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Jurado-González F, García-Torres F, Contreras A, Muñoz-Navarro R, González-Blanch C, Adrián Medrano L, Ruiz-Rodríguez P, Moreno EM, Pérez-Dueñas C, Cano-Vindel A, Moriana JA. Comparing psychological versus pharmacological treatment in emotional disorders: A network analysis. PLoS One 2024; 19:e0301675. [PMID: 38568925 PMCID: PMC10990220 DOI: 10.1371/journal.pone.0301675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 03/11/2024] [Indexed: 04/05/2024] Open
Abstract
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.
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Affiliation(s)
- Francisco Jurado-González
- Department of Psychology, University of Cordoba/Maimonides Institute for Biomedical Research of Cordoba (IMIBIC)/Reina Sofia University Hospital, Cordoba, Spain
| | - Francisco García-Torres
- Department of Psychology, University of Cordoba/Maimonides Institute for Biomedical Research of Cordoba (IMIBIC)/Reina Sofia University Hospital, Cordoba, Spain
| | - Alba Contreras
- University Catholique San Antonio of Murcia, Murcia, Spain
| | - Roger Muñoz-Navarro
- Department of Psychology and Sociology, Faculty of Social and Human Sciences, University of Zaragoza, Teruel, Spain
| | - César González-Blanch
- Mental Health Centre, Marqués de Valdecilla University Hospital—IDIVAL, Santander, Cantabria, Spain
| | | | - Paloma Ruiz-Rodríguez
- Castilla La Nueva Primary Care Centre, Health Service of Madrid, Fuenlabrada, Madrid, Spain
| | - Eliana M. Moreno
- Department of Psychology, University of Cordoba/Maimonides Institute for Biomedical Research of Cordoba (IMIBIC)/Reina Sofia University Hospital, Cordoba, Spain
| | - Carolina Pérez-Dueñas
- Department of Psychology, University of Cordoba/Maimonides Institute for Biomedical Research of Cordoba (IMIBIC)/Reina Sofia University Hospital, Cordoba, Spain
| | | | - Juan A. Moriana
- Department of Psychology, University of Cordoba/Maimonides Institute for Biomedical Research of Cordoba (IMIBIC)/Reina Sofia University Hospital, Cordoba, Spain
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2
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Ramsey KA, Essoe JKY, Boyle N, Patrick AK, McGuire JF. Immersive Virtual Reality Exposures for the Treatment of Childhood Anxiety. Child Psychiatry Hum Dev 2023:10.1007/s10578-023-01628-4. [PMID: 37985621 DOI: 10.1007/s10578-023-01628-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/27/2023] [Indexed: 11/22/2023]
Abstract
Exposure-based cognitive behavior therapy (CBT) has demonstrated efficacy and is recommended as a front-line treatment for childhood anxiety. Unfortunately, challenges exist that impact the effective implementation of exposure-based CBT in clinical practice. One of the primary challenges is the accessibility and availability of exposure stimuli (e.g., spiders, storms, heights) in CBT sessions. Immersive virtual reality (VR) has shown promise as a scalable and sustainable solution to address this clinical need, but remains largely untested in youth with anxiety disorders. Here, we examine the use of VR exposures in the treatment of youth with an anxiety disorder (i.e., specific phobias). We aimed to investigate: (1) the feasibility and clinical benefit of VR exposures; (2) whether VR exposures elicit changes in physiological arousal and/or subjective distress; and (3) whether habituation serves as a mechanism across physiological and subjective outcomes for VR exposures. Three youth and their parents completed a clinical evaluation, which was followed by a one session treatment (OST) with VR exposures. Afterward, youth and parents completed clinical assessments one-week and 1-month after treatment. Immersive VR exposures were found to be feasible and demonstrated clinical benefit for reducing anxiety severity. Additionally, VR exposures elicited changes in both physiological and subjective outcomes. Finally, physiological habituation to VR exposures was observed among participants who exhibited treatment response at follow-up. Collectively, these findings demonstrate preliminary evidence that VR exposures are feasible, tolerable, and show some therapeutic benefit for treating youth with anxiety.
