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Palmer CE, Marshall E, Millgate E, Warren G, Ewbank M, Cooper E, Lawes S, Smith A, Hutchins-Joss C, Young J, Bouazzaoui M, Margoum M, Healey S, Marshall L, Mehew S, Cummins R, Tablan V, Catarino A, Welchman AE, Blackwell AD. Combining Artificial Intelligence and Human Support in Mental Health: Digital Intervention With Comparable Effectiveness to Human-Delivered Care. J Med Internet Res 2025; 27:e69351. [PMID: 40152000 DOI: 10.2196/69351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2024] [Revised: 02/17/2025] [Accepted: 03/07/2025] [Indexed: 03/29/2025] Open
Abstract
BACKGROUND Escalating mental health demand exceeds existing clinical capacity, necessitating scalable digital solutions. However, engagement remains challenging. Conversational agents can enhance engagement by making digital programs more interactive and personalized, but they have not been widely adopted. This study evaluated a digital program for anxiety in comparison to external comparators. The program used an artificial intelligence (AI)-driven conversational agent to deliver clinician-written content via machine learning, with clinician oversight and user support. OBJECTIVE This study aims to evaluate the engagement, effectiveness, and safety of this structured, evidence-based digital program with human support for mild, moderate, and severe generalized anxiety. Statistical analyses sought to determine whether the program reduced anxiety more than a propensity-matched waiting control and was statistically noninferior to real-world, propensity-matched face-to-face and typed cognitive behavioral therapy (CBT). METHODS Prospective participants (N=299) were recruited from the National Health Service (NHS) or social media in the United Kingdom and given access to the digital program for up to 9 weeks (study conducted from October 2023 to May 2024). End points were collected before, during, and after the digital program, as well as at a 1-month follow-up. External comparator groups were created through propensity matching of the digital program sample with NHS Talking Therapies (NHS TT) data from ieso Digital Health (typed CBT) and Dorset HealthCare (DHC) University NHS Foundation Trust (face-to-face CBT). Superiority and noninferiority analyses were conducted to compare anxiety symptom reduction (change on the 7-item Generalized Anxiety Disorder Scale [GAD-7]) between the digital program group and the external comparator groups. The program included human support, and clinician time spent per participant was calculated. RESULTS Participants used the program for a median of 6 hours over 53 days, with 232 of the 299 (77.6%) engaged (ie, completing a median of 2 hours over 14 days). There was a large, clinically meaningful reduction in anxiety symptoms for the digital program group (per-protocol [PP; n=169]: mean GAD-7 change -7.4, d=1.6; intention-to-treat [ITT; n= 99]: mean GAD-7 change -5.4, d=1.1). The PP effect was statistically superior to the waiting control (d=1.3) and noninferior to the face-to-face CBT group (P<.001) and the typed CBT group (P<.001). Similarly, for the ITT sample, the digital program showed superiority to waiting control (d=0.8) and noninferiority to face-to-face CBT (P=.002), with noninferiority to typed CBT approaching significance (P=.06). Effects were sustained at the 1-month follow-up. Clinicians overseeing the digital program spent a mean of 1.6 hours (range 31-200 minutes) of clinician time in sessions per participant. CONCLUSIONS By combining AI and human support, the digital program achieved clinical outcomes comparable to human-delivered care, while significantly reducing the required clinician time by up to 8 times compared with global care estimates. These findings highlight the potential of technology to scale evidence-based mental health care, address unmet needs, and ultimately impact quality of life and reduce the economic burden globally. TRIAL REGISTRATION ISRCTN Registry ISRCTN52546704; http://www.isrctn.com/ISRCTN52546704.
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Affiliation(s)
| | | | | | | | | | - Elisa Cooper
- ieso Digital Health Ltd, Cambridge, United Kingdom
| | | | | | | | | | | | - Morad Margoum
- Dorset HealthCare University NHS Foundation, Poole, United Kingdom
| | - Sandra Healey
- Dorset HealthCare University NHS Foundation, Poole, United Kingdom
| | | | - Shaun Mehew
- ieso Digital Health Ltd, Cambridge, United Kingdom
| | | | | | - Ana Catarino
- ieso Digital Health Ltd, Cambridge, United Kingdom
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Lindberg MS, Lundqvist J, Brattmyr M, Solem S, Hjemdal O, Roos E, Björgvinsson T, Cornish P, Havnen A. Treatment and prevention of common mental health problems: comparisons of four low-intensity interventions in a community outpatient setting. Psychother Res 2025:1-18. [PMID: 40239633 DOI: 10.1080/10503307.2025.2485165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2024] [Revised: 01/14/2025] [Accepted: 03/23/2025] [Indexed: 04/18/2025] Open
Abstract
Objective: Low-intensity interventions based on cognitive behavioral therapy are often used to scale up treatment volumes for common mental health problems. However, mode of delivery could have implications for outcomes. Methods: This was an observational study of adults seeking treatment in a naturalistic setting of outpatient community mental health services (N = 897). Depending on their problem description, patients were allocated to four different low-intensity interventions: group psychoeducation, group therapies, guided self-help, and one-to-one consultations. Pre-to posttreatment changes on the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and Work- and Social Adjustment Scale (WSAS) were estimated using linear mixed-effects models and propensity score weighted analyses. Results: The proportion of patients achieving clinically significant change (CSC), and time used to achieve CSC varied between interventions, with guided self-help showing the highest rates of CSC (53-66%, d = 0.62-1.04) and group psychoeducation being most time-effective intervention. For subclinical patients, guided self-help had the lowest rates of reliable deterioration (0-8%). Conclusion: Low-intensity interventions within routine community mental health care have acceptable outcomes. Mode of delivery appears to be important for rates of CSC, therapist time investment, and prevention of deterioration. Future studies should investigate which low-intensity interventions work for whom.
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Affiliation(s)
- Martin Schevik Lindberg
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
- Health and Welfare, Trondheim Municipality, Norway
| | - Jakob Lundqvist
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Martin Brattmyr
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Stian Solem
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Odin Hjemdal
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
- Diakonhjemmet Hospital, Oslo, Norway
| | - Eirik Roos
- Health and Welfare, Trondheim Municipality, Norway
| | | | - Peter Cornish
- Student Counselling and Wellness Centre, Memorial University of Newfoundland, St. John's, Canada
- Stepped Care Solutions, St. John's, Canada
- Student Mental Health, University of California, Berkeley, CA, USA
| | - Audun Havnen
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
- Division of Psychiatry, Nidaros Community Mental Health Centre, St. Olav's University Hospital, Trondheim, Norway
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Ulhaq S, Cheradi K, Ahmed A, Thanki K, Dalby M. Improving capacity and flow in a children and young people's Community Eating Disorder Service (CEDS): how a quality improvement initiative led to a reduction in waiting times in the service. BMJ Open Qual 2025; 14:e002959. [PMID: 40122574 PMCID: PMC11934362 DOI: 10.1136/bmjoq-2024-002959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Accepted: 03/04/2025] [Indexed: 03/25/2025] Open
Abstract
Eating disorders are serious mental health conditions associated with significant morbidity and mortality. High levels of demand on services have led to increases in wait times to access support. Early intervention of eating disorders is critical to prevent entrenchment of illness and improve prognosis, with long wait times associated with higher rates of relapse.The East London Community Eating Disorder Service has seen an increase in wait time for routine referral from the 2-week local target to 17 weeks. Additionally, there have been long wait times to access treatment, including therapy and psychiatry support.A quality improvement (QI) framework was used in June 2022 to tackle the issues with capacity and flow with an aim to reduce wait times for routine referral from 17 weeks to 2 weeks in 12 months.A QI project team was formed which sought to understand the demands and capacity of the system using process mapping.From this, the team created a driver diagram and used Plan, Do, Study, Act cycles to test change iteratively. Measurements and data were displayed on control and run charts to help learn from the change ideas tested.Improvements were made and sustained, including reduction of routine referral wait time from 17 weeks to 2 weeks in 12 months. Additionally, internal wait lists reduced from 73 patients on the psychiatry list to 0 in 3 months and from 50 families waiting for therapy to 0 in 7 months.A number of inactive cases reduced from 65 to 0 during testing, thus contributing to improved flow through the service. A striking £130 233.21 annual savings in agency staff expenditure was achieved by January 2023.This has enabled a positive culture shift in the service.
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Affiliation(s)
- Sophia Ulhaq
- CYP- CEDS (CAMHS), East London NHS Foundation Trust, London, UK
| | | | - Abab Ahmed
- East London NHS Foundation Trust, London, UK
| | | | - Mark Dalby
- East London NHS Foundation Trust, London, UK
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Nawaz S, Bee P, Faija C. How to maintain recovery following low-intensity interventions for anxiety and/or depression? A qualitative exploration through perspectives of professionals and stakeholders. J Affect Disord 2025; 372:582-597. [PMID: 39694332 DOI: 10.1016/j.jad.2024.12.054] [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: 07/29/2024] [Revised: 11/25/2024] [Accepted: 12/14/2024] [Indexed: 12/20/2024]
Abstract
BACKGROUND Globally, 301 million people have anxiety disorders and 280 million have depression. Talking therapies are the preferred option against pharmacological treatment for these populations. In the UK, over half of those who received low-intensity evidence-based talking therapy for anxiety and/or depression relapsed within a year. This study explored practitioners and stakeholders' perspectives on current practices routinely use to maintain recovery over time and identified opportunities to improve long-term treatment effectiveness in NHS Talking Therapies services. METHODS This is a qualitative study using semi-structured interviews. Twenty-five participants were interviewed remotely. Data were analysed deductively using the Consolidated Framework for Implementation Research (CFIR) and inductively to allow emerging codes that did not map into the framework. RESULTS Of the 36 CFIR domains, 27 were evidenced in the data, and 17 new constructs were developed. Data emphasised the absence of standardised approaches in addressing relapse prevention, limitations on available resources, the need for further training, the importance of defining recovery beyond clinical symptoms, and recommendations were identified to support recovery over time. LIMITATIONS The sample comprised primarily White British females, reflecting the current workforce. Those interested in participating may have resulted in social desirability biases. Furthermore, focussing on professional perspectives may not represent service user experiences. CONCLUSIONS All participants agreed on the importance of interventions targeting recovery over time and emphasised the need for effective training and resources to support professionals and patients in sustaining treatment gains over time. Cost-effective interventions targeting long-term recovery could prove fruitful to improve current provision.
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Affiliation(s)
- Saher Nawaz
- School of Health Sciences, Division of Nursing, Midwifery and Social Work, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.
| | - Penny Bee
- School of Health Sciences, Division of Nursing, Midwifery and Social Work, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Cintia Faija
- School of Health Sciences, Division of Nursing, Midwifery and Social Work, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK; Department of Primary Care & Mental Health, Institute of Population Health, Faculty of Health and Life Sciences, University of Liverpool, UK
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Tabara MF. Addressing social function in the treatment of depression: A call for holistic approaches. World J Psychiatry 2025; 15:102658. [PMID: 39974494 PMCID: PMC11758034 DOI: 10.5498/wjp.v15.i2.102658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2024] [Revised: 11/30/2024] [Accepted: 12/19/2024] [Indexed: 01/14/2025] Open
Abstract
This article discusses the importance of addressing social functioning impairment in patients with residual depressive symptoms, as highlighted in the study by Liao et al. The authors showed that social dysfunction persists in many patients despite symptom remission. This observation calls for a shift in depression treatment strategies, with an emphasis on integrating social functioning as a key treatment goal. This article suggests targeted interventions that focus on both symptomatic relief and the restoration of social function.
