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Hawkins RD, Kuo CH, Robinson C. Young adults' views on the mechanisms underpinning the impact of pets on symptoms of anxiety and depression. Front Psychiatry 2024; 15:1355317. [PMID: 38425998 PMCID: PMC10902138 DOI: 10.3389/fpsyt.2024.1355317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 01/29/2024] [Indexed: 03/02/2024] Open
Abstract
Introduction Emerging adulthood is considered a peak age for the onset of mental health difficulties with approximately 75% of mental health disorders being diagnosed during this developmental period. Companion animals confer both risk and benefits to mental health yet the potential underpinning mechanisms which explain such impacts are not fully understood. This study aimed to gather an in-depth understanding of young adults' lived experience of how their companion dogs and cats may impact their mental health symptoms and the perceived mechanisms which explain their effects. Methods Semi-structured interviews were carried out with 16 young adults aged 18-26 years, from the United Kingdom, who either had a companion dog, cat, or both. All participants had difficulties with anxiety and or depression, and 12 had received a formal diagnosis of an affective disorder. Results Five overarching themes and one subtheme were identified through reflexive thematic analysis using an inductive approach: Theme 1: Pet impact on generalized anxiety and panic, Subtheme 1A: Pet impact on social anxiety and loneliness; Theme 2: Pet impact on low mood, depression, and stress; Theme 3: Pet impact on severe mental health and suicide prevention; Theme 4: Staying well; Theme 5: Positive outlook and successful futures. Several perceived mechanisms underpinning the impacts of pets for mental health were also identified. Discussion These findings have relevance for the development and evaluation of mental health interventions and treatment protocols aimed at young adults with mental health difficulties, where companion animals may prove to be effective for symptom management and improvements in positive wellbeing.
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Affiliation(s)
- Roxanne D. Hawkins
- Clinical and Health Psychology, School of Health in Social Science, The University of Edinburgh, Edinburgh, United Kingdom
| | - Chih-Hsin Kuo
- Psychology Division, The University of Stirling, Stirling, United Kingdom
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Baigent M, Smith D, Battersby M, Lawn S, Redpath P, McCoy A. The Australian version of IAPT: clinical outcomes of the multi-site cohort study of NewAccess. J Ment Health 2023; 32:341-350. [PMID: 32394756 DOI: 10.1080/09638237.2020.1760224] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND The United Kingdom IAPT (Improving Access to Psychological Therapies) approach of delivering low intensity therapies for symptoms of depression and anxiety was adapted for Australia and named NewAccess. Clinical outcomes of the service were evaluated in three sites between October 2013 and 2016. AIMS This paper describes the clinical outcomes in the Australian health setting. METHODS Prospective cohort study with repeated measures. Both intent-to-treat and per protocol analyses were conducted for primary outcomes measures Patient Health Questionnaire-9 (nine item), and Generalised Anxiety Disorder (seven item). Secondary measures were Phobia Scale and Work and Social Adjustment Scale. RESULTS Three thousand nine hundred and forty-six individuals were assessed, and 3269 attended at least two treatment sessions. Forty percent were males. There was a clinically meaningful reduction (improvement) shown by reliable recovery rates in both depression and anxiety symptoms at post-treatment assessment (68%; 95% CI: 66-70%) with large effect sizes (1.23 for depression and 1.25 for anxiety). Outcomes in PHQ-9 and GAD-7 were not influenced by age or sex, but recovery rates were significantly reduced by relationship status (single or separated). Unemployment reduced PHQ-9 outcomes but not GAD-7 outcomes. CONCLUSION NewAccess demonstrated positive clinical outcomes in Australia, that compared favourably with international studies with the same methodology.
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Affiliation(s)
- Michael Baigent
- Beyond Blue, Victoria, Australia.,Discipline of Psychiatry, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - David Smith
- Discipline of Psychiatry, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Malcolm Battersby
- Discipline of Psychiatry, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Sharon Lawn
- Discipline of Psychiatry, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Paula Redpath
- Discipline of Psychiatry, College of Medicine and Public Health, Flinders University, Adelaide, Australia
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Liu T, Xu J, Cheng H, Zhang Y, Wang S, Lin L, Tian L. Effects of internet-based cognitive behavioral therapy on anxiety and depression symptoms in cancer patients: A meta-analysis. Gen Hosp Psychiatry 2022; 79:135-145. [PMID: 36375342 DOI: 10.1016/j.genhosppsych.2022.09.003] [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: 08/01/2022] [Revised: 09/17/2022] [Accepted: 09/19/2022] [Indexed: 11/04/2022]
Abstract
PURPOSE This meta-analysis was to critically evaluate the effects of Internet-based cognitive behavioral therapy (ICBT) on the symptoms of anxiety and depression in cancer patients. METHODS Eight Chinese and English databases (CNKI, Wanfang, VIP, CBM, Cochrane Library, PubMed, Embase, and PsycINFO) were systematically searched from the inception of databases to May 2022 for relevant randomized controlled trials (RCTs). According to the Cochrane Collaboration criteria, two reviewers independently assessed the risk of bias and extract data from included studies. All analyses were performed with Review Manager 5.4. RESULTS Thirteen qualified studies were included in the meta-analysis, twelve of which reported the effect of ICBT on anxiety in 2079 cancer patients; thirteen of the studies reported the effect of ICBT on depression in 2179 patients. The meta-analysis indicated that ICBT was effective in improving anxiety [SMD = -0.37, 95%CI (-0.62, -0.12), P < 0.01, I2 = 86%] and depression [SMD = -0.27, 95%CI (-0.44, -0.09), P < 0.01, I2 = 72%] symptoms in cancer patients, especially those undergoing anti-cancer treatment. Therapist-guided ICBT was more effective than self-directed ICBT. ICBT lasting for ≤12 weeks could relieve anxiety and depressive symptoms of cancer patients. ICBT with number of modules ≥5 had a small effect on anxiety and depression relief while ICBT with number of modules <5 was found to be ineffective. CONCLUSIONS ICBT lasting for ≤12 weeks, especially therapist-directed, helps relieve the anxiety and depressive symptoms of cancer patients. The ideal number of modules for ICBT and its long-term efficacy need to be validated by more studies of higher-quality.
