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Scott AJ, Correa AB, Bisby MA, Dear BF. Appreciating the Limits and Opportunities of Meta-Analyses to Understand Complex Psychological Trajectories: Reply to da Silveira et al. PSYCHOTHERAPY AND PSYCHOSOMATICS 2024; 93:280-281. [PMID: 38838654 PMCID: PMC11332306 DOI: 10.1159/000539166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 04/29/2024] [Indexed: 06/07/2024]
Affiliation(s)
- Amelia J Scott
- School of Psychological Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Ashleigh B Correa
- School of Psychological Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Madelyne A Bisby
- School of Psychological Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Blake F Dear
- School of Psychological Sciences, Macquarie University, Sydney, New South Wales, Australia
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2
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Scott AJ, Correa AB, Bisby MA, Dear BF. Depression and Anxiety Trajectories in Chronic Disease: A Systematic Review and Meta-Analysis. PSYCHOTHERAPY AND PSYCHOSOMATICS 2023; 92:227-242. [PMID: 37607505 DOI: 10.1159/000533263] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 07/24/2023] [Indexed: 08/24/2023]
Abstract
INTRODUCTION People living with chronic diseases are at an increased risk of anxiety and depression, which are associated with poorer medical and psychosocial outcomes. Many studies have examined the trajectories of depression and anxiety in people with specific diseases, including the predictors of these trajectories. This is valuable for understanding the process of adjustment to diseases and informing treatment planning. However, no review has yet synthesised this information across chronic diseases. METHODS Electronic databases were searched for studies reporting trajectories of depression or anxiety in chronic disease samples. Data extracted included sample characteristics, results from trajectory analyses, and predictors of trajectories. Meta-analysis of the overall pooled prevalence of depression and anxiety trajectories was conducted, and qualitative synthesis of disease severity predictors was undertaken. RESULTS Following search and screening, 67 studies were included (N = 61,201 participants). Most participants followed a stable nonclinical trajectory for depression (69.0% [95% CI: 65.6, 72.2]) and anxiety (73.4% [95% CI: 66.3, 79.5]). Smaller but meaningful subsamples followed a trajectory of depression and anxiety symptoms consistently in the clinical range (11.8% [95% CI: 9.2, 14.8] and 13.7% [95% CI: 9.3, 19.7], respectively). Several clinical and methodological moderators emerged, and qualitative synthesis suggested that few aspects of disease severity were associated with participants' trajectories. CONCLUSION Most people with chronic disease follow a trajectory of distress that is low and stable, suggesting that most people psychologically adjust to living with chronic disease. Evidence also suggests that the nature and severity of the disease are not meaningful predictors of psychological distress.
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Affiliation(s)
- Amelia J Scott
- School of Psychological Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Ashleigh B Correa
- School of Psychological Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Madelyne A Bisby
- School of Psychological Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Blake F Dear
- School of Psychological Sciences, Macquarie University, Sydney, New South Wales, Australia
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3
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Fava GA. An Editor's Journey Ends, but the Journal's Mission Continues. PSYCHOTHERAPY AND PSYCHOSOMATICS 2022; 91:218-226. [PMID: 35724641 DOI: 10.1159/000524654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 04/19/2022] [Indexed: 11/19/2022]
Affiliation(s)
- Giovanni A Fava
- Department of Psychiatry, University at Buffalo, State University of New York, Buffalo, New York, New York, USA
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4
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Munder T, Geisshüsler A, Krieger T, Zimmermann J, Wolf M, Berger T, Watzke B. Intensity of Treatment as Usual and Its Impact on the Effects of Face-to-Face and Internet-Based Psychotherapy for Depression: A Preregistered Meta-Analysis of Randomized Controlled Trials. PSYCHOTHERAPY AND PSYCHOSOMATICS 2022; 91:200-209. [PMID: 35158363 DOI: 10.1159/000521951] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 01/06/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Treatment as usual (TAU) is the most frequently used control group in randomized trials of psychotherapy for depression. Concerns have been raised that the heterogeneity of treatments in TAU leads to biased estimates of psychotherapy efficacy and to an unclear difference between TAU and control groups like waiting list (WL). OBJECTIVE We investigated the impact of control group intensity (i.e., amount and degree to which elements of common depression treatments are provided) on the effects of face-to-face and internet-based psychotherapy for depression. METHODS We conducted a preregistered meta-analysis (www.osf.io/4mzyd). We included trials comparing psychotherapy with TAU or WL in patients with symptoms of unipolar depression. Six indicators were used to assess control group intensity. PRIMARY OUTCOME Standardized mean difference (SMD) of psychotherapy and control in depressive symptoms at treatment termination. RESULTS We included 89 trials randomizing 14,474 patients to 113 psychotherapy conditions and 89 control groups (TAU in 42 trials, WL in 47 trials). Control group intensity predicted trial results in preregistered (one-sided ps < 0.042) and exploratory analyses. Psychotherapy effects were significantly smaller (one-sided p = 0.002) in trials with higher intensity TAU (SMD = 0.324, CI 0.209 to 0.439) than in trials with lower intensity TAU (SMD = 0.628, CI 0.455 to 0.801). Psychotherapy effects against lower intensity TAU did not differ from effects against WL (two-sided p = 0.663). CONCLUSIONS Our results suggest that variation in TAU intensity impacts the outcome of trials. More scrutiny in the design of control groups for clinical trials is recommended.
