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Brotto LA, Basson R, Grabovac A, Chivers ML, Zdaniuk B, Bodnar TS, Weinberg J. Impact of mindfulness versus supportive sex education on stress in women with sexual interest/arousal disorder. J Behav Med 2024; 47:721-733. [PMID: 38668816 DOI: 10.1007/s10865-024-00491-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 04/09/2024] [Indexed: 08/02/2024]
Abstract
Low desire in women is the most common sexual difficulty, and stress has been identified as a significant predictor of symptoms. We evaluated a mindfulness-based cognitive therapy (MBCT) group treatment versus a sex education comparison group treatment (STEP) on self-reported stress and on the physiological stress response measured via morning-to-evening cortisol slope in 148 women with a diagnosis of sexual interest/arousal disorder (SIAD). Perceived stress decreased following treatment in both groups, and significantly more after MBCT. The cortisol slope was steeper (indicative of better stress system regulation) from pre-treatment to 6-month follow-up, with no differences between the groups. As an exploratory analysis, we found that the reduction in perceived stress predicted increases in sexual desire and decreases in sex-related distress for participants after MBCT only. These findings suggest that group mindfulness targeting women with low sexual desire leads to improvements in self-reported and physiological stress, with improvements in self-reported stress partially accounting for improvements in sexual desire and distress.
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Affiliation(s)
- Lori A Brotto
- Department of Obstetrics and Gynaecology, University of British Columbia, 2775 Laurel Street, 6th Floor, Vancouver, BC, V5Z 1M9, Canada.
| | - Rosemary Basson
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Andrea Grabovac
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | | | - Bozena Zdaniuk
- Department of Obstetrics and Gynaecology, University of British Columbia, 2775 Laurel Street, 6th Floor, Vancouver, BC, V5Z 1M9, Canada
| | - Tamara S Bodnar
- Department of Cellular and Physiological Sciences, University of British Columbia, Vancouver, Canada
| | - Joanne Weinberg
- Department of Cellular and Physiological Sciences, University of British Columbia, Vancouver, Canada
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Schillings C, Meißner E, Erb B, Bendig E, Schultchen D, Pollatos O. Effects of a Chatbot-Based Intervention on Stress and Health-Related Parameters in a Stressed Sample: Randomized Controlled Trial. JMIR Ment Health 2024; 11:e50454. [PMID: 38805259 PMCID: PMC11167325 DOI: 10.2196/50454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 02/09/2024] [Accepted: 03/26/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Stress levels and the prevalence of mental disorders in the general population have been rising in recent years. Chatbot-based interventions represent novel and promising digital approaches to improve health-related parameters. However, there is a lack of research on chatbot-based interventions in the area of mental health. OBJECTIVE The aim of this study was to investigate the effects of a 3-week chatbot-based intervention guided by the chatbot ELME, specifically with respect to the ability to reduce stress and improve various health-related parameters in a stressed sample. METHODS In this multicenter two-armed randomized controlled trial, 118 individuals with medium to high stress levels were randomized to the intervention group (n=59) or the treatment-as-usual control group (n=59). The ELME chatbot guided participants of the intervention group through 3 weeks of training based on the topics stress, mindfulness, and interoception, with practical and psychoeducative elements delivered in two daily interactive intervention sessions via a smartphone (approximately 10-20 minutes each). The primary outcome (perceived stress) and secondary outcomes (mindfulness; interoception or interoceptive sensibility; subjective well-being; and emotion regulation, including the subfacets reappraisal and suppression) were assessed preintervention (T1), post intervention (T2; after 3 weeks), and at follow-up (T3; after 6 weeks). During both conditions, participants also underwent ecological momentary assessments of stress and interoceptive sensibility. RESULTS There were no significant changes in perceived stress (β03=-.018, SE=.329; P=.96) and momentary stress. Mindfulness and the subfacet reappraisal significantly increased in the intervention group over time, whereas there was no change in the subfacet suppression. Well-being and momentary interoceptive sensibility increased in both groups over time. CONCLUSIONS To gain insight into how the intervention can be improved to achieve its full potential for stress reduction, besides a longer intervention duration, specific sample subgroups should be considered. The chatbot-based intervention seems to have the potential to improve mindfulness and emotion regulation in a stressed sample. Future chatbot-based studies and interventions in health care should be designed based on the latest findings on the efficacy of rule-based and artificial intelligence-based chatbots. TRIAL REGISTRATION German Clinical Trials Register DRKS00027560; https://drks.de/search/en/trial/DRKS00027560. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-doi.org/10.3389/fdgth.2023.1046202.