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Affiliation(s)
- Muhammed Fatih Tabara
- Department of Psychiatry, Firat University School of Medicine, Elazig 23200, Türkiye
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Yani DI, Chua JYX, Wong JCM, Pikkarainen M, Shorey S. The Effects of Universal Educational Interventions in Improving Mental Health Literacy, Depression, and Anxiety Among Adolescents: A Systematic Review and Meta-Analysis. Int J Ment Health Nurs 2025; 34:e13494. [PMID: 39710627 DOI: 10.1111/inm.13494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Revised: 11/18/2024] [Accepted: 11/28/2024] [Indexed: 12/24/2024]
Abstract
Adolescents are susceptible to developing depression and anxiety, and educational interventions could improve their mental well-being. This systematic review aimed to evaluate the effectiveness of universal educational prevention interventions in improving mental health literacy, depression, and anxiety among adolescents. Eight electronic databases were searched until June 2024: Cochrane Library, PubMed, EMBASE, CINAHL, PsycINFO, Scopus, Web of Science, ProQuest Dissertations, and Theses Global. Since the included studies assessed various aspects of mental health literacy, the results for mental health literacy were synthesized narratively. In contrast, a meta-analysis using a random-effects model was applied to the depression and anxiety outcomes. Heterogeneity was examined using I2 statistics and Cochran's Q Chi-squared test. The Cochrane risk of bias tool and the GRADE approach conducted quality appraisal at the study and outcome levels, respectively. The review was reported according to the PRISMA guidelines. This review included 34 randomized controlled trials. Universal education prevention interventions were found to be promising in improving adolescents' mental health literacy but showed limited effects on individual mental health literacy components and on reducing depression (SMD = -0.06, 95%CI: [-0.11, -0.02], Z = 2.58, p = 0.01, I2 = 45%) and anxiety (SMD = -0.00, 95%CI: [-0.06, 0.06], Z = 0.07, p = 0.94, I2 = 58%) at post-intervention. Future trials should consider using a hybrid delivery model utilizing health care and the non-health care professionals. These interventions must incorporate skills-based sessions to develop emotional regulation strategies, complemented by extended follow-up periods that include booster sessions to reinforce learning. Given the very low quality of evidence as rated by the GRADE approach, current findings need to be interpreted with caution.
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Affiliation(s)
- Desy Indra Yani
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Faculty of Nursing, Universitas Padjadjaran, Jatinangor, Indonesia
| | - Joelle Yan Xin Chua
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - John Chee Meng Wong
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Minna Pikkarainen
- Department of Rehabilitation and Health Technology, Faculty of Health Sciences and Department of Product Design, Faculty of Technology, Art and Design, Oslomet, Oslo Metropolitan University, Oslo, Norway
| | - Shefaly Shorey
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Allen KJD, Elliott MV, Ronold EH, Rajgopal NA, Hammar Å, Johnson SL. The Memory and Affective Flexibility Task: a new behavioral tool to assess neurocognitive processes implicated in emotion-related impulsivity and internalizing symptoms. Front Psychiatry 2025; 16:1456691. [PMID: 39950173 PMCID: PMC11823637 DOI: 10.3389/fpsyt.2025.1456691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2024] [Accepted: 01/06/2025] [Indexed: 02/16/2025] Open
Abstract
Background Cognitive rigidity and working memory impairment are established features of internalizing syndromes. Growing evidence suggests that deficits in affective control -cognitive control in the context of emotion - may underpin elevated emotion-related impulsivity in various psychiatric disorders. Objective This study examines two components of affective control (affective flexibility and emotional working memory) as potential neurocognitive processes linking emotion-related impulsivity to internalizing psychopathology. Method Undergraduate participants (analysis n = 120) completed the Memory and Affective Flexibility Task (MAFT), a novel behavioral assessment designed to assess hot cognition in affective flexibility and emotional working memory performance, alongside self-report measures of impulsivity and symptoms of internalizing disorders. Results Structural equation modeling suggested that less accurate working memory during neutral trials (cool cognition) was associated with more symptoms of internalizing psychopathology. However, effects of hot working memory and affective flexibility were not significantly related to emotion-related impulsivity or psychopathology scores. Conclusions Although findings provide no support for the validity of MAFT indices of hot cognition, these results replicate and extend work on the importance of cool working memory and emotion-related impulsivity as correlates of psychopathology.
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Affiliation(s)
- Kenneth J. D. Allen
- Department of Psychology, University of California, Berkeley, Berkeley, CA, United States
| | - Matthew V. Elliott
- Department of Psychology, University of California, Berkeley, Berkeley, CA, United States
| | - Eivind H. Ronold
- Department of Medical and Biological Psychology, University of Bergen, Bergen, Norway
- Division of Psychiatry, Haukeland University Hospital, University of Bergen, Bergen, Norway
| | - Nandini A. Rajgopal
- Department of Psychology, University of California, Berkeley, Berkeley, CA, United States
| | - Åsa Hammar
- Department of Medical and Biological Psychology, University of Bergen, Bergen, Norway
- Department of Clinical Sciences Lund, Psychiatry, Faculty of Medicine Lund University, Lund, Sweden
- Office for Psychiatry and Habilitation, Psychiatry Research Skåne, Lund, Sweden
| | - Sheri L. Johnson
- Department of Psychology, University of California, Berkeley, Berkeley, CA, United States
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Asad A, Kirk M, Zhu S, Dong X, Gao M. Effects of Prebiotics and Probiotics on Symptoms of Depression and Anxiety in Clinically Diagnosed Samples: Systematic Review and Meta-analysis of Randomized Controlled Trials. Nutr Rev 2024:nuae177. [PMID: 39731509 DOI: 10.1093/nutrit/nuae177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2024] Open
Abstract
CONTEXT The use of prebiotics and probiotics as a treatment for psychiatric conditions has gained interest due to their potential to modulate the gut-brain axis. This review aims to assess the effectiveness of these interventions in reducing symptoms of depression and anxiety in psychiatric populations. OBJECTIVE The aim was to comprehensively review and appraise the effectiveness of prebiotic, probiotic, and synbiotic interventions in reducing clinical depression and anxiety symptoms. DATA SOURCES Systematic searches were conducted across Embase, Medline, PsycINFO, CINAHL, Cochrane Library, and Science Citation Index from database inception to May 22, 2023. DATA EXTRACTION Randomized controlled trials investigating prebiotic, probiotic, or synbiotic interventions for treating clinical depression or anxiety symptoms in clinical samples were included. Data were extracted on study characteristics, intervention details, and outcome measures. The Cochrane Collaboration Tool was used to assess the risk of bias. DATA ANALYSIS The standardized mean difference (SMD) was calculated using Hedge's g as the metric of effect size. A random-effects model was applied to estimate pooled effect sizes with 95% CIs. Subgroup analyses were performed based on study characteristics, methodological factors, and intervention types. Sensitivity analyses excluded studies with a high risk of bias. RESULTS Twenty-three RCTs involving 1401 patients met the inclusion criteria, with 20 trials providing sufficient data for meta-analysis. Of these, 18 trials investigated probiotics for depression, 9 trials assessed probiotics for anxiety, and 3 trials examined prebiotics for depression. Probiotics demonstrated a significant reduction in depression symptoms (SMD: -0.96; 95% CI: -1.31, -0.61) and a moderate reduction in anxiety symptoms (SMD: -0.59; 95% CI: -0.98, -0.19). Prebiotics did not show a significant effect on depression (SMD: -0.28; 95% CI: -0.61, 0.04). High heterogeneity was observed across studies, and subgroup analyses indicated that study duration and probiotic formulations contributed to the variation in effect sizes. CONCLUSION Probiotics showed substantial reductions in depression symptoms and moderate reductions in anxiety symptoms. Prebiotics showed a nonsignificant trend toward reducing depression. An adjunctive mental health treatment approach that diagnoses, monitors, and treats the gut microbiome alongside traditional pharmacological treatment holds promise for clinical practice. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration no. CRD42023424136.
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Affiliation(s)
- Afrida Asad
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, United Kingdom
- Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, United Kingdom
| | - Megan Kirk
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, United Kingdom
- NIHR Oxford Health Biomedical Research Centre, Warneford Hospital, Oxford OX3 7JX, United Kingdom
| | - Sufen Zhu
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, United Kingdom
| | - Xue Dong
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, United Kingdom
| | - Min Gao
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, United Kingdom
- NIHR Oxford Health Biomedical Research Centre, Warneford Hospital, Oxford OX3 7JX, United Kingdom
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Saccenti D, Lauro LJR, Crespi SA, Moro AS, Vergallito A, Grgič RG, Pretti N, Lamanna J, Ferro M. Boosting Psychotherapy With Noninvasive Brain Stimulation: The Whys and Wherefores of Modulating Neural Plasticity to Promote Therapeutic Change. Neural Plast 2024; 2024:7853199. [PMID: 39723244 PMCID: PMC11669434 DOI: 10.1155/np/7853199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Accepted: 12/04/2024] [Indexed: 12/28/2024] Open
Abstract
The phenomenon of neural plasticity pertains to the intrinsic capacity of neurons to undergo structural and functional reconfiguration through learning and experiential interaction with the environment. These changes could manifest themselves not only as a consequence of various life experiences but also following therapeutic interventions, including the application of noninvasive brain stimulation (NIBS) and psychotherapy. As standalone therapies, both NIBS and psychotherapy have demonstrated their efficacy in the amelioration of psychiatric disorders' symptoms, with a certain variability in terms of effect sizes and duration. Consequently, scholars suggested the convenience of integrating the two interventions into a multimodal treatment to boost and prolong the therapeutic outcomes. Such an approach is still in its infancy, and the physiological underpinnings substantiating the effectiveness and utility of combined interventions are still to be clarified. Therefore, this opinion paper aims to provide a theoretical framework consisting of compelling arguments as to why adding NIBS to psychotherapy can promote therapeutic change. Namely, we will discuss the physiological effects of the two interventions, thus providing a rationale to explain the potential advantages of a combined approach.
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Affiliation(s)
- Daniele Saccenti
- Department of Psychology, Sigmund Freud University, Milan, Italy
| | - Leonor J. Romero Lauro
- Department of Psychology and NeuroMi, University of Milano-Bicocca, Milan, Italy
- Cognitive Studies, Cognitive Psychotherapy School and Research Center, Milan, Italy
| | - Sofia A. Crespi
- Cognitive Studies, Cognitive Psychotherapy School and Research Center, Milan, Italy
- Faculty of Psychology, Vita-Salute San Raffaele University, Milan, Italy
| | - Andrea S. Moro
- Department of Psychology, Sigmund Freud University, Milan, Italy
- Center for Behavioral Neuroscience and Communication (BNC), Vita-Salute San Raffaele University, Milan, Italy
| | | | | | - Novella Pretti
- Cognitive Studies, Cognitive Psychotherapy School and Research Center, Milan, Italy
- Clinical Psychology Center, Division of Neurology, Galliera Hospital, Genoa, Italy
| | - Jacopo Lamanna
- Faculty of Psychology, Vita-Salute San Raffaele University, Milan, Italy
- Center for Behavioral Neuroscience and Communication (BNC), Vita-Salute San Raffaele University, Milan, Italy
| | - Mattia Ferro
- Department of Psychology, Sigmund Freud University, Milan, Italy
- Center for Behavioral Neuroscience and Communication (BNC), Vita-Salute San Raffaele University, Milan, Italy
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Shah L, Chua JYX, Goh YS, Chee CYI, Chong SC, Mathews J, Lim LHK, Chan YH, Mörelius E, Shorey S. Effectiveness of peer support interventions in improving mothers' psychosocial well-being during the perinatal period: A systematic review and meta-analysis. Worldviews Evid Based Nurs 2024; 21:652-664. [PMID: 39279033 DOI: 10.1111/wvn.12747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Revised: 08/02/2024] [Accepted: 08/15/2024] [Indexed: 09/18/2024]
Abstract
BACKGROUND Many mothers experience poor psychological outcomes during their perinatal period. The presence of depression and anxiety has a significant adverse impact on the mother's health and the infant's development. AIM This review aimed to examine the effectiveness of peer support interventions in improving depression, anxiety, and perceived social support among mothers during the perinatal period. METHODS This study was a systematic review and meta-analysis of randomized controlled trials. The reporting of this review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020. Cochrane's Risk of Bias Tool for randomized controlled trials was used to examine the methodological quality of the included studies. The certainty of the evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. A comprehensive search was conducted from inception till May 2024 across seven databases: Pubmed, Scopus, CINAHL, Web of Science, ProQuest, PsycINFO, and Embase. RESULTS The results of the meta-analysis of the 12 included studies showed that peer support interventions could reduce depression and anxiety levels but not perceived social support levels. Sub-group analyses based on the mode of intervention delivery showed significant reductions on depression levels in online and face-to-face groups but not telephone call groups. Follow-up data analyses showed that peer support interventions could improve depression, anxiety, and perceived social support across a duration of 1-6 months post-intervention. LINKING EVIDENCE TO ACTION This review provides a deeper understanding of the effect of peer support interventions on mothers in the perinatal period. This can have a positive impact on current knowledge aimed at improving the well-being of mothers and thus, their infants, partners, and entire family unit. Findings showed that peer support interventions can positively improve psychological well-being of mothers in the perinatal period in the short and long term. Peer support can ultimately be considered as a standardized part of perinatal care. Future recommendations include implementing a combination of face-to-face and online approaches to peer support interventions delivered with both individual and group components.