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Affiliation(s)
- Thomas Munder
- Department of Psychology, University of Zurich, Zurich, Switzerland
| | | | - Tobias Krieger
- Institute of Psychology, University of Bern, Bern, Switzerland
| | | | - Markus Wolf
- Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Thomas Berger
- Institute of Psychology, University of Bern, Bern, Switzerland
| | - Birgit Watzke
- Department of Psychology, University of Zurich, Zurich, Switzerland
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5
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Balon R. What Is a Review Article and What Are Its Purpose, Attributes, and Goal(s). PSYCHOTHERAPY AND PSYCHOSOMATICS 2022; 91:152-155. [PMID: 35313309 DOI: 10.1159/000522385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 02/01/2022] [Indexed: 11/19/2022]
Affiliation(s)
- Richard Balon
- Departments of Psychiatry and Behavioral Neurosciences and Anesthesiology, Wayne State University, Detroit, Michigan, USA
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6
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Janssen NP, Hendriks GJ, Baranelli CT, Lucassen P, Oude Voshaar R, Spijker J, Huibers MJH. How Does Behavioural Activation Work? A Systematic Review of the Evidence on Potential Mediators. PSYCHOTHERAPY AND PSYCHOSOMATICS 2021; 90:85-93. [PMID: 32898847 DOI: 10.1159/000509820] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 06/18/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Behavioural activation is an effective treatment for depression, but little is known about its working mechanisms. Theoretically, its effect is thought to rely on an interplay between activation and environmental reward. OBJECTIVE The present systematic review examines the mediators of behavioural activation for depression. METHODS A systematic literature search without time restrictions in Medline, EMBASE, PsycINFO, The Cochrane Library, and CINAHL resulted in 14 relevant controlled and uncontrolled prospective treatment studies that also performed formal mediation analyses to investigate their working mechanisms. After categorising the mediators investigated, we systematically compared the studies' methodological quality and performed a narrative synthesis of the findings. RESULTS Most studies focused on activation or environmental reward, with 21 different mediators being investigated using questionnaires that focused on psychological processes or beliefs. The evidence for both activation and environmental reward as mediators was weak. CONCLUSIONS Non-significant results, poor methodological quality of some of the studies, and differences in questionnaires employed precluded any firm conclusions as to the significance of any of the mediators. Future research should exploit knowledge from fundamental research, such as reward motivation from neurobiology. Furthermore, the use of experience sampling methods and idiographic analyses in bigger samples is recommended to investigate potential causal pathways in individual patients.