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Affiliation(s)
- Tingting Liu
- The First Affiliated Hospital of Soochow University, Suzhou 215006, People's Republic of China; School of Nursing, Medical College of Soochow University, Suzhou 215006, People's Republic of China
| | - Juan Xu
- The First Affiliated Hospital of Soochow University, Suzhou 215006, People's Republic of China
| | - Hui Cheng
- School of Nursing, Medical College of Soochow University, Suzhou 215006, People's Republic of China
| | - Yueyue Zhang
- School of Nursing, Medical College of Soochow University, Suzhou 215006, People's Republic of China
| | - Shaotong Wang
- School of Nursing, Medical College of Soochow University, Suzhou 215006, People's Republic of China
| | - Lu Lin
- The First Affiliated Hospital of Soochow University, Suzhou 215006, People's Republic of China; School of Nursing, Medical College of Soochow University, Suzhou 215006, People's Republic of China.
| | - Li Tian
- The First Affiliated Hospital of Soochow University, Suzhou 215006, People's Republic of China; School of Nursing, Medical College of Soochow University, Suzhou 215006, People's Republic of China.
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Puddephatt J, Irizar P, Jones A, Gage SH, Goodwin L. Associations of common mental disorder with alcohol use in the adult general population: a systematic review and meta-analysis. Addiction 2022; 117:1543-1572. [PMID: 34729837 PMCID: PMC9300028 DOI: 10.1111/add.15735] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 10/15/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND AIMS Research has shown that alcohol use and common mental disorders (CMDs) co-occur; however, little is known about how the global prevalence of alcohol use compares across different CMDs. We aimed to (i) report global associations of alcohol use (alcohol use disorder (AUD), binge drinking and consumption) comparing those with and without a CMD, (ii) examine how this differed among those with and without specific types of CMDs and (iii) examine how results may differ by study characteristics. METHODS We used a systematic review and meta-analysis. Cross-sectional, cohort, prospective, longitudinal and case-control studies reporting the prevalence of alcohol use among those with and without a CMD in the general population were identified using PsycINFO, MEDLINE, PsyARTICLES, PubMed, Scopus and Web of Science until March 2020. Depression, anxiety and phobia were included as a CMD. Studies were included if they used a standardized measure of alcohol use. A random-effects meta-analysis was conducted to generate pooled prevalence and associations of AUD with CMD with 95% confidence intervals (CI). A narrative review is provided for binge drinking and alcohol consumption RESULTS: A total of 512 full-texts were reviewed, 51 included in our final review and 17 in our meta-analyses (n = 382 201). Individuals with a CMD had a twofold increase in the odds of reporting an AUD [odds ratio (OR) = 2.02, 95% CI = 1.72-2.36]. The odds of having an AUD were similar when stratified by the type of CMD (mood disorder: OR = 2.00, 95% CI = 1.62-2.47; anxiety/phobic disorder: OR = 1.94, 95% CI = 1.35-2.78). An analysis of study characteristics did not reveal any clear explanations for between-study heterogeneity (I2 > 80%). There were no clear patterns for associations between having a CMD and binge drinking or alcohol consumption, respectively. CONCLUSIONS People with common mental disorders (depression, anxiety, phobia) are twice as likely to report an alcohol use disorder than people without common mental disorders.
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Affiliation(s)
| | | | - Andrew Jones
- Department of PsychologyUniversity of LiverpoolLiverpoolUK
| | | | - Laura Goodwin
- Department of PsychologyUniversity of LiverpoolLiverpoolUK
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5
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Kopp TM, Frey TM, Zakrajsek M, Nystrom J, Koutsounadis GN, Falcone KS, Zhang Y, Wall E, Byczkowski T, Mittiga MR. Poorly Controlled Pediatric Fracture Pain Requiring Unplanned Medical Assistance or Advice. Pediatr Emerg Care 2022; 38:e410-e416. [PMID: 34986594 DOI: 10.1097/pec.0000000000002304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study aimed to define the proportion of children who seek assistance for poorly controlled fracture pain, identify factors associated with requesting help, and explore caregivers' opioid preferences. METHODS We enrolled 251 children and their caregivers in the orthopedic surgery clinic of a tertiary care children's hospital. Children 5 to 17 years old presenting within 10 days of injury for follow-up for a single-extremity, nonoperative long bone fracture(s) were eligible. The primary outcome was seeking unscheduled evaluation or advice for poorly controlled pain before the first routine follow-up appointment by telephone call, medical visit, or rescheduling to an earlier appointment. Factors associated with the outcome were assessed using bivariable analysis. RESULTS Overall, 7.3% (95% confidence interval, 4.1%-10.6%) of participants sought unscheduled evaluation or advice for poorly controlled pain. The 2 most common reasons were to obtain over-the-counter analgesic dosage information (64.7%) and a stronger analgesic (29.4%). These children were more likely to have a leg fracture, have an overriding or translated fracture, or require manual reduction under procedural sedation. These children had higher Patient-Reported Outcomes Measurement Information System Pain Behavior and Pain Interference scores and more anxious caregivers. One-third of caregivers expressed hesitancy or refusal to use opioids to treat severe pain, and 45.7% reported potential addiction or abuse as the rationale. CONCLUSIONS A notable proportion of children seek assistance for poorly controlled fracture-related pain. Medical providers should target discharge instructions to the identified risk factors and engage caregivers in shared decision making if opioids are recommended.