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Affiliation(s)
- Lubna Shah
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Joelle Yan Xin Chua
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yong Shian Goh
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | | | - Shang Chee Chong
- Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, Singapore, Singapore
| | - Jancy Mathews
- National University Polyclinics, National University Health System, Singapore, Singapore
| | - Lina Hsiu Kim Lim
- Immunology Translational Research Program & Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yiong Huak Chan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Evalotte Mörelius
- Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health, Linköping University, Linköping, Sweden
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Australia
- School of Nursing, University of Jordan, Amman, Jordan
| | - Shefaly Shorey
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Moriarty AS, Paton LW, Snell KIE, Archer L, Riley RD, Buckman JEJ, Chew Graham CA, Gilbody S, Ali S, Pilling S, Meader N, Phillips B, Coventry PA, Delgadillo J, Richards DA, Salisbury C, McMillan D. Development and validation of a prognostic model to predict relapse in adults with remitted depression in primary care: secondary analysis of pooled individual participant data from multiple studies. BMJ MENTAL HEALTH 2024; 27:e301226. [PMID: 39467616 PMCID: PMC11529744 DOI: 10.1136/bmjment-2024-301226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2024] [Accepted: 10/09/2024] [Indexed: 10/30/2024]
Abstract
BACKGROUND Relapse of depression is common and contributes to the overall associated morbidity and burden. We lack evidence-based tools to estimate an individual's risk of relapse after treatment in primary care, which may help us more effectively target relapse prevention. OBJECTIVE The objective was to develop and validate a prognostic model to predict risk of relapse of depression in primary care. METHODS Multilevel logistic regression models were developed, using individual participant data from seven primary care-based studies (n=1244), to predict relapse of depression. The model was internally validated using bootstrapping, and generalisability was explored using internal-external cross-validation. FINDINGS Residual depressive symptoms (OR: 1.13 (95% CI: 1.07 to 1.20), p<0.001) and baseline depression severity (OR: 1.07 (1.04 to 1.11), p<0.001) were associated with relapse. The validated model had low discrimination (C-statistic 0.60 (0.55-0.65)) and miscalibration concerns (calibration slope 0.81 (0.31-1.31)). On secondary analysis, being in a relationship was associated with reduced risk of relapse (OR: 0.43 (0.28-0.67), p<0.001); this remained statistically significant after correction for multiple significance testing. CONCLUSIONS We could not predict risk of depression relapse with sufficient accuracy in primary care data, using routinely recorded measures. Relationship status warrants further research to explore its role as a prognostic factor for relapse. CLINICAL IMPLICATIONS Until we can accurately stratify patients according to risk of relapse, a universal approach to relapse prevention may be most beneficial, either during acute-phase treatment or post remission. Where possible, this could be guided by the presence or absence of known prognostic factors (eg, residual depressive symptoms) and targeted towards these. TRIAL REGISTRATION NUMBER NCT04666662.
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Affiliation(s)
- Andrew S Moriarty
- Hull York Medical School and Department of Health Sciences, University of York, York, Yorkshire, UK
| | - Lewis W Paton
- Hull York Medical School and Department of Health Sciences, University of York, York, Yorkshire, UK
| | - Kym I E Snell
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Lucinda Archer
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Richard D Riley
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Joshua E J Buckman
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
- iCope—Camden and Islington Psychological Therapies Services, Camden and Islington NHS Foundation Trust, London, UK
| | | | - Simon Gilbody
- Hull York Medical School and Department of Health Sciences, University of York, York, UK
| | - Shehzad Ali
- Schulich School of Medicine & Dentistry, Western University, London, Great Britain, Canada
| | - Stephen Pilling
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | - Nick Meader
- Population Health Sciences Institute, University of Newcastle upon Tyne, Newcastle upon Tyne, UK
| | - Bob Phillips
- Hull York Medical School, University of York, York, Yorkshire, UK
| | - Peter A Coventry
- Department of Health Sciences, University of York, York, Yorkshire, UK
| | - Jaime Delgadillo
- Department of Psychology, The University of Sheffield, Sheffield, UK
| | - David A Richards
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Hordaland, Norway
| | - Chris Salisbury
- Centre for Academic Primary Care, University of Bristol, Bristol, UK
| | - Dean McMillan
- Hull York Medical School and Department of Health Sciences, University of York, York, Yorkshire, UK
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12
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Nocerino R, Mercuri C, Bosco V, Giordano V, Simeone S, Guillari A, Rea T. Development and Management of Avoidant/Restrictive Food Intake Disorder and Food Neophobia in Pediatric Patients with Food Allergy: A Comprehensive Review. Nutrients 2024; 16:3034. [PMID: 39275348 PMCID: PMC11397472 DOI: 10.3390/nu16173034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2024] [Revised: 09/04/2024] [Accepted: 09/06/2024] [Indexed: 09/16/2024] Open
Abstract
Avoidant/Restrictive Food Intake Disorder (ARFID) and food neophobia present significant challenges in pediatric healthcare, particularly among children with food allergies (FAs). These eating disorders, characterized by the persistent avoidance or restriction of food, can lead to severe nutritional deficiencies and psychosocial impairments. The presence of FAs further complicates these eating behaviors, as the fear of allergic reactions exacerbates avoidance and restrictive patterns. This comprehensive review synthesizes current knowledge on ARFID and food neophobia, focusing on their definitions, characteristics, and the unique challenges they present in the context of FAs. The review explores the critical role of healthcare professionals, especially nurses, in integrating psychological and clinical care to improve outcomes for affected children. A multidisciplinary approach, including Cognitive Behavioral Therapy (CBT) and Family-Based Therapy (FBT), is emphasized as essential in addressing the complex needs of these patients. The review also highlights the need for standardized treatment protocols and further research on the long-term outcomes of these disorders, aiming to enhance therapeutic strategies and family support systems. Effective management of ARFID and food neophobia in the context of FAs requires a holistic and integrated approach to mitigate the profound impacts on a child's growth, development, and overall well-being.
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Affiliation(s)
- Rita Nocerino
- Department of Translational Medical Science, University of Naples Federico II, 80131 Naples, Italy
- ImmunoNutritionLab at CEINGE Advanced Biotechnologies, University of Naples Federico II, 80131 Naples, Italy
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", 00133 Rome, Italy
| | - Caterina Mercuri
- Department of Clinical and Experimental Medicine, University of Catanzaro MagnaGraecia, 88100 Catanzaro, Italy
| | - Vincenzo Bosco
- Department of Medical and Surgical Sciences, University Hospital Mater Domini, Magna Graecia University, 88100 Catanzaro, Italy
| | | | - Silvio Simeone
- Department of Clinical and Experimental Medicine, University of Catanzaro MagnaGraecia, 88100 Catanzaro, Italy
| | - Assunta Guillari
- Department of Translational Medical Science, University of Naples Federico II, 80131 Naples, Italy
| | - Teresa Rea
- Department of Public Health, University of Naples "Federico II", 80131 Naples, Italy
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13
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Gold AK, Rabideau DJ, Nolte D, Faria CM, Deng S(Y, George N, Boccagno C, Temes CM, Kamali M, Akpolat N, Nierenberg AA, Sylvia LG. Does baseline psychiatric symptom severity predict well-being improvement in low-intensity mindfulness interventions? PSYCHIATRY RESEARCH COMMUNICATIONS 2024; 4:100182. [PMID: 39391206 PMCID: PMC11466231 DOI: 10.1016/j.psycom.2024.100182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/12/2024]
Abstract
Regardless of baseline psychiatric symptom severity, individuals can improve from psychotherapy, including from low-intensity psychosocial treatments. We conducted a secondary analysis of a randomized trial of low-intensity mindfulness interventions to explore if and how specific indices of baseline symptom severity were associated with well-being trajectories during treatment and follow-up. In the original study, participants (N = 4, 411) with physical and mental health conditions were randomly assigned to one of two low-intensity mindfulness interventions (eight-session mindfulness-based cognitive therapy or a three-session mindfulness intervention). In this secondary analysis, we pooled across treatment groups and stratified participants into subgroups based on self-reported baseline levels of anxiety, depression, and social functioning. We used linear mixed effects models and descriptive trajectory plots to evaluate differences in well-being trajectories between subgroups. Baseline symptom severity was associated with well-being trajectory such that those with more severe anxiety, depression, or social functioning at baseline had generally lower well-being across time. All subgroups experienced initial improvement in well-being during the treatment period, though individuals with worse symptom severity tended not to sustain improvements and rebounded back towards baseline well-being levels during follow-up. These data suggest that, for individuals with more severe mental health symptoms, eight or three-session mindfulness-based interventions may still be clinically useful (as patients with more severe symptoms in this study were able to experience initial improvement in well-being from such interventions). However, for such patients, offering these mindfulness-based interventions for a longer duration may have prevented symptom rebounding.
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Affiliation(s)
- Alexandra K. Gold
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Dustin J. Rabideau
- Harvard Medical School, Boston, MA, USA
- Biostatistics, Massachusetts General Hospital, Boston, MA, USA
| | - Daniel Nolte
- Biostatistics, Massachusetts General Hospital, Boston, MA, USA
| | - Caylin M. Faria
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | | | - Nevita George
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Chelsea Boccagno
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Christina M. Temes
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Masoud Kamali
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Nur Akpolat
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Andrew A. Nierenberg
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Louisa G. Sylvia
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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14
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Headley E, Kellett S, Bee C, Lancashire J, Aadahl V, Bone C, Power N. Types and mechanisms of idiographic change during guided self-help for anxiety. Psychol Psychother 2024; 97:498-517. [PMID: 38924285 DOI: 10.1111/papt.12536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 05/09/2024] [Accepted: 05/31/2024] [Indexed: 06/28/2024]
Abstract
OBJECTIVES To compare idiographic change during two formats of guided self-help (GSH); cognitive-behavioural therapy guided self-help (CBT-GSH) and cognitive analytic therapy guided self-help (CAT-GSH). DESIGN Qualitative inductive thematic analysis. METHODS Semi-structured interviews with N = 17 participants with a reliable change outcome on the GAD-7 after completing GSH for anxiety. Changes were categorised and themes extracted. RESULTS No differences between CAT-GSH and CBT-GSH were found regarding types of change reported. The five overarching themes found were personal qualities of success, enlightenment through understanding, specific tools and techniques, changes to relationships and tailoring support. Four themes maximally differentiated between the two different types of GSH; CAT-GSH enabled relational insight and change whilst CBT-GSH enabled better understanding of anxiety, new coping techniques and supportive relationships. CONCLUSIONS Both common and model-specific factors contribute to patient change during GSH. Whilst all forms of GSH are grounded in the psychoeducational approach, separate theoretical foundations and associated methods facilitate different types of ideographic change.
