognitive Behavioral Therapy (RCBT), a manualized therapeutic approach designed to assist depressed individuals to develop depression-reducing thoughts and behaviors informed by their own religious beliefs, practices, and resources. This treatment approach has been developed for 5 major world religions (Christianity, Judaism, Islam, Buddhism, and Hinduism), increasing its potential to aid the depressed medically ill from a variety of religious backgrounds.
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Affiliation(s)
| | - Harold G Koenig
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center
| | - Clive J Robins
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center
| | | | | | - Harvey J Cohen
- Division of Geriatrics, Department of Medicine, Duke University Medical Center
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Abstract
Background: The proposal of a 4-year plan to integrate treatment of people with long term medical conditions (LTCs) into the IAPT service (Department of Health, 2011) seeks for research to understand the effectiveness of IAPT interventions for this patient group. Aim: The aim of this service development pilot work was to develop an intervention that is effective for people with Type 2 Diabetes Mellitus (T2DM). It was hypothesized that the standard IAPT intervention would not be effective, but that it can be adapted so that it is effective both in terms of mood and self-management of T2DM. Method: Clients (n = 95) who experienced mild to moderate depression and/or anxiety and had a diagnosis of T2DM opted to attend. The intervention was adapted over a series of cohorts from a standard Step 2 intervention. A team of Psychological Wellbeing Practitioners (PWPs), a Clinical Health Psychologist and a General Practitioner worked in collaboration, using outcomes measures and feedback from service users and facilitators. Results: The standard IAPT Step 2 intervention met with challenges when specifically targeting this client group. Using paired t-tests, the modified Step 2 intervention demonstrated significant improvements from pre- to postintervention measures both in terms of psychological (n = 17) and physical (n = 9) outcomes. Conclusion: It is concluded that it may be possible to modify a generic Step 2 IAPT intervention to demonstrate improvements both in terms of psychological wellbeing and self-management of T2DM. The main adaptations were related to more targeted recruitment and linking of diabetes specifically into the CBT model.
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Harris S, Farrand P, Dickens C. Behavioural activation interventions for depressed individuals with a chronic physical illness: a systematic review protocol. Syst Rev 2013; 2:105. [PMID: 24237689 PMCID: PMC3843584 DOI: 10.1186/2046-4053-2-105] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Accepted: 11/12/2013] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Depression is common in people with chronic physical illness and is associated with worse medical outcomes. Cognitive behavioural therapy and problem-solving improve depression, although usually have small to moderate effects among people with chronic physical illness. Behavioural activation interventions for depression, which aim to increase positive reinforcement from the environment by encouraging individuals to increase pleasant/rewarding activities, have been reported to be equivalent to cognitive behavioural therapy. However, the effectiveness of behavioural activation interventions for depression in individuals with chronic physical illness is unclear. The aims of this systematic review are to identify the extent to which different forms of behavioural activation have been used as a treatment for depression in this population, examine the effectiveness of the interventions, and identify any adaptations which have been made specifically to the interventions for individuals with a range of chronic physical illnesses. METHODS/DESIGN Electronic databases will be systematically searched using terms relevant to behavioural activation and depression, and the subset of studies in people with chronic physical illnesses will be identified by manual searching. References and citations of eligible studies will be searched and experts in this field will be contacted to identify additional papers. All study designs will be included in this review to allow for a more extensive identification of the extent of different forms of behavioural activation interventions. The different forms of behavioural activation and the specific chronic physical health conditions for which this intervention has been used will be reviewed narratively. For the effectiveness of the interventions, if sufficient randomised controlled trials have been undertaken the results will be meta-analysed. Non-randomised studies will be narratively synthesised and adaptations to the interventions will also be narratively reviewed. DISCUSSION The findings will inform the design, development and subsequent evaluation of a behavioural activation intervention for depression in people with a chronic physical illness. PROSPERO registration number: CRD42013004500.
