Comparing the effectiveness of individual and group therapy for students with symptoms of anxiety and depression: A randomized pilot study

An interactive online educational environment to reduce anxiety, improve emotional well-being, and critical thinking for college students

Interactive education can reduce anxiety among students by creating a supportive and supportive learning environment. This approach can also stimulate critical thinking, as it requires active student participation in debates, analysis, and discussions. The purpose of this study is to determine the impact of interactive learning on Zoom on the anxiety, emotional well-being, and critical thinking of college students. The experiment involved 80 college students between 18 and 21 years of age. The research was performed by scientists from the [Zhengzhou University of Technology] University. To analyze the impact of the proposed strategy on emotional and cognitive well-being, the study used a set of questionnaires, namely Taylor Manifest Anxiety Scale, WAM (Well-being Assessment Measure), and Subjective Questionnaire for assessing critical thinking. The obtained results confirm the effectiveness of the interactive learning methodology, which significantly reduced anxiety and increased the level of critical thinking among students. Anxiety decreased by 14 points, and critical thinking improved by 2.5 points, indicating positive dynamics of psychological and cognitive development. Despite the positive results, some contextual factors such as the level of the learning environment, cultural characteristics, and the personalities of students can influence the generalization of the findings. These findings can have practical application in the pedagogical practice of creating a favorable learning environment. Future research may focus on improving the methodology of interactive learning, studying its impact on other aspects of learning and development. It is also necessary to explore the use of interactive learning in various cultural and educational contexts.

Comparing psychological versus pharmacological treatment in emotional disorders: A network analysis

Transdiagnostic group cognitive behavioural therapy (TD-GCBT) is more effective in improving symptoms and severity of emotional disorders (EDs) than treatment as usual (TAU; usually pharmacological treatment). However, there is little research that has examined the effects of these treatments on specific symptoms. This study used Network Intervention Analysis (NIA) to investigate the direct and differential effects of TD-GCBT + TAU and TAU on specific symptoms of anxiety and depression. Data are from a multicentre randomised clinical trial (N = 1061) comparing TD-GCBT + TAU versus TAU alone for EDs. The networks included items from the PHQ-9 (depression) and GAD-7 (anxiety) questionnaire and mixed graphical models were estimated at pre-treatment, post-treatment and 3-, 6- and 12-month follow-up. Results revealed that TD-GCBT + TAU was associated with direct effects, mainly on several anxiety symptoms and depressed mood after treatment. New direct effects on other depressive symptoms emerged during the follow-up period promoted by TD-GCBT compared to TAU. Our results suggest that the improvement of anxiety symptoms after treatment might precipitate a wave of changes that favour a decrease in depressive symptomatology. NIA is a methodology that can provide fine-grained insight into the likely pathways through which treatments exert their effects.

A comparison of the effectiveness of cognitive behavioural interventions based on delivery features for elevated symptoms of depression in adolescents: A systematic review

Background

Depression is a public health problem and common amongst adolescents. Cognitive behavioural therapy (CBT) is widely used to treat adolescent depression but existing research does not provide clear conclusions regarding the relative effectiveness of different delivery modalities.

Objectives

The primary aim is to estimate the relative efficacy of different modes of CBT delivery compared with each other and control conditions for reducing depressive symptoms in adolescents. The secondary aim is to compare the different modes of delivery with regard to intervention completion/attrition (a proxy for intervention acceptability).

Search Methods

The Cochrane Depression, Anxiety and Neurosis Clinical Trials Register was searched in April 2020. MEDLINE, PsycInfo, EMBASE, four other electronic databases, the CENTRAL trial registry, Google Scholar and Google were searched in November 2020, together with reference checking, citation searching and hand-searching of two databases.

Selection Criteria

Randomised controlled trials (RCTs) of CBT interventions (irrespective of delivery mode) to reduce symptoms of depression in young people aged 10-19 years with clinically relevant symptoms or diagnosis of depression were included.

Data Collection and Analysis

Screening and data extraction were completed by two authors independently, with discrepancies addressed by a third author. CBT interventions were categorised as follows: group CBT, individual CBT, remote CBT, guided self-help, and unguided self-help. Effect on depressive symptom score was estimated across validated self-report measures using Hedges' g standardised mean difference. Acceptability was estimated based on loss to follow-up as an odds ratio. Treatment rankings were developed using the surface under the cumulative ranking curve (SUCRA). Pairwise meta-analyses were conducted using random effects models where there were two or more head-to-head trials. Network analyses were conducted using random effects models.

