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Kaufman A, Nemeroff R. Motivation to change predicts college students' utilization of self-help resources. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2024:1-9. [PMID: 38592799 DOI: 10.1080/07448481.2024.2334082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 03/11/2024] [Indexed: 04/11/2024]
Abstract
Background: Stress and mental health difficulties are common burdens on college students. College counseling centers have been overrun by demand. Thus, self-help interventions may offer a promising alternative to traditional college counseling services. Methods: The current study examined the influence of perceived stress, motivation to change, and self-efficacy beliefs on college students' use of self-help resources, to determine whether these factors would predict follow-up with self-help recommendations. Results: Results of stepwise linear regression models suggest that perceived stress and self-efficacy did not predict self-help resource utilization. Different types of self-help recommendations did not predict different levels of follow-up. However, motivation to change was a significant predictor college students' self-help resource use, and this variable was particularly important when self-help recommendations were less structured. Conclusions: These findings can help to predict which college students are likely to make use of self-help resources, and inform targeted individual treatment.
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Affiliation(s)
- Alyson Kaufman
- Department of Psychology, William Paterson University, Wayne, New Jersey, USA
| | - Robin Nemeroff
- Department of Psychology, William Paterson University, Wayne, New Jersey, USA
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Kim YR, An Z, Han SW, Ko JK, Hwa Kwag K. Recovery-focused self-help intervention using vodcasts for patients with personality disorder: feasibility randomised controlled trial. BJPsych Open 2024; 10:e31. [PMID: 38229480 PMCID: PMC10897696 DOI: 10.1192/bjo.2023.647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 11/23/2023] [Accepted: 12/14/2023] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND Availability of long-term psychological interventions for personality disorders is limited because of their high intensity and cost. Research in evidence-based, low-intensity interventions is needed. AIMS This study aimed to examine the feasibility, acceptability and potential impact of a low-intensity, digital guided self-help (GSH) intervention that is focused on emotion regulation, recovery-oriented and provides in-the-moment delivery for patients with personality disorders. METHOD We conducted a single-blind feasibility trial. A total of 43 patients with a personality disorder were recruited and randomly assigned to either a GSH arm (n = 22) or a treatment-as-usual arm (n = 21). The GSH intervention included a series of short videos offering psychoeducation and support, personalised feedback using text messages, and supportive telephone calls, for 4 weeks in addition to treatment as usual. Outcomes of emotional disturbance, emotion dysregulation, self-harm behaviours and decentring ability were measured at baseline, 4 weeks (end of intervention) and 8 weeks (follow-up). RESULTS All patients who attended the first session continued until the last session. There was an interaction effect between time and group on anxiety (P = 0.027, Δη2 = 0.10), where the GSH group showed a significant reduction in anxiety at follow-up (P = 0.003, d = 0.25). The GSH group increased in decentring ability at the end of intervention (P = 0.007, d = -0.65), and the decrease in self-harm behaviours continued until follow-up (P = 0.02, d = 0.57). CONCLUSIONS The results suggest that a personalised digital GSH with a focus on recovery could reduce anxiety and self-harm behaviours at short-term follow-up.
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Affiliation(s)
- Youl-Ri Kim
- Institute of Eating Disorders and Mental Health, Inje University, South Korea; and Department of Psychiatry, Ilsan Paik Hospital, Inje University, South Korea
| | - Zhen An
- Institute of Eating Disorders and Mental Health, Inje University, South Korea
| | - Soo Wan Han
- Institute of Eating Disorders and Mental Health, Inje University, South Korea
| | - Jeong Kyung Ko
- Institute of Eating Disorders and Mental Health, Inje University, South Korea
| | - Kyung Hwa Kwag
- Institute of Eating Disorders and Mental Health, Inje University, South Korea
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Morris L, Lovell K, McEvoy P, Emsley R, Carter LA, Edge D, Bates R, Wallwork T, Mansell W. A brief transdiagnostic group (the take control course) compared to individual low-intensity CBT for depression and anxiety: a randomized non-inferiority trial. Cogn Behav Ther 2023; 52:176-197. [PMID: 36625458 DOI: 10.1080/16506073.2022.2143418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Few studies have examined brief transdiagnostic groups. The Take Control Course (TCC) was developed for patients with mild to moderate common mental health problems. We examined whether TCC is non-inferior to individual low-intensity cognitive behaviour therapy (CBT) in a single-blind individually randomised parallel non-inferiority trial. The primary outcomes were depression (PHQ9) and anxiety (GAD7) at 6-month follow-up (primary outcome point) and 12-month follow-up. The non-inferiority margin that we set, based on previous trials, corresponds to approximately 3 points on the PHQ9 and approximately 2.5 points on the GAD7. Intention-to-treat (ITT) and per-protocol (PP) analyses of 6-month data of 156 randomised patients indicated that TCC was non-inferior to individual low-intensity CBT on anxiety (ITT Coefficient = 0.24; 95% CI: -1.45 to 1.92; d = 0.04; p = .79), and depression (ITT Coefficient = 0.82; 95% CI: -1.06 to 2.69; d = 0.14; p = .39) outcomes, and functioning (ITT Coefficient = 0.69; 95% CI: -2.56 to 3.94; d = 0.08; p = .68). The findings at 12 months were inconclusive and require further testing. This randomised trial provides preliminary support that TCC is not less effective than short-term individual CBT within Improving Access to Psychological Therapies (IAPT) services.