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Affiliation(s)
- Sarah Harris
- Mood Disorders Centre, Psychology, College of Life and Environmental Sciences, University of Exeter, Exeter EX4 4QG, England
| | - Paul Farrand
- Mood Disorders Centre, Psychology, College of Life and Environmental Sciences, University of Exeter, Exeter EX4 4QG, England
| | - Chris Dickens
- University of Exeter Medical School, College House, St Luke’s Campus, Exeter EX1 2 LU, UK
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Meijer A, Roseman M, Delisle VC, Milette K, Levis B, Syamchandra A, Stefanek ME, Stewart DE, de Jonge P, Coyne JC, Thombs BD. Effects of screening for psychological distress on patient outcomes in cancer: a systematic review. J Psychosom Res 2013; 75:1-17. [PMID: 23751231 PMCID: PMC3833882 DOI: 10.1016/j.jpsychores.2013.01.012] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Revised: 01/11/2013] [Accepted: 01/12/2013] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Several practice guidelines recommend routine screening for psychological distress in cancer care. The objective was to evaluate the effect of screening cancer patients for psychological distress by assessing the (1) effectiveness of interventions to reduce distress among patients identified as distressed; and (2) effects of screening for distress on distress outcomes. METHODS CINAHL, Cochrane, EMBASE, ISI, MEDLINE, PsycINFO, and SCOPUS databases were searched through April 6, 2011 with manual searches of 45 relevant journals, reference list review, citation tracking of included articles, and trial registry reviews through June 30, 2012. Articles in any language on cancer patients were included if they (1) compared treatment for patients with psychological distress to placebo or usual care in a randomized controlled trial (RCT); or (2) assessed the effect of screening on psychological distress in a RCT. RESULTS There were 14 eligible RCTs for treatment of distress, and 1 RCT on the effects of screening on patient distress. Pharmacological, psychotherapy and collaborative care interventions generally reduced distress with small to moderate effects. One study investigated effects of screening for distress on psychological outcomes, and it found no improvement. CONCLUSION Treatment studies reported modest improvement in distress symptoms, but only a single eligible study was found on the effects of screening cancer patients for distress, and distress did not improve in screened patients versus those receiving usual care. Because of the lack of evidence of beneficial effects of screening cancer patients for distress, it is premature to recommend or mandate implementation of routine screening.
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Affiliation(s)
- Anna Meijer
- Interdisciplinary Center for Psychopathology and Emotion Regulation, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Michelle Roseman
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada,Department of Psychiatry, McGill University, Montréal, Quebéc, Canada
| | - Vanessa C. Delisle
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada,Department of Educational and Counselling Psychology, McGill University, Montréal, Quebéc, Canada
| | - Katherine Milette
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada,Department of Educational and Counselling Psychology, McGill University, Montréal, Quebéc, Canada
| | - Brooke Levis
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
| | - Achyuth Syamchandra
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
| | - Michael E. Stefanek
- Office of Research Administration, Indiana University, Bloomington, Indiana, USA
| | - Donna E. Stewart
- Women’s Health Program, University Health Network, Toronto, Ontario, Canada,Departments of Psychiatry, Obstetrics and Gynaecology, Family and Community Medicine, Medicine, Surgery and Anesthesia, University of Toronto, Ontario, Canada
| | - Peter de Jonge
- Interdisciplinary Center for Psychopathology and Emotion Regulation, University Medical Center Groningen, University of Groningen, The Netherlands
| | - James C. Coyne
- Behavioral Oncology Program, Abramson Cancer Center and Department of Psychiatry, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, USA,Health Psychology Section, Department of Health Sciences, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Brett D. Thombs
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada,Department of Psychiatry, McGill University, Montréal, Quebéc, Canada,Department of Educational and Counselling Psychology, McGill University, Montréal, Quebéc, Canada,Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montréal, Quebéc, Canada,Department of Medicine, McGill University, Montréal, Quebéc, Canada,School of Nursing, McGill University, Montréal, Quebéc, Canada