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Affiliation(s)
- Emma Headley
- Sheffield Teaching Hospital NHS Foundation Trust, Sheffield, UK
| | - Stephen Kellett
- Rotherham Doncaster and South Humber NHS Foundation Trust, UK and Clinical and Applied Psychology Unit, University of Sheffield, Rotherham, UK
| | - Charlotte Bee
- Pennine Care NHS Foundation Trust, Ashton-under-Lyne, UK
| | | | - Vikki Aadahl
- Pennine Care NHS Foundation Trust, Ashton-under-Lyne, UK
| | - Claire Bone
- Sheffield Health and Social Care NHS Foundation Trust, Sheffield, UK
| | - Niall Power
- Derbyshire Community Health Services NHS Foundation Trust, Derbyshire, UK
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15
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Ackerman A, Afzal N, Lautarescu A, Wilson CA, Nadkarni A. Non-specialist delivered psycho-social interventions for women with perinatal depression living in rural communities: A systematic review. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003031. [PMID: 38976687 PMCID: PMC11230560 DOI: 10.1371/journal.pgph.0003031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 06/03/2024] [Indexed: 07/10/2024]
Abstract
Evidence from low- and middle-income countries suggests that non-specialist-delivered interventions effectively improve access to perinatal mental health care. However, there have been no systematic attempts to synthesize the evidence on effectiveness, relevance, and application of this strategy to resource-limited settings such as rural areas. The aim of this review is to synthesize the evidence about the effectiveness of non-specialist delivered interventions in improving depression and related outcomes in women with perinatal depression living in rural communities. Seven electronic databases were searched using the following search concepts: perinatal depression (e.g., puerperal depression, antenatal depression), rural areas (e.g., remote, nonmetropolitan, underserved), and non-specialist workers (e.g., lay worker, volunteer aide, informal caretaker. The risk of bias was assessed using RoB-2 and ROBINS-I tools. A narrative synthesis was performed as the high degree of study heterogeneity precluded a meta-analysis. Nine unique studies were eligible for inclusion. Psychoeducation and problem-solving techniques were the most used intervention elements. Two interventions significantly reduced the prevalence of perinatal depression compared to usual care, and three interventions reported effectiveness in reducing depression symptom severity. There was little to no consistent evidence for other outcomes, including but not limited to maternal health care utilization, breastfeeding behaviors, and child health. This review provides limited evidence to suggest that non-specialist delivered interventions effectively improved outcomes among women with perinatal depression living in rural communities. The paucity of high-quality studies included in this review demonstrates that this rural demographic is frequently neglected in the context of maternal mental health research.
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Affiliation(s)
- Anouk Ackerman
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- UCLA David Geffen School of Medicine, Los Angeles, California, United States of America
| | - Nimrah Afzal
- Department of Psychology, University of Bath, Bath, United Kingdom
| | - Alexandra Lautarescu
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Claire A Wilson
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Abhijit Nadkarni
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
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16
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Lorimer B, Kellett S, Giesemann J, Lutz W, Delgadillo J. An investigation of treatment return after psychological therapy for depression and anxiety. Behav Cogn Psychother 2024; 52:149-162. [PMID: 37563726 DOI: 10.1017/s1352465823000322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
BACKGROUND Some patients return for further psychological treatment in routine services, although it is unclear how common this is, as scarce research is available on this topic. AIMS To estimate the treatment return rate and describe the clinical characteristics of patients who return for anxiety and depression treatment. METHOD A large dataset (N=21,029) of routinely collected clinical data (2010-2015) from an English psychological therapy service was analysed using descriptive statistics. RESULTS The return rate for at least one additional treatment episode within 1-5 years was 13.7%. Furthermore, 14.5% of the total sessions provided by the service were delivered to treatment-returning patients. Of those who returned, 58.0% continued to show clinically significant depression and/or anxiety symptoms at the end of their first treatment, while 32.0% had experienced a demonstrable relapse before their second treatment. CONCLUSIONS This study estimates that approximately one in seven patients return to the same service for additional psychological treatment within 1-5 years. Multiple factors may influence the need for additional treatment, and this may have a major impact on service activity. Future research needs to further explore and better determine the characteristics of treatment returners, prioritise enhancement of first treatment recovery, and evaluate relapse prevention interventions.
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Affiliation(s)
- Ben Lorimer
- Department of Psychology, University of Sheffield, SheffieldS1 2LT, UK
- Present address: Mental Health and Addiction Research Group, Department of Health Sciences, University of York, York, UK
| | - Stephen Kellett
- Clinical and Applied Psychology Unit, Department of Psychology, University of Sheffield, SheffieldS1 2LT, UK
- Rotherham Doncaster and South Humber NHS Foundation Trust, UK
| | - Julia Giesemann
- Department of Psychology, University of Trier, Trier, Germany
| | - Wolfgang Lutz
- Department of Psychology, University of Trier, Trier, Germany
| | - Jaime Delgadillo
- Clinical and Applied Psychology Unit, Department of Psychology, University of Sheffield, SheffieldS1 2LT, UK
- Rotherham Doncaster and South Humber NHS Foundation Trust, UK
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17
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Barber KE, Woods DW, Ely LJ, Saunders SM, Compton SN, Neal-Barnett A, Franklin ME, Capriotti MR, Conelea CA, Twohig MP. Long-term follow-up of acceptance-enhanced behavior therapy for trichotillomania. Psychiatry Res 2024; 333:115767. [PMID: 38330639 PMCID: PMC10911454 DOI: 10.1016/j.psychres.2024.115767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 01/26/2024] [Accepted: 01/28/2024] [Indexed: 02/10/2024]
Abstract
Acceptance-enhanced behavior therapy for trichotillomania (AEBT-TTM) is effective in reducing trichotillomania (TTM) symptoms, but the durability of treatment effects remains in question. This study analyzed 6-month follow-up data from a large randomized clinical trial comparing AEBT-TTM to an active psychoeducation and supportive therapy control (PST). Adults with TTM (N=85; 92% women) received 10 sessions of AEBT-TTM or PST across 12 weeks. Independent evaluators assessed participants at baseline, post-treatment, and 6 months follow-up. For both AEBT-TTM and PST, self-reported and evaluator-rated TTM symptom severity decreased from baseline to follow-up. TTM symptoms did not worsen from post-treatment to follow-up. At follow-up, AEBT-TTM and PST did not differ in rates of treatment response, TTM diagnosis, or symptom severity. High baseline TTM symptom severity was a stronger predictor of high follow-up severity for PST than for AEBT-TTM, suggesting AEBT-TTM may be a better option for more severe TTM. Results support the efficacy of AEBT-TTM and show that treatment gains were maintained over time. Although AEBT-TTM yielded lower symptoms at post-treatment, 6-month follow-up outcomes suggest AEBT-TTM and PST may lead to similar symptom levels in the longer term. Future research should examine mechanisms that contribute to long-term gain maintenance.
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Affiliation(s)
- Kathryn E Barber
- Department of Psychology, Marquette University, 317 Cramer Hall, 604 North 16th St., Milwaukee, WI 53233, USA
| | - Douglas W Woods
- Department of Psychology, Marquette University, 317 Cramer Hall, 604 North 16th St., Milwaukee, WI 53233, USA.
| | - Laura J Ely
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Stephen M Saunders
- Department of Psychology, Marquette University, 317 Cramer Hall, 604 North 16th St., Milwaukee, WI 53233, USA
| | - Scott N Compton
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | | | | | | | - Christine A Conelea
- Department of Psychiatry & Behavioral Sciences, University of Minnesota, Minneapolis, MN, USA
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18
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Shu Y, Ao N, Wen X, Cui Z, Qu D, Chen R. The p factor outweighs the specific internalizing factor in predicting recurrences of adolescent depression. Eur Psychiatry 2024; 67:e28. [PMID: 38425212 PMCID: PMC10988157 DOI: 10.1192/j.eurpsy.2024.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 01/23/2024] [Accepted: 01/24/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND The early prediction of adolescent depression recurrence poses a significant challenge in the field. This study aims to investigate and compare the abilities of the general psychopathology factor (p) and the specific internalizing factor, in predicting depression recurrence over a 2-year course, as well as identifying remitted depressed adolescents from healthy adolescents. Longitudinal changes of these two factors in different trajectory groups were also tracked to examine their sensitivity to sustained remission and relapse. METHODS We included 255 baseline-remitted depressed adolescents and a healthy control group (n = 255) matched in age, sex, and race, sourced from the Adolescent Brain Cognitive Development Study. The linear mixed model was employed for the statistical analysis. RESULTS The p factor not only effectively discriminated between remitted depressed adolescents and healthy controls but also robustly predicted the depression recurrence over a subsequent 2-year course. The specific internalizing factor could only differentiate remitted depressed adolescents from healthy controls. Additionally, a noteworthy longitudinal decline of the p factor in the sustained-remission group was observed. CONCLUSIONS Psychopathology factors serve as the inherent and enduring measurement of long-term mental health aberrations. Longitudinal results indicate that the p factor is more sensitive to respond to sustained remission than the internalizing factor. The ability of the overall p factor to anticipate depression relapse, unlike the specific internalizing factor, suggests the clinical interventions should monitor and mitigate the coincident symptoms across all dimensions to preempt relapse of adolescent depression, rather than an exclusive focus on internalizing symptoms.
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Affiliation(s)
- Yinuo Shu
- Chinese Institute for Brain Research, Beijing, China
| | - Na Ao
- Chinese Institute for Brain Research, Beijing, China
| | - Xue Wen
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Zaixu Cui
- Chinese Institute for Brain Research, Beijing, China
| | - Diyang Qu
- Vanke School of Public Health, Tsinghua University, Beijing, China
- Institute for Healthy China, Tsinghua University, Beijing, China
| | - Runsen Chen
- Vanke School of Public Health, Tsinghua University, Beijing, China
- Institute for Healthy China, Tsinghua University, Beijing, China
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19
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Bruijniks SJE, Hollon SD, Lemmens LHJM, Peeters FPML, Arntz A, Cuijpers P, Twisk J, Dingemanse P, Willems L, van Oppen P, van den Boogaard M, Spijker J, Huibers MJH. Long-term outcomes of once weekly v. twice weekly sessions of cognitive behavioral therapy and interpersonal psychotherapy for depression. Psychol Med 2024; 54:517-526. [PMID: 37665012 DOI: 10.1017/s0033291723002143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
BACKGROUND Twice weekly sessions of cognitive behavioral therapy (CBT) and interpersonal psychotherapy (IPT) for major depressive disorder (MDD) lead to less drop-out and quicker and better response compared to once weekly sessions at posttreatment, but it is unclear whether these effects hold over the long run. AIMS Compare the effects of twice weekly v. weekly sessions of CBT and IPT for depression up to 24 months since the start of treatment. METHODS Using a 2 × 2 factorial design, this multicentre study randomized 200 adults with MDD to once or twice weekly sessions of CBT or IPT over 16-24 weeks, up to a maximum of 20 sessions. Main outcome measures were depression severity, measured with the Beck Depression Inventory-II and the Longitudinal Interval Follow-up Evaluation. Intention-to-treat analyses were conducted. RESULTS Compared with patients who received once weekly sessions, patients who received twice weekly sessions showed a significant decrease in depressive symptoms up through month 9, but this effect was no longer apparent at month 24. Patients who received CBT showed a significantly larger decrease in depressive symptoms up to month 24 compared to patients who received IPT, but the between-group effect size at month 24 was small. No differential effects between session frequencies or treatment modalities were found in response or relapse rates. CONCLUSIONS Although a higher session frequency leads to better outcomes in the acute phase of treatment, the difference in depression severity dissipated over time and there was no significant difference in relapse.
