1
|
Bartsch DR, Cooke-O'Connor L, Connerty TJ, van Roekel H, Cammell P. Acceptability and feasibility of a short-term group therapy for people with borderline personality disorder symptoms. Australas Psychiatry 2024:10398562241246485. [PMID: 38621694 DOI: 10.1177/10398562241246485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
OBJECTIVE This study evaluated the acceptance, feasibility and safety of a short-term group program for adults (18 years and older) and youth (16 to 18 years) with borderline personality disorder (BPD) symptoms. Termed Road Maps, the content and development were informed by common treatment factors identified from evidence-based therapies for BPD. METHOD Two-hundred and eight people consented to participate in the research trial and completed baseline measures. Intervention participants rated the acceptability and subjective experience of the group. Attrition rates informed feasibility, and serious adverse events were tracked to identify potential harms. RESULTS Participant post-group ratings of the group's acceptability and subjective experience were above average across both adult and youth populations. Attrition rate after commencement of group was 38% for adults and 27% among youth. The incidence rate of emergency department presentations was reduced by 41% in the 6 months post-group, relative to 6 months pre-group. CONCLUSIONS The current study provides preliminary support for the acceptability and feasibility of a short-term group therapy program for people with a diagnosis of BPD. Road Maps may be a useful intermediate intervention in a broader model of stepped care. Australian New Zealand Clinical Trials Registry, https://www.anzctr.org.au/ACTRN12622000849796.aspx, (ACTRN12622000849796).
Collapse
Affiliation(s)
- Dianna R Bartsch
- Borderline Personality Disorder Collaborative, Barossa Hills Fleurieu Local Health Network, SA Health, Adelaide, SA, Australia; and School of Psychology, The University of Adelaide, Adelaide, SA, Australia
| | - Laura Cooke-O'Connor
- Borderline Personality Disorder Collaborative, Barossa Hills Fleurieu Local Health Network, SA Health, Adelaide, SA, USA
| | - Tracy J Connerty
- Borderline Personality Disorder Collaborative, Barossa Hills Fleurieu Local Health Network, SA Health, Adelaide, SA, USA
| | - Helen van Roekel
- Borderline Personality Disorder Collaborative, Barossa Hills Fleurieu Local Health Network, SA Health, Adelaide, SA, USA
| | - Paul Cammell
- Borderline Personality Disorder Collaborative, Barossa Hills Fleurieu Local Health Network, SA Health, Adelaide, SA, USA
| |
Collapse
|
2
|
Dewa LH, Thibaut B, Pattison N, Campbell SJ, Woodcock T, Aylin P, Archer S. Treating insomnia in people who are incarcerated: a feasibility study of a multicomponent treatment pathway. Sleep Adv 2024; 5:zpae003. [PMID: 38370440 PMCID: PMC10873789 DOI: 10.1093/sleepadvances/zpae003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 12/11/2023] [Indexed: 02/20/2024]
Abstract
Around 60% of people who are incarcerated have insomnia; 6-10 times more prevalent than the general population. Yet, there is no standardized, evidence-based approach to insomnia treatment in prison. We assessed the feasibility of a treatment pathway for insomnia in a high-secure prison to inform a future randomized controlled trial (RCT) and initial efficacy data for sleep and mental health outcomes. We used a within-participants pre-post design. The stepped-care pathway included: self-management with peer support, environmental aids, and cognitive behavioral therapy for insomnia (CBTi). Assessment measures for insomnia, well-being, mood, anxiety, suicidality, overall health, sleepiness, fatigue, and cognitive functioning were administered at baseline and pathway exit. Feasibility criteria included eligibility to participate, CBTi uptake, and assessment completion. Forty-two adult males who are incarcerated were approached of which 95.2% were eligible. Of those deemed eligible, most participated (36/40, 90.0%). Most who completed baseline completed post-assessments (28/36, 77.8%) and of these, most showed improvements in their subjective sleep (27/28, 96.4%). Large reductions were found from pre- to posttreatment in insomnia severity (d = -1.81, 95% CI: 8.3 to 12.9) and 57.0% reported no clinically significant insomnia symptoms at post-assessment. There was no overall change in actigraphy-measured sleep. Large treatment benefits were found for depression, anxiety, well-being, and cognitive functioning, with a medium benefit on suicidal ideation. The treatment pathway for insomnia in prison was feasible and may be an effective treatment for insomnia in people who are incarcerated, with additional promising benefits for mental health. A pragmatic RCT across different prison populations is warranted. This paper is part of the Sleep and Circadian Health in the Justice System Collection.