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Vriezekolk JE, Eijsbouts AMM, van Lankveld WGJM, Beenackers H, Geenen R, van den Ende CHM. An acceptance-oriented cognitive-behavioral therapy in multimodal rehabilitation: a pre-post test evaluation in highly distressed patients with rheumatic diseases. PATIENT EDUCATION AND COUNSELING 2013; 91:357-363. [PMID: 23428511 DOI: 10.1016/j.pec.2013.01.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Revised: 01/24/2013] [Accepted: 01/25/2013] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To examine the potential effectiveness of a multimodal rehabilitation program including an acceptance-oriented cognitive-behavioral therapy for highly distressed patients with rheumatic diseases. METHODS An observational study employing a one-group pre-post test design (N=25). The primary outcome was psychological distress. Secondary outcomes were quality of life, illness acceptance, and coping flexibility. Group pre-to-post and pre-to-12 months follow-up treatment changes were evaluated by paired-samples t-tests and Cohen's effect sizes (d). Individual changes were evaluated by the reliable change index (RCI) and clinically significant change (CSC) parameters. RESULTS Significant effects were found post-treatment and maintained at 12 months in psychological distress (d>0.80), illness acceptance (d=1.48) and the SF-36 subscales role physical, vitality, and mental health (d ≥ 0.65). No significant effects were found for coping flexibility and the SF-36 subscales physical functioning, bodily pain, social functioning, and role emotional. Both a reliable (RCI) and clinically significant (CSC) improvement was observed for almost half of the highly distressed patients. CONCLUSION The patients enrolled in the multimodal rehabilitation program showed improved psychological health status from pre to post-treatment. PRACTICE IMPLICATIONS A randomized clinical trial is needed to confirm or refute the added value of an acceptance-oriented cognitive-behavioral therapy for highly distressed patients in rehabilitation.
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Geenen R, Newman S, Bossema ER, Vriezekolk JE, Boelen PA. Psychological interventions for patients with rheumatic diseases and anxiety or depression. Best Pract Res Clin Rheumatol 2013; 26:305-19. [PMID: 22867928 DOI: 10.1016/j.berh.2012.05.004] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2012] [Revised: 05/14/2012] [Accepted: 05/21/2012] [Indexed: 11/16/2022]
Abstract
The prevalence of clinical anxiety and clinical depression in rheumatic diseases is about twice the prevalence seen in the general population. At a milder level, the occurrence of psychological distress that does not fulfil diagnostic criteria of anxiety and depression is even higher. Evidence indicates that this high prevalence is multifactorial. Correlational studies suggest that possible factors for anxiety and depression include the suffering accompanying somatic symptoms, functional limitations, pro-inflammatory cytokines, helplessness due to the uncontrollable, unpredictable and progressive nature of the disease, and other factors associated with having a chronic disease. This article reviews the prevalence and diagnosis of anxiety and depression in rheumatic diseases and it examines the contents and the impact of psychological interventions to address these difficulties for patients.
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Affiliation(s)
- Rinie Geenen
- Utrecht University, Department of Clinical and Health Psychology, Utrecht, The Netherlands.
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Skokou M, Soubasi E, Gourzis P. Depression in multiple sclerosis: a review of assessment and treatment approaches in adult and pediatric populations. ISRN NEUROLOGY 2012; 2012:427102. [PMID: 23097716 PMCID: PMC3477767 DOI: 10.5402/2012/427102] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/26/2012] [Accepted: 09/17/2012] [Indexed: 12/18/2022]
Abstract
Multiple sclerosis is a chronic demyelinating disease affecting one million people worldwide, with a significant burden of psychiatric comorbidity. Depression is the commonest psychiatric manifestation but still remains largely underdiagnosed and undertreated. The present work reviews current knowledge on diagnosis, assessment, and somatic and psychotherapeutic treatment interventions for depression in adult and pediatric populations of patients with multiple sclerosis.