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Affiliation(s)
- Lydia Morris
- Division of Psychology & Mental Health, University of Manchester, Coupland 1 Building, Oxford Rd, Manchester M13 9PL, UK
| | - Karina Lovell
- Division of Nursing, Midwifery & Social Work, University of Manchester, Greater Manchester Mental Health NHS Foundation Trust, Oxford Rd, Manchester M13 9PL, UK
| | - Phil McEvoy
- Six Degrees Social Enterprise, Greenwood Business Centre, Southwood House, Regent Road, Salford M5 4QH, UK
| | - Richard Emsley
- Institute of Psychiatry, Psychology & Neuroscience, King's College, University of London, 16 De Crespigny Park, London SE5 8AB, UK
| | - Lesley-Anne Carter
- Division of Population Health, Health Services Research & Primary Care, University of Manchester, Jean McFarlane Building, Oxford Rd, Manchester M13 9PL, UK
| | - Dawn Edge
- Division of Psychology & Mental Health, University of Manchester, Coupland 1 Building, Oxford Rd, Manchester M13 9PL, UK
| | - Rachel Bates
- Six Degrees Social Enterprise, Greenwood Business Centre, Southwood House, Regent Road, Salford M5 4QH, UK
| | - Tanya Wallwork
- Six Degrees Social Enterprise, Greenwood Business Centre, Southwood House, Regent Road, Salford M5 4QH, UK
| | - Warren Mansell
- School of Population Health, Curtin University, Kent Street, Bentley 6102, Western Australia
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A randomized controlled trial of two 10-session cognitive behaviour therapies for eating disorders: An exploratory investigation of which approach works best for whom. Behav Res Ther 2021; 146:103962. [PMID: 34534858 DOI: 10.1016/j.brat.2021.103962] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 09/02/2021] [Accepted: 09/07/2021] [Indexed: 11/21/2022]
Abstract
Cognitive behaviour therapy for eating disorders (CBT-ED) outperforms other treatments for non-underweight eating disorders in adults, but we have limited ability to match CBT-ED to individual profiles. We examined if we could identify who benefits most from two forms of 10-session CBT-ED; one emphasizing early behaviour change with substantial content on improving body image (CBT-T), and the other including motivational work and no content on body image using chapters from self-help books (CBTm). Participants were 98 consecutive referrals to the Flinders University Services for Eating Disorders. Fourteen clinical psychology postgraduates delivered the treatment under expert supervision. Outcome measures were completed on five occasions: baseline, 4-, 10-, 14- and 22-weeks post-randomisation. Our primary outcome was global eating psychopathology. Moderators included motivation (readiness and confidence to change) and body avoidance and body checking. Intent-to-treat analyses showed no difference between the groups with a significant main effect of time associated with large effect size improvements, commensurate with longer forms of CBT-ED. Participants with lower readiness to change in CBTm had significantly greater decreases in disordered eating over follow-up compared to those with low motivation in CBT-T. People with lower readiness to change might benefit from the incorporation of motivational work in CBT-ED.