Collapse
Affiliation(s)
- Lindsay H Dewa
- Imperial College London, School of Public Health, London, UK
| | - Bethan Thibaut
- Imperial College London, School of Public Health, London, UK
| | | | | | - Thomas Woodcock
- Imperial College London, School of Public Health, London, UK
| | - Paul Aylin
- Imperial College London, School of Public Health, London, UK
| | - Stephanie Archer
- University of Cambridge, Department of Public Health and Primary Care, UK
| |
Collapse
|
3
|
Deotto A, Fabiano GF, Chung BYT, Wade SL, Anagnostou E, Crosbie J, Kelley E, Nicolson R, Andrade BF, Miller SP, Williams TS. Stepping up to COVID-19: A Clinical Trial of a Telepsychology Positive Parenting Program Targeting Behavior Problems in Children With Neurological Risk. J Pediatr Psychol 2023:jsad032. [PMID: 37316980 DOI: 10.1093/jpepsy/jsad032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 05/19/2023] [Accepted: 05/19/2023] [Indexed: 06/16/2023] Open
Abstract
OBJECTIVE To evaluate the feasibility, acceptability, and preliminary efficacy of a stepped-care parenting program implemented during COVID-19 among families of behaviorally at-risk children with neurological or neurodevelopmental disorders aged 3-9 years. METHODS Stepped-care I-InTERACT-North increased psychological support across 3 steps, matched to family needs: (1) guided self-help (podcast), (2) brief support, and (3) longer-term parent support. The intervention was provided by clinicians at The Hospital for Sick Children. Recruitment occurred via hospital and research cohort referral. A single-arm trial using a pragmatic prospective pre-post mixed-method design was utilized to assess accrual, engagement, acceptability, and preliminary efficacy. RESULTS Over 15 months, 68 families enrolled (83% consent rate) and 56 families completed stepped-care (Step 1 = 56; Step 2 = 39; Step 3 = 28), with high adherence across Steps (100%, 98%, and 93%, respectively). Parents reported high acceptability, reflected in themes surrounding accessibility, comprehension, effectiveness, and targeted care. Positive parenting skill increases were documented, and robust improvement in child behavior problems was apparent upon Step 3 completion (p =.001, d = .390). Stepped-care was as effective as traditional delivery, while improving consent and completion rates within a pandemic context. CONCLUSIONS This stepped-care telepsychology parenting program provides a compelling intervention model to address significant gaps in accessible mental health intervention while simultaneously balancing the need for efficient service. Findings inform program scalability beyond COVID-19 and emphasize the value of stepped-care intervention in delivering and monitoring mental health treatment.
Collapse
Affiliation(s)
- Angela Deotto
- Division of Neurology, Department of Psychology, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Psychology, Faculty of Health, York University, Toronto, ON, Canada
| | - Giulia F Fabiano
- Division of Neurology, Department of Psychology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Beryl Y T Chung
- Division of Neurology, Department of Psychology, The Hospital for Sick Children, Toronto, ON, Canada
- Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Shari L Wade
- Division of Physical Medicine and Rehabilitation, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Evdokia Anagnostou
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Jennifer Crosbie
- Department of Psychiatry, The Hospital for Sick Children Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Elizabeth Kelley
- Department of Psychology, Queens University, Kingston, ON, Canada
| | - Rob Nicolson
- Department of Psychiatry, Western University, London, ON, Canada
- Lawson Health Research Institute, London Health Sciences Centre, London, ON, Canada
| | - Brendan F Andrade
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Steven P Miller
- Faculty of Medicine, BC Children's Hospital, Vancouver, BC, Canada
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Tricia S Williams
- Division of Neurology, Department of Psychology, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Psychology, Faculty of Health, York University, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
| |
Collapse
|
4
|
Williams LK, Ftanou M, Pearson EJ. Virtual Delivery of Stepped-Care Cognitive Behaviour Therapy for Cancer Related Fatigue: A Feasibility Study. Integr Cancer Ther 2023; 22:15347354231191701. [PMID: 37571803 PMCID: PMC10422894 DOI: 10.1177/15347354231191701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 05/15/2023] [Accepted: 07/17/2023] [Indexed: 08/13/2023] Open
Abstract
PURPOSE About 1 in 3 people experience persistent fatigue after cancer treatment. People with severe fatigue describe a disabling lack of stamina, anxiety, depression and distressing cognitive changes. Cognitive behavior therapy (CBT) is recommended for people with severe fatigue after cancer treatment, however due to limited resources and lack of available clinicians very few people with cancer have access. This study explored feasibility of a virtual stepped-care CBT program. METHODS English speaking adults experiencing persistent fatigue who had either completed cancer treatment, or with stable disease on maintenance therapies were recruited. All participants engaged in a 6-week supported self-help program using a CBT workbook targeting fatigue (STEP 1). After the self-help program, participants with severe ongoing fatigue were stepped-up to a telehealth CBT group focused to fatigue led by a Clinical Psychologist (STEP 2). Feasibility and perceived changes were assessed at baseline, 6 and 12 weeks. RESULTS Of 19 participants, 17 completed STEP 1 and 8 completed STEP 2. Remotely delivered CBT was feasible with high retention, adherence, participant feasibility and satisfaction scores. Cost to deliver STEP 1 was AUD $145 and STEP 2, AUD $280 per participant. Overall, fatigue and self-efficacy improved significantly following STEP 1. Participants with higher baseline fatigue achieved limited improvements with self-help alone, requiring guidance to set achievable goals and reframe cognitions. Fatigue, self-efficacy and mood improved with STEP 2. CONCLUSIONS Remotely delivered CBT for cancer fatigue was feasible. The effectiveness of stratified rather than stepped CBT approach, based on fatigue severity should be trialed. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry (ACTRN # 11 12622000420741).