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Affiliation(s)
- Sanne J E Bruijniks
- Department of Clinical Psychology and Psychotherapy, University of Freiburg, Freiburg, Germany
- Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands
| | - Steven D Hollon
- Department of Psychology, Vanderbilt University, Nashville, TN, USA
| | - Lotte H J M Lemmens
- Department of Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands
| | - Frenk P M L Peeters
- Department of Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands
| | - Arnoud Arntz
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Pim Cuijpers
- Department of Clinical Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jos Twisk
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - Pieter Dingemanse
- Department of Mood Disorders, Altrecht Mental Health Institute, Utrecht, The Netherlands
| | - Linda Willems
- Department of Mood Disorders, GGZ Oost Brabant, Oss, The Netherlands
| | - Patricia van Oppen
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit/GGZ inGeest and Public Health Research Institute, Amsterdam, The Netherlands
| | | | - Jan Spijker
- Center of Depression Expertise, Pro Persona Mental Health Care; and Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Marcus J H Huibers
- Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands
- NPI Center for Personality Disorders/ARKIN, Amsterdam, The Netherlands
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20
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Luo RCX, Wang D, Zhou H, Lang XE, Zhang XY. Prevalence and clinical profile of comorbid anxiety in young adult patients with first-episode and drug-naive major depressive disorder. Early Interv Psychiatry 2023. [PMID: 38011857 DOI: 10.1111/eip.13478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 08/27/2023] [Accepted: 11/19/2023] [Indexed: 11/29/2023]
Abstract
AIM Patients with major depressive disorder (MDD) frequently have coexisting anxiety disorders. However, few studies have focused on the prevalence and risk factors of comorbid anxiety symptoms in young adult first-episode and drug-naive (FEDN) MDD patients. METHODS We recruited 520 FEDN MDD patients and collected their demographic and clinical data. The Hamilton Depression Rating Scale (HAMD), the Hamilton Anxiety Rating Scale (HAMA) and the positive scale of the Positive and Negative Syndrome Scale (PANSS) were used to measure depressive symptoms, anxiety symptoms and psychotic symptoms, respectively. RESULTS Anxiety symptoms were found in 79.6% of young adult patients. Besides, anxiety group patients had a higher prevalence of psychotic symptoms than the non-anxiety group. Anxiety symptoms were substantially related to suicide attempts in young adult patients. Logistic analysis shows that suicide attempts and total HAMD scores were significantly associated with anxiety symptoms. CONCLUSIONS The findings show that anxiety symptoms are common in Chinese young adult MDD patients. The anxiety group was more likely to have psychotic symptoms, suicide attempts, and more severe depressive symptoms than the non-anxiety group. Suicide attempts were associated with anxiety symptoms in young adult MDD patients, suggesting the importance of reducing anxiety symptoms in this population to prevent suicides.
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Affiliation(s)
- Rui-Chen-Xi Luo
- Department of Psychiatry, School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China
| | - Dongmei Wang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Huixia Zhou
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Xiao E Lang
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Xiang-Yang Zhang
- Department of Psychiatry, School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
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21
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Prasad N, Chien I, Regan T, Enrique A, Palacios J, Keegan D, Munir U, Tanno R, Richardson H, Nori A, Richards D, Doherty G, Belgrave D, Thieme A. Deep learning for the prediction of clinical outcomes in internet-delivered CBT for depression and anxiety. PLoS One 2023; 18:e0272685. [PMID: 38011176 PMCID: PMC10681250 DOI: 10.1371/journal.pone.0272685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 11/02/2023] [Indexed: 11/29/2023] Open
Abstract
In treating depression and anxiety, just over half of all clients respond. Monitoring and obtaining early client feedback can allow for rapidly adapted treatment delivery and improve outcomes. This study seeks to develop a state-of-the-art deep-learning framework for predicting clinical outcomes in internet-delivered Cognitive Behavioural Therapy (iCBT) by leveraging large-scale, high-dimensional time-series data of client-reported mental health symptoms and platform interaction data. We use de-identified data from 45,876 clients on SilverCloud Health, a digital platform for the psychological treatment of depression and anxiety. We train deep recurrent neural network (RNN) models to predict whether a client will show reliable improvement by the end of treatment using clinical measures, interaction data with the iCBT program, or both. Outcomes are based on total improvement in symptoms of depression (Patient Health Questionnaire-9, PHQ-9) and anxiety (Generalized Anxiety Disorder-7, GAD-7), as reported within the iCBT program. Using internal and external datasets, we compare the proposed models against several benchmarks and rigorously evaluate them according to their predictive accuracy, sensitivity, specificity and AUROC over treatment. Our proposed RNN models consistently predict reliable improvement in PHQ-9 and GAD-7, using past clinical measures alone, with above 87% accuracy and 0.89 AUROC after three or more review periods, outperforming all benchmark models. Additional evaluations demonstrate the robustness of the achieved models across (i) different health services; (ii) geographic locations; (iii) iCBT programs, and (iv) client severity subgroups. Results demonstrate the robust performance of dynamic prediction models that can yield clinically helpful prognostic information ready for implementation within iCBT systems to support timely decision-making and treatment adjustments by iCBT clinical supporters towards improved client outcomes.
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Affiliation(s)
- Niranjani Prasad
- Microsoft Health Futures, Microsoft Research, Cambridge, United Kingdom
| | | | - Tim Regan
- Cambridge Respiratory Innovations, Cambridge, United Kingdom
| | - Angel Enrique
- SilverCloud Science, SilverCloud Health, Dublin, Ireland
- E-Mental Health Group, School of Psychology, Trinity College Dublin, Dublin, Ireland
| | - Jorge Palacios
- SilverCloud Science, SilverCloud Health, Dublin, Ireland
- E-Mental Health Group, School of Psychology, Trinity College Dublin, Dublin, Ireland
| | - Dessie Keegan
- SilverCloud Science, SilverCloud Health, Dublin, Ireland
| | - Usman Munir
- Microsoft Health Futures, Microsoft Research, Cambridge, United Kingdom
| | | | - Hannah Richardson
- Microsoft Health Futures, Microsoft Research, Cambridge, United Kingdom
| | - Aditya Nori
- Microsoft Health Futures, Microsoft Research, Cambridge, United Kingdom
| | - Derek Richards
- SilverCloud Science, SilverCloud Health, Dublin, Ireland
- E-Mental Health Group, School of Psychology, Trinity College Dublin, Dublin, Ireland
| | - Gavin Doherty
- SilverCloud Science, SilverCloud Health, Dublin, Ireland
- School of Computer Science and Statistics, Trinity College Dublin, Dublin, Ireland
| | | | - Anja Thieme
- Microsoft Health Futures, Microsoft Research, Cambridge, United Kingdom
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22
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Zabihiyeganeh M, Afshar SV, Kadijani AA, Janbozorgi M, Akbari A, Yahyazadeh H, Mirzaei A. How durable are the effects of cognitive-behavioural therapy in controlling fibromyalgia symptoms? A prospective cohort study. Musculoskeletal Care 2023; 21:890-894. [PMID: 36987397 DOI: 10.1002/msc.1766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 03/18/2023] [Accepted: 03/23/2023] [Indexed: 03/30/2023]
Abstract
PURPOSE Cognitive-behavioural therapy (CBT) is widely used for the treatment of fibromyalgia. However, there is no consensus on the durability of its effects on these patients. In this study, we evaluated how durable are the effects of CBT in controlling fibromyalgia symptoms. METHODS Forty-eight fibromyalgia patients treated with traditional face-to-face CBT were included. CBT was performed in 20 consecutive group sessions. To evaluate the durability of treatment, the effects of CBT on fibromyalgia symptoms were checked at five time-points: before the CBT, immediately after the CBT, 3 months after the CBT, 6 months after the CBT, and 12 months after the CBT. Outcome measures were the Fibromyalgia impact questionnaire (FIQ) and widespread pain index (WPI). RESULTS The mean FIQ score of the patients was 68.3 ± 18.8 before the CBT and 50.5 ± 14.1 1 week after the CBT (p < 0.001). The mean post-CBT FIQ score did not significantly change three and 6 months after the CBT (p = 0.11 and p = 0.09, respectively) while the positive effects of CBT significantly diminished after 12 months (p < 0.001). The mean WPI was 10.4 ± 3.6 before the CBT and 8.6 ± 3.1 1 week after the end of CBT (p < 0.001). The mean WPI of three and 6 months was not statistically different from that immediately after the CBT (p = 0.18 and p = 0.15, respectively), while after 12 months, it significantly worsened (p < 0.001). CONCLUSION CBT's beneficial effects for fibromyalgia patients are durable for 6 months. Complementary CBT sessions could be implemented to boost the CBT effect after this period.
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Affiliation(s)
- Mozhdeh Zabihiyeganeh
- Bone and Joint Reconstruction Research Center, Department of Orthopedics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Sedigheh Vafaee Afshar
- Bone and Joint Reconstruction Research Center, Department of Orthopedics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Azade Amini Kadijani
- Basic and Molecular Epidemiology of Gastrointestinal Disorders Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Masoud Janbozorgi
- Department of Psychology, Research Institute of Hawzah and University, Ghom, Iran
| | - Abolfazl Akbari
- Colorectal Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Hooman Yahyazadeh
- Bone and Joint Reconstruction Research Center, Department of Orthopedics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
- Department of Orthopedic Surgery, Farhikhtegan Hospital, Faculty of Medicine, Tehran Medical Sciences Islamic Azad University, Tehran, Iran
| | - Alireza Mirzaei
- Bone and Joint Reconstruction Research Center, Department of Orthopedics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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Renn BN, Sams N, Areán PA, Raue PJ. A low-intensity behavioral intervention for depression in older adults delivered by lay coaches: proof-of-concept trial. Aging Ment Health 2023; 27:1403-1410. [PMID: 35694856 PMCID: PMC9741665 DOI: 10.1080/13607863.2022.2084709] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 05/27/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVES A broader workforce is necessary to expand U.S. geriatric mental health services. We examined (1) feasibility of training undergraduate students to deliver Do More, Feel Better (DMFB), an evidence-informed program for depression; and (2) feasibility, acceptability, and outcomes in a single-arm proof-of-concept trial. METHOD In Study 1, we taught DMFB to 18 upper-level undergraduate students and assessed fidelity using role plays. In Study 2, four students delivered six weekly DMFB sessions to 12 community-dwelling older adults (M = 66.83 years old, SD = 10.39) with depression (PHQ ≥ 10). Patient outcomes were change in pre- to post-treatment depressive symptoms, disability, and the target mechanism of increased activity. RESULTS Fidelity was high in the course (Study 1; 82.4% of role plays rated as 'passing') and the trial (Study 2; 100% of 24 sessions rated as 'passing'). The majority (83.3%) of patients were retained and evidenced statistically and clinically significant improvement in depressive symptoms (Hamilton Rating Scale for Depression [HAM-D]), disability (World Health Organization's Disability Assessment Schedule 2.0 [WHODAS 2.0], and activity (Behavioral Activation for Depression Scale [BADS]). CONCLUSION It is feasible to train bachelor's-level students to deliver a brief, structured intervention for depression. Future research should consider implementation strategies and stakeholder feedback.
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Affiliation(s)
- Brenna N Renn
- Department of Psychology, University of Nevada, Las Vegas, NV, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Nichole Sams
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Patricia A Areán
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Patrick J Raue
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
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24
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Gromer D, Hildebrandt LK, Stegmann Y. The Role of Expectancy Violation in Extinction Learning: A Two-Day Online Fear Conditioning Study. CLINICAL PSYCHOLOGY IN EUROPE 2023; 5:e9627. [PMID: 37732150 PMCID: PMC10508258 DOI: 10.32872/cpe.9627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 04/03/2023] [Indexed: 09/22/2023] Open
Abstract
Background Exposure therapy is at the core of the treatment of pathological anxiety. While the inhibitory learning model proposes a framework for the mechanisms underlying exposure therapy, in particular expectancy violation, causal evidence for its assumptions remains elusive. Therefore, the aim of the current study was to provide evidence for the influence of expectancy violation on extinction retention by manipulating the magnitude of expectancy violation during extinction learning. Method In total, 101 individuals completed a web-based fear conditioning protocol, consisting of a fear acquisition and extinction phase, as well as a spontaneous recovery and fear reinstatement test 24h later. To experimentally manipulate expectancy violation, participants were presented only with states of the conditioned stimulus that either weakly or strongly predicted the aversive outcome. Consequently, the absence of any aversive outcomes in the extinction phase resulted in low or high expectancy violation, respectively. Results We found successful fear acquisition and manipulation of expectancy violation, which was associated with reduced threat ratings for the high compared to the low expectancy violation group directly after extinction learning. On Day 2, inhibitory CS-noUS associations could be retrieved for expectancy ratings, whereas there were no substantial group differences for threat ratings. Conclusion These findings indicate that the magnitude of expectancy violation is related to the retrieval of conscious threat expectancies, but it is unclear how these changes translate to affective components (i.e., threat ratings) of the fear response and to symptoms of pathological anxiety.