Main Results

Sixty-eight studies were included in the review. The mean age of participants ranged from 10 to 19.5 years, and on average 60% of participants were female. The majority of studies were conducted in schools (28) or universities (6); other settings included primary care, clinical settings and the home. The number of CBT sessions ranged from 1 to 16, the frequency of delivery from once every 2 weeks to twice a week and the duration of each session from 20 min to 2 h. The risk of bias was low across all domains for 23 studies, 24 studies had some concerns and the remaining 21 were assessed to be at high risk of bias. Sixty-two RCTs (representing 6435 participants) were included in the pairwise and network meta-analyses for post-intervention depressive symptom score at post-intervention. All pre-specified treatment and control categories were represented by at least one RCT. Although most CBT approaches, except remote CBT, demonstrated superiority over no intervention, no approaches performed clearly better than or equivalent to another. The highest and lowest ranking interventions were guided self-help (SUCRA 83%) and unguided self-help (SUCRA 51%), respectively (very low certainty in treatment ranking). Nineteen RCTs (3260 participants) were included in the pairwise and network meta-analyses for 6 to 12 month follow-up depressive symptom score. Neither guided self-help nor remote CBT were evaluated in the RCTs for this time point. Effects were generally attenuated for 6- to 12-month outcomes compared to posttest. No interventions demonstrated superiority to no intervention, although unguided self-help and group CBT both demonstrated superiority compared to TAU. No CBT approach demonstrated clear superiority over another. The highest and lowest ranking approaches were unguided self-help and individual CBT, respectively. Sixty-two RCTs (7347 participants) were included in the pairwise and network meta-analyses for intervention acceptability. All pre-specified treatment and control categories were represented by at least one RCT. Although point estimates tended to favour no intervention, no active treatments were clearly inferior. No CBT approach demonstrated clear superiority over another. The highest and lowest ranking active interventions were individual CBT and group CBT respectively. Pairwise meta-analytic findings were similar to those of the network meta-analysis for all analyses. There may be age-based subgroup effects on post-intervention depressive symptoms. Using the no intervention control group as the reference, the magnitudes of effects appear to be larger for the oldest age categories compared to the other subgroups for each given comparison. However, they were generally less precise and formal testing only indicated a significant difference for group CBT. Findings were robust to pre-specified sensitivity analyses separating out the type of placebo and excluding cluster-RCTs, as well as an additional analysis excluding studies where we had imputed standard deviations.

Authors' Conclusions

At posttreatment, all active treatments (group CBT, individual CBT, guided self-help, and unguided self-help) except for remote CBT were more effective than no treatment. Guided self-help was the most highly ranked intervention but only evaluated in trials with the oldest adolescents (16-19 years). Moreover, the studies of guided self-help vary in the type and amount of therapist support provided and longer-term results are needed to determine whether effects persist. The magnitude of effects was generally attenuated for 6- to 12-month outcomes. Although unguided self-help was the lowest-ranked active intervention at post-intervention, it was the highest ranked at follow-up. This suggests the need for further research into whether interventions with self-directed elements enable young people to maintain effects by continuing or revisiting the intervention independently, and whether therapist support would improve long-term outcomes. There was no clear evidence that any active treatments were more acceptable to participants than any others. The relative effectiveness of intervention delivery modes must be taken into account in the context of the needs and preferences of individual young people, particularly as the differences between effect sizes were relatively small. Further research into the type and amount of therapist support that is most acceptable to young people and most cost-effective would be particularly useful.

A data-driven simulation approach to quantify the effect of group counseling on system performance of college counseling centers

Objective: To investigate the effectiveness, from a system's perspective, of offering group counseling options in college counseling centers. Methods: We achieve this through a data-driven simulation-based approach with the aim of providing administrators with a quantitative tool that informs their decision-making process. Results: Our simulation experiments reveal that offering group counseling options without resource reallocation does not have the desired positive impact on the system's performance. However, with resource reallocation, our results demonstrate that the introduction of group counseling options can significantly improve the performance of the system by as much as 40%. Conclusions: Group counseling options, coupled with proper resource reallocation strategies, are effective in reducing access time of first-time patients by as much as 40%. The effect of group counseling is highly dependent on both the number of offered groups as well as their scheduling policy. Scheduling policies have to be scrutinized in light of their resulting group waiting time and resource-utilization efficiency.

Stressors among young Australian university students: A qualitative study

OBJECTIVE

To explore stressors among young university students.

PARTICIPANTS

Twenty-nine 18- to 25-year-old university students.

METHOD

Four focus group discussions (n = 29) were conducted to explore mental health and stressors among domestic and international university students. Data was analyzed using thematic analysis to identify emerging themes and relationships.