Collapse
Affiliation(s)
- Lauren K. Williams
- Peter MacCallum Cancer Centre, Melbourne, VIC Australia
- Ovarian Cancer Australia, Melbourne, VIC, Australia
| | - Maria Ftanou
- Peter MacCallum Cancer Centre, Melbourne, VIC Australia
- The University of Melbourne, Melbourne, VIC, Australia
| | - Elizabeth J. Pearson
- Peter MacCallum Cancer Centre, Melbourne, VIC Australia
- The University of Melbourne, Melbourne, VIC, Australia
| |
Collapse
|
5
|
Ciria-Suarez L, Costas L, Flix-Valle A, Serra-Blasco M, Medina JC, Ochoa-Arnedo C. A Digital Cancer Ecosystem to Deliver Health and Psychosocial Education as Preventive Intervention. Cancers (Basel) 2022; 14. [PMID: 35954388 DOI: 10.3390/cancers14153724] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 07/27/2022] [Accepted: 07/28/2022] [Indexed: 12/04/2022] Open
Abstract
Health education and psychosocial interventions prevent emotional distress, and the latter has been shown to have an impact on survival. In turn, digital health education interventions may help promote equity by reaching a higher number of cancer patients, both because they avoid journeys to the hospital, by and having a better efficiency. A total of 234 women recently diagnosed with breast cancer in a comprehensive cancer center used the digital ecosystem ICOnnecta’t from March 2019 to March 2021. ICOnnecta’t consists of four care levels, provided to patients according to their level of distress. The second level of this intervention consists of an educational campus, which was analyzed to track users’ interests and their information-seeking behavior. Overall, 99 out of 234 women (42.3%) used the educational campus. There were no significant differences in sociodemographic and clinical variables between the campus users and non-users. Among users, the median number of resources utilized per user was four (interquartile range: 2−9). Emotional and medical resources were the contents most frequently viewed and the audiovisual format the most consulted (p < 0.01). Resources were used mainly within the first three months from enrolment. Users who were guided to visit the virtual campus were more active than spontaneous users. Offering an early holistic health educational platform inside a digital cancer ecosystem, with health professionals involved, can reach more patients, promoting equity in the access of cancer information and prevention, from the very beginning of the disease.
Collapse
|
6
|
Medina JC, Flix-Valle A, Rodríguez-Ortega A, Hernández-Ribas R, Lleras de Frutos M, Ochoa-Arnedo C. ICOnnecta't: Development and Initial Results of a Stepped Psychosocial eHealth Ecosystem to Facilitate Risk Assessment and Prevention of Early Emotional Distress in Breast Cancer Survivors' Journey. Cancers (Basel) 2022; 14:974. [PMID: 35205722 DOI: 10.3390/cancers14040974] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 02/12/2022] [Accepted: 02/14/2022] [Indexed: 12/19/2022] Open
Abstract
Simple Summary In current clinical practice, between one third and a half of patients diagnosed with cancer experience distress. Moreover, many of these psychosocial needs often remain unaddressed, although effective interventions exist. Nowadays, eHealth solutions like ICOnnecta’t offer new tools to overcome these limitations and improve access to treatment. This digital ecosystem has been proved to be feasible to implement, reaching good acceptability, use, and satisfaction between users. In addition, it allowed symptom monitoring in real time, facilitating preventive early interventions. Overall, fostering social support appears as a key to facilitate a resilient response after diagnosis. Abstract Psychosocial interventions prevent emotional distress and facilitate adaptation in breast cancer (BC). However, conventional care presents accessibility barriers that eHealth has the potential to overcome. ICOnnecta’t is a stepped digital ecosystem designed to build wellbeing and reduce psychosocial risks during the cancer journey through a European-funded project. Women recently diagnosed with BC in a comprehensive cancer center were offered the ecosystem. ICOnnecta’t consists of four care levels, provided according to users’ distress: screening and monitoring, psychoeducation campus, peer-support community, and online-group psychotherapy. Descriptive analyses were conducted to assess the platform’s implementation, while multilevel linear models were used to study users’ psychosocial course after diagnosis. ICOnnecta’t showed acceptance, use and attrition rates of 57.62, 74.60, and 29.66%, respectively. Up to 76.19% of users reported being satisfied with the platform and 75.95% informed that it was easy to use. A total of 443 patients’ needs were detected and responsively managed, leading 94.33% of users to remain in the preventive steps. In general, strong social support led to a better psychosocial course. ICOnnecta’t has been successfully implemented. The results showed that it supported the development of a digital relation with healthcare services and opened new early support pathways.