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Affiliation(s)
- Noortje P Janssen
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands, .,Department of Primary and Community Care, Research Institute of Health Sciences, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands, .,Institute for Integrated Mental Health Care "Pro Persona,", Nijmegen, The Netherlands,
| | - Gert-Jan Hendriks
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands.,Institute for Integrated Mental Health Care "Pro Persona,", Nijmegen, The Netherlands.,Department of Psychiatry, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands
| | - Céline T Baranelli
- Department of Primary and Community Care, Research Institute of Health Sciences, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands
| | - Peter Lucassen
- Department of Primary and Community Care, Research Institute of Health Sciences, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands
| | - Richard Oude Voshaar
- University Medical Center Groningen, Interdisciplinary Center for Psychopathology of Emotion Regulation (ICPE), University of Groningen, Groningen, The Netherlands
| | - Jan Spijker
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands.,Institute for Integrated Mental Health Care "Pro Persona,", Nijmegen, The Netherlands.,Department of Psychiatry, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands
| | - Marcus J H Huibers
- Department of Clinical Psychology, VU University, Amsterdam, The Netherlands
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7
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Wang J, Cosci F. Neonatal Withdrawal Syndrome following Late in utero Exposure to Selective Serotonin Reuptake Inhibitors: A Systematic Review and Meta-Analysis of Observational Studies. PSYCHOTHERAPY AND PSYCHOSOMATICS 2021; 90:299-307. [PMID: 33971648 DOI: 10.1159/000516031] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 03/20/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION A clear picture of neonatal withdrawal signs due to in utero selective serotonin reuptake inhibitor (SSRI) exposure and its consequences is still missing. OBJECTIVE A systematic review and a meta-analysis were performed to provide an overview of neonatal withdrawal signs following late in utero exposure to SSRIs and to quantify the corresponding risks. METHODS MEDLINE, Web of Science, and Embase were searched from inception to January 2021. The Meta-Analysis of Observational Studies in Epidemiology (MOOSE) guidelines were followed. English-language observational studies reporting on acute postpartum outcomes following late in utero exposure to SSRIs or SSRIs/venlafaxine were evaluated. RESULTS Of 2,269 citations reviewed, 79 studies were assessed for eligibility; 13 were included in the qualitative analysis of the literature, which allowed us to identify 26 signs. A meta-analysis was run separately for studies on SSRI exposure (n = 3) and those on SSRI/venlafaxine exposure (n = 6). Hypoglycemia was identified as a withdrawal sign based on the SSRI studies. Tremors, hypotonia, tachycardia, rapid breathing, respiratory distress, and hypertonia were identified as withdrawal signs based on the SSRI/venlafaxine studies. CONCLUSIONS The present work provides a framework for the identification of neonatal SSRI withdrawal syndrome. Tapering and discontinuation of antidepressant drugs before and during the early phase of pregnancy are worth attempting to prevent the occurrence of this syndrome.
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Affiliation(s)
- Jianjun Wang
- Department of Neurology and Psychology, Shenzhen Traditional Chinese Medicine Hospital, The Fourth Clinical Medical College, Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Fiammetta Cosci
- Department of Health Sciences, University of Florence, Florence, Italy.,Clinical Pharmacopsychology Laboratory, University of Florence, Florence, Italy.,Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands
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8
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Svensson M, Nilsson T, Perrin S, Johansson H, Viborg G, Falkenström F, Sandell R. The Effect of Patient's Choice of Cognitive Behavioural or Psychodynamic Therapy on Outcomes for Panic Disorder: A Doubly Randomised Controlled Preference Trial. PSYCHOTHERAPY AND PSYCHOSOMATICS 2021; 90:107-118. [PMID: 33227785 DOI: 10.1159/000511469] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 09/04/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION It remains unclear whether offering psychiatric patients their preferred treatment influences outcomes at the symptom level. OBJECTIVE To assess whether offering patients with panic disorder with/without agoraphobia (PD/A) a choice between 2 psychotherapies yields superior outcomes to random assignment. METHODS In a doubly randomised, controlled preference trial (DRCPT), 221 adults with PD/A were randomly assigned to: choosing panic-focused psychodynamic therapy (PFPP) or panic control treatment (PCT; a form of cognitive behavioural therapy); random assignment to PFPP or PCT; or waiting list control. Primary outcomes were PD/A severity, work status and work absences at post-treatment assessment. Outcomes at post-treatment assessment, 6-, 12-, and 24-month follow-ups were assessed using segmented multilevel linear growth models. RESULTS At post-treatment assessment, the choice and random conditions were superior to the control for panic severity but not work status/absences. The choice and random conditions did not differ during treatment or follow-up for the primary outcomes. For panic severity, PCT was superior to PFPP during treatment (standardised mean difference, SMD, -0.64; 95% confidence interval, CI, -1.02 to -0.25); PFPP was superior to PCT during follow-up (SMD 0.62; 95% CI 0.27-0.98). There was no allocation by treatment type interaction (SMD -0.57; 95% CI -1.31 to 0.17). CONCLUSIONS Previous studies have found that offering patients their preferred treatment yields small to moderate effects but have not employed designs that could rigorously test preference effects. In this first DRCPT of 2 evidence-based psychotherapies, allowing patients with PD/A to choose their preferred treatment was not associated with improved outcomes. Further DRCPTs are needed.