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Affiliation(s)
- Tara M Kopp
- From the Department of Pediatrics, Norton Children's and University of Louisville School of Medicine, Louisville, KY
| | | | | | - Jennifer Nystrom
- Section of Emergency Medicine, Nationwide Children's Hospital, Columbus, OH
| | - Gena N Koutsounadis
- New York Institute of Technology School of Osteopathic Medicine, Old Westbury, NY
| | | | - Yin Zhang
- Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center
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Roberts T, Daniels J, Hulme W, Horner D, Lyttle MD, Samuel K, Graham B, Hirst R, Reynard C, Barrett M, Carlton E. COVID-19 emergency response assessment study: a prospective longitudinal survey of frontline doctors in the UK and Ireland: study protocol. BMJ Open 2020; 10:e039851. [PMID: 32788191 PMCID: PMC7422647 DOI: 10.1136/bmjopen-2020-039851] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 07/22/2020] [Accepted: 07/23/2020] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION The COVID-19 pandemic is putting an unprecedented strain on healthcare systems globally. The psychological impact on frontline doctors of dealing with the COVID-19 pandemic is currently unknown. This longitudinal professional survey aims to understand the evolving and cumulative effects of working during the COVID-19 outbreak on the psychological well-being of doctors working in emergency departments (ED), intensive care units (ICU) and anaesthetics during the pandemic. METHODS AND ANALYSIS This study is a longitudinal questionnaire-based study with three predefined time points spanning the acceleration, peak and deceleration phases of the COVID-19 pandemic.The primary outcomes are psychological distress and post-trauma stress as measured by the General Health Questionnaire-12 (GHQ-12) and Impact of Events Scale-Revised (IES-R). Data related to personal and professional characteristics will also be collected. Questionnaires will be administered prospectively to all doctors working in ED, ICU and anaesthetics in the UK and Ireland via existing research networks during the sampling period. Data from the questionnaires will be analysed to assess the prevalence and degree of psychological distress and trauma, and the nature of the relationship between personal and professional characteristics and the primary outcomes. Data will be described, analysed and disseminated at each time point; however, the primary endpoint will be psychological distress and trauma at the final time point. ETHICS AND DISSEMINATION Ethical approval was obtained from the University of Bath, UK (ref: 4421), and Children's Health Ireland at Crumlin, Ethics Committee. Regulatory approval from the Health Regulation Authority (UK), Health and Care Research Wales (IRAS: 281944).This study is limited by the fact that it focuses on doctors only and is survey based without further qualitative interviews of participants. It is expected this study will provide clear evidence of the psychological impact of COVID-19 on doctors and will allow present and future planning to mitigate against any psychological impact. TRIAL REGISTRATION NUMBER ISRCTN10666798.
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Affiliation(s)
- Tom Roberts
- Trainee Emergency Research Network, The Royal College of Emergency Medicine, London, UK
- Emergency Department, Bristol Royal Hospital for Children, Bristol, UK
| | - Jo Daniels
- Department of Psychology, University of Bath, Bath, Somerset, UK
| | | | - Daniel Horner
- Trainee Emergency Research Network, The Royal College of Emergency Medicine, London, UK
- Department of Intensive Care, Salford Royal Hospitals NHS Trust, Salford, UK
| | - Mark David Lyttle
- Emergency Department, Bristol Royal Hospital for Children, Bristol, UK
- Faculty of Health and Applied Science, University of the West of England, Bristol, UK
| | - Katie Samuel
- Department of Anaesthesia, North Bristol NHS Trust, Westbury on Trym, Bristol, UK
| | - Blair Graham
- Faculty of Health, University of Plymouth, Plymouth, Devon, UK
- Emergency Department, Plymouth Hospitals NHS Foundation Trust, Plymouth, UK
| | - Robert Hirst
- Department of Anaesthesia, North Bristol NHS Trust, Westbury on Trym, Bristol, UK
| | - Charles Reynard
- Department of Cardviovascular Sciences, The University of Manchester, Manchester, UK
| | - Michael Barrett
- School of Medicine, Women's and Children's Health, University College Dublin, Dublin, Ireland
| | - Edward Carlton
- Trainee Emergency Research Network, The Royal College of Emergency Medicine, London, UK
- Emergency Department, North Bristol NHS Trust, Westbury on Trym, UK
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Bales M, Pambrun E, Melchior M, Glangeaud-Freudenthal NC, Charles MA, Verdoux H, Sutter-Dallay AL. Prenatal Psychological Distress and Access to Mental Health Care in the ELFE Cohort. Eur Psychiatry 2020; 30:322-8. [DOI: 10.1016/j.eurpsy.2014.11.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Revised: 09/08/2014] [Accepted: 11/17/2014] [Indexed: 11/28/2022] Open
Abstract
AbstractBackground:Pregnant women are vulnerable to the deleterious impact of environmental stressors. The aims were to identify the environmental and pregnancy characteristics independently associated with prenatal psychological distress and access to mental health care.Methods:We used data from the French cohort Étude Longitudinale Française depuis l’Enfance (ELFE), a nationally representative cohort of children followed-up from birth to adulthood. Information about prenatal psychological status and access to mental health care was collected during the maternity stay. Maternal/pregnancy characteristics independently associated with psychological distress and access to mental health care were explored using multivariate analyses.Results:Of the 15,143 mothers included, 12.6% reported prenatal psychological distress. Prenatal distress was more frequent in women with very low economical status, alcohol/tobacco use, unplanned/unwanted pregnancy, late pregnancy declaration, multiparity and complicated pregnancy (high number of prenatal visits, prenatal diagnosis examination, obstetrical complications). Of the women reporting prenatal distress, 25% had a prenatal consultation with a mental health specialist and 11% used psychotropic drugs during pregnancy. Decreased likelihood to consult a mental health specialist was found in young women, with intermediate educational level and born abroad.Limitations:Causal inferences should be made cautiously as the questionnaire did not collect information on the temporal sequence between psychological distress and associated characteristics.Conclusions:Women with social and obstetrical vulnerabilities are at increased risk of poor mental health during pregnancy. Improving mental health care access during pregnancy is a public health priority.