Collapse
|
7
|
Ramirez AC, Grebe SC, McNeel MM, Limon DL, Schneider SC, Berry LN, Goin-Kochel RP, Cepeda SL, Voigt RG, Salloum A, Storch EA. Parent-led, stepped-care cognitive-behavioral therapy for youth with autism and co-occurring anxiety: study rationale and method. Braz J Psychiatry 2020; 42:638-645. [PMID: 32520166 PMCID: PMC7678910 DOI: 10.1590/1516-4446-2020-0897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 03/01/2020] [Indexed: 11/21/2022]
Abstract
Anxiety disorders affect up to 50% of individuals with autism spectrum disorder (ASD) and are significantly impairing to the person affected, as well as to their loved ones. Cognitive-behavioral therapy (CBT) has been established as the gold-standard treatment for anxiety disorders among typically developing youth and adults, and demonstrates similar efficacy among youth with high-functioning autism (HFA). Many CBT interventions utilize a "full-package" treatment approach to treat co-occurring anxiety in youth with ASD. However, these service delivery systems are often therapist-intensive, costly, and impractical, thereby compromising full engagement and treatment adherence. This paper describes the design, rationale, and methodology of a study examining stepped-care CBT for youth with HFA and co-occurring anxiety - a clinical trial examining the efficacy of low-intensity, parent-led CBT as the first line of treatment and utilizing a more intensive, therapist-led intervention for nonresponders. The study will evaluate the potential benefits of stepped-care and parent-led therapist-assisted interventions, predictors of treatment response, and the economic value of using a stepped-care model. Implications for practice will be discussed.
Collapse
Affiliation(s)
- Ana C. Ramirez
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
- Autism Center, Texas Children’s Hospital, Houston, TX, USA
| | - Stacey C. Grebe
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Morgan M. McNeel
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Danica L. Limon
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
- Autism Center, Texas Children’s Hospital, Houston, TX, USA
| | - Sophie C. Schneider
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Leandra N. Berry
- Autism Center, Texas Children’s Hospital, Houston, TX, USA
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Robin P. Goin-Kochel
- Autism Center, Texas Children’s Hospital, Houston, TX, USA
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Sandra L. Cepeda
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Robert G. Voigt
- Autism Center, Texas Children’s Hospital, Houston, TX, USA
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
- Meyer Center for Developmental Pediatrics, Texas Children’s Hospital, Houston, TX, USA
| | - Alison Salloum
- School of Social Work, University of South Florida, Tampa, FL, USA
| | - Eric A. Storch
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| |
Collapse
|
8
|
Gaudiano BA, Davis CH, Miller IW, Uebelacker L. Pilot randomized controlled trial of a video self-help intervention for depression based on acceptance and commitment therapy: Feasibility and acceptability. Clin Psychol Psychother 2020; 27:396-407. [PMID: 32087610 DOI: 10.1002/cpp.2436] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 02/02/2020] [Accepted: 02/13/2020] [Indexed: 11/10/2022]
Abstract
A common setting where depression is identified and treated is in primary care, where there is a need for low-intensity and cost-effective interventions to be used as part of a stepped-care model. The current study involved a pilot, parallel-group, randomized controlled trial of a video self-help intervention for primary care patients based on acceptance and commitment therapy (ACT). The intervention, called LifeStories, consisted of storytelling vignettes of patients describing their use of ACT-consistent coping skills for depression. Primary care patients were recruited to determine feasibility, acceptability, and potential clinical effects of the intervention. Twenty-one participants were assigned to use LifeStories over a period of 4 weeks, and 19 participants were assigned to an attention-matched comparison group. Qualitative feedback indicated that participants using LifeStories found the intervention to be engaging and useful in transmitting key ACT principles. Furthermore, those receiving LifeStories rated their level of "transportation" or immersion in the videos higher than the control group. Both conditions showed large improvements in levels of depression at a 12-week follow-up. There were no significant differences in symptom outcomes between groups; however, because this was a pilot study, it was not powered to detect differences between interventions. Both conditions additionally showed smaller effect size changes in psychological flexibility, a key ACT mechanism. The results suggest LifeStories to be a feasible and acceptable psychological intervention that may improve depression, and further research is warranted to determine its effectiveness as part of a stepped-care approach to treating depression in primary care.