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Affiliation(s)
- Daniel Gromer
- Department of Psychology, University of Würzburg, Würzburg, Germany
| | | | - Yannik Stegmann
- Department of Psychology, University of Würzburg, Würzburg, Germany
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25
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Phillips R, Durkin M, Engward H, Cable G, Iancu M. The impact of caring for family members with mental illnesses on the caregiver: a scoping review. Health Promot Int 2023; 38:daac049. [PMID: 35472137 PMCID: PMC10269136 DOI: 10.1093/heapro/daac049] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023] Open
Abstract
A large number of multidisciplinary, qualitative and quantitative research suggests that providing care for family members with mental health illnesses can have both positive and negative effects on the carers' wellbeing. However, to date a comprehensive overview and synthesis of literature that compares and contrasts positive and negative effects of family-caregiving on the carer is missing. To address this gap, this scoping review examines the effects of family-caregiving on carers' wellbeing. A Boolean search generated a total of 92 relevant articles that were included in the analysis. The results suggest that, to understand the effects of family-caregiving on the carer's mental and physical wellbeing, it is necessary to take a combination of situational and sociodemographic characteristics into consideration. Elderly, female, spousal-carers and primary-carers may be a group that is at risk of suffering from a lack of positive mental and physical wellbeing as a result of caring. However, the negative effects of caregiving can be balanced by extraversion, social support and religious or spiritual beliefs. Therefore, future interventions that aim to promote family caregivers' wellbeing may need to take personality, particular circumstances as well as cultural and personal beliefs into consideration.
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Affiliation(s)
- Rita Phillips
- Robert Gordon University, Garthdee House, Garthdee Road, Aberdeen AB10 7QB, UK
| | | | - Hilary Engward
- Anglia Ruskin University, Cambridge Campus, East Rd, Cambridge CB1 1PT, UK
| | - Graham Cable
- Anglia Ruskin University, Cambridge Campus, East Rd, Cambridge CB1 1PT, UK
| | - Maria Iancu
- Anglia Ruskin University, Cambridge Campus, East Rd, Cambridge CB1 1PT, UK
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26
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Boulicault M, Goering S, Klein E, Dougherty D, Widge AS. The Role of Family Members in Psychiatric Deep Brain Stimulation Trials: More Than Psychosocial Support. NEUROETHICS-NETH 2023; 16:14. [PMID: 37250273 PMCID: PMC10212803 DOI: 10.1007/s12152-023-09520-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 04/08/2023] [Indexed: 05/31/2023]
Abstract
Family members can provide crucial support to individuals participating in clinical trials. In research on the "newest frontier" of Deep Brain Stimulation (DBS)-the use of DBS for psychiatric conditions-family member support is frequently listed as a criterion for trial enrollment. Despite the significance of family members, qualitative ethics research on DBS for psychiatric conditions has focused almost exclusively on the perspectives and experiences of DBS recipients. This qualitative study is one of the first to include both DBS recipients and their family members as interview participants. Using dyadic thematic analysis-an approach that takes both the individuals and the relationship as units of analyses-this study analyzes the complex ways in which family relationships can affect DBS trial participation, and how DBS trial participation in turn influences family relationships. Based on these findings, we propose ways to improve study designs to better take family relationships into account, and better support family members in taking on the complex, essential roles that they play in DBS trials for psychiatric conditions. Supplementary Information The online version contains supplementary material available at 10.1007/s12152-023-09520-7.
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Affiliation(s)
- Marion Boulicault
- Department of Philosophy, University of Edinburgh, Edinburgh, UK
- Center for Neurotechnology, University of Washington, Seattle, WA USA
| | - Sara Goering
- Center for Neurotechnology, University of Washington, Seattle, WA USA
- Department of Philosophy, University of Washington, Seattle, WA USA
| | - Eran Klein
- Center for Neurotechnology, University of Washington, Seattle, WA USA
- Department of Neurology, Oregon Health & Science University School of Medicine, Portland, OR USA
| | - Darin Dougherty
- Neurotherapeutics Division, Department of Psychiatry, Massachusetts General Hospital, Boston, MA USA
- Harvard Medical School, Boston, MA USA
| | - Alik S. Widge
- Medical Discovery Team on Addiction, University of Minnesota, Minneapolis, MN USA
- Department of Psychiatry & Behavioral Sciences, University of Minnesota, Minneapolis, MN USA
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27
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Altaweel N, Upthegrove R, Surtees A, Durdurak B, Marwaha S. Personality traits as risk factors for relapse or recurrence in major depression: a systematic review. Front Psychiatry 2023; 14:1176355. [PMID: 37215669 PMCID: PMC10196019 DOI: 10.3389/fpsyt.2023.1176355] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 04/05/2023] [Indexed: 05/24/2023] Open
Abstract
Background Major depressive disorder (MDD) is highly recurrent. Identifying risk factors for relapse in depression is essential to improve prevention plans and therapeutic outcomes. Personality traits and personality disorders are widely considered to impact outcomes in MDD. We aimed to evaluate the role of personality aspects in the risk of relapse and recurrence in MDD. Method A PROSPERO-registered systematic review was conducted using Medline, Embase, PsycINFO, Web of Science and CINAHL as data sources, together with hand searching of four journals over the five years till 2022. There was independent abstract selection, quality assessment and data extraction from each study. Results Twenty two studies me t eligibility criteria involving 12,393 participants. Neurotic personality features are significantly associated with the risk of relapse and recurrence of depression, though the data is not uniform. There is some, though limited, evidence that borderline, obsessive-compulsive and dependent personality traits or disorders increase the risk for relapse in depression. Limitations The small number, in addition to the methodological heterogeneity of the included studies, did not allow further analysis, such as meta-analysis. Conclusion People with high neuroticism and dependent personality traits, borderline personality disorder or obsessive-compulsive personality disorder, compared to those without, may be at a higher risk of experiencing relapse or recurrence of MDD. Specific and targeted interventions may potentially reduce relapse and recurrence rates in these groups and could improve outcomes. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=235919, identifier: CRD42021235919.
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Affiliation(s)
- Nada Altaweel
- School of Psychology, Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom
- Department of Psychology, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Rachel Upthegrove
- School of Psychology, Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom
- Birmingham Woman's and Children's NHS Foundation Trust, Birmingham, United Kingdom
| | - Andrew Surtees
- School of Psychology, Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom
- Birmingham Woman's and Children's NHS Foundation Trust, Birmingham, United Kingdom
| | - Buse Durdurak
- School of Psychology, Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom
| | - Steven Marwaha
- School of Psychology, Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom
- Birmingham Woman's and Children's NHS Foundation Trust, Birmingham, United Kingdom
- Specialist Mood Disorders Clinic, Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, United Kingdom
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28
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Hadden LM, Penny H, Jones AL, Partridge AM, Lancaster TM, Allen C. Pre-frontal stimulation does not reliably increase reward responsiveness. Cortex 2023; 159:268-285. [PMID: 36669446 PMCID: PMC10823575 DOI: 10.1016/j.cortex.2022.11.011] [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: 07/04/2022] [Revised: 10/17/2022] [Accepted: 11/25/2022] [Indexed: 12/24/2022]
Abstract
Depression is the leading cause of disability worldwide and its effects can be fatal, with over 800,000 people dying by suicide each year. Neuromodulatory treatments such as transcranial magnetic stimulation (TMS) are being used to treat depression. Despite its endorsement by two regulatory bodies: NICE (2016) and the FDA (2008), there are major questions about the treatment efficacy and biological mechanisms of TMS. Ahn et al.'s (2013) justified the use of TMS in a clinical context in an important study indicating that excitatory TMS increases reward responsiveness. A pseudo-replication of this study by Duprat et al., (2016) also found a similar effect of active TMS, but only with the addition of an exploratory covariate to the analyses-trait reward responsiveness. Here we replicate Ahn et al.'s (2013) key study, and to test the reliability of the effects, and their dependency on trait reward responsiveness as described by Duprat et al., (2016). Using excitatory and sham TMS, we tested volunteers using the probabilistic learning task to measure their reward responsiveness both before and after stimulation. We also examined affect (positive, negative) following stimulation. Irrespective of TMS, the task was shown to be sensitive to reward responsiveness. However, we did not show TMS to be effective in increasing reward responsiveness and we did not replicate Ahn et al., (2013) or Duprat et al., (2016)'s key findings for TMS efficacy, where we provide evidence favouring the null. Moreover, exploratory analyses suggested following active stimulation, positive affect was reduced. Given our findings, we question the basic effects, which support the use of TMS for depression, particularly considering potential deleterious effects of reduced positive affect in patients with depression.
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Affiliation(s)
- L M Hadden
- Cardiff University, School of Psychology, Tower Building, Park Place, Cardiff, CF10 3AT, UK
| | - H Penny
- Cardiff University, School of Psychology, Tower Building, Park Place, Cardiff, CF10 3AT, UK; Aneurin Bevan University Health Board, St Cadoc's Hospital, Lodge Road, Caerleon, NP18 3XQ, UK
| | - A L Jones
- School of Psychology, Faculty of Medicine, Health, and Life Sciences, Singleton Park, Swansea University, SA2 8PP, UK
| | - A M Partridge
- University of Sheffield, Research Services, New Spring House, 231 Glossop Road, Sheffield, S10 2GW, UK
| | - T M Lancaster
- Cardiff University, School of Psychology, Tower Building, Park Place, Cardiff, CF10 3AT, UK; University of Bath, Department of Psychology, Claverton Down, BA2 7AY, UK
| | - C Allen
- Cardiff University, School of Psychology, Tower Building, Park Place, Cardiff, CF10 3AT, UK; Department of Psychology, Durham University, Durham, DH1 3LE, UK.
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29
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Morris L, Lovell K, McEvoy P, Emsley R, Carter LA, Edge D, Bates R, Wallwork T, Mansell W. A brief transdiagnostic group (the take control course) compared to individual low-intensity CBT for depression and anxiety: a randomized non-inferiority trial. Cogn Behav Ther 2023; 52:176-197. [PMID: 36625458 DOI: 10.1080/16506073.2022.2143418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Few studies have examined brief transdiagnostic groups. The Take Control Course (TCC) was developed for patients with mild to moderate common mental health problems. We examined whether TCC is non-inferior to individual low-intensity cognitive behaviour therapy (CBT) in a single-blind individually randomised parallel non-inferiority trial. The primary outcomes were depression (PHQ9) and anxiety (GAD7) at 6-month follow-up (primary outcome point) and 12-month follow-up. The non-inferiority margin that we set, based on previous trials, corresponds to approximately 3 points on the PHQ9 and approximately 2.5 points on the GAD7. Intention-to-treat (ITT) and per-protocol (PP) analyses of 6-month data of 156 randomised patients indicated that TCC was non-inferior to individual low-intensity CBT on anxiety (ITT Coefficient = 0.24; 95% CI: -1.45 to 1.92; d = 0.04; p = .79), and depression (ITT Coefficient = 0.82; 95% CI: -1.06 to 2.69; d = 0.14; p = .39) outcomes, and functioning (ITT Coefficient = 0.69; 95% CI: -2.56 to 3.94; d = 0.08; p = .68). The findings at 12 months were inconclusive and require further testing. This randomised trial provides preliminary support that TCC is not less effective than short-term individual CBT within Improving Access to Psychological Therapies (IAPT) services.