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Facilitating access to iCBT: a randomized controlled trial assessing a translated version of an empirically validated program using a minimally monitored delivery model. Behav Cogn Psychother 2019; 48:185-202. [PMID: 31416489 DOI: 10.1017/s135246581900047x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Despite its established efficacy, access to internet-delivered CBT (iCBT) remains limited in a number of countries. Translating existing programs and using a minimally monitored model of delivery may facilitate its dissemination across countries. AIMS This randomized control trial aims to evaluate the efficacy of an iCBT transdiagnostic program translated from English to French and offered in Canada using a minimally monitored delivery model for the treatment of anxiety and depression. METHOD Sixty-three French speakers recruited in Canada were randomized to iCBT or a waiting-list. A French translation of an established program, the Wellbeing Course, was offered over 8 weeks using a minimally monitored delivery model. Primary outcome measures were the Generalized Anxiety Disorder-7 (GAD-7) and the Patient Health Questionnaire-9 (PHQ-9), which were obtained pre-treatment, post-treatment and at 3-month follow-up. RESULTS Mixed-effects models revealed that participants in the treatment group had significantly lower PHQ-9 and GAD-7 scores post-treatment than controls with small between-groups effect sizes (d = 0.34 and 0.37, respectively). Within-group effect sizes on primary outcome measures were larger in the treatment than control group. Clinical recovery rates on the PHQ-9 and GAD-7 were significantly higher among the treatment group (40 and 56%, respectively) than the controls (13 and 16%, respectively). CONCLUSIONS The provision of a translated iCBT program using a minimally monitored delivery model may improve patients' access to treatment of anxiety and depression across countries. This may be an optimal first step in improving access to iCBT before sufficient resources can be secured to implement a wider range of iCBT services.
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Bennett SD, Cuijpers P, Ebert DD, McKenzie Smith M, Coughtrey AE, Heyman I, Manzotti G, Shafran R. Practitioner Review: Unguided and guided self-help interventions for common mental health disorders in children and adolescents: a systematic review and meta-analysis. J Child Psychol Psychiatry 2019; 60:828-847. [PMID: 30775782 DOI: 10.1111/jcpp.13010] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/31/2018] [Indexed: 11/28/2022]
Abstract
Mental health problems are common in children and adolescents, yet evidence-based treatments are hard to access. Self-help interventions can increase such access. The aim of this paper was to conduct a systematic review and meta-analysis of the use of guided and unguided self-help for children and young people with symptoms of common mental health disorders. In contrast to previous reviews of self-help in children, all types of self-help and multiple mental health disorders were investigated in order to increase power to investigate potential moderators of efficacy. Importantly, studies with control arms as well as those comparing against traditional face-to-face treatments were included. Fifty studies (n = 3396 participants in self-help/guided self-help conditions) met the inclusion criteria. Results demonstrated a moderate positive effect size for guided and unguided self-help interventions when compared against a control group (n = 44; g = 0.49; 95% CI: 0.37 to 0.61, p < .01) and a small but significant negative effect size when compared to other therapies (n = 15; g = -0.17; 95% CI: -0.27 to -0.07, p < .01). Few potential moderators had a significant effect on outcome. Most comparisons resulted in significant heterogeneity and therefore results are interpreted with caution.
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Affiliation(s)
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | | | - Anna E Coughtrey
- UCL Great Ormond Street Institute of Child Health, London, UK.,Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Isobel Heyman
- UCL Great Ormond Street Institute of Child Health, London, UK.,Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Grazia Manzotti
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Roz Shafran
- UCL Great Ormond Street Institute of Child Health, London, UK
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Facilitating the Dissemination of iCBT for the Treatment of Anxiety and Depression: A Feasibility Study. BEHAVIOUR CHANGE 2018. [DOI: 10.1017/bec.2018.14] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
AbstractTranslating existing internet-based cognitive-behavioural therapy (iCBT), along with the use of transdiagnostic and self-guided formats, may prove to be a cost-effective option of disseminating iCBT. Only recently have encouraging findings been reported for a self-guided delivery. This study assessed the feasibility of a French and self-guided version of an existing English iCBT course, called the Wellbeing Course, for the treatment of anxiety and depression. Existing ICBT programs have not yet been delivered in French, although this language is spoken worldwide. Thirty-one participants were included in a single group pre-post open trial with a 3-month follow-up. Feasibility outcomes were attrition, treatment adherence, acceptability, and preliminary efficacy. Primary outcome measures were the Patient Health Questionnaire 9-item (PHQ-9) and the Generalised Anxiety Disorder 7-item (GAD-7). Nearly 75% of the participants completed the program. Over 80% of the participants provided posttreatment and follow-up data. All study completers reported that they would recommend the Wellbeing Course to a friend having similar problems. Significant reductions in symptoms of anxiety and depression were found following treatment, consistent with earlier studies. These preliminary findings support the use of the assessed strategies to facilitate the cross-cultural dissemination of iCBT for a more universal access to quality psychological care.