Collapse
Affiliation(s)
- Brandon A Gaudiano
- Psychosocial Research Program, Butler Hospital, Providence, Rhode Island.,Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Carter H Davis
- Department of Psychology, Utah State University, Logan, Utah
| | - Ivan W Miller
- Psychosocial Research Program, Butler Hospital, Providence, Rhode Island.,Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Lisa Uebelacker
- Psychosocial Research Program, Butler Hospital, Providence, Rhode Island.,Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island
| |
Collapse
|
9
|
Baglioni C, Altena E, Bjorvatn B, Blom K, Bothelius K, Devoto A, Espie CA, Frase L, Gavriloff D, Tuuliki H, Hoflehner A, Högl B, Holzinger B, Järnefelt H, Jernelöv S, Johann AF, Lombardo C, Nissen C, Palagini L, Peeters G, Perlis ML, Posner D, Schlarb A, Spiegelhalder K, Wichniak A, Riemann D. The European Academy for Cognitive Behavioural Therapy for Insomnia: An initiative of the European Insomnia Network to promote implementation and dissemination of treatment. J Sleep Res 2019; 29:e12967. [PMID: 31856367 DOI: 10.1111/jsr.12967] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 11/13/2019] [Accepted: 11/21/2019] [Indexed: 12/18/2022]
Abstract
Insomnia, the most prevalent sleep disorder worldwide, confers marked risks for both physical and mental health. Furthermore, insomnia is associated with considerable direct and indirect healthcare costs. Recent guidelines in the US and Europe unequivocally conclude that cognitive behavioural therapy for insomnia (CBT-I) should be the first-line treatment for the disorder. Current treatment approaches are in stark contrast to these clear recommendations, not least across Europe, where, if any treatment at all is delivered, hypnotic medication still is the dominant therapeutic modality. To address this situation, a Task Force of the European Sleep Research Society and the European Insomnia Network met in May 2018. The Task Force proposed establishing a European CBT-I Academy that would enable a Europe-wide system of standardized CBT-I training and training centre accreditation. This article summarizes the deliberations of the Task Force concerning definition and ingredients of CBT-I, preconditions for health professionals to teach CBT-I, the way in which CBT-I should be taught, who should be taught CBT-I and to whom CBT-I should be administered. Furthermore, diverse aspects of CBT-I care and delivery were discussed and incorporated into a stepped-care model for insomnia.
Collapse
Affiliation(s)
- Chiara Baglioni
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany.,Department of Human Sciences, University of Rome 'G. Marconi' - Telematic, Rome, Italy
| | - Ellemarije Altena
- UMR 5287, Institut de Neurosciences Intégratives et Cognitives d'Aquitaine, Neuroimagerie et Cognition Humaine, CNRS, Université de Bordeaux, Bordeaux, France
| | - Bjørn Bjorvatn
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Kerstin Blom
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, and Stockholm Health Care Services, Stockholm County Council, Huddinge Hospital, Stockholm, Sweden
| | | | | | - Colin A Espie
- Nuffield Department of Clinical Neuroscience, Sleep and Circadian Neuroscience Institute, University of Oxford, Oxford, UK
| | - Lukas Frase
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Dimitri Gavriloff
- Nuffield Department of Clinical Neuroscience, Sleep and Circadian Neuroscience Institute, University of Oxford, Oxford, UK
| | - Hion Tuuliki
- Nordic Sleep Centre, Tallinn, Estonia.,Tartu University Hospital, Tartu, Estonia
| | - Andrea Hoflehner
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Birgit Högl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Heli Järnefelt
- Finnish Institute of Occupational Health, Helsinki, Finland.,Department of Psychology and Logopedics, University of Helsinki, Finland
| | - Susanna Jernelöv
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, and Stockholm Health Care Services, Stockholm County Council, Huddinge Hospital, Stockholm, Sweden.,Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Sweden
| | - Anna F Johann
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany.,Medical Psychology and Medical Sociology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Caterina Lombardo
- Department of Psychology, "Sapienza" University of Rome, Rome, Italy
| | - Christoph Nissen
- University Hospital of Psychiatry and Psychotherapy, Bern, Switzerland
| | - Laura Palagini
- Department of Neuroscience, University of Pisa, Pisa, Italy
| | - Geert Peeters
- Sleep Medicine Centre Kempenhaeghe, Heeze, The Netherlands
| | - Michael L Perlis
- Department of Psychiatry, Upenn Behavioral Sleep Medicine Program, University of Pennsylvania, Philadelphia, PA, USA
| | - Donn Posner
- Stanford University School of Medicine, Stanford, CA, USA
| | - Angelika Schlarb
- Department of Psychology, University of Bielefeld, Bielefeld, Germany
| | - Kai Spiegelhalder
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Adam Wichniak
- Sleep Medicine Centre and Third Department of Psychiatry, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Dieter Riemann
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany
| |
Collapse
|
10
|
Nicholas J, Ringland KE, Graham AK, Knapp AA, Lattie EG, Kwasny MJ, Mohr DC. Stepping Up: Predictors of 'Stepping' within an iCBT Stepped-Care Intervention for Depression. Int J Environ Res Public Health 2019; 16:E4689. [PMID: 31775297 PMCID: PMC6926538 DOI: 10.3390/ijerph16234689] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 11/21/2019] [Accepted: 11/22/2019] [Indexed: 12/26/2022]
Abstract
Internet-based cognitive behavioral therapy (iCBT) may overcome barriers to mental health care and has proven efficacious. However, this approach currently exists outside the existing mental health care delivery system. Stepped care is a proposed framework for integrating digital mental health (DMH) into health systems by initiating iCBT and "stepping up" care to a more intensive intervention should iCBT prove ineffective. This study explores pre-treatment factors associated with reaching stepping criteria among patients receiving iCBT. This exploratory analysis of a stepped care arm of a larger randomized trial examined participants who were stepped to a more intensive intervention if they did not respond to iCBT. The association of pre-treatment factors on stepping were examined using Kruskal-Wallis and Chi-square tests. One-fifth of the 151 participants met criteria for stepping within the 20-week treatment period. Only pre-treatment depression severity and treatment preference were associated with increased likelihood of stepping (p = 0.049 and 0.048, respectively). The low number of individuals who stepped provides support for iCBT as an effective, low intensity treatment for depression. The modest association of pre-treatment depression and preference to not receive iCBT may be useful in identifying patients who are less likely to respond.
