Effects of an internet-based cognitive behavioral therapy (iCBT) intervention on improving depressive symptoms and work-related outcomes among nurses in Japan: a protocol for a randomized controlled trial

Google effects on memory: a meta-analytical review of the media effects of intensive Internet search behavior

People are increasingly using the web for fact-checking and other forms of information seeking. The "Google effects" refers to the idea that individuals rely on the Internet as a source of knowledge rather than remembering it for themselves. However, few literature review have yet comprehensively examined the media effects of this intensive Internet search behavior. In this study, by carrying out meta-analysis, we found that google effects is closely associated with cognitive load, behavioral phenotype and cognitive self-esteem. And this phenomenon is also more likely to happen while using a mobile phone to browse the Internet rather than a computer. People with a larger knowledge base are less susceptible to the consequences of Internet use than those with a smaller knowledge base. The media effect was stronger for persons who had used the Internet before than for those who had not. And meta-analyses show that participants in North America (parameter = -1.0365, 95%CI = [-1.8758, -0.1972], p < 0.05) are more susceptible to frequent Internet search behavior relative to other regions. Overall, google effects on memory challenges the way individuals seek and read information, and it may lead to changes in cognitive and memory mechanisms.

Individual-level interventions for reducing occupational stress in healthcare workers

BACKGROUND

Healthcare workers can suffer from work-related stress as a result of an imbalance of demands, skills and social support at work. This may lead to stress, burnout and psychosomatic problems, and deterioration of service provision. This is an update of a Cochrane Review that was last updated in 2015, which has been split into this review and a review on organisational-level interventions.  OBJECTIVES: To evaluate the effectiveness of stress-reduction interventions targeting individual healthcare workers compared to no intervention, wait list, placebo, no stress-reduction intervention or another type of stress-reduction intervention in reducing stress symptoms.  SEARCH METHODS: We used the previous version of the review as one source of studies (search date: November 2013). We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, PsycINFO, CINAHL, Web of Science and a trials register from 2013 up to February 2022.

SELECTION CRITERIA

We included randomised controlled trials (RCT) evaluating the effectiveness of stress interventions directed at healthcare workers. We included only interventions targeted at individual healthcare workers aimed at reducing stress symptoms.  DATA COLLECTION AND ANALYSIS: Review authors independently selected trials for inclusion, assessed risk of bias and extracted data. We used standard methodological procedures expected by Cochrane. We categorised interventions into ones that: 1. focus one's attention on the (modification of the) experience of stress (thoughts, feelings, behaviour);  2. focus one's attention away from the experience of stress by various means of psychological disengagement (e.g. relaxing, exercise);  3. alter work-related risk factors on an individual level; and ones that 4. combine two or more of the above.  The crucial outcome measure was stress symptoms measured with various self-reported questionnaires such as the Maslach Burnout Inventory (MBI), measured at short term (up to and including three months after the intervention ended), medium term (> 3 to 12 months after the intervention ended), and long term follow-up (> 12 months after the intervention ended).  MAIN RESULTS: This is the second update of the original Cochrane Review published in 2006, Issue 4. This review update includes 89 new studies, bringing the total number of studies in the current review to 117 with a total of 11,119 participants randomised.  The number of participants per study arm was ≥ 50 in 32 studies. The most important risk of bias was the lack of blinding of participants.  Focus on the experience of stress versus no intervention/wait list/placebo/no stress-reduction intervention Fifty-two studies studied an intervention in which one's focus is on the experience of stress. Overall, such interventions may result in a reduction in stress symptoms in the short term (standardised mean difference (SMD) -0.37, 95% confidence interval (CI) -0.52 to -0.23; 41 RCTs; 3645 participants; low-certainty evidence) and medium term (SMD -0.43, 95% CI -0.71 to -0.14; 19 RCTs; 1851 participants; low-certainty evidence). The SMD of the short-term result translates back to 4.6 points fewer on the MBI-emotional exhaustion scale (MBI-EE, a scale from 0 to 54). The evidence is very uncertain (one RCT; 68 participants, very low-certainty evidence) about the long-term effect on stress symptoms of focusing one's attention on the experience of stress. Focus away from the experience of stress versus no intervention/wait list/placebo/no stress-reduction intervention  Forty-two studies studied an intervention in which one's focus is away from the experience of stress. Overall, such interventions may result in a reduction in stress symptoms in the short term (SMD -0.55, 95 CI -0.70 to -0.40; 35 RCTs; 2366 participants; low-certainty evidence) and medium term (SMD -0.41 95% CI -0.79 to -0.03; 6 RCTs; 427 participants; low-certainty evidence). The SMD on the short term translates back to 6.8 fewer points on the MBI-EE. No studies reported the long-term effect. Focus on work-related, individual-level factors versus no intervention/no stress-reduction intervention Seven studies studied an intervention in which the focus is on altering work-related factors. The evidence is very uncertain about the short-term effects (no pooled effect estimate; three RCTs; 87 participants; very low-certainty evidence) and medium-term effects and long-term effects (no pooled effect estimate; two RCTs; 152 participants, and one RCT; 161 participants, very low-certainty evidence) of this type of stress management intervention.  A combination of individual-level interventions versus no intervention/wait list/no stress-reduction intervention Seventeen studies studied a combination of interventions. In the short-term, this type of intervention may result in a reduction in stress symptoms (SMD -0.67 95%, CI -0.95 to -0.39; 15 RCTs; 1003 participants; low-certainty evidence). The SMD translates back to 8.2 fewer points on the MBI-EE. On the medium term, a combination of individual-level interventions may result in a reduction in stress symptoms, but the evidence does not exclude no effect (SMD -0.48, 95% CI -0.95 to 0.00; 6 RCTs; 574 participants; low-certainty evidence). The evidence is very uncertain about the long term effects of a combination of interventions on stress symptoms (one RCT, 88 participants; very low-certainty evidence). Focus on stress versus other intervention type  Three studies compared focusing on stress versus focusing away from stress and one study a combination of interventions versus focusing on stress. The evidence is very uncertain about which type of intervention is better or if their effect is similar.