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Affiliation(s)
| | | | - Sean Perrin
- Department of Psychology, Lund University, Lund, Sweden
| | | | - Gardar Viborg
- Department of Psychology, Lund University, Lund, Sweden
| | - Fredrik Falkenström
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Rolf Sandell
- Department of Psychology, Lund University, Lund, Sweden
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Cosci F, Fava GA. When Anxiety and Depression Coexist: The Role of Differential Diagnosis Using Clinimetric Criteria. PSYCHOTHERAPY AND PSYCHOSOMATICS 2021; 90:308-317. [PMID: 34344013 DOI: 10.1159/000517518] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 05/31/2021] [Indexed: 11/19/2022]
Abstract
Depressive and anxiety disorders are frequently associated. Depression may be a complication of anxiety and anxiety can complicate depression. The nature of their relationship has been a source of controversy. Reviews generally base their conclusions on randomized controlled trials and meta-analyses that refer to the average patient and often clash with the variety of clinical presentations that may occur when anxiety and depression coexist. The aim of this review was to examine the literature according to profiling of subgroups of patients based on clinimetric criteria, in line with the recently developed concept of medicine-based evidence. We critically reviewed the literature pertaining to the specific presentations of anxiety and depression, outlining the advantages and disadvantages of each treatment approach. The following prototypic cases were presented: depression secondary to an active anxiety disorder, depression in patients with anxiety disorders under treatment, anxious depression, anxiety as a residual component of depression, and demoralization secondary to anxiety disorder. We argue that the selection of treatment when anxiety and depression coexist should take into account the modalities of presentation and be filtered by clinical judgment. Very different indications may ensue when the literature is examined according to this perspective.
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Affiliation(s)
- Fiammetta Cosci
- Department of Health Sciences, University of Florence, Florence, Italy.,Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands
| | - Giovanni A Fava
- Department of Psychiatry, University at Buffalo, State University of New York, New York, New York, USA
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10
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Reins JA, Buntrock C, Zimmermann J, Grund S, Harrer M, Lehr D, Baumeister H, Weisel K, Domhardt M, Imamura K, Kawakami N, Spek V, Nobis S, Snoek F, Cuijpers P, Klein JP, Moritz S, Ebert DD. Efficacy and Moderators of Internet-Based Interventions in Adults with Subthreshold Depression: An Individual Participant Data Meta-Analysis of Randomized Controlled Trials. PSYCHOTHERAPY AND PSYCHOSOMATICS 2021; 90:94-106. [PMID: 32544912 DOI: 10.1159/000507819] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 04/04/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Evidence on effects of Internet-based interventions to treat subthreshold depression (sD) and prevent the onset of major depression (MDD) is inconsistent. OBJECTIVE We conducted an individual participant data meta-analysis to determine differences between intervention and control groups (IG, CG) in depressive symptom severity (DSS), treatment response, close to symptom-free status, symptom deterioration and MDD onset as well as moderators of intervention outcomes. METHODS Randomized controlled trials were identified through systematic searches via PubMed, PsycINFO, Embase and Cochrane Library. Multilevel regression analyses were used to examine efficacy and moderators. RESULTS Seven trials (2,186 participants) were included. The IG was superior in DSS at all measurement points (posttreatment: 6-12 weeks; Hedges' g = 0.39 [95% CI: 0.25-0.53]; follow-up 1: 3-6 months; g = 0.30 [95% CI: 0.15-0.45]; follow-up 2: 12 months, g = 0.27 [95% CI: 0.07-0.47], compared with the CG. Significantly more participants in the IG than in the CG reached response and close to symptom-free status at all measurement points. A significant difference in symptom deterioration between the groups was found at the posttreatment assessment and follow-up 2. Incidence rates for MDD onset within 12 months were lower in the IG (19%) than in the CG (26%). Higher initial DSS and older age were identified as moderators of intervention effect on DSS. CONCLUSIONS Our findings provide evidence for Internet-based interventions to be a suitable low-threshold intervention to treat individuals with sD and to reduce the incidence of MDD. This might be particularly true for older people with a substantial symptom burden.