Collapse
Affiliation(s)
- Jennifer Nicholas
- Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Northwestern University, Chicago, IL 60611, USA; (K.E.R.); (A.K.G.); (A.A.K.); (E.G.L.); (D.C.M.)
| | - Kathryn E. Ringland
- Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Northwestern University, Chicago, IL 60611, USA; (K.E.R.); (A.K.G.); (A.A.K.); (E.G.L.); (D.C.M.)
- Department of Communication Studies, Northwestern University, Chicago, IL 60611, USA
| | - Andrea K. Graham
- Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Northwestern University, Chicago, IL 60611, USA; (K.E.R.); (A.K.G.); (A.A.K.); (E.G.L.); (D.C.M.)
- Department of Medical Social Sciences, Northwestern University, Chicago, IL 60611, USA
| | - Ashley A. Knapp
- Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Northwestern University, Chicago, IL 60611, USA; (K.E.R.); (A.K.G.); (A.A.K.); (E.G.L.); (D.C.M.)
| | - Emily G. Lattie
- Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Northwestern University, Chicago, IL 60611, USA; (K.E.R.); (A.K.G.); (A.A.K.); (E.G.L.); (D.C.M.)
- Department of Medical Social Sciences, Northwestern University, Chicago, IL 60611, USA
| | - Mary J. Kwasny
- Biostatistics Collaboration Center, Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA;
| | - David C. Mohr
- Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Northwestern University, Chicago, IL 60611, USA; (K.E.R.); (A.K.G.); (A.A.K.); (E.G.L.); (D.C.M.)
| |
Collapse
|
11
|
Abstract
Background and aims Although first treatment approaches for Internet Use Disorders (IUDs) have proven to be effective, health care utilization remained low. New service models focus on integrated health care systems, which facilitate access and reduce burdens of health care utilization, and stepped-care interventions, which efficiently provide individualized therapy. Methods An integrated health care approach for IUD intended to (a) be easily accessible and comprehensive, (b) cover a variety of comorbid syndromes, and (c) take heterogeneous levels of impairment into account was investigated in a one-armed prospective intervention study on n = 81 patients, who were treated from 2012 to 2016. Results First, patients showed significant improvement in Compulsive Internet Use over time, as measured by hierarchical linear modeling. Effect sizes of outcome change from baseline to 6-month follow-up ranged from d = 0.48 to d = 1.46. Second, differential effects were found depending on patients' compliance, demonstrating that high compliance resulted in significantly higher rates of change. Third, patients referred to minimal interventions did not differ significantly in amount of change from patients referred to intensive psychotherapy. Discussion Tailored interventions result in higher efficiency through optimized resource allocation and equal amounts of symptom change in all treatment conditions. Moreover, comprehensive, low-threshold interventions seem to increase health service utilization.
Collapse
Affiliation(s)
- Katajun Lindenberg
- 1 Institute for Psychology, University of Education Heidelberg , Heidelberg, Germany
| | - Carolin Szász-Janocha
- 1 Institute for Psychology, University of Education Heidelberg , Heidelberg, Germany
| | - Sophie Schoenmaekers
- 1 Institute for Psychology, University of Education Heidelberg , Heidelberg, Germany
| | - Ulrich Wehrmann
- 2 Rural District Office Rhine Neckar, Public Health Department , Heidelberg, Germany
| | - Eva Vonderlin
- 3 Institute for Psychology, Heidelberg University , Heidelberg, Germany
| |
Collapse
|
12
|
Nahum-Shani I, Ertefaie A, Lucy X, Lynch KG, McKay JR, Oslin D, Almirall D. A SMART data analysis method for constructing adaptive treatment strategies for substance use disorders. Addiction 2017; 112:901-909. [PMID: 28029718 PMCID: PMC5431579 DOI: 10.1111/add.13743] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 06/03/2016] [Accepted: 12/19/2016] [Indexed: 01/04/2023]
Abstract
AIMS To demonstrate how Q-learning, a novel data analysis method, can be used with data from a sequential, multiple assignment, randomized trial (SMART) to construct empirically an adaptive treatment strategy (ATS) that is more tailored than the ATSs already embedded in a SMART. METHOD We use Q-learning with data from the Extending Treatment Effectiveness of Naltrexone (ExTENd) SMART (N = 250) to construct empirically an ATS employing naltrexone, behavioral intervention, and telephone disease management to reduce alcohol consumption over 24 weeks in alcohol dependent individuals. RESULTS Q-learning helped to identify a subset of individuals who, despite showing early signs of response to naltrexone, require additional treatment to maintain progress. CONCLUSIONS Q-learning can inform the development of more cost-effective, adaptive treatment strategies for treating substance use disorders.