AUTHORS' CONCLUSIONS

Our review shows that there may be an effect on stress reduction in healthcare workers from individual-level stress interventions, whether they focus one's attention on or away from the experience of stress. This effect may last up to a year after the end of the intervention. A combination of interventions may be beneficial as well, at least in the short term. Long-term effects of individual-level stress management interventions remain unknown. The same applies for interventions on (individual-level) work-related risk factors. The bias assessment of the studies in this review showed the need for methodologically better-designed and executed studies, as nearly all studies suffered from poor reporting of the randomisation procedures, lack of blinding of participants and lack of trial registration. Better-designed trials with larger sample sizes are required to increase the certainty of the evidence. Last, there is a need for more studies on interventions which focus on work-related risk factors.

Mental health of nursing professionals: Internet-based interventions

This study aimed to analyze published evidence about how the Internet is used in mental health interventions for nurses. This integrative literature review searched MEDLINE (PubMed), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Base de Dados em Enfermagem (BDENF), and the Web of Science. Data was collected in July 2020. Six articles addressed the research question - "What Internet-based mental health interventions exist for nurses?" -, of which five were randomized clinical trials (2 protocols and 3 completed trials) and 1 was a cohort study. Identified intervention programs consisted of 4 interactive webpages and 2 smartphone apps, based on cognitive behavioral and holistic approaches. The intervention programs were effective in reducing stress, anxiety, and depression among nurses; however, there was a lack of scientific evidence on the subject and a research gap regarding other approaches.

Cognitive Behavioral Therapy for AIDS Prevention among College Students in China: A Cluster Randomized Controlled Trial

BACKGROUND

Acquired immune deficiency syndrome (AIDS) is a serious worldwide public health problem and has become the focus of prevention and control in China, while the student population is the key population for AIDS prevention.

OBJECTIVE

The purpose of this study was to investigate the effects of cognitive behavioral therapy (CBT) on college students' AIDS-related cognitions, attitudes, and behaviors, and to find programmatic strategies for AIDS prevention in terms of changing college students' cognitions and behaviors.

METHODS

In a cluster randomized controlled trial, 233 undergraduate students were assigned to the CBT group (CBT-based intervention, n=92), the TAU group (treatment as usual, n=72), and the CON group (no intervention, n=59). AIDS-related knowledge, attitudes, and behaviors of participants were assessed at pre-intervention, post-intervention, and follow-up.

RESULTS

After one month of the study, AIDS-related knowledge, attitudes, and behaviors improved in both the TAU and CBT groups, while there were no significant changes in the CON group. The intervention effect was more significant and sustainable in the CBT group compared to the TAU group.