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Affiliation(s)
- Christine Schillings
- Department of Clinical and Health Psychology, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Echo Meißner
- Institute of Distributed Systems, Ulm University, Ulm, Germany
| | - Benjamin Erb
- Institute of Distributed Systems, Ulm University, Ulm, Germany
| | - Eileen Bendig
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Dana Schultchen
- Department of Clinical and Health Psychology, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Olga Pollatos
- Department of Clinical and Health Psychology, Institute of Psychology and Education, Ulm University, Ulm, Germany
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Breuer-Asher I, Ritholz MD, Horwitz DL, Manejwala O, Behar E, Fundoiano-Hershcovitz Y. Association of Digital Engagement With Relaxation Tools and Stress Level Reduction: Retrospective Cohort Study. JMIR Form Res 2024; 8:e50506. [PMID: 38502164 PMCID: PMC10988373 DOI: 10.2196/50506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 10/12/2023] [Accepted: 02/27/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Stress is an emotional response caused by external triggers and is a high-prevalence global problem affecting mental and physical health. Several different digital therapeutic solutions are effective for stress management. However, there is limited understanding of the association between relaxation components and stress levels when using a digital app. OBJECTIVE This study investigated the contribution of relaxation tools to stress levels over time. We hypothesized that participation in breathing exercises and cognitive behavioral therapy-based video sessions would be associated with a reduction in stress levels. We also hypothesized a significant reduction specifically in participants' perceived sense of burden and lack of productivity when engaged with breathing exercises and video sessions. METHODS Stress levels were evaluated in a real-world data cohort using a behavioral health app for digital intervention and monitoring change. This retrospective real-world analysis of users on a mobile platform-based treatment followed users (N=490) who started with moderate and above levels of stress and completed at least 2 stress assessments. The levels of stress were tracked throughout the first 10 weeks. A piecewise mixed effects model was applied to model the trajectories of weekly stress mean scores in 2 time segments (1-6 weeks and 6-10 weeks). Next, a simple slope analysis was used for interpreting interactions probing the moderators: breathing exercises and video sessions. Piecewise mixed-effects models were also used to model the trajectories of specific perceived stress item rates in the stress questionnaire in the 2 segments (1-6 weeks and 6-10 weeks) and whether they are moderated by the relaxation engagements. Simple slope analysis was also used here for the interpretation of the interactions. RESULTS Analysis revealed a significant decrease in stress symptoms (β=-.25; 95% CI -0.32 to -0.17; P<.001) during the period of 1-6 weeks of app use that was maintained during the period of 6-10 weeks. Breathing exercises significantly moderated the reduction in stress symptoms during the period of 1-6 weeks (β=-.07; 95% CI -0.13 to -0.01; P=.03), while engagement in digital video sessions did not moderate stress scores. Engagement in digital video sessions, as well as breathing exercises, significantly moderated the reduction in perceived sense of burden and lack of productivity during weeks 1-6 and remained stable during weeks 6-10 on both items. CONCLUSIONS This study sheds light on the association between stress level reduction and specific components of engagement in a digital health app, breathing exercises, and cognitive behavioral therapy-based video sessions. Our findings provide a basis for further investigation of current and moderating factors that contribute to the personalization of digital intervention. In addition, results may aid in developing a more comprehensive understanding of how digital intervention tools work for mental health and for whom they are most effective.