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Affiliation(s)
- Kesley A Ramsey
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, 550 N Broadway, Suite 206, Baltimore, MD, 21205, USA.
| | - Joey Ka-Yee Essoe
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Psychology, University of Maine at Farmington, Farmington, ME, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, 550 N Broadway, Suite 206, Baltimore, MD, 21205, USA
| | - Nathan Boyle
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- University of Maryland College Park, College Park, MD, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, 550 N Broadway, Suite 206, Baltimore, MD, 21205, USA
| | - Ainsley K Patrick
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Psychology, University of Kansas, Lawrence, KS, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, 550 N Broadway, Suite 206, Baltimore, MD, 21205, USA
| | - Joseph F McGuire
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, 550 N Broadway, Suite 206, Baltimore, MD, 21205, USA
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3
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Bernstein EE, Phillips KA, Greenberg JL, Curtiss J, Hoeppner SS, Wilhelm S. Mechanisms of cognitive-behavioral therapy effects on symptoms of body dysmorphic disorder: a network intervention analysis. Psychol Med 2023; 53:2531-2539. [PMID: 37310300 PMCID: PMC10264834 DOI: 10.1017/s0033291721004451] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Body dysmorphic disorder (BDD) is a severe and undertreated condition. Although cognitive-behavioral therapy (CBT) is the first-line psychosocial treatment for this common disorder, how the intervention works is insufficiently understood. Specific pathways have been hypothesized, but only one small study has examined the precise nature of treatment effects of CBT, and no prior study has examined the effects of supportive psychotherapy (SPT). METHODS This study re-examined a large trial (n = 120) comparing CBT to SPT for BDD. Network intervention analyses were used to explore symptom-level data across time. We computed mixed graphical models at multiple time points to examine relative differences in direct and indirect effects of the two interventions. RESULTS In the resulting networks, CBT and SPT appeared to differentially target certain symptoms. The largest differences included CBT increasing efforts to disengage from and restructure unhelpful thoughts and resist BDD rituals, while SPT was directly related to improvement in BDD-related insight. Additionally, the time course of differences aligned with the intended targets of CBT; cognitive effects emerged first and behavioral effects second, paralleling cognitive restructuring in earlier sessions and the emphasis on exposure and ritual prevention in later sessions. Differences in favor of CBT were most consistent for behavioral targets. CONCLUSIONS CBT and SPT primarily affected different symptoms. To improve patient care, the field needs a better understanding of how and when BDD treatments and treatment components succeed. Considering patient experiences at the symptom level and over time can aid in refining or reorganizing treatments to better fit patient needs.
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Affiliation(s)
- Emily E Bernstein
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Katharine A Phillips
- Rhode Island Hospital and Alpert Medical School of Brown University, Providence, RI, USA
- New York-Presbyterian Hospital and Weill Cornell Medical College, New York, NY, USA
| | | | - Joshua Curtiss
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Susanne S Hoeppner
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Sabine Wilhelm
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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4
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Friedberg RD. Pediatrician-friendly perspectives on cognitive behavioral therapy for anxious youth: Current status and clinical implications for the next normal. World J Clin Pediatr 2021; 10:112-123. [PMID: 34868888 PMCID: PMC8603637 DOI: 10.5409/wjcp.v10.i6.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 07/04/2021] [Accepted: 09/01/2021] [Indexed: 02/06/2023] Open
Abstract
Pediatric anxiety disorders are common and often debilitating conditions. Cognitive is a psychosocial intervention that represents a potentially powerful antidote to these disorders. This article reviews data from treatment outcome studies, meta-analyses, and systematic reviews as well as from moderation/mediational investigations. The literature supports the efficacy, effectiveness, and durability of positive treatment outcomes for pediatric anxiety disorders. Recommendations for clinical applications are suggested.
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Affiliation(s)
- Robert D Friedberg
- Center for the Study and Treatment of Anxious Youth, Palo Alto University, San Jose, CA 95136, United States
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5
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Monteleone AM, Cardi V, Ambwani S, Cascino G, Albano G, Pellegrino F, Treasure J. Network intervention analysis to assess the trajectory of change and treatment effects associated with the use of online guided self-help for anorexia nervosa. Early Interv Psychiatry 2021; 15:1210-1216. [PMID: 33058456 DOI: 10.1111/eip.13064] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 08/16/2020] [Accepted: 09/26/2020] [Indexed: 12/19/2022]
Abstract
AIM The aim of this study was to use the innovative technique of Network Intervention Analysis (NIA) to examine the trajectory of symptom change associated with the use of a digital guided self-help intervention (RecoveryMANTRA) to augment treatment as usual in adult anorexia nervosa. METHODS Self-reported eating disorder symptoms and mood (stress, anxiety and depression), work and social adjustment, motivation and treatment (Treatment as usual + RecoveryMANTRAand Treatment as usual) were included as nodes in the network and examined using NIA. Networks were computed at baseline (n = 88, 99), at end of treatment (6 weeks, n = 71, 75) and at 6- (n = 58, 63) and 12-month (n = 52, 63) follow-up. RESULTS RecoveryMANTRA was associated with a direct effect on anxiety, shape concern and restraint at the end of the intervention. This effect was not maintained at follow-up. There were no direct effects of RecoveryMANTRA on motivation, stress and depression. CONCLUSIONS These findings indicate that RecoveryMANTRA exerts a direct effect on eating disorder symptoms and anxiety. NIA is a promising method to evaluate trajectories of clinical change and direct and indirect effects of a therapeutic intervention compared to a control condition.