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Affiliation(s)
- Jo Annika Reins
- Department of Health Psychology and Applied Biological Psychology, Institute of Psychology, Leuphana University Lueneburg, Lueneburg, Germany
| | - Claudia Buntrock
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | | | - Simon Grund
- Leibniz Institute for Science and Mathematics Education, University of Kiel, Kiel, Germany
| | - Mathias Harrer
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Dirk Lehr
- Department of Health Psychology and Applied Biological Psychology, Institute of Psychology, Leuphana University Lueneburg, Lueneburg, Germany
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Ulm University, Ulm, Germany
| | - Kiona Weisel
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Matthias Domhardt
- Department of Clinical Psychology and Psychotherapy, Ulm University, Ulm, Germany
| | - Kotaro Imamura
- Department of Mental Health, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Norito Kawakami
- Department of Mental Health, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Viola Spek
- Fontys University of Applied Sciences, Eindhoven, The Netherlands
| | - Stephanie Nobis
- Institute of Psychology, Leuphana University Lueneburg, Lueneburg, Germany
| | - Frank Snoek
- Department of Medical Psychology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jan Philipp Klein
- Department of Psychiatry and Psychotherapy, Luebeck University, Luebeck, Germany
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - David Daniel Ebert
- Department of Medical Psychology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands,
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11
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Gleeson JFM, Eleftheriadis D, Santesteban-Echarri O, Koval P, Bastian B, Penn DL, Lim MH, Ryan RM, Alvarez-Jimenez M. Positive and meaningful lives: Systematic review and meta-analysis of eudaimonic well-being in first-episode psychosis. Early Interv Psychiatry 2021; 15:1072-1091. [PMID: 33037789 DOI: 10.1111/eip.13049] [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: 02/27/2020] [Revised: 07/13/2020] [Accepted: 09/26/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND First-episode psychosis typically has its onset during adolescence. Prolonged deficits in social functioning are common in FEP and yet often variance in functioning remains unexplained. Developmental psychology frameworks may be useful for understanding these deficits. Eudaimonic well-being (EWB), or positive self-development, is a developmental psychology construct that has been shown to predict mental health outcomes across multiple populations but has not been systematically reviewed in FEP. AIM Our aim was to systematically review the evidence for: the predictors of EWB, the effectiveness of EWB interventions and to examine the quality of this research in FEP. METHODS Selected studies measured either composite or components of EWB. A systematic search produced 2876 abstracts and 122 articles were identified for full screening which produced 17 final papers with 2459 participants. RESULTS Studies comprised six RCTs, eight prospective follow-up studies and three case-controlled studies. Self-esteem and self-efficacy were the most commonly measured components. A meta-analysis of RCTs revealed no statistically significant effect of interventions on self-esteem. The extant research indicates that character strengths may be associated with higher EWB. Self-esteem may be lower in FEP compared with age matched controls but not different from ultra-high risk patients. Self-esteem appears to be associated with poorer insight and improved therapeutic alliance. Significant problems with both external and internal validity of reviewed studies were apparent. CONCLUSIONS The hypotheses that lowered EWB is a risk factor for both onset of FEP and for poorer functional outcomes warrant further investigation. There is currently no evidence for effective interventions for EWB in FEP.