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Dalgleish T, Black M, Johnston D, Bevan A. Transdiagnostic approaches to mental health problems: Current status and future directions. J Consult Clin Psychol 2020; 88:179-195. [PMID: 32068421 PMCID: PMC7027356 DOI: 10.1037/ccp0000482] [Citation(s) in RCA: 297] [Impact Index Per Article: 74.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 11/25/2019] [Indexed: 12/19/2022]
Abstract
Despite a longstanding and widespread influence of the diagnostic approach to mental ill health, there is an emerging and growing consensus that such psychiatric nosologies may no longer be fit for purpose in research and clinical practice. In their place, there is gathering support for a "transdiagnostic" approach that cuts across traditional diagnostic boundaries or, more radically, sets them aside altogether, to provide novel insights into how we might understand mental health difficulties. Removing the distinctions between proposed psychiatric taxa at the level of classification opens up new ways of classifying mental health problems, suggests alternative conceptualizations of the processes implicated in mental health, and provides a platform for novel ways of thinking about onset, maintenance, and clinical treatment and recovery from experiences of disabling mental distress. In this Introduction to a Special Section on Transdiagnostic Approaches to Psychopathology, we provide a narrative review of the transdiagnostic literature in order to situate the Special Section articles in context. We begin with a brief history of the diagnostic approach and outline several challenges it currently faces that arguably limit its applicability in current mental health science and practice. We then review several recent transdiagnostic approaches to classification, biopsychosocial processes, and clinical interventions, highlighting promising novel developments. Finally, we present some key challenges facing transdiagnostic science and make suggestions for a way forward. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Tim Dalgleish
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge
| | - Melissa Black
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge
| | - David Johnston
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge
| | - Anna Bevan
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge
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McEnery C, Lim MH, Knowles A, Rice S, Gleeson J, Howell S, Russon P, Miles C, D'Alfonso S, Alvarez-Jimenez M. Development of a Moderated Online Intervention to Treat Social Anxiety in First-Episode Psychosis. Front Psychiatry 2019; 10:581. [PMID: 31474889 PMCID: PMC6702333 DOI: 10.3389/fpsyt.2019.00581] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 07/23/2019] [Indexed: 01/09/2023] Open
Abstract
Background: It is well established that social anxiety disorder (SAD) is a significant clinical problem for individuals with a psychotic disorder. Comorbid social anxiety in individuals with psychosis has been associated with poorer premorbid functioning, increased depression, and a reduced quality of life. Cognitive behavior therapy (CBT) is recommended for people with psychosis as a first-line psychological treatment; however, its focus and evaluation primarily revolves around reducing psychotic symptoms and not necessarily targeting comorbid social anxiety symptoms. We developed a novel online social cognitive behavioral intervention (entitled EMBRACE) specifically designed to treat social anxiety symptoms in first episode psychosis (FEP). Methods: The key clinical and engagement features of the intervention were established through integrating evidence-based material derived from 1) CBT-based treatment models for SAD, 2) relevant literature findings related to psychosis and its clinical correlates (e.g., shame, social rank, and its relationship with social anxiety and paranoia), 3) feedback from youth focus groups in order to inform a user-centered intervention design, and 4) a highly multidisciplinary collaborative development approach to design therapy comics. Results: A detailed description of the final version of the 12-week online social intervention to treat social anxiety in FEP is presented. Conclusion: The EMBRACE intervention was designed to provide young people with the necessary skills and confidence to overcome social anxiety within a supportive, safe online space. By design, it allows young people the opportunity to practice their newly learnt skills to connect with others and in doing so, learn to embrace their true authentic selves.
