An Ecological Momentary Intervention for people with social anxiety: A descriptive case study

This study describes the development and pilot evaluation of a smartphone- delivered Ecological Momentary Intervention (EMI) for people with social anxiety symptoms. Using a software engineering framework (agile modeling, model-driven development, bottom-up development), mental health experts and software developers collaborated to develop a 4-module EMI app designed to reduce social anxiety in real-time. Fifty-five participants with social anxiety were randomly allocated to the EMI or a wait-list control arm. App downloads, usage and user satisfaction data were collected and mental health outcomes assessed at baseline and post-intervention. Software development practices allowed mental health experts to distil core elements of a psychological intervention into discrete software components but there were challenges in engaging mental health experts in the process. Relative to control there was no significant reduction in social anxiety among the EMI participants in the pilot trial. However, post-test data were available for only 4 intervention and 10 control participants and only 2 (4.0%) of the EMI participants downloaded the app. The two participants who both accessed the app and completed the post-test reported being satisfied with the intervention. Future research should address managing resources and providing additional training to support ongoing engagement with key stakeholders.

Development of the RMT20, a composite screener to identify common mental disorders

BACKGROUND

There are few very brief measures that accurately identify multiple common mental disorders.

AIMS

The aim of this study was to develop and assess the psychometric properties of a new composite measure to screen for five common mental disorders.

METHOD

Two cross-sectional psychometric surveys were used to develop (n = 3175) and validate (n = 3620) the new measure, the Rapid Measurement Toolkit-20 (RMT20) against diagnostic criteria. The RMT20 was tested against a DSM-5 clinical checklist for major depression, generalised anxiety disorder, panic disorder, social anxiety disorder and post-traumatic stress disorder, with comparison with two measures of general psychological distress: the Kessler-10 and Distress Questionnaire-5.

RESULTS

The area under the curve for the RMT20 was significantly greater than for the distress measures, ranging from 0.86 to 0.92 across the five disorders. Sensitivity and specificity at prescribed cut-points were excellent, with sensitivity ranging from 0.85 to 0.93 and specificity ranging from 0.73 to 0.83 across the five disorders.

CONCLUSIONS

The RMT20 outperformed two established scales assessing general psychological distress, is free to use and has low respondent burden. The measure is well-suited to clinical screening, internet-based screening and large-scale epidemiological surveys.

The role of maladaptive personality domains across multiple levels of the HiTOP structure

This study aimed to examine associations between maladaptive personality traits and psychopathology from the perspective of the hierarchical taxonomy of psychopathology (HiTOP). We tested hierarchical structural models to further validate a portion of the structural components of HiTOP. We also tested a priori personality and psychopathology associations with three levels of the HiTOP hierarchy: general psychopathology, spectra and syndromes/disorders. We used a large sample from the general Australian population who completed a large set of personality and psychopathology inventories online. Confirmatory factor analyses indicated that internalizing, externalizing and thought dysfunction spectra emerged structurally, as expected per HiTOP, but also revealed that obsessive-compulsive disorder loaded on both internalizing and thought dysfunction and attention deficit hyperactivity disorder on both externalizing and internalizing. Furthermore, results indicated that almost all personality and psychopathology hypotheses were supported, although trait antagonism did not predict externalizing to the degree initially expected. Implications for personality and psychopathology are discussed. © 2019 John Wiley & Sons, Ltd.

A novel multi-component online intervention to improve the mental health of university students: Randomised controlled trial of the Uni Virtual Clinic

BACKGROUND

Of the millions of students enrolled in university, up to 50% will experience a mental disorder. Many of these students do not seek help, and for those who do, university-based services are often over-burdened. Anonymous, evidence-based, online interventions can improve students' access to mental health support. The Uni Virtual Clinic (UVC) is a transdiagnostic online mental health program designed specifically for university students. This paper reports on a randomised controlled trial examining the effectiveness of the UVC in a sample of Australian university students.