CONCLUSIONS

The application of CBT in AIDS prevention among college students is feasible, acceptable, and effective. CBT can increase the level of knowledge about AIDS, improve AIDS-related attitudes, and increase willingness to use condoms. CBT is expected to replace traditional health education as an innovative tool for AIDS prevention because of its long-lasting and efficacious nature.

The quantity and quality of scientific evidence about the health of working women in occupational health of Japan: A scoping review

OBJECTIVE

We aim to investigate the quantity and quality of scientific evidence dealing with comprehensive health issues of working women in occupational health.

METHODS

This scoping review of original articles that investigated comprehensive health issues of working women aged 19-64 years in Japan was published in PubMed (1967-2022) and Igaku Chuo Zasshi (or Ichu-shi, 1982-2022). Using identical broad search terms, we first identified 17 122 English and 6154 Japanese articles. We excluded those with clinically relevant topics, or ethnicity other than Japanese and included 853 English and 855 Japanese articles for review and classified them into nine research areas considered to be critical factors for women in the workforce and five study design groups to investigate the quality of the evidence accumulated.

RESULTS

Among 853 English-language articles in PubMed, "Mental health" was the most frequent area studied, followed by "Work-related disease" and "Lifestyle-related disease." Among 855 Japanese-language articles from Ichu-shi, "Mental health" was the most frequently studied area followed by "Work and balance," and "Work-related disease." "Infertility, pregnancy, and childbirth" and "Menstruation, menopause, and genital disease" were well studied in Ichu-shi but scarcely published in PubMed. "Harassment and discrimination" were sparsely reported in both databases. As for research designs, many articles in both PubMed and Ichu-shi employed descriptive or cross-sectional study designs. However, a few studies employed cohort/longitudinal or interventional studies.

CONCLUSION

The results underscored the need for higher-quality study designs with more scientific evidence on working women's health in the field of occupational health.

Research on the Necessity of AIDS Intervention for College Students Based on Cognitive Behavioral Therapy

BACKGROUND

Despite abundant research on AIDS prevention and intervention, many residual factors influence the actual impact of the intervention at a population level. Misconceptions held by subjects lead to patterns of behavior, which do not reflect levels of cognition.

METHODS

Cognition and behavioral patterns relating to HIV were investigated without intervention in freshmen before and after a two-year study period. A total of 461 freshmen studying at the university in Wuhan, Hubei Province, China, were enrolled in September 2019. Data management and analysis were performed by SPSS 25.0 software.

RESULTS

Throughout the two years' study, no significant changes in the cognitive level regarding AIDS were found while the frequency of sexual behavior increased significantly. A trend of inconsistency between cognition and behavior was identified.

CONCLUSION

During a two-year period without intervention, it was found that the sexual behavior of university students gradually increased, perceptions regarding AIDS-related subjects were incomplete and awareness of HIV infection risk was still weak. A phenomenon described as the separation of knowledge from behavior was detected. Misconceptions that influenced behavioral patterns were identified as critical factors. Therefore, we propose that cognitive behavioral therapy may change the actual impact of AIDS prevention interventions.

Efficacy of Internet-Based Cognitive Behavioral Therapy for Depression and Anxiety among Global Population during the COVID-19 Pandemic: A Systematic Review and Meta-Analysis of a Randomized Controlled Trial Study