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Affiliation(s)
- Carla McEnery
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.,Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia
| | - Michelle H Lim
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, VIC, Australia.,Iverson Health Innovation Research Institute, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Ann Knowles
- Department of Psychological Sciences, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Simon Rice
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.,Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia
| | - John Gleeson
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, VIC, Australia
| | - Simmone Howell
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.,Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia
| | - Penni Russon
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.,Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia
| | - Chris Miles
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.,Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia
| | - Simon D'Alfonso
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.,Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia.,School of Computing and Information Systems, University of Melbourne, Parkville, VIC, Australia
| | - Mario Alvarez-Jimenez
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.,Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia
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Martínez-Borba V, Suso-Ribera C, Osma J. The Use of Information and Communication Technologies in Perinatal Depression Screening: A Systematic Review. CYBERPSYCHOLOGY BEHAVIOR AND SOCIAL NETWORKING 2018; 21:741-752. [DOI: 10.1089/cyber.2018.0416] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
| | | | - Jorge Osma
- Facultad de Ciencias Sociales y Humanas, University of Zaragoza, Teruel, Spain
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Pailing AN, Reniers RLEP. Depressive and socially anxious symptoms, psychosocial maturity, and risk perception: Associations with risk-taking behaviour. PLoS One 2018; 13:e0202423. [PMID: 30110384 PMCID: PMC6093696 DOI: 10.1371/journal.pone.0202423] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 08/02/2018] [Indexed: 02/06/2023] Open
Abstract
Risk-taking behaviour and onset of mental illness peak in adolescence and young adulthood. This study evaluated the interconnectedness of the domains of risk-taking behaviour, mental health (symptoms of depression and social anxiety), psychosocial maturity, risk perception, age, and gender in a sample of 306 adolescents and young adults. Participants between the ages of 16 and 35 completed online self-report measures assessing risk-taking behaviour, depressive symptoms, socially anxious symptoms, psychosocial maturity and risk perception. Socially anxious symptoms, psychosocial maturity, and risk perception were directly associated with risk-taking behaviour. Correlations between depressive symptoms, socially anxious symptoms, and psychosocial maturity were found. Psychosocial maturity proved a better predictor of risk-taking behaviour than age in this cohort. The findings indicate that mental health impacts upon risk-taking behaviour and that consideration should be given to psychosocial maturity in attempts to reduce adolescent and young adult risk-taking behaviour.
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Affiliation(s)
- Adam N. Pailing
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Renate L. E. P. Reniers
- Institute of Clinical Sciences, University of Birmingham, Birmingham, United Kingdom
- Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom
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12
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Black M, Hitchcock C, Bevan A, O Leary C, Clarke J, Elliott R, Watson P, LaFortune L, Rae S, Gilbody S, Kuyken W, Johnston D, Newby JM, Dalgleish T. The HARMONIC trial: study protocol for a randomised controlled feasibility trial of Shaping Healthy Minds-a modular transdiagnostic intervention for mood, stressor-related and anxiety disorders in adults. BMJ Open 2018; 8:e024546. [PMID: 30082367 PMCID: PMC6078277 DOI: 10.1136/bmjopen-2018-024546] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 06/15/2018] [Accepted: 06/20/2018] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Anxiety, mood and trauma-related disorders are common, affecting up to 20% of adults. Many of these individuals will experience symptoms of more than one disorder as diagnostically defined. However, most psychological treatments focus on individual disorders and are less effective for those who experience comorbid disorders. The Healthy and Resilient Mind Programme: Building Blocks for Mental Wellbeing (HARMONIC) trial introduces a novel transdiagnostic intervention (Shaping Healthy Minds (SHM)), which synthesises several evidence-based treatment techniques to address the gap in effective interventions for people with complex and comorbid difficulties. This early phase trial aims to estimate the efficacy and feasibility of the transdiagnostic intervention in preparation for a later-phase randomised controlled trial, and to explore mechanisms of change. METHODS/ANALYSIS We outline a patient-level two-arm randomised controlled trial (HARMONIC) that compares SHM to treatment-as-usual for individuals aged >18 years (n=50) with comorbid mood, anxiety, obsessive-compulsive or trauma/stressor disorders diagnoses, recruited from outpatient psychological services within the UK National Health Service (NHS). The co-primary outcomes will be 3-month follow-up scores on self-report measures of depressive symptoms, anxiety symptoms, and disability and functional impairment. Secondary outcomes include changes in symptoms linked to individual disorders. We will assess the feasibility and acceptability of SHM, the utility of proposed outcome measures, and refine the treatment manuals in preparation for a later-phase trial. ETHICS AND DISSEMINATION This trial protocol has been approved by the Health Research Authority of the NHS of the UK (East of England, Reference: 16/EE/0095). We anticipate that trial findings will inform future revisions of clinical guidelines for numerous forms of mood, anxiety and stressor-related disorders. Findings will be disseminated broadly via peer-reviewed empirical journal articles, conference presentations, clinical workshops and a trial website. TRIAL REGISTRATION NCT03143634; Pre-results.
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Affiliation(s)
- Melissa Black
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, National Health Service, Fulbourn, UK
| | - Caitlin Hitchcock
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, National Health Service, Fulbourn, UK
| | - Anna Bevan
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - Cliodhna O Leary
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, National Health Service, Fulbourn, UK
| | - James Clarke
- Cambridgeshire and Peterborough NHS Foundation Trust, National Health Service, Fulbourn, UK
| | - Rachel Elliott
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, National Health Service, Fulbourn, UK
| | - Peter Watson
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - Louise LaFortune
- Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Sarah Rae
- Cambridgeshire and Peterborough NHS Foundation Trust, National Health Service, Fulbourn, UK
| | - Simon Gilbody
- Department of Health Sciences, University of York, York, UK
| | - Willem Kuyken
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - David Johnston
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, National Health Service, Fulbourn, UK
| | - Jill M Newby
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Tim Dalgleish
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, National Health Service, Fulbourn, UK
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13
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Hilliard ME, Tully C, Monaghan M, Wang J, Streisand R. Design and development of a stepped-care behavioral intervention to support parents of young children newly diagnosed with type 1 diabetes. Contemp Clin Trials 2017; 62:1-10. [PMID: 28821468 PMCID: PMC5641251 DOI: 10.1016/j.cct.2017.08.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 08/10/2017] [Accepted: 08/14/2017] [Indexed: 11/30/2022]
Abstract
One of the most common chronic conditions of childhood, the prevalence of type 1 diabetes (T1D) in young children is increasing. Early childhood development complicates optimal T1D management and glycemic outcomes. Parents are at risk for elevated psychological distress, especially immediately following diagnosis. Few empirically supported interventions are available to support parents and promote optimal T1D management during this vulnerable period. This paper reports on the development and study design of First STEPS: Study of Type 1 in Early childhood and Parenting Support. The aim of this trial is to evaluate the efficacy of a stepped care behavioral intervention for parents of young children over the first year following a new T1D diagnosis. The stepped care design provides participants with up to three intensity levels, or steps, of clinical behavioral intervention support based on need, compared to usual care. Intervention steps include peer parent coaching, telephone-based behavioral support, personalized psychological assessment and recommendations, and intensive assessment of T1D glycemic management with recommendations. Primary outcomes include children's glycemic control and parents' psychosocial functioning. Secondary outcomes include children's behavioral and psychosocial functioning. Exploratory analyses will evaluate demographic, disease-specific, and psychosocial factors related to progression in and response to each step of the intervention.