METHODS

University students with elevated psychological distress (K10>15; n = 200) were randomised to the UVC intervention or a waitlist control condition for a period of 6 weeks. Baseline, post-intervention, and 3-month follow-up surveys assessed depression, anxiety, self-efficacy, quality of life, adherence, and satisfaction with the UVC intervention.

RESULTS

Mixed models analysis demonstrated that use of the UVC was associated with small significant reductions in social anxiety and small improvements in academic self-efficacy. The program was not effective in reducing symptoms of depression, anxiety, or psychological distress compared to a control group. The majority of participants in the intervention condition who were retained at follow-up engaged with the program, and most of these participants reported satisfaction with the UVC.

DISCUSSION

The results suggest that multi-component online interventions such as the UVC have utility in a university environment. Future trials of the UVC should examine the impact of guidance and/or tailoring on treatment efficacy, and the potential role of the UVC in a stepped care model incorporating on-campus services.

Suicide Stigma and Suicide Literacy in a Clinical Sample

OBJECTIVE

The aims of this study were to (1) investigate levels and correlates of suicide stigma and suicide literacy in a sample of individuals attending a tertiary depression clinic in Australia (N = 287), with comparison to a community-based Australian sample (N = 1,410), and (2) validate measures of suicide stigma and literacy in a clinical sample.

METHOD

Australian adults (N = 287) aged 18-78 years referred by their general practitioners for assessment at a psychiatric clinic for patients with difficult-to-treat mood disorders were recruited to complete a survey, including measures of suicide literacy, suicide stigma, mental health symptoms, and demographics.

RESULTS

Compared to the Australian community sample, participants in the clinical sample reported lower suicide literacy, lower suicide stigma, greater glorification of suicide, and greater attribution of suicide to isolation. Suicide ideation was associated with greater glorification of suicide. Females had higher suicide literacy and lower suicide stigma than males. The psychometric properties of the suicide stigma measure appeared to be robust and consistent with previous evaluations.

CONCLUSION

Given the low levels of suicide literacy in this clinical sample, suicide prevention initiatives designed for community settings may also be important in clinical settings.

Efficacy of a transdiagnostic, video-based online program for reducing depression, anxiety, and suicidal ideation in adults: Protocol for a randomised controlled trial

Background

Transdiagnostic online interventions have the potential to overcome help seeking barriers, address symptom comorbidity, and increase accessibility to evidence-based treatments. However, there is currently a lack of high quality studies examining brief transdiagnostic interventions, as well as research examining optimal methods for screening and providing members of the community with access to these interventions. This randomised controlled trial will compare a brief, video-based transdiagnostic online intervention (FitMindKit) to an attention matched control condition (HealthWatch).

Aims

The aims of the study are to (1) examine the efficacy of FitMindKit in reducing depression symptoms, anxiety symptoms, suicidal ideation, and disability relative to HealthWatch and (2) compare uptake of the program via the Internet with uptake via general practices and pharmacies (methods used in a parallel implementation study).

Methods

A two-arm randomised controlled trial will be conducted with adults residing in the Australian Capital Territory, Australia. Participants will be recruited online via social media advertisements, screened, and randomised to receive one of two four-week programs: FitMindKit (12-module psychotherapeutic intervention) or HealthWatch (12-module program providing general health information). Participants will be assessed at baseline and 4 weeks post-baseline.

Results

Findings from the trial will provide important knowledge regarding the utility and optimal implementation of brief transdiagnostic interventions for depression and anxiety in the community.

Conclusions

This trial has strong potential to increase access to evidence-based treatments in the community by directly addressing several factors that impede this access, such as symptom comorbidity and a lack of knowledge regarding optimal implementation pathways.

Trial registration

This trial is registered with the Australian New Zealand Clinical Trials Registry (number ACTRN12618001688279).