Collapse
Affiliation(s)
- Inbal Nahum-Shani
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan 48106;
| | - Ashkan Ertefaie
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, New York, 14642;
| | - Xi Lucy
- Department of Statistics, University of Michigan, Ann Arbor, Michigan 48109;
| | - Kevin G. Lynch
- Treatment Research Center and Center for Studies of Addictions, Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania 19104;
| | - James R. McKay
- Center on the Continuum of Care in the Addictions, Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania 19104, and Philadelphia Veterans Administration Medical Center, Philadelphia, Pennsylvania 19104;
| | - David Oslin
- Philadelphia Veterans Administration Medical Center, Philadelphia, Pennsylvania 19104, and Treatment Research Center and Center for Studies of Addictions, Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania 19104;
| | - Daniel Almirall
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan 48106;
| |
Collapse
|
13
|
Duffy M, Sharer M, Cornman H, Pearson J, Pitorak H, Fullem A. Integrating Mental Health and HIV Services in Zimbabwean Communities: A Nurse and Community-led Approach to Reach the Most Vulnerable. J Assoc Nurses AIDS Care 2015; 28:186-198. [PMID: 26525564 DOI: 10.1016/j.jana.2015.09.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 09/23/2015] [Indexed: 11/26/2022]
Abstract
Alcohol use and depression negatively impact adherence, retention in care, and HIV progression, and people living with HIV (PLWH) have disproportionately higher depression rates. In developing countries, more than 76% of people with mental health issues receive no treatment. We hypothesized that stepped-care mental health/HIV integration provided by multiple service professionals in Zimbabwe would be acceptable and feasible. A three-phase mixed-method design was used with a longitudinal cohort of 325 nurses, community health workers, and traditional medicine practitioners in nine communities. During Phase 3, 312 PLWH were screened by nurses for mental health symptoms; 28% were positive. Of 59 PLWH screened for harmful alcohol and substance use, 36% were positive. Community health workers and traditional medicine practitioners screened 123 PLWH; 54% were positive for mental health symptoms and 29% were positive for alcohol and substance abuse. Findings indicated that stepped-care was acceptable and feasible for all provider types.
Collapse
|
14
|
Bosmans JE, Dozeman E, van Marwijk HWJ, van Schaik DJF, Stek ML, Beekman ATF, van der Horst HE. Cost-effectiveness of a stepped care programme to prevent depression and anxiety in residents in homes for the older people: a randomised controlled trial. Int J Geriatr Psychiatry 2014; 29:182-90. [PMID: 23765874 DOI: 10.1002/gps.3987] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Accepted: 04/24/2013] [Indexed: 11/11/2022]
Abstract
BACKGROUND Depression and anxiety are common in residents of elderly homes. Both disorders have negative effects on functioning, well-being and health-care utilisation. Besides treatment, prevention can be an option to reduce the burden of mental disorders. The objective of this study was to evaluate the cost-effectiveness of a stepped care programme to prevent the onset of depression and anxiety disorders in residents of elderly homes compared with usual care from a societal perspective. METHODS Outcomes were incidence of depression and/or anxiety, severity of depressive and anxiety symptoms and quality-adjusted life years. Health-care utilisation was measured during interviews. Multiple imputation was used to impute missing cost and effect data. Uncertainty around cost differences and incremental cost-effectiveness ratios was estimated using bootstrapping. Cost-effectiveness planes and acceptability curves were created. RESULTS The incidence of depression and anxiety combined in the intervention group was not reduced in comparison with the usual care group. There was also no effect on the other outcomes. Mean total costs in the intervention group were €838 higher than in the usual care group, but this difference was not statistically significant (95% confidence interval, -593 to 2420). Cost-effectiveness planes showed that there was considerable uncertainty. Cost-effectiveness acceptability curves showed that the maximum probability of the intervention being cost-effective in comparison with usual care was 0.46 for reducing the incidence of depression and anxiety combined. CONCLUSION A stepped care programme to prevent depression and anxiety in older people living in elderly homes was not considered cost-effective in comparison with usual care.
Collapse
Affiliation(s)
- J E Bosmans
- Department of Health Sciences and EMGO Institute for Health and Care Research, Faculty of Earth and Life Sciences, VU University Amsterdam, Amsterdam, The Netherlands
| | | | | | | | | | | | | |
Collapse
|
15
|
van der Aa HP, van Rens GH, Comijs HC, Bosmans JE, Margrain TH, van Nispen RM. Stepped-care to prevent depression and anxiety in visually impaired older adults--design of a randomised controlled trial. BMC Psychiatry 2013; 13:209. [PMID: 23937975 DOI: 10.1186/1471-244X-13-209] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Accepted: 08/07/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Subthreshold depression and anxiety are common in the growing population of visually impaired older adults and increase the risk of full-blown depressive or anxiety disorders. Adequate treatment may prevent the development of depression or anxiety in this high risk group. METHOD/DESIGN A stepped-care programme was developed based on other effective interventions and focus groups with professionals and patient representatives of three low vision rehabilitation organisations in The Netherlands and Belgium. The final programme consists of four steps: 1) watchful waiting, 2) guided self-help, 3) problem solving treatment, 4) referral to general practitioner. The (cost-)effectiveness of this programme is evaluated in a randomised controlled trial. Patients (N = 230) are randomly assigned to either a treatment group (stepped-care) or a control group (usual care). The primary outcome is the incidence of depressive and anxiety disorders, measured with the Mini International Neuropsychiatric Interview (MINI). DISCUSSION Preventive interventions for depression and anxiety have received little attention in the field of low vision. A stepped-care programme that focuses on both depression and anxiety has never been investigated in visually impaired older adults before. If the intervention is shown to be effective, this study will result in an evidence based treatment programme to prevent depression or anxiety in patients from low vision rehabilitation organisations. The pragmatic design of the study greatly enhances the generalisability of the results. However, a possible limitation is the difficulty to investigate the contribution of each individual step. TRIAL REGISTRATION Identifier: NTR3296.