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Affiliation(s)
| | - Marilyn D Ritholz
- Joslin Diabetes Center, Harvard Medical School, Boston, MA, United States
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Wickens N, McGivern L, de Gouveia Belinelo P, Milroy H, Martin L, Wood F, Bullman I, Janse van Rensburg E, Woolard A. A wellbeing program to promote mental health in paediatric burn patients: Study protocol. PLoS One 2024; 19:e0294237. [PMID: 38359022 PMCID: PMC10868872 DOI: 10.1371/journal.pone.0294237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 10/27/2023] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND One of the most traumatic injuries a child can experience is a severe burn. Despite improvements in medical treatments which have led to better physical outcomes and reduced mortality rates for paediatric burns patients, the psychological impact associated with experiencing such a traumatic injury has mostly been overlooked. This is concerning given the high incidence of psychopathology amongst paediatric burn survivors. OBJECTIVES This project will aim to pilot test and evaluate a co-designed trauma-focused intervention to support resilience and promote positive mental health in children and adolescents who have sustained an acute burn injury. Our first objective is to collect pilot data to evaluate the efficacy of the intervention and to inform the design of future trauma-focussed interventions. Our second objective is to collect pilot data to determine the appropriateness of the developed intervention by investigating the changes in mental health indicators pre- and post-intervention. This will inform the design of future interventions. METHODS This pilot intervention study will recruit 40 children aged between 6-17 years who have sustained an acute burn injury and their respective caregivers. These participants will have attended the Stan Perron Centre of Excellence for Childhood Burns at Perth Children's Hospital. Participants will attend a 45-minute weekly or fortnightly session for six weeks that involves building skills around information gathering, managing reactions (behaviours and thoughts), identifying, and bolstering coping skills, problem solving and preventing setbacks. The potential effects and feasibility of our intervention will be assessed through a range of age-appropriate screening measures which will assess social behaviours, personal qualities, mental health and/or resilience. Assessments will be administered at baseline, immediately post-intervention, at 6- and 12-months post-intervention. CONCLUSION The results of this study will lay the foundation for an evidence-based, trauma-informed approach to clinical care for paediatric burn survivors and their families in Western Australia. This will have important implications for the design of future support offered to children with and beyond burn injuries, and other medical trauma populations.
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Affiliation(s)
- Nicole Wickens
- Telethon Kids Institute, Perth Children’s Hospital, Nedlands, Western Australia, Australia
| | - Lisa McGivern
- Telethon Kids Institute, Perth Children’s Hospital, Nedlands, Western Australia, Australia
- The University of Western Australia, Crawley, Western Australia, Australia
| | | | - Helen Milroy
- Telethon Kids Institute, Perth Children’s Hospital, Nedlands, Western Australia, Australia
- The University of Western Australia, Crawley, Western Australia, Australia
| | - Lisa Martin
- Burn Injury Research Unit, The University of Western Australia, Crawley, Western Australia, Australia
- Burn Service of Western Australia, Perth Children’s Hospital, Nedlands, Western Australia, Australia
| | - Fiona Wood
- Burn Injury Research Unit, The University of Western Australia, Crawley, Western Australia, Australia
- Burn Service of Western Australia, Perth Children’s Hospital, Nedlands, Western Australia, Australia
| | - Indijah Bullman
- Telethon Kids Institute, Perth Children’s Hospital, Nedlands, Western Australia, Australia
| | - Elmie Janse van Rensburg
- Telethon Kids Institute, Perth Children’s Hospital, Nedlands, Western Australia, Australia
- The University of Western Australia, Crawley, Western Australia, Australia
| | - Alix Woolard
- Telethon Kids Institute, Perth Children’s Hospital, Nedlands, Western Australia, Australia
- The University of Western Australia, Crawley, Western Australia, Australia
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Liebherr M, Brandtner A, Brand M, Tang YY. Digital mindfulness training and cognitive functions: A preregistered systematic review of neuropsychological findings. Ann N Y Acad Sci 2024; 1532:37-49. [PMID: 38197226 DOI: 10.1111/nyas.15095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
Traditional mindfulness interventions have been frequently reported to be effective in improving cognitive functions. In recent years, however, traditional programs are being increasingly replaced by technology-enabled mindfulness training programs. The aim of the present systematic review (PROSPERO ID: CRD42021289480) is to evaluate the research evidence on their effects on cognitive functions. Empirical training studies in the realm of digital mindfulness training that fulfilled the inclusion criteria led to 19 studies and 1654 participants being included in this review from among the papers searched in PubMed, Scopus, and Web of Knowledge. Results support previous assumptions on the potential of digital mindfulness training, with the most robust effect on attention control, followed by executive regulation, memory, cognitive flexibility, and other cognitive functions. However, the number of studies that did not find significant changes at least equaled, if not exceeded, the number of studies that found increases. The heterogeneity of identified studies prompted us to discuss several aspects in order to help the future development of digital applications.
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Affiliation(s)
- Magnus Liebherr
- General Psychology: Cognition and Center for Behavioral Addiction Research (CeBAR), University of Duisburg-Essen, Duisburg, Germany
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, Essen, Germany
| | - Annika Brandtner
- General Psychology: Cognition and Center for Behavioral Addiction Research (CeBAR), University of Duisburg-Essen, Duisburg, Germany
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, Essen, Germany
| | - Matthias Brand
- General Psychology: Cognition and Center for Behavioral Addiction Research (CeBAR), University of Duisburg-Essen, Duisburg, Germany
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, Essen, Germany
| | - Yi-Yuan Tang
- College of Health Solutions, Arizona State University, Tempe, Arizona, USA
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