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Affiliation(s)
- Maria Skokou
- Department of Psychiatry, School of Medicine and University Hospital of Patras, University of Patras, Rio, 26504 Patras, Greece
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Abstract
Cognitive behavioral therapy (CBT) refers to a popular therapeutic approach that has been applied to a variety of problems. The goal of this review was to provide a comprehensive survey of meta-analyses examining the efficacy of CBT. We identified 269 meta-analytic studies and reviewed of those a representative sample of 106 meta-analyses examining CBT for the following problems: substance use disorder, schizophrenia and other psychotic disorders, depression and dysthymia, bipolar disorder, anxiety disorders, somatoform disorders, eating disorders, insomnia, personality disorders, anger and aggression, criminal behaviors, general stress, distress due to general medical conditions, chronic pain and fatigue, distress related to pregnancy complications and female hormonal conditions. Additional meta-analytic reviews examined the efficacy of CBT for various problems in children and elderly adults. The strongest support exists for CBT of anxiety disorders, somatoform disorders, bulimia, anger control problems, and general stress. Eleven studies compared response rates between CBT and other treatments or control conditions. CBT showed higher response rates than the comparison conditions in 7 of these reviews and only one review reported that CBT had lower response rates than comparison treatments. In general, the evidence-base of CBT is very strong. However, additional research is needed to examine the efficacy of CBT for randomized-controlled studies. Moreover, except for children and elderly populations, no meta-analytic studies of CBT have been reported on specific subgroups, such as ethnic minorities and low income samples.
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Hart SL, Hoyt MA, Diefenbach M, Anderson DR, Kilbourn KM, Craft LL, Steel JL, Cuijpers P, Mohr DC, Berendsen M, Spring B, Stanton AL. Meta-analysis of efficacy of interventions for elevated depressive symptoms in adults diagnosed with cancer. J Natl Cancer Inst 2012; 104:990-1004. [PMID: 22767203 DOI: 10.1093/jnci/djs256] [Citation(s) in RCA: 144] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Cancer patients are at increased risk for depression compared with individuals with no cancer diagnosis, yet few interventions target depressed cancer patients. METHODS Efficacy of psychotherapeutic and pharmacologic interventions for depression in cancer patients who met an entry threshold for depressive symptoms was examined by meta-analysis. Five electronic databases were systematically reviewed to identify randomized controlled trials meeting the selection criteria. Effect sizes were calculated using Hedges' g and were pooled to compare pre- and postrandomization depressive symptoms with a random effects model. Subgroup analyses tested moderators of effect sizes, such as comparison of different intervention modalities, with a mixed effects model. All statistical tests were two-sided. RESULTS Ten randomized controlled trials (six psychotherapeutic and four pharmacologic studies) met the selection criteria; 1362 participants with mixed cancer types and stages had been randomly assigned to treatment groups. One outlier trial was removed from analyses. The random effects model showed interventions to be superior to control conditions on reducing depressive symptoms postintervention (Hedges' g = 0.43, 95% confidence interval = 0.30 to 0.56, P < .001). In the four psychotherapeutic trials with follow-up assessment, interventions were more effective than control conditions up to 12-18 months after patients were randomly assigned to treatment groups (P < .001). Although each approach was more effective than the control conditions in improving depressive symptoms (P < .001), subgroup analyses showed that cognitive behavioral therapy appeared more effective than problem-solving therapy (P = .01), but not more effective than pharmacologic intervention (P = .07). CONCLUSIONS Our findings suggest that psychological and pharmacologic approaches can be targeted productively toward cancer patients with elevated depressive symptoms. Research is needed to maximize effectiveness, accessibility, and integration into clinical care of interventions for depressed cancer patients.