RESULTS

Five primary stressors emerged from the data: Balance, Interpersonal Relationships, Future Prospects, Performance Pressure and Financial Issues and Employment. Although many distinct relationships were identified between themes, "Balance" affected and influenced most other stressors.

CONCLUSIONS

Five stressors were identified, most of which related to a lack of balance and time-management. Too many competing commitments and difficulty prioritizing were key influences. Interventions and policy to address stressors in students may reduce student psychological stress. Universities can provide support for students to prioritize commitments, provide flexible study opportunities and offer financial guidance.

Development of a comprehensive flourishing intervention to promote mental health using an e-Delphi technique

BACKGROUND

Although observational studies have already shown promising results of flourishing, a broader concept of health based on positive psychology, there is still a gap in the literature regarding studies that combine different topics of flourishing in a single intervention.

OBJECTIVES

To develop a comprehensive and integrate intervention based on positive psychology gathering different topics of flourishing to improve mental health outcomes in individuals with depressive symptoms.

METHODS

The following steps were performed: (1) a comprehensive literature review; (2) the designing of a 12-session group intervention based on the values, virtues, and topics of flourishing; (3) assessment of the rationale, coherence, and feasibility by a panel of healthcare professionals answering semi-structured questions, and (4) application of an e-Delphi technique including mental health experts to reach a consensus of at least 80% for each item of the protocol.

RESULTS

A total of 25 experts participated in the study, 8 in the panel with semi-structured questions and 17 in the e-Delphi technique. A three-round e-Delphi technique was required to reach a consensus for all items. In the first round, a consensus was reached for 86.2% of the items. The remaining items (13.8%) were either excluded or reformulated. In the second round, a consensus was not obtained on one item, which was reformulated and approved in the third round. Qualitative analyses of the open questions were performed and suggestions for the protocol were considered. The final version of the intervention was composed of 12 weekly group sessions with 90-min each. The topics included in the intervention were physical and mental health, virtues and character strengths, love, gratitude, kindness, volunteering, happiness, social support, family, friends and community, forgiveness, compassion, resilience, spirituality, purpose and meaning of life, imagining the "best possible future," and flourishing.

CONCLUSION

The flourishing intervention was successfully developed using an e-Delphi technique. The intervention is ready to be tested in an experimental study to verify its feasibility and effectiveness.

A Survey of Group Coordinators in College and University Counseling Centers: Findings and Recommendations

In an era of increasing demands on college counseling centers (CCs), many CCs appoint a group coordinator (GC) to oversee the implementation of a group therapy program. It is common knowledge in the field that this role is essential to develop and maintain a thriving group program, yet little information is available to understand best practices. An exploratory survey of GCs in CCs was conducted to understand the descriptive features of those occupying the role as well as typical responsibilities, resources, and job satisfaction. We analyzed responses from 53 GCs in the US and Canada. Generally, GCs reported managing a wide range of responsibilities and having limited resources (administrative time, reduced caseload) and inconsistent CC staff practices (group training, weekly group meeting). On average, GCs reported moderate satisfaction with their role and resources and high satisfaction with CC leadership. Correlations were found between positive CC culture toward group and staff involvement, groups per semester, GC responsibilities, group program structures, and GC role satisfaction. Rates of group utilization were significantly higher for GCs with two or more administrative hours and for CCs that held a weekly meeting about groups. Staff group involvement, representing strength of CC culture toward group, was significantly higher if the GC held an administrative role. The article concludes with recommendations for best practices for the GC role and directions for future research.

Brief psychological treatments for emotional disorders in Primary and Specialized Care: A randomized controlled trial

Background/Objective Brief transdiagnostic psychotherapies are a possible treatment for emotional disorders. We aimed to determine their efficacy on mild/moderate emotional disorders compared with treatment as usual (TAU) based on pharmacological interventions. Method: This study was a single-blinded randomized controlled trial with parallel design of three groups. Patients (N = 102) were assigned to brief individual psychotherapy (n = 34), brief group psychotherapy (n = 34) or TAU (n = 34). Participants were assessed before and after the interventions with the following measures: PHQ-15, PHQ-9, PHQ-PD, GAD-7, STAI, BDI-II, BSI-18, and SCID. We conducted per protocol and intention-to-treat analyses. Results: Brief psychotherapies were more effective than TAU for the reduction of emotional disorders symptoms and diagnoses with moderate/high effect sizes. TAU was only effective in reducing depressive symptoms. Conclusions: Brief transdiagnostic psychotherapies might be the treatment of choice for mild/moderate emotional disorders and they seem suitable to be implemented within health care systems.