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Affiliation(s)
| | - Valentina Cardi
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - Giammarco Cascino
- Department of Medicine, Surgery and Dentistry 'Scuola Medica Salernitana', Section of Neurosciences, University of Salerno, Salerno, Italy
| | - Gaia Albano
- Department of Psychology, Educational Sciences and Human Movement, University of Palermo, Palermo, Italy
| | - Francesca Pellegrino
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Janet Treasure
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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6
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Kaiser T, Boschloo L, Berger T, Meyer B, Späth-Nellissen C, Schröder J, Hohagen F, Moritz S, Klein JP. Maintaining Outcomes of Internet-Delivered Cognitive-Behavioral Therapy for Depression: A Network Analysis of Follow-Up Effects. Front Psychiatry 2021; 12:598317. [PMID: 33959044 PMCID: PMC8095668 DOI: 10.3389/fpsyt.2021.598317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 03/16/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Depression is a highly prevalent mental disorder, but only a fraction of those affected receive evidence-based treatments. Recently, Internet-based interventions were introduced as an efficacious and cost-effective approach. However, even though depression is a heterogenous construct, effects of treatments have mostly been determined using aggregated symptom scores. This carries the risk of concealing important effects and working mechanisms of those treatments. Methods: In this study, we analyze outcome and long-term follow-up data from the EVIDENT study, a large (N = 1,013) randomized-controlled trial comparing an Internet intervention for depression (Deprexis) with care as usual. We use Network Intervention Analysis to examine the symptom-specific effects of the intervention. Using data from intermediary and long-term assessments that have been conducted over 36 months, we intend to reveal how the treatment effects unfold sequentially and are maintained. Results: Item-level analysis showed that scale-level effects can be explained by small item-level effects on most depressive symptoms at all points of assessment. Higher scores on these items at baseline predicted overall symptom reduction throughout the whole assessment period. Network intervention analysis offered insights into potential working mechanisms: while deprexis directly affected certain symptoms of depression (e.g., worthlessness and fatigue) and certain aspects of the quality of life (e.g., overall impairment through emotional problems), other domains were affected indirectly (e.g., depressed mood and concentration as well as activity level). The configuration of direct and indirect effects replicates previous findings from another study examining the same intervention. Conclusions: Internet interventions for depression are not only effective in the short term, but also exert long-term effects. Their effects are likely to affect only a small subset of problems. Patients reporting these problems are likely to benefit more from the intervention. Future studies on online interventions should examine symptom-specific effects as they potentially reveal the potential of treatment tailoring. Clinical Trial Registration: ClinicalTrials.gov, Identifier: NCT02178631.
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Affiliation(s)
- Tim Kaiser
- Department of Psychology, University of Salzburg, Salzburg, Austria.,Department of Psychology, University of Greifswald, Greifswald, Germany
| | - Lynn Boschloo
- Faculty of Behavioural and Movement Sciences, Clinical Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Thomas Berger
- Department of Psychology, Bern University, Bern, Switzerland
| | | | | | - Johanna Schröder
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Fritz Hohagen
- Department of Psychiatry, Lübeck University, Lübeck, Germany
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg Eppendorf, Hamburg, Germany
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7
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In-Session Involvement in Anxious Youth Receiving CBT with/without Medication. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2020. [DOI: 10.1007/s10862-020-09810-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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8
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Boden JM, Monk NJ. Commentary on Pacek et al. (2019): Cannabis and major depression-a network theory proposal. Addiction 2020; 115:944-945. [PMID: 31981263 DOI: 10.1111/add.14949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 12/20/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Joseph M Boden
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Nathan J Monk
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
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