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Affiliation(s)
- Stacey L Hart
- Department of Psychology, University of California Los Angeles, CA 90095-1563, USA
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Krebber AMH, Leemans CR, de Bree R, van Straten A, Smit F, Smit EF, Becker A, Eeckhout GM, Beekman ATF, Cuijpers P, Verdonck-de Leeuw IM. Stepped care targeting psychological distress in head and neck and lung cancer patients: a randomized clinical trial. BMC Cancer 2012; 12:173. [PMID: 22574757 PMCID: PMC3502336 DOI: 10.1186/1471-2407-12-173] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Accepted: 05/03/2012] [Indexed: 12/03/2022] Open
Abstract
Background Psychological distress is common in cancer survivors. Although there is some evidence on effectiveness of psychosocial care in distressed cancer patients, referral rate is low. Lack of adequate screening instruments in oncology settings and insufficient availability of traditional models of psychosocial care are the main barriers. A stepped care approach has the potential to improve the efficiency of psychosocial care. The aim of the study described herein is to evaluate efficacy of a stepped care strategy targeting psychological distress in cancer survivors. Methods/design The study is designed as a randomized clinical trial with 2 treatment arms: a stepped care intervention programme versus care as usual. Patients treated for head and neck cancer (HNC) or lung cancer (LC) are screened for distress using OncoQuest, a computerized touchscreen system. After stratification for tumour (HNC vs. LC) and stage (stage I/II vs. III/IV), 176 distressed patients are randomly assigned to the intervention or control group. Patients in the intervention group will follow a stepped care model with 4 evidence based steps: 1. Watchful waiting, 2. Guided self-help via Internet or a booklet, 3. Problem Solving Treatment administered by a specialized nurse, and 4. Specialized psychological intervention or antidepressant medication. In the control group, patients receive care as usual which most often is a single interview or referral to specialized intervention. Primary outcome is the Hospital Anxiety and Depression Scale (HADS). Secondary outcome measures are a clinical level of depression or anxiety (CIDI), quality of life (EQ-5D, EORTC QLQ-C30, QLQ-HN35, QLQ-LC13), patient satisfaction with care (EORTC QLQ-PATSAT), and costs (health care utilization and work loss (TIC-P and PRODISQ modules)). Outcomes are evaluated before and after intervention and at 3, 6, 9 and 12 months after intervention. Discussion Stepped care is a system of delivering and monitoring treatments, such that effective, yet least resource-intensive, treatment is delivered to patients first. The main aim of a stepped care approach is to simplify the patient pathway, provide access to more patients and to improve patient well-being and cost reduction by directing, where appropriate, patients to low cost (self-)management before high cost specialist services. Trial registration NTR1868
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Affiliation(s)
- Anne-Marie H Krebber
- Department of Otolaryngology/Head and Neck Surgery, VU University Medical Center, Amsterdam, the Netherlands
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Vriezekolk JE, Geenen R, van den Ende CHM, Slot H, van Lankveld WGJM, van Helmond T. Behavior change, acceptance, and coping flexibility in highly distressed patients with rheumatic diseases: feasibility of a cognitive-behavioral therapy in multimodal rehabilitation. PATIENT EDUCATION AND COUNSELING 2012; 87:171-177. [PMID: 21978928 DOI: 10.1016/j.pec.2011.09.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2011] [Revised: 08/30/2011] [Accepted: 09/01/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To describe the development and feasibility of the integration of a cognitive-behavioral therapy (CBT) within a multimodal rehabilitation program for highly distressed patients with rheumatic diseases. METHODS Development included the detailed specification of the theoretical and empirical-based underpinnings of the CBT and the comprehensive description of its design and content. Feasibility was assessed by percentage of eligible patients, attrition and attendance rates, and patient satisfaction. RESULTS The developed CBT component seeks to decrease psychological distress and improve activities and participation across multiple life domains by accomplishing behavior change, acceptance, and coping flexibility. Motivational interviewing was applied to endorse patients' own reasons to change. Forty percent (35/87) of the eligible patients were admitted to the program. Attendance rate (>95%) was high. Patient satisfaction ranged from 6.8 to 8.0 (10-point scale). CONCLUSION Integrating CBT within a multimodal rehabilitation program is feasible. An acceptable proportion of the intended patient sample is eligible and patient's attendance and satisfaction is high. PRACTICE IMPLICATIONS Patients with impaired physical and psychosocial functioning despite adequate medical treatment pose a great challenge. Their treatment outcome may be improved by screening and selecting highly distressed patients and offering them a CBT embedded in multimodal rehabilitation program.