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Affiliation(s)
- John F M Gleeson
- Healthy Brain and Mind Research Centre, School of Behavioural and Health Sciences, Australian Catholic University, Fitzroy, Victoria, Australia
| | - Dina Eleftheriadis
- Healthy Brain and Mind Research Centre, School of Behavioural and Health Sciences, Australian Catholic University, Fitzroy, Victoria, Australia.,Orygen, The University of Melbourne, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Olga Santesteban-Echarri
- Mathison Centre for Mental Health Research & Education, Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Peter Koval
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Brock Bastian
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - David L Penn
- Healthy Brain and Mind Research Centre, School of Behavioural and Health Sciences, Australian Catholic University, Fitzroy, Victoria, Australia.,Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Michelle H Lim
- Centre for Mental Health & Iverson Health Research Innovation Institute, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Richard M Ryan
- Department of Psychology, University of Rochester, Rochester, New York, USA.,Institute for Positive Psychology and Education, Australian Catholic University, North Sydney, New South Wales, Australia
| | - Mario Alvarez-Jimenez
- Orygen, The University of Melbourne, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
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12
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Rosendahl S, Sattel H, Lahmann C. Effectiveness of Body Psychotherapy. A Systematic Review and Meta-Analysis. Front Psychiatry 2021; 12:709798. [PMID: 34566712 PMCID: PMC8458738 DOI: 10.3389/fpsyt.2021.709798] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 08/03/2021] [Indexed: 12/12/2022] Open
Abstract
Despite the growing relevance and applicability of elements based on and derived from the embodied mind paradigm, body psychotherapy (BPT) appears not to be a well-established treatment option. This might be due to a lack of proof for its efficacy. We searched electronic databases (Pubmed MEDLINE, PsycInfo, and PSYNDEX) for randomized controlled trials (RCTs) examining predefined BPT interventions. A total of 2,180 references were screened, of which 113 studies were scrutinized in detail and 18 RCTs finally included. The observed effect size (ES) demonstrated medium effects of BPT on primary outcomes psychopathology and psychological distress. In case of significant statistical heterogeneity, exploratory subgroup analyses revealed diagnosis and the degree of control group activity as noteworthy moderators. For secondary outcomes, evidence was scarce, and an improvement could be demonstrated only for coping abilities. The identified evidence indicates that BPT is beneficial for a wide spectrum of psychic suffering. There is a strong need for high-quality studies with bigger samples and for well-defined diagnostic entities to underpin its effectiveness.
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Affiliation(s)
- Sophie Rosendahl
- Department of Pneumology and Respiratory Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany
| | - Heribert Sattel
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany
| | - Claas Lahmann
- Faculty of Medicine, Department of Psychosomatic Medicine and Psychotherapy, Medical Center—University of Freiburg, University of Freiburg, Freiburg im Breisgau, Germany
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13
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Abbass A, Town J, Holmes H, Luyten P, Cooper A, Russell L, Lumley MA, Schubiner H, Allinson J, Bernier D, De Meulemeester C, Kroenke K, Kisely S. Short-Term Psychodynamic Psychotherapy for Functional Somatic Disorders: A Meta-Analysis of Randomized Controlled Trials. PSYCHOTHERAPY AND PSYCHOSOMATICS 2021; 89:363-370. [PMID: 32428905 DOI: 10.1159/000507738] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Accepted: 04/04/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Functionalsomatic disorders (FSD) are common and costly, thereby driving the need for the development of effective brief treatment options. Short-term psychodynamic psychotherapy (STPP) is one candidate treatment method. OBJECTIVE To review and meta-analyze, where possible, randomized controlled trials (RCTs) of STPP for FSD. METHODS Following a systematic search of the literature, we performed a meta-analysis of available RCT groups to determine the effects of STPP on a range of outcomes after treatment, and medium- and long-term follow-ups. RESULTS In meta-analyses of 17 RCTs, STPP significantly outperformed minimal treatment, treatment as usual, or waiting list controls on somatic symptom measures at all time frames, with small to large magnitude effect sizes. Descriptive reviews of 5 RCTs suggest that STPP performed at least as well as other bona fide psychological therapies. Limitations of this meta-analysis include small samples of studies and possible publication bias. CONCLUSIONS STPP is a valid treatment option for diverse FSD conditions resulting in somatic symptom reductions that persist over time. STPP should be included in FSD treatment guidelines.