Collapse
|
16
|
van Dijk SE, Pols AD, Adriaanse MC, Bosmans JE, Elders PJ, van Marwijk HW, van Tulder MW. Cost-effectiveness of a stepped-care intervention to prevent major depression in patients with type 2 diabetes mellitus and/or coronary heart disease and subthreshold depression: design of a cluster-randomized controlled trial. BMC Psychiatry 2013; 13:128. [PMID: 23651614 DOI: 10.1186/1471-244X-13-128] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Accepted: 04/24/2013] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Co-morbid major depression is a significant problem among patients with type 2 diabetes mellitus and/or coronary heart disease and this negatively impacts quality of life. Subthreshold depression is the most important risk factor for the development of major depression. Given the highly significant association between depression and adverse health outcomes and the limited capacity for depression treatment in primary care, there is an urgent need for interventions that successfully prevent the transition from subthreshold depression into a major depressive disorder. Nurse led stepped-care is a promising way to accomplish this. The aim of this study is to evaluate the cost-effectiveness of a nurse-led indicated stepped-care program to prevent major depression among patients with type 2 diabetes mellitus and/or coronary heart disease in primary care who also have subthreshold depressive symptoms. METHODS/DESIGN An economic evaluation will be conducted alongside a cluster-randomized controlled trial in approximately thirty general practices in the Netherlands. Randomization takes place at the level of participating practice nurses. We aim to include 236 participants who will either receive a nurse-led indicated stepped-care program for depressive symptoms or care as usual. The stepped-care program consists of four sequential but flexible treatment steps: 1) watchful waiting, 2) guided self-help treatment, 3) problem solving treatment and 4) referral to the general practitioner. The primary clinical outcome measure is the cumulative incidence of major depressive disorder as measured with the Mini International Neuropsychiatric Interview. Secondary outcomes include severity of depressive symptoms, quality of life, anxiety and physical outcomes. Costs will be measured from a societal perspective and include health care utilization, medication and lost productivity costs. Measurements will be performed at baseline and 3, 6, 9 and 12 months. DISCUSSION The intervention being investigated is expected to prevent new cases of depression among people with type 2 diabetes mellitus and/or coronary heart disease and subthreshold depression, with subsequent beneficial effects on quality of life, clinical outcomes and health care costs. When proven cost-effective, the program provides a viable treatment option in the Dutch primary care system. TRIAL REGISTRATION Dutch Trial Register NTR3715.
Collapse
|
17
|
Carels RA, Young KM, Hinman N, Gumble A, Koball A, Oehlhof MW, Darby L. Stepped-care in obesity treatment: matching treatment intensity to participant performance. Eat Behav 2012; 13:112-8. [PMID: 22365792 PMCID: PMC3510656 DOI: 10.1016/j.eatbeh.2012.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2011] [Revised: 12/06/2011] [Accepted: 01/10/2012] [Indexed: 01/22/2023]
Abstract
This investigation examined the effectiveness of a self-help (SH), stepped-care (SC) weight loss program. Based on a failure to achieve pre-assigned weight loss goals, participants were eligible to be stepped-up from a SH program to two levels of treatment intensity (weight loss group [WLG]; individual counseling [IC]) beyond SH. The primary outcome was change in body weight. Fifty-three overweight/obese adults (BMI≥27 kg/m(2); mean BMI of 37.3, SD=6.6, 89% Caucasian, and 77% female) participated in an 18-week weight loss intervention. During several phases of the investigation, those stepped-up to more intensive treatment lost comparable weight to those who were not stepped-up. Nevertheless, by the end of treatment, individuals who remained in SH (M=8.6%) lost a significantly greater percentage of weight than individuals who received SH+IC (M=4.7%; p<.05) and individuals in SH+IC lost a significantly greater percentage of weight than individuals who received SH+WLG+IC (M=1.6%; p<.05). While some individuals benefited from being stepped-up to greater intensity treatment, other individuals experienced little benefit. The application of SC principles to the treatment of obesity needs further study.
Collapse
Affiliation(s)
- Robert A. Carels
- Corresponding author at: Bowling Green State University, Department of Psychology, Bowling Green, OH 43403, United States. Tel.: +1 419 372 9405; fax: +1 419 372 6013, (R.A. Carels)
| | | | | | | | | | | | | |
Collapse
|