Background: Depression and anxiety have become the most common mental health disorders worldwide during the COVID-19 pandemic, and increasing interest in telemedicine has led to the innovation of using internet-based cognitive behavioral therapy (iCBT). Objective: This systematic review and meta-analysis aimed to evaluate the efficacy of iCBT for depression and anxiety among the global population during the COVID-19 pandemic. Methods: A literature search was conducted on PubMed, Scopus, Cochrane, ProQuest, Wiley, and Web of Science using the PRISMA framework, and only randomized controlled trials (RCTs) were included in the study. A critical appraisal was also performed using Cochrane’s Risk of Bias (RoB) 2. The meta-analysis used random-effects models to analyze pooled mean difference (MD) and its p-value. Results: Twelve RCTs were included for qualitative analysis and nine RCTs, which yielded 6778 patients with depression and 6556 patients with anxiety during the COVID-19 pandemic, were included for quantitative analysis. Despite high heterogeneity, all studies had a low risk of bias. Pre- and post-iCBT intervention in the depression forest plot depicts a significant effect (p < 0.00001) with a pooled MD of 4.73 (95% CI: 4.55−4.90), while the pre- and post-iCBT intervention depicts a significant effect (p < 0.00001) with a pooled MD of 4.50 (95% CI: 4.34−4.67). This demonstrates that iCBT was found to significantly decrease depression and anxiety scores in patients during the COVID-19 pandemic. However, substantial heterogeneity was also found (I2 = 93%; p < 0.00001 and I2 = 90%) for the pre-/post-depression and anxiety forest plots, respectively. Conclusions: This meta-analysis comprises an evidence-based result for iCBT to treat depression and anxiety in the COVID-19 population, as indicated by the significantly lower assessment scores. Delivering iCBT in this situation needs to be considered more extensively, as it has promising results and yields the benefits of technological advancement in psychotherapy.

The effects of the type of delivery of cognitive-behavioral therapy for healthcare workers: A systematic review

OBJECTIVE

The aim of this literature review is to assess the extent of knowledge of the effectiveness of cognitive-behavioral therapy (CBT) for healthcare workers by type of delivery.

METHODS

The study examined relevant literature published between 2009 and 2020 using searches of four scientific databases: PubMed, CINAHL, Embase, and PsycINFO.

RESULTS

For work stress, work-related outcomes, and mental and musculoskeletal problems, the effectiveness of face-to-face (FTF) interventions were confirmed, whereas, for stress and insomnia, the effectiveness of non-face-to-face (NFTF) interventions was confirmed. FTF interventions were proven to make a significant difference to the outcome of the goal; however, their effects were not clearly distinguished from those of NFTF interventions.

CONCLUSION

Results of this review highlight the lack of research aimed at establishing the effectiveness of NFTF interventions. In addition, further research is needed on the long-term effectiveness of the intervention process and perception of participants and clinicians on group delivery interventions.

Mechanism and therapeutic strategies of depression after myocardial infarction

Depression resulted as an important factor associated with the myocardial infarction (MI) prognosis. Patients with MI also have a higher risk for developing depression. Although the issue of depression after MI has become a matter of clinical concern, the molecular mechanism underlying depression after MI remains unclear, whereby several strategies suggested have not got ideal effects, such as selective serotonin reuptake inhibitors. In this review, we summarized and discussed the occurrence mechanism of depression after MI, such as 5-hydroxytryptamine (5-HT) dysfunction, altered hypothalamus-pituitary-adrenal (HPA) axis function, gut microbiota imbalance, exosomal signal transduction, and inflammation. In addition, we offered a succinct overview of treatment, as well as some promising molecules especially from natural products for the treatment of depression after MI.

Internet-based cognitive behavioural therapy programme with and without videoconference guidance sessions: A randomized controlled trial to treat work-related symptoms of anxiety and depression

This study provides the results from the implementation of a highly structured therapist-guided iCBT programme for people with work-related anxiety and depression, in terms of programme efficacy, participants' adherence and satisfaction. Seventy-seven national police workers were randomly allocated to one of two groups: without additional videoconference sessions (web platform with guidance of therapist) and with additional videoconference sessions (same intervention as the previous group, plus two videoconference guidance sessions with a psychologist). The intervention was composed of 12 sessions and took place for 17-20 weeks. We found an adherence rate of 36.4%, with no differences between groups. All participants endorsed lower depression (BDI-II F(1) = 36.98, p < .001; ATQ F(1) = 24.22, p < .001), and anxiety (STAI-State F(1) = 76.62, p < .001) after the programme. As a variable related to anxiety and depression in workplace, participants also showed higher assertiveness levels (RAS F(1) = 8.96, p < .001). A significant reduction of the mean level of anxiety perceived by participants as the intervention programme progressed was observed in both groups (F(2) = 7.44; p = .003). Participants were satisfied with the therapists' intervention and with the programme. No significant group effects were found for any of the measures. Reduction in depression levels was maintained in the 12-month follow-up, but levels of anxiety increased. This study is innovative, as it is the first controlled trial to analyse the effect of two added videoconference sessions, and it includes short- and long-term measures, which is not usual. The results are discussed to clarify the role of the contact with the therapist to improve treatment adherence.