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Brunault P, Jacobi D, Miknius V, Bourbao-Tournois C, Huten N, Gaillard P, Couet C, Camus V, Ballon N. High preoperative depression, phobic anxiety, and binge eating scores and low medium-term weight loss in sleeve gastrectomy obese patients: a preliminary cohort study. PSYCHOSOMATICS 2012; 53:363-70. [PMID: 22458986 DOI: 10.1016/j.psym.2011.12.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2011] [Revised: 12/12/2011] [Accepted: 12/13/2011] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Although depression, anxiety, and binge eating are prevalent in candidates for bariatric surgery, their impact on weight loss is unknown following sleeve gastrectomy. This study assesses the associations between weight loss and preoperative depression, anxiety, and binge eating scores in patients undergoing sleeve gastrectomy for morbid obesity. METHOD This cohort study included 34 patients who underwent sleeve gastrectomy for morbid obesity between May 2006 and February 2010 in a French tertiary referral center. We assessed preoperative depression (using the Beck depression inventory and the SCL-90-R depression subscale), anxiety (using the Hamilton anxiety rating scale and the SCL-90-R anxiety subscales), and binge eating (using the bulimic investigatory test, Edinburgh). The primary outcome was the percentage of excess weight loss at 12 months (PEWL). RESULTS The preoperative mean body mass index (BMI) was 55.3 kg/m2 ± 10.2 kg/m2 and 41.7 kg/m2 ± 8.7 kg/m2 at the 12-month follow-up visit. The mean PEWL was 46.8% ± 15.8%. After adjusting for the preoperative BMI, the PEWL was negatively associated with preoperative scores for depression (β= -0.357; P < 0.05), phobic anxiety (β = -0.340; P < 0.05), interpersonal sensitivity (β = -0.328; P < 0.05), and binge eating (β = -0.315; P = 0.05). Other forms of anxiety were not correlated with the PEWL. CONCLUSIONS Higher preoperative depression, phobic anxiety, interpersonal sensitivity, and binge eating scores are associated with low postoperative weight loss in patients undergoing sleeve gastrectomy. Future studies should assess the preoperative prevalence of syndromal or subsyndromal atypical depression and its relationship to postoperative weight loss in bariatric surgery candidates.
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Affiliation(s)
- Paul Brunault
- CHRU de Tours, Clinique Psychiatrique Universitaire, Tours, France.
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Abstract
The selection of treatment in depression should be filtered by clinical judgment, taking into consideration a number of clinical variables, such as characteristics and severity of depressive episode, co-occurring symptomatology and problems (not necessarily syndromes), medical comorbidities, and patient’s history with particular reference to treatment of previous episodes, if they occurred. Such information should be placed within what is actually available in the specific treatment setting and should be integrated with the patient’s preferences. In clinical practice, on the one end, clinical decisions may be affected by irrational factors (eg, exposure to massive doses of pharmaceutical propaganda or familiarity with a specific psychotherapy or medication). On the other end, psychiatrists often use sophisticated forms of clinical judgment that are suitable for clinical challenges but are not addressed by current research strategies. There is increasing awareness of the need of differentiating depression according to specific subtypes, yet clear-cut indications for these subdivisions are still missing. The role of biomarkers, despite many promising research strategies, is still far from offering reliable clinical guidance. In the meanwhile, there are important indications that come from clinical research. Treatment of depression may be conceptualized as integrated treatment of the various components of symptomatology, lifestyle, and social adjustment. An integrated treatment model, discussed in detail elsewhere, is realistic and practical, and not just idealistic. It may be frustrating to those who like oversimplified biological models; however, approaches that integrate clinimetrics, patient priorities, lifestyle issues, and clinical judgment are more in keeping with the complexity of clinical situations and the challenge of depression treatment.
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Affiliation(s)
- Elena Tomba
- Department of Psychology, University of Bologna, Viale Berti Pichat 5, 40127 Bologna, Italy
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