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Affiliation(s)
- Allan Abbass
- Centre for Emotions and Health, Dalhousie University, Halifax, Nova Scotia, Canada,
| | - Joel Town
- Centre for Emotions and Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Hannah Holmes
- Department of Psychology, Wayne State University, Detroit, Michigan, USA
| | - Patrick Luyten
- University of Leuven, Leuven, Belgium.,University College London, London, United Kingdom
| | - Angela Cooper
- Centre for Emotions and Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Leo Russell
- Devon Partnership NHS Trust, Devon, United Kingdom
| | - Mark A Lumley
- Department of Psychology, Wayne State University, Detroit, Michigan, USA
| | - Howard Schubiner
- Ascension Providence Hospital and Michigan State University College of Human Medicine, Southfield, Michigan, USA
| | | | - Denise Bernier
- Centre for Emotions and Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Kurt Kroenke
- Indiana University and Regenstrief Institute, Indianapolis, Indiana, USA
| | - Steve Kisely
- Centre for Emotions and Health, Dalhousie University, Halifax, Nova Scotia, Canada.,University of Queensland, Woolloongabba, Queensland, Australia
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14
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Mustafa FA. The Trouble with Evidence-Based Medicine. PSYCHOTHERAPY AND PSYCHOSOMATICS 2021; 89:251. [PMID: 32101859 DOI: 10.1159/000506166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 01/24/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Feras Ali Mustafa
- Department of Liaison Psychiatry, Battle House, Northampton General Hospital, Northampton, United Kingdom,
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15
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Carrozzino D, Patierno C, Fava GA, Guidi J. The Hamilton Rating Scales for Depression: A Critical Review of Clinimetric Properties of Different Versions. PSYCHOTHERAPY AND PSYCHOSOMATICS 2021; 89:133-150. [PMID: 32289809 DOI: 10.1159/000506879] [Citation(s) in RCA: 103] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 02/27/2020] [Indexed: 11/19/2022]
Abstract
The format of the original Hamilton Rating Scale for Depression (HAM-D) was unstructured: only general instructions were provided for rating individual items. Over the years, a number of modified versions of the HAM-D have been proposed. They differ not only in the number of items, but also in modalities of administration. Structured versions, including item definitions, anchor points and semi-structured or structured interview questions, were developed. This comprehensive review was conducted to examine the clinimetric properties of the different versions of the HAM-D. The aim was to identify the HAM-D versions that best display the clinimetric properties of reliability, validity, and sensitivity to change. The search was conducted on MEDLINE, Scopus, Web of Science, and PubMed, and yielded a total of 35,473 citations, but only the most representative studies were included. The structured versions of the HAM-D were found to display the highest inter-rater and test-retest reliability. The Clinical Interview for Depression and the 6-item HAM-D showed the highest sensitivity in differentiating active treatment from placebo. The findings indicate that the HAM-D is a valid and sensitive clinimetric index, which should not be discarded in view of obsolete and not clinically relevant psychometric criteria. The HAM-D, however, requires an informed use: unstructured forms should be avoided and the type of HAM-D version that is selected should be specified in the registration of the study protocol and in the methods of the trial.
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Affiliation(s)
| | - Chiara Patierno
- Department of Psychology, University of Bologna, Bologna, Italy
| | - Giovanni A Fava
- Department of Psychiatry, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Jenny Guidi
- Department of Psychology, University of Bologna, Bologna, Italy
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16
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Guidi J, Fava GA. Sequential Combination of Pharmacotherapy and Psychotherapy in Major Depressive Disorder: A Systematic Review and Meta-analysis. JAMA Psychiatry 2021; 78:261-269. [PMID: 33237285 PMCID: PMC7689568 DOI: 10.1001/jamapsychiatry.2020.3650] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
IMPORTANCE The sequential model emerged from the awareness that the persistence of residual symptoms and the frequent occurrence of psychiatric comorbidity were both associated with poor long-term outcome of major depressive disorder (MDD). OBJECTIVE To conduct an updated meta-analysis to examine the association of the sequential combination of pharmacotherapy and psychotherapy with reduced risk of relapse and recurrence in MDD. DATA SOURCES Keyword searches were conducted in PubMed, PsycInfo, Web of Science, and the Cochrane Library from inception of each database through November 2019. Reference lists from relevant studies were examined using the following keywords: sequential treatment, drugs and psychotherapy, combined treatment, continuation or maintenance, relapse or recurrence and prevention, and depress* or major depress*, selecting adults and randomized controlled trials as additional limits. Authors of selected articles were contacted if needed. STUDY SELECTION Randomized clinical trials examining the effectiveness of the sequential use of psychotherapy following response to acute-phase pharmacotherapy in the treatment of adult remitted patients with MDD were selected independently by 2 reviewers. DATA EXTRACTION AND SYNTHESIS The methods used fulfilled the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. Data extraction and methodologic quality assessment were conducted independently by the reviewers. Examination of the pooled results was performed based on the random-effects model. Heterogeneity between study results and likelihood of significant publication bias were assessed. Sensitivity analyses and meta-regressions were also run. MAIN OUTCOMES AND MEASURES The primary outcome measures were relapse or recurrence rates of MDD, as defined by study investigators, at the longest available follow-up. RESULTS Seventeen randomized clinical trials met criteria for inclusion in the meta-analysis, with 1 study yielding 2 comparisons (2283 patients overall, with 1208 patients in a sequential treatment arm and 1075 in a control arm). The pooled risk ratio for relapse/recurrence of MDD was 0.84 (95% CI, 0.74-0.94), suggesting a relative advantage in preventing relapse/recurrence for the sequential combination of treatments compared with control conditions. CONCLUSIONS AND RELEVANCE The results of this systematic review and meta-analysis indicate that the sequential integration of psychotherapy following response to acute-phase pharmacotherapy, alone or combined with antidepressant medication, was associated with reduced risk of relapse and recurrence in MDD. The preventive value of the sequential strategy relies on abatement of residual symptoms and/or increase in psychological well-being. The steps for implementing the sequential approach in remitted patients with recurrent MDD are provided.