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Affiliation(s)
- Lydia Morris
- Division of Psychology & Mental Health, University of Manchester, Coupland 1 Building, Oxford Rd, Manchester M13 9PL, UK
| | - Karina Lovell
- Division of Nursing, Midwifery & Social Work, University of Manchester, Greater Manchester Mental Health NHS Foundation Trust, Oxford Rd, Manchester M13 9PL, UK
| | - Phil McEvoy
- Six Degrees Social Enterprise, Greenwood Business Centre, Southwood House, Regent Road, Salford M5 4QH, UK
| | - Richard Emsley
- Institute of Psychiatry, Psychology & Neuroscience, King's College, University of London, 16 De Crespigny Park, London SE5 8AB, UK
| | - Lesley-Anne Carter
- Division of Population Health, Health Services Research & Primary Care, University of Manchester, Jean McFarlane Building, Oxford Rd, Manchester M13 9PL, UK
| | - Dawn Edge
- Division of Psychology & Mental Health, University of Manchester, Coupland 1 Building, Oxford Rd, Manchester M13 9PL, UK
| | - Rachel Bates
- Six Degrees Social Enterprise, Greenwood Business Centre, Southwood House, Regent Road, Salford M5 4QH, UK
| | - Tanya Wallwork
- Six Degrees Social Enterprise, Greenwood Business Centre, Southwood House, Regent Road, Salford M5 4QH, UK
| | - Warren Mansell
- School of Population Health, Curtin University, Kent Street, Bentley 6102, Western Australia
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30
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Maas genannt Bermpohl F, Hülsmann L, Martin A. Efficacy of mindfulness- and acceptance-based cognitive-behavioral therapies for bodily distress in adults: a meta-analysis. Front Psychiatry 2023; 14:1160908. [PMID: 37151971 PMCID: PMC10157071 DOI: 10.3389/fpsyt.2023.1160908] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 04/04/2023] [Indexed: 05/09/2023] Open
Abstract
Objective Bodily distress, i.e., somatoform disorders and associated functional somatic syndromes, is highly prevalent, often persistent and highly disabling. It has been proposed that "third wave" therapies may be beneficial variants of cognitive behavioral treatments. However, evidence on their efficacy is scarce. This meta-analysis examines the efficacy of "third wave" psychotherapies (mindfulness-based cognitive therapy [MBCT], mindfulness-based stress reduction [MBSR], and acceptance and commitment therapy [ACT]) in adults with bodily distress. Method We included randomized controlled trials (RCTs) treating adults with bodily distress using MBCT, MBSR, and ACT compared to inactive and non-specific control groups. A random effects model was used. The primary outcome was somatic symptom severity. Secondary outcomes were degrees of depression and of anxiety, health anxiety, perceived health status, mindfulness, psychological inflexibility, and pain acceptance. Results Sixteen RCTs with 1,288 participants were included in the analysis (k = 4 MBCT, k = 7 MBSR, k = 5 ACT; k = 7 fibromyalgia, k = 5 irritable bowel syndrome, k = 1 chronic fatigue syndrome, k = 2 bodily distress, k = 1 medically unexplained symptoms). However, not all studies provided data for each of the relevant outcomes. The analyses revealed that "third wave" therapies were more effective than control conditions in reducing somatic symptom severity (k = 15, n = 1,100, g = -0.51, 95%CI -0.69; -0.32). Heterogeneity was moderate (I 2 = 52.8%, 95%CI 15.1 to 73.8). Effects for secondary outcomes were small to moderate with varying degrees of heterogeneity. We did not find differences between the different therapy approaches (mindfulness- vs. acceptance-based therapies); neither therapy dosis (i.e., total duration of therapy sessions) nor number of sessions were significant moderators of efficacy. Conclusions The therapies addressing mindfulness and acceptance proved to be more effective than control conditions. Hence, they are promising treatment approaches for bodily distress. However, there is still need for research on which patient groups may benefit from these psychological approaches. Systematic review registration https://osf.io/g7hby, identifier: 10.17605/OSF.IO/4RZGC.
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Demir S, Ercan F. The effectiveness of cognitive behavioral therapy-based group counseling on depressive symptomatology, anxiety levels, automatic thoughts, and coping ways Turkish nursing students: A randomized controlled trial. Perspect Psychiatr Care 2022; 58:2394-2406. [PMID: 35332542 DOI: 10.1111/ppc.13073] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 12/20/2021] [Accepted: 03/12/2022] [Indexed: 11/27/2022] Open
Abstract
PURPOSE This study aimed to evaluate the effectiveness of cognitive behavioral therapy (CBT)-based group counseling focused on depressive symptoms, anxiety levels, automatic thoughts, and coping ways among undergraduate nursing students with mild to moderate depressive symptoms. DESIGN AND METHODS A randomized, nonblinded, controlled trial was conducted. The study was completed with a total of 63 participants (n = 31, intervention group; n = 32, control group). The effect of the intervention was evaluated with Beck depression inventory, Beck anxiety inventory, automatic thoughts questionnaire, and ways of coping questionnaire. The measurements were taken three times: pretest, posttest, and 2-months posttest. FINDINGS CBT-based group counseling was found to reduce depressive symptoms, automatic thoughts, and ineffective coping with stress and to increase effective coping with stress. In both groups, 2-months posttest mean anxiety score was lower than the pre-test mean score. PRACTICE IMPLICATIONS CBT-based group counseling reduced depressive symptoms, automatic thoughts, and emotion-focused/ineffective ways for coping with stress.
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Affiliation(s)
- Satı Demir
- Department of Psychiatric and Mental Health Nursing, Faculty of Health Sciences, Gazi University, Ankara, Turkey
| | - Feride Ercan
- Department of Psychiatric and Mental Health Nursing, Faculty of Health Sciences, Gazi University, Ankara, Turkey
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Smith ORF, Sæther SMM, Haug E, Knapstad M. Long-term outcomes at 24- and 36-month follow-up in the intervention arm of the randomized controlled trial of Prompt Mental Health Care. BMC Psychiatry 2022; 22:598. [PMID: 36076192 PMCID: PMC9461100 DOI: 10.1186/s12888-022-04227-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 08/24/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Whether long-term symptom improvement is maintained after treatment in services such as the Norwegian Prompt Mental Health Care (PMHC) and the English Improving Access to Psychological Therapies is not yet known. In this prospective study, we investigate whether improvements observed at 6-month follow-up are maintained at 24- and 36-month follow-up among clients who received PMHC. METHOD Data from the treatment arm of the randomized controlled trial of PMHC were used (n = 459). The main outcomes were (reliable) recovery rate and symptoms of depression (PHQ-9) and anxiety (GAD-7). Primary outcome data at 24- and 36-months follow-up were available for 47% and 39% of participants, respectively. Secondary outcomes were work participation, functional status, health-related quality of life, and positive mental well-being. Sensitivity analyses with regard to missing data assumptions were conducted for the primary continuous outcomes. RESULTS Improvements were maintained at 24- and 36-month follow-up for symptoms of depression and anxiety, (reliable) recovery rate, and health-related quality of life. Small linear improvements since 6-month follow-up were observed for work participation, functional status, and positive mental well-being. Sensitivity analyses did not substantially alter the findings for symptoms of depression and anxiety mentioned above. CONCLUSIONS Our findings support the long-term effectiveness of PMHC, but results should be interpreted with caution due to lacking follow-up data at 24- and 36-month in the control group, and substantial attrition.
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Affiliation(s)
- Otto R. F. Smith
- grid.418193.60000 0001 1541 4204Division of Mental and Physical Health, Department of Health Promotion, Norwegian Institute of Public Health, Zander Kaaes gate 7, 5015 Bergen, Norway ,grid.418193.60000 0001 1541 4204Centre for Evaluation of Public Health Measure, Norwegian Institute of Public Health, Bergen, Norway ,grid.458561.b0000 0004 0611 5642Department of Teacher Education, NLA University College, Pb 74 Sandviken, 5812 Bergen, Norway
| | - Solbjørg M. M. Sæther
- grid.418193.60000 0001 1541 4204Division of Mental and Physical Health, Department of Health Promotion, Norwegian Institute of Public Health, Zander Kaaes gate 7, 5015 Bergen, Norway
| | - Ellen Haug
- grid.458561.b0000 0004 0611 5642Department of Teacher Education, NLA University College, Pb 74 Sandviken, 5812 Bergen, Norway ,grid.7914.b0000 0004 1936 7443Department of Health Promotion and Development, University of Bergen, 5020 Bergen, Norway
| | - Marit Knapstad
- grid.418193.60000 0001 1541 4204Division of Mental and Physical Health, Department of Health Promotion, Norwegian Institute of Public Health, Zander Kaaes gate 7, 5015 Bergen, Norway
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Gabr H, Baragilly M, Willis BH. Measuring and exploring mental health determinants: a closer look at co-residents' effect using a multilevel structural equations model. BMC Med Res Methodol 2022; 22:236. [PMID: 36045347 PMCID: PMC9429464 DOI: 10.1186/s12874-022-01711-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 08/12/2022] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Previous research has demonstrated that individual risk of mental illness is associated with individual, co-resident, and household risk factors. However, modelling the overall effect of these risk factors presents several methodological challenges. In this study we apply a multilevel structural equation model (MSEM) to address some of these challenges and the impact of the different determinants when measuring mental health risk. STUDY DESIGN AND SETTING Two thousand, one hundred forty-three individuals aged 16 and over from 888 households were analysed based on the Household Survey for England-2014 dataset. We applied MSEM to simultaneously measure and identify psychiatric morbidity determinants while accounting for the dependency among individuals within the same household and the measurement errors. RESULTS Younger age, female gender, non-working status, headship of the household, having no close relationship with other people, having history of mental illness and obesity were all significant (p < 0.01) individual risk factors for psychiatric morbidity. A previous history of mental illness in the co-residents, living in a deprived household, and a lack of closeness in relationships among residents were also significant predictors. Model fit indices showed a very good model specification (CFI = 0.987, TLI = 0.980, RMSEA = 0.023, GFI = 0.992). CONCLUSION Measuring and addressing mental health determinants should consider not only an individual's characteristics but also the co-residents and the households in which they live.
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Affiliation(s)
- Hend Gabr
- Department of Mathematics, Insurance, and Statistics, Faculty of Commerce, Menoufia University, Shebeen El-Kom, Menoufia, Egypt
| | - Mohammed Baragilly
- Department of Mathematics, Insurance, and Applied Statistics, Helwan University, Helwan, Egypt
- Istitute of Immunology and Immunotherapy, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Brian H Willis
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
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Psychological interventions to prevent relapse in anxiety and depression: A systematic review and meta-analysis. PLoS One 2022; 17:e0272200. [PMID: 35960783 PMCID: PMC9374222 DOI: 10.1371/journal.pone.0272200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 07/14/2022] [Indexed: 11/19/2022] Open
Abstract
Objectives
The aim of this review is to establish the effectiveness of psychological relapse prevention interventions, as stand-alone interventions and in combination with maintenance antidepressant treatment (M-ADM) or antidepressant medication (ADM) discontinuation for patients with remitted anxiety disorders or major depressive disorders (MDD).
Methods
A systematic review and a meta-analysis were conducted. A literature search was conducted in PubMed, PsycINFO and Embase for randomised controlled trials (RCTs) comparing psychological relapse prevention interventions to treatment as usual (TAU), with the proportion of relapse/recurrence and/or time to relapse/recurrence as outcome measure.
Results
Thirty-six RCTs were included. During a 24-month period, psychological interventions significantly reduced risk of relapse/recurrence for patients with remitted MDD (RR 0.76, 95% CI: 0.68–0.86, p<0.001). This effect persisted with longer follow-up periods, although these results were less robust. Also, psychological interventions combined with M-ADM significantly reduced relapse during a 24-month period (RR 0.76, 95% CI: 0.62–0.94, p = 0.010), but this effect was not significant for longer follow-up periods. No meta-analysis could be performed on relapse prevention in anxiety disorders, as only two studies focused on relapse prevention in anxiety disorders.
Conclusions
In patients with remitted MDD, psychological relapse prevention interventions substantially reduce risk of relapse/recurrence. It is recommended to offer these interventions to remitted MDD patients. Studies on anxiety disorders are needed.
Systematic review registration number
PROSPERO 2018: CRD42018103142.