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Groves SJ, Porter RJ, Jordan J, Knight R, Carter JD, McIntosh VVW, Fernando K, Frampton CMA, Mulder RT, Lacey C, Joyce PR. Changes in neuropsychological function after treatment with metacognitive therapy or cognitive behavior therapy for depression. Depress Anxiety 2015; 32:437-44. [PMID: 25677736 DOI: 10.1002/da.22341] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 08/11/2014] [Accepted: 11/12/2014] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Metacognitive therapy (MCT) is an innovative treatment model addressing patterns of negative thinking seen in emotional disorders. Unlike cognitive behavior therapy (CBT), MCT has strategies targeting dysfunctional cognitive and metacognitive processes underlying perseverative thinking patterns and attentional biases. The aim of this pilot study was to compare changes in neuropsychological functioning related to executive function and attention in outpatients with depression following treatment with MCT or CBT. METHODS Forty-eight participants referred for outpatient treatment of depression were randomized to 12 weeks of MCT (n = 23) or CBT (n = 25). Mood severity and neuropsychological functioning were assessed at pretreatment, 4 weeks, and at end treatment (12 weeks). RESULTS There were no significant group differences at pretreatment or 4 weeks on any neuropsychological test, although overall both groups showed a small improvement by 4 weeks. At end treatment, the MCT group demonstrated significantly greater improvement in performance on a task requiring spatial working memory and attention than the CBT group. Changes in executive functioning and attention were independent of change in mood symptoms. CONCLUSIONS MCT may have an advantage over CBT in improving aspects of executive function, including attention. MCT's emphasis on attentional training and flexible control of thinking may have a beneficial effect on neuropsychological functioning, consistent with the purported mechanism of action.
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Affiliation(s)
- Samantha J Groves
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand.,Psychology Department, University of Otago, Dunedin, Dunedin, New Zealand
| | - Richard J Porter
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand.,Canterbury District Health Board, Christchurch, New Zealand
| | - Jennifer Jordan
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand.,Canterbury District Health Board, Christchurch, New Zealand
| | - Robert Knight
- Psychology Department, University of Otago, Dunedin, Dunedin, New Zealand
| | - Janet D Carter
- Psychology Department, University of Canterbury, Christchurch, New Zealand
| | | | - Kumari Fernando
- Department of Psychological Medicine, University of Otago, Dunedin, Dunedin, New Zealand
| | | | - Roger T Mulder
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand.,Canterbury District Health Board, Christchurch, New Zealand
| | - Cameron Lacey
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand.,Canterbury District Health Board, Christchurch, New Zealand
| | - Peter R Joyce
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
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Impact of Self-Help Schema Therapy on Psychological Distress and Early Maladaptive Schemas: A Randomised Controlled Trial. BEHAVIOUR CHANGE 2015. [DOI: 10.1017/bec.2014.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Self-help cognitive behaviour therapy has been found helpful in treating anxiety and depression. Recent evidence suggests that self-help schema therapy may represent another treatment alternative. The present study aimed to provide a preliminary assessment of the efficacy of self-help schema therapy on psychological distress and early maladaptive schemas (EMSs) using a 6-week treatment protocol with minimal email contact. Method: Participants were recruited from the general population and randomly assigned to self-help schema therapy (n = 32) or a waitlist (n = 32). Intent-to-treat analyses and study completer analyses were conducted using repeated-measures analyses of variance (time × group). Results: Intent-to-treat analyses revealed that treatment produced a marginal improvement in distress, but no change in EMSs. Among study completers (n = 34), self-help schema therapy yielded large reductions in distress scores on the Outcome Questionnaire-45.2 (partial eta squared = .16). Compared to the waitlist, self-help schema therapy also produced a moderate decrease in EMSs (partial eta squared = .10). The majority of study completers showed reliable clinical change in distress and reported high levels of satisfaction with the intervention. Conclusion: Self-help schema therapy may be an effective treatment for those individuals who persist in treatment. Self-help schema therapy has the potential to help a large number of individuals who may not otherwise have access to services. More research is needed to determine variables associated with treatment adherence and successful outcome.
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