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Affiliation(s)
- Jenny Guidi
- Department of Psychology, University of Bologna, Bologna, Italy
| | - Giovanni A. Fava
- Department of Psychiatry, University at Buffalo, State University of New York, Buffalo
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17
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Fava GA. The Decline of Pluralism in Medicine: Dissent Is Welcome. PSYCHOTHERAPY AND PSYCHOSOMATICS 2020; 89:1-5. [PMID: 31838479 DOI: 10.1159/000505085] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 11/21/2019] [Indexed: 12/27/2022]
Affiliation(s)
- Giovanni A Fava
- Department of Psychiatry, University at Buffalo, State University of New York, Buffalo, New York, USA,
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18
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Cosci F, Mansueto G, Fava GA. Relapse prevention in recurrent major depressive disorder. A comparison of different treatment options based on clinical experience and a critical review of the literature. Int J Psychiatry Clin Pract 2020; 24:341-348. [PMID: 32716222 DOI: 10.1080/13651501.2020.1779308] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Reducing the risk of relapses is a critical component of major depressive disorders treatment. Guidelines suggest maintenance with antidepressant drugs in recurrent depression, but this solution has recently been questioned. OBJECTIVE The aim of this article is to provide a critical review of the literature of the main treatment options currently available to prevent relapse and recurrence in depression. METHODS We compared long-term antidepressant therapy (i.e., indefinite maintenance of antidepressant), intermittent antidepressant therapy (i.e., use of antidepressants mainly limited to the acute phases), use of psychotherapy in the sequential model (i.e., pharmacotherapy in the acute phase and psychotherapy in the residual phase). RESULTS We argue that the same solution may not apply to all patients and question the feasibility of a single course of treatment in the setting of complex disorders that are encountered in practice. The clinician should weigh advantages and disadvantages in the individual case. CONCLUSIONS The sequential model appears to be particularly indicated in recurrent depression. KEY POINTS Relapse is a major challenge of depressive disorders treatment Treatment options currently available include long-term antidepressants, intermittent antidepressants, addition of psychotherapy to pharmacotherapy in the sequential model Maintenance with antidepressants in recurrent depression has recently been questioned The sequential model appears to be particularly indicated in recurrent depression.
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Affiliation(s)
- Fiammetta Cosci
- Department of Health Sciences, University of Florence, Florence, Italy.,Department of Psychiatry & Neuropsychology, Maastricht University, Maastricht, the Netherlands
| | - Giovanni Mansueto
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Giovanni Andrea Fava
- Department of Psychiatry, State University of New York at Buffalo, Buffalo, NY, USA
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Fava GA. The Age of Transition. PSYCHOTHERAPY AND PSYCHOSOMATICS 2020; 90:1-4. [PMID: 33080595 DOI: 10.1159/000511544] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 09/13/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Giovanni A Fava
- Department of Psychiatry, University at Buffalo, State University of New York, Buffalo, New York, USA,
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20
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Braillon A, Naudet F. Meta-Analyses and the Janus Effect. PSYCHOTHERAPY AND PSYCHOSOMATICS 2020; 89:50. [PMID: 31715607 DOI: 10.1159/000504201] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 10/17/2019] [Indexed: 01/16/2023]
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