The development and validation of static and adaptive screeners to measure the severity of panic disorder, social anxiety disorder, and obsessive compulsive disorder

A series of static and adaptive screeners for panic disorder, social anxiety disorder (SAD), and obsessive compulsive disorder (OCD) were developed and compared using data-driven methods to facilitate the measurement of each disorder in community samples. Data comprised 3175 respondents for the development sample and 3755 respondents for the validation sample, recruited independently using Facebook advertising. Item Response Theory (IRT) was utilized to develop static continuous screeners and to simulate computerized adaptive algorithms. The screeners consisted of a small subset of items from each bank (79% reduction in items for panic disorder, 85% reduction in items for SAD, and 84% reduction in items for OCD) that provided similar scores (r = 0.88-0.96). Both static and adaptive screeners were valid with respect to existing scales that purportedly measure similar constructs (r > 0.70 for panic disorder, r > 0.76 for SAD, and r > 0.68 for OCD). The adaptive scales were able to maintain a higher level of precision in comparison to the static scales and evidenced slightly higher concordance with scores generated by the full item banks. The screeners for panic disorder, SAD, and OCD could be used as a flexible approach to measure and monitor the severity of psychopathology in tailored treatment protocols.

FitMindKit: Randomised controlled trial of an automatically tailored online program for mood, anxiety, substance use and suicidality

PURPOSE

Online mental health programs can be effective in reducing symptoms of depression, anxiety disorders, substance use and suicidal ideation. However, most existing e-mental health programs focus on a single domain of mental health, neglecting comorbidity. Furthermore, few programs are tailored to the symptom patterns of the individual user. FitMindKit was designed to overcome the gaps of existing e-mental health programs, providing tailored, transdiagnostic therapeutic content to address a range of comorbid mental health symptoms. A trial was conducted to test the program's efficacy.

METHODS

Australian adults with elevated symptoms of depression, anxiety, suicidal ideation and/or substance use were recruited through social media, with n = 194 randomised into a fully-automated trial of a 10-day brief intervention. Participants were randomly allocated to receive FitMindKit tailored to their symptoms, an untailored generic version of FitMindKit, or an attention control.

RESULTS

Mixed model repeated measures ANOVA indicated that participants in both FitMindKit and the attention control had significant reductions in symptom composite scores. Effects were not significantly greater in the FitMindKit program relative to control, either at post-test or 3-month follow-up. No effects were detected for specific decreases in depression, generalized anxiety, social anxiety, panic, suicidal ideation or alcohol/substance use. There were no significant differences between the tailored and static versions in effectiveness or adherence. Participants in the tailored and static conditions were more satisfied than in the control condition, with some evidence favouring the tailored condition. High attrition reduced power to find effects.

CONCLUSIONS

FitMindKit provides a model for addressing comorbid mental health symptoms in an online program, using automated tailoring to symptom patterns. Modifications to the program are recommended, along with the need for larger trials to test the effects of tailoring on mental health outcomes.

Developing and Validating a Computerized Adaptive Test to Measure Broad and Specific Factors of Internalizing in a Community Sample

Highly efficient assessments that better account for comorbidity between mood and anxiety disorders (internalizing) are required to identify individuals who are most at risk of psychopathology in the community. The current study examined the efficiency and validity associated with a multidimensional computerized adaptive test (CAT) to measure broad and specific levels of internalizing psychopathology. The sample comprised 3,175 respondents to an online survey. Items from five banks (generalized anxiety, depression, obsessive-compulsive disorder, panic disorder, social anxiety disorder) were jointly calibrated using a bifactor item response theory model. Simulations indicated that an adaptive algorithm could accurately (rs ≥ 0.90) estimate general internalizing and specific disorder scores using on average 44 items in comparison with the full 133-item bank (67% reduction in items). Scores on the CAT demonstrate convergent and divergent validity with previously validated short severity scales and could significantly differentiate cases of DSM-5 disorder. As such, the CAT validly measures both broad and specific constructs of internalizing disorders in a manner similar to the full item bank and a static brief form but with greater gains in efficiency and, therefore, a reduced degree of respondent burden.