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Affiliation(s)
- Marisa E Hilliard
- Texas Children's Hospital and Baylor College of Medicine, Houston, TX, United States
| | - Carrie Tully
- Children's National Health System, Washington, DC, United States
| | - Maureen Monaghan
- Children's National Health System, Washington, DC, United States; George Washington University, School of Medicine, Washington, DC, United States
| | - Jichuan Wang
- Children's National Health System, Washington, DC, United States; George Washington University, School of Medicine, Washington, DC, United States
| | - Randi Streisand
- Children's National Health System, Washington, DC, United States; George Washington University, School of Medicine, Washington, DC, United States.
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14
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Socioeconomic inequalities in treatment of individuals with common mental disorders regarding subsequent development of mental illness. Soc Psychiatry Psychiatr Epidemiol 2017; 52:1015-1022. [PMID: 28497357 PMCID: PMC5534196 DOI: 10.1007/s00127-017-1389-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 05/01/2017] [Indexed: 11/12/2022]
Abstract
PURPOSE Socioeconomic differences appear to be reflected in both, the development and the treatment of common mental disorders (CMDs, i.e. depressive, anxiety and stress-related disorders). Underlying mechanisms of these inequalities are to date not fully understood. This study aimed to investigate if (1) there are socioeconomic differences with regard to type of treatment and (2) if the socioeconomic status modifies the association between treatment and subsequent inpatient care or suicide attempt, respectively, in individuals with CMDs. METHODS The study population comprised 66,097 individuals aged 18-59 on sick-leave due to a CMD during 2006 in Sweden. Cox regression with a follow-up from 2007 through 2010 estimated crude and multivariate hazard ratios (HR) with 95% confidence intervals (CI). RESULTS Individuals with sickness absence due to CMDs and a higher educational level were had a lower proportions of specialised health care and combined psychiatric medication than their counterparts with lower education. However, if high educated CMD patients received more combined medication, associations with subsequent mental inpatient care (p < 0.01) and suicide attempt (p < 0.05) were stronger than for their counterparts with low education. Moreover, previous inpatient care due to mental disorders was associated with higher HRs of subsequent suicide attempt in CMD patients with high education (HR 5.88; CI 3.02-11.45) compared to those with low education (1.96; 1.06-3.60). CONCLUSION Findings suggest that socioeconomic inequalities shape differences in treatment measures and mental health development in individuals with CMDs. These differences might signal discrepancies in treatment per se or reflect morbidity differences requiring different treatment regimens, or may be due to the fact that different diagnoses are given in different educational strata due to differential role of stigma.
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15
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Irgens AC, Hoffart A, Nysæter TE, Haaland VØ, Borge FM, Pripp AH, Martinsen EW, Dammen T. Thought Field Therapy Compared to Cognitive Behavioral Therapy and Wait-List for Agoraphobia: A Randomized, Controlled Study with a 12-Month Follow-up. Front Psychol 2017; 8:1027. [PMID: 28676782 PMCID: PMC5477545 DOI: 10.3389/fpsyg.2017.01027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 06/02/2017] [Indexed: 11/25/2022] Open
Abstract
Background: Thought field therapy (TFT) is used for many psychiatric conditions, but its efficacy has not been sufficiently documented. Hence, there is a need for studies comparing TFT to well-established treatments. This study compares the efficacy of TFT and cognitive behavioral therapy (CBT) for patients with agoraphobia. Methods: Seventy-two patients were randomized to CBT (N = 24), TFT (N = 24) or a wait-list condition (WLC) (N = 24) after a diagnostic procedure including the MINI PLUS that was performed before treatment or WLC. Following a 3 months waiting period, the WL patients were randomized to CBT (n = 12) or TFT (n = 12), and all patients were reassessed after treatment or waiting period and at 12 months follow-up. At first we compared the three groups CBT, TFT, and WL. After the post WL randomization, we compared CBT (N = 12 + 24 = 36) to TFT (N = 12 + 24 = 36), applying the pre-treatment scores as baseline for all patients. The primary outcome measure was a symptom score from the Anxiety Disorders Interview Scale that was performed by an interviewer blinded to the treatment condition. For statistical comparisons, we used the independent sample’s t-test, the Fisher’s exact test and the ANOVA and ANCOVA tests. Results: Both CBT and TFT showed better results than the WLC (p < 0.001) at post-treatment. Post-treatment and at the 12-month follow-up, there were not significant differences between CBT and TFT (p = 0.33 and p = 0.90, respectively). Conclusion: This paper reports the first study comparing TFT to CBT for any disorder. The study indicated that TFT may be an efficient treatment for patients with agoraphobia. Trial Registration:https://clinicaltrials.gov/, identifier NCT00932919.
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Affiliation(s)
| | - Asle Hoffart
- Research Institute, Modum BadVikersund, Norway.,Department of Psychology, University of OsloOslo, Norway
| | - Tor E Nysæter
- Department of Psychiatry, Sørlandet HospitalArendal, Norway
| | - Vegard Ø Haaland
- Department of Psychology, University of OsloOslo, Norway.,Department of Psychiatry, Sørlandet HospitalKristiansand, Norway
| | | | - Are H Pripp
- Oslo Centre of Biostatistics and Epidemiology, Research Support Services, Oslo University HospitalOslo, Norway
| | - Egil W Martinsen
- University of Oslo, Institute of Clinical Medicine, Oslo University Hospital, Division of Mental Health and AddictionOslo, Norway
| | - Toril Dammen
- Department of Behavioral Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of OsloOslo, Norway
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16
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Newby JM, Twomey C, Yuan Li SS, Andrews G. Transdiagnostic computerised cognitive behavioural therapy for depression and anxiety: A systematic review and meta-analysis. J Affect Disord 2016; 199:30-41. [PMID: 27060430 DOI: 10.1016/j.jad.2016.03.018] [Citation(s) in RCA: 106] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 02/17/2016] [Accepted: 03/07/2016] [Indexed: 11/16/2022]
Abstract
An increasing number of computerised transdiagnostic cognitive behavioural therapy programs (TD-cCBT) have been developed in the past decade, but there are no meta-analyses to explore the efficacy of these programs, nor moderators of the effects. The current meta-analysis focused on studies evaluating TD-cCBT interventions to examine their effects on anxiety, depression and quality of life (QOL). Results from 17 RCTs showed computerised TD-cCBT outperformed control conditions on all outcome measures at post-treatment, with large effect sizes for depression (g's=.84), and medium effect sizes for anxiety (g=.78) and QOL (g=.48). RCT quality was generally good, although heterogeneity was moderate to high. Further analyses revealed that studies comparing TD-cCBT to waitlist controls had the largest differences (g=.93) compared to active (g=.59) and usual care control groups (g=.37) on anxiety outcomes, but there was no influence of control group subtype on depression outcomes. Treatment length, symptom target (mixed versus anxiety only), treatment design (standardised versus tailored), and therapist experience (students versus qualified therapists) did not influence the results. Preliminary evidence from 4 comparisons with disorder-specific treatments suggests transdiagnostic treatments are as effective for reducing anxiety, and there may be small but superior outcomes for TD-cCBT programs for reducing depression (g=.21) and improving QOL (g=.21) compared to disorder-specific cCBT. These findings show that TD-cCBT programs are efficacious, and have comparable effects to disorder-specific cCBT programs.
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Affiliation(s)
- Jill M Newby
- Clinical Research Unit for Anxiety and Depression (CRUfAD), School of Psychiatry, Faculty of Medicine, UNSW Australia at St Vincent's Hospital, Sydney, Australia.
| | - Conal Twomey
- Faculty of Social and Human Sciences, University of Southampton, Southampton, UK
| | - Susan Shi Yuan Li
- Clinical Research Unit for Anxiety and Depression (CRUfAD), School of Psychiatry, Faculty of Medicine, UNSW Australia at St Vincent's Hospital, Sydney, Australia
| | - Gavin Andrews
- Clinical Research Unit for Anxiety and Depression (CRUfAD), School of Psychiatry, Faculty of Medicine, UNSW Australia at St Vincent's Hospital, Sydney, Australia
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17
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Pham Q, Khatib Y, Stansfeld S, Fox S, Green T. Feasibility and Efficacy of an mHealth Game for Managing Anxiety: “Flowy” Randomized Controlled Pilot Trial and Design Evaluation. Games Health J 2016; 5:50-67. [DOI: 10.1089/g4h.2015.0033] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Quynh Pham
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
- Playlab London, London, United Kingdom
| | - Yasmin Khatib
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Stephen Stansfeld
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Simon Fox
- Playlab London, London, United Kingdom
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18
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Barnes M, Sherlock S, Thomas L, Kessler D, Kuyken W, Owen-Smith A, Lewis G, Wiles N, Turner K. No pain, no gain: depressed clients' experiences of cognitive behavioural therapy. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2013; 52:347-64. [PMID: 24117909 DOI: 10.1111/bjc.12021] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Revised: 03/29/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Cognitive behavioural therapy (CBT) is an effective treatment for depression, but many clients do not complete therapy. What clients find difficult about CBT is poorly understood. This study explored clients' views and experiences of face-to-face CBT. DESIGN A mixed methods design was used to collect data as part of the CoBalT trial. METHOD Participants randomized to CBT indicated their reasons for never starting or stopping therapy on the follow-up questionnaires. In-depth qualitative interviews took place with a purposive sample (n = 26) of those randomized to CBT. Framework analysis was used to analyse across the data. RESULTS Seventy-four participants withdrew from therapy or were discharged for non-adherence. A total of 54 (73%) gave reasons for not starting or stopping CBT; mostly the time/location was inconvenient or they had other commitments. Interviews identified that clients could struggle in, and between, CBT sessions. This was true for those who did and did not complete therapy. CBT homework was the biggest challenge and was often associated with negative school homework experiences. Although clients may have disliked aspects of CBT, those who attended more than one session felt that they had gained insight into managing their depression. CONCLUSION Highlighting the possible barriers to adherence in CBT can help clinicians to better prepare clients in making an informed choice about therapy. Exploring these issues during therapy may also help with engagement. Despite the challenges, clients can still benefit from CBT by learning strategies that enable them to effectively deal with their depression.
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Affiliation(s)
- Maria Barnes
- School of Social and Community Medicine, University of Bristol, UK
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Crane RS, Kuyken W. The Implementation of Mindfulness-Based Cognitive Therapy: Learning From the UK Health Service Experience. Mindfulness (N Y) 2012; 4:246-254. [PMID: 23956806 PMCID: PMC3742431 DOI: 10.1007/s12671-012-0121-6] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Mindfulness-based cognitive therapy (MBCT) is an effective depression prevention programme for people with a history of recurrent depression. In the UK, the National Institute for Clinical Excellence (NICE) has suggested that MBCT is a priority for implementation. This paper explores the exchange, synthesis and application of evidence and guidance on MBCT between the academic settings generating the evidence and delivering practitioner training and the practice settings where implementation takes place. Fifty-seven participants in a workshop on MBCT implementation in the NHS were asked for their experience of facilitators and obstacles to implementation, and a UK-wide online survey of 103 MBCT teachers and stakeholders was conducted. While MBCT is starting to become available in the NHS, this is rarely part of a strategic, coherent or appropriately resourced approach. A series of structural, political cultural, educational, emotional and physical/technological obstacles and facilitators to implementation were identified. Nearly a decade since NICE first recommended MBCT, only a small number of mental health services in the UK have systematically implemented the guidance. Guiding principles for implementation are set out. We offer an implementation resource to facilitate the transfer of MBCT knowledge into action.
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Affiliation(s)
- Rebecca S Crane
- Centre for Mindfulness Research and Practice, School of Psychology, Bangor University, Gwynedd, LL57 1UT UK
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20
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Richards DA. Stepped care: a method to deliver increased access to psychological therapies. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2012; 57:210-5. [PMID: 22480585 DOI: 10.1177/070674371205700403] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To introduce stepped care as a method of organizing the delivery of treatments, and to consider the factors necessary for implementation. METHOD Stepped care is described within the context of strategies such as collaborative care that aim to increase access to mental health care through the improved coordination of care between primary and specialist mental health services. Results from the implementation of stepped care in the United Kingdom and elsewhere are used to highlight the factors required for introducing stepped care into routine services. Issues to address when implementing high-volume services for common mental health problems are derived from this experience. RESULTS Stepped care sits within the continuum of organizational systems, from situations where responsibility rests almost entirely with primary care clinicians to systems where all patients are managed by specialists for the entire duration of their treatment. Its core principles of delivering low-burden treatments first, followed by careful patient progress monitoring to step patients up to more intensive treatment, are easy to articulate but lead to considerable implementation diversity when services attempt to work in this manner. Services need to ensure they have specific staff competency training, including skills in delivering evidence-based treatments, access to telephony, and smart patient management informatics systems. CONCLUSIONS Stepped care can provide the delivery system for supported self-management. To be successful, health systems need high levels of clinical outcome data and appropriately trained workers. Further attention is required to ensure equity of access and to reduce patient attrition in these systems.
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Affiliation(s)
- David A Richards
- Mood Disorders Centre, College of Life and Environmental Sciences, University of Exeter, Exeter, England.
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Richards DA, Bower P, Pagel C, Weaver A, Utley M, Cape J, Pilling S, Lovell K, Gilbody S, Leibowitz J, Owens L, Paxton R, Hennessy S, Simpson A, Gallivan S, Tomson D, Vasilakis C. Delivering stepped care: an analysis of implementation in routine practice. Implement Sci 2012; 7:3. [PMID: 22248385 PMCID: PMC3283464 DOI: 10.1186/1748-5908-7-3] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2011] [Accepted: 01/16/2012] [Indexed: 11/23/2022] Open
Abstract
Background In the United Kingdom, clinical guidelines recommend that services for depression and anxiety should be structured around a stepped care model, where patients receive treatment at different 'steps,' with the intensity of treatment (i.e., the amount and type) increasing at each step if they fail to benefit at previous steps. There are very limited data available on the implementation of this model, particularly on the intensity of psychological treatment at each step. Our objective was to describe patient pathways through stepped care services and the impact of this on patient flow and management. Methods We recorded service design features of four National Health Service sites implementing stepped care (e.g., the types of treatments available and their links with other treatments), together with the actual treatments received by individual patients and their transitions between different treatment steps. We computed the proportions of patients accessing, receiving, and transiting between the various steps and mapped these proportions visually to illustrate patient movement. Results We collected throughput data on 7,698 patients referred. Patient pathways were highly complex and very variable within and between sites. The ratio of low (e.g., self-help) to high-intensity (e.g., cognitive behaviour therapy) treatments delivered varied between sites from 22:1, through 2.1:1, 1.4:1 to 0.5:1. The numbers of patients allocated directly to high-intensity treatment varied from 3% to 45%. Rates of stepping up from low-intensity treatment to high-intensity treatment were less than 10%. Conclusions When services attempt to implement the recommendation for stepped care in the National Institute for Health and Clinical Excellence guidelines, there were significant differences in implementation and consequent high levels of variation in patient pathways. Evaluations driven by the principles of implementation science (such as targeted planning, defined implementation strategies, and clear activity specification around service organisation) are required to improve evidence on the most effective, efficient, and acceptable stepped care systems.
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Affiliation(s)
- David A Richards
- Mood Disorders Centre, University of Exeter, Exeter, EX4 4QG, UK.
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