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Moriarty AS, Meader N, Snell KIE, Riley RD, Paton LW, Dawson S, Hendon J, Chew-Graham CA, Gilbody S, Churchill R, Phillips RS, Ali S, McMillan D. Predicting relapse or recurrence of depression: systematic review of prognostic models. Br J Psychiatry 2022; 221:448-458. [PMID: 35048843 DOI: 10.1192/bjp.2021.218] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Relapse and recurrence of depression are common, contributing to the overall burden of depression globally. Accurate prediction of relapse or recurrence while patients are well would allow the identification of high-risk individuals and may effectively guide the allocation of interventions to prevent relapse and recurrence. AIMS To review prognostic models developed to predict the risk of relapse, recurrence, sustained remission, or recovery in adults with remitted major depressive disorder. METHOD We searched the Cochrane Library (current issue); Ovid MEDLINE (1946 onwards); Ovid Embase (1980 onwards); Ovid PsycINFO (1806 onwards); and Web of Science (1900 onwards) up to May 2021. We included development and external validation studies of multivariable prognostic models. We assessed risk of bias of included studies using the Prediction model risk of bias assessment tool (PROBAST). RESULTS We identified 12 eligible prognostic model studies (11 unique prognostic models): 8 model development-only studies, 3 model development and external validation studies and 1 external validation-only study. Multiple estimates of performance measures were not available and meta-analysis was therefore not necessary. Eleven out of the 12 included studies were assessed as being at high overall risk of bias and none examined clinical utility. CONCLUSIONS Due to high risk of bias of the included studies, poor predictive performance and limited external validation of the models identified, presently available clinical prediction models for relapse and recurrence of depression are not yet sufficiently developed for deploying in clinical settings. There is a need for improved prognosis research in this clinical area and future studies should conform to best practice methodological and reporting guidelines.
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Affiliation(s)
- Andrew S Moriarty
- Mental Health and Addiction Research Group, Department of Health Sciences, University of York, UK and Hull York Medical School, University of York, UK
| | - Nicholas Meader
- Centre for Reviews and Dissemination, University of York, UK and Cochrane Common Mental Disorders, University of York, UK
| | - Kym I E Snell
- Centre for Prognosis Research, School of Medicine, Keele University, UK
| | - Richard D Riley
- Centre for Prognosis Research, School of Medicine, Keele University, UK
| | - Lewis W Paton
- Mental Health and Addiction Research Group, Department of Health Sciences, University of York, UK
| | - Sarah Dawson
- Cochrane Common Mental Disorders, University of York, UK and Bristol Medical School, University of Bristol, UK
| | - Jessica Hendon
- Centre for Reviews and Dissemination, University of York, UK and Cochrane Common Mental Disorders, University of York, UK
| | | | - Simon Gilbody
- Mental Health and Addiction Research Group, Department of Health Sciences, University of York, UK and Hull York Medical School, University of York, UK
| | - Rachel Churchill
- Centre for Reviews and Dissemination, University of York, UK and Cochrane Common Mental Disorders, University of York, UK
| | | | - Shehzad Ali
- Mental Health and Addiction Research Group, Department of Health Sciences, University of York, UK and Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, Canada
| | - Dean McMillan
- Mental Health and Addiction Research Group, Department of Health Sciences, University of York, UK and Hull York Medical School, University of York, UK
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Hunt C, Campbell-Sills L, Chavira D, Craske M, Sherbourne C, Sullivan G, Roy-Byrne P, Stein MB, Bomyea J. Prospective relations between anxiety sensitivity and transdiagnostic anxiety following cognitive-behavioral therapy: Evidence from the Coordinated Anxiety Learning management trial. Behav Res Ther 2022; 155:104119. [PMID: 35640310 DOI: 10.1016/j.brat.2022.104119] [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: 03/15/2022] [Revised: 04/28/2022] [Accepted: 05/08/2022] [Indexed: 11/15/2022]
Abstract
Previous research has implicated reductions in anxiety sensitivity (AS) - the dispositional tendency to fear anxiety-related sensations - as critical to change during cognitive behavioral therapy (CBT) for anxiety. However, the relationship of AS to anxiety symptom remittance following CBT remains largely unknown. To address this gap, the current study evaluated prospective associations between AS and symptoms of various anxiety disorders following completion of the Coordinated Anxiety Learning and Management (CALM) study- a large clinical trial evaluating the efficacy of a brief, computer-facilitated CBT intervention for transdiagnostic anxiety within primary care. Participants were randomized to CALM (n = 460) or a control treatment (n = 501) and completed self-report measures of general and disorder-specific anxiety symptoms at pretreatment and at 6-month, 12-month, and 18-month follow-up. Longitudinal relations between AS and each anxiety measure across timepoints and within each treatment group were assessed using cross-lagged panel models. Results indicated that higher AS following CALM predicted greater anxiety symptoms at the subsequent timepoint for all anxiety symptoms except social anxiety symptoms. Higher anxiety following treatment also predicted later AS. These findings implicate AS as an indicator of transdiagnostic anxiety remittance and suggest that targeting AS could be useful for reducing clinical anxiety relapse following CBT.
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Affiliation(s)
- Christopher Hunt
- VA San Diego Healthcare System, Center of Excellence for Stress and Mental Health, USA; University of California San Diego, Department of Psychiatry, USA
| | | | | | | | | | | | | | - Murray B Stein
- University of California San Diego, Department of Psychiatry, USA; University of California San Diego, Department of Family Medicine and Public Health, USA
| | - Jessica Bomyea
- VA San Diego Healthcare System, Center of Excellence for Stress and Mental Health, USA; University of California San Diego, Department of Psychiatry, USA.
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Heise M, Werthmann J, Murphy F, Tuschen-Caffier B, Renner F. Imagine How Good That Feels: The Impact of Anticipated Positive Emotions on Motivation for Reward Activities. COGNITIVE THERAPY AND RESEARCH 2022. [DOI: 10.1007/s10608-022-10306-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Abstract
Background
Disease burden and unsatisfactory treatment outcomes call for innovation in treatments of depression. Prospective mental imagery, i.e. future-directed voluntary imagery-based thought, about potentially-rewarding activities may offer a mechanistically-informed intervention that targets deficits in reward processing, a core clinical feature of depression. We propose that the previously described impact of prospective mental imagery on motivation for everyday activities is facilitated by affective forecasting, i.e. predictions about an individual’s emotional response to the imagined activities.
Methods
Participants (N = 120) self-nominated six activities to engage in over the following week and were randomized to either: (1) an affective forecasting imagery condition (n = 40); (2) a neutral process imagery condition (n = 40); or (3) a no-imagery control condition (n = 40).
Results
As predicted, increases in motivation ratings from pre to post experimental manipulation were significantly higher following affective forecasting imagery compared to both neutral process imagery (d = 0.62) and no-imagery (d = 0.91). Contrary to predictions, the number of activities participants engaged in did not differ between conditions.
Conclusions
Results provide initial evidence for a potentially important role of affective forecasting in prospective mental imagery. We discuss how these findings can inform future research aiming to harness prospective mental imagery’s potential for clinical applications.
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Hauschildt M, Arlt S, Moritz S, Yassari AH, Jelinek L. Efficacy of metacognitive training for depression as add-on intervention for patients with depression in acute intensive psychiatric inpatient care: A randomized controlled trial. Clin Psychol Psychother 2022; 29:1542-1555. [PMID: 35274407 DOI: 10.1002/cpp.2733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 02/08/2022] [Accepted: 03/07/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND Metacognitive training for depression (D-MCT) is a novel low-intensity group training for economic treatment of depression. Previous studies demonstrate its efficacy in moderately depressed outpatients. The present study evaluated efficacy and patients' perspective of the D-MCT in severely depressed psychiatric inpatients. METHODS In a randomized-controlled trial, 75 individuals with a major depressive disorder (MDD) were allocated to D-MCT versus euthymic therapy as add-on (twice a week) to cognitive-behavioural-based (CBT) inpatient-care. Depressive symptoms (HDRS, BDI), dysfunctional (meta)cognition (DAS, MCQ-30) and subjective appraisal were assessed at baseline, 4 weeks (post) and 3 months (follow-up). RESULTS Participants in both conditions showed a large decline in depression at post and follow-up-assessment. No superior add-effect of D-MCT versus active control emerged for depression severity on top of the inpatient care. However, among patients with a diagnosis of MDD with no (vs. at least one) comorbidity, D-MCT participants showed a larger decline in depressive (meta-)cognition at follow-up with medium-to-large effect sizes. D-MCT was evaluated as superior in overall appraisal, treatment preference, motivation and satisfaction. LIMITATIONS The follow-up time interval of 3 months may have been too short to detect long-term effects. There is emerging evidence that modification of (meta)cognition unfolds its full effects only with time. Effects of CBT inpatient-care on outcome parameters cannot be differentiated. CONCLUSIONS Although D-MCT as an add-on was not superior in complete case analyses, results suggest greater benefit for patients with MDD and no comorbidity. D-MCT proved feasible in acute-psychiatric inpatient-care and was highly accepted by patients. Future studies should investigate the role of modified (meta)cognition on long-term treatment outcome, including dropout and relapse rates.
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Affiliation(s)
- Marit Hauschildt
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sönke Arlt
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Amir H Yassari
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lena Jelinek
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Rigas C, Park H, Nassim M, Su CL, Greenway K, Lipman M, McVeigh C, Novak M, Trinh E, Alam A, Suri RS, Mucsi I, Torres-Platas SG, Noble H, Sekhon H, Rej S, Lifshitz M. Long-term Effects of a Brief Mindfulness Intervention Versus a Health Enhancement Program for Treating Depression and Anxiety in Patients Undergoing Hemodialysis: A Randomized Controlled Trial. Can J Kidney Health Dis 2022; 9:20543581221074562. [PMID: 35273807 PMCID: PMC8902179 DOI: 10.1177/20543581221074562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Indexed: 11/29/2022] Open
Abstract
Background: Depression and anxiety affect approximately 50% of patients with kidney
failure receiving hemodialysis and are associated with decreased quality of
life and increased risk of hospitalization and mortality. A Brief
Mindfulness Intervention (BMI) may be promising in treating depressive and
anxiety symptoms in this population, but the long-term sustainability of the
intervention’s effects is unknown. Objective: We previously conducted a randomized controlled trial (RCT; n = 55) comparing
an 8-week BMI with an active control (Health Enhancement Program [HEP]) for
patients receiving dialysis, with depression and/or anxiety. Here, we
examine the 6-month follow-up data to determine the long-term sustainability
of BMI versus HEP in reducing (1) depressive symptoms, (2) anxiety symptoms,
and (3) the efficacy of BMI versus HEP in reducing the likelihood of
hospitalization. Design: In this study, we analyzed 6-month follow-up data from an 8-week
assessor-blinded parallel RCT, which evaluated the efficacy of a BMI against
an active control, HEP, in patients receiving hemodialysis with symptoms of
depression and/or anxiety. Setting: The study took place at hemodialysis centers in 4 tertiary-care hospitals in
Montreal, Canada. Participants: Participants included adults aged ≥18 years who were receiving in-center
hemodialysis 3 times per week and had symptoms of depression and/or anxiety
as indicated by a score ≥6 on the Patient Health Questionnaire–9 (PHQ-9)
and/or the General Anxiety Disorder–7 (GAD-7). Methods: Participants were randomized to the treatment arm (BMI) or the active control
arm (HEP) and completed assessments at baseline, 8 weeks, and 6-month
follow-up. Depression was assessed using the PHQ-9, and anxiety was assessed
by the GAD-7. Hospitalization rates were assessed using medical chart
information. Results: We observed significant decrease in depression scores over 6 months in both
BMI and HEP groups, with no significant difference between groups. Anxiety
scores significantly decreased over 6 months, but only in the BMI group.
Brief Mindfulness Intervention and Health Enhancement Program were
comparable in terms of hospitalization rates. Limitations: The limitations of our study include the modest sample size and lack of a
third arm such as a waitlist control. Conclusions: Our results suggest that the beneficial effects of BMI and HEP for improving
mood disorder symptoms in patients receiving dialysis persist at 6-month
follow-up. Both interventions showed sustained effects for depressive
symptoms, but BMI may be more useful in this population given its efficacy
in reducing anxiety symptoms as well. Trial registration: Prior to recruitment, the trial had been registered (ClinicalTrials.gov
Identifier: NCT03406845).
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Affiliation(s)
- Christina Rigas
- Geri-PARTy Research Group, Jewish General Hospital, Montreal, QC, Canada
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Haley Park
- Geri-PARTy Research Group, Jewish General Hospital, Montreal, QC, Canada
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Marouane Nassim
- Geri-PARTy Research Group, Jewish General Hospital, Montreal, QC, Canada
| | - Chien-Lin Su
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
| | - Kyle Greenway
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Mark Lipman
- Division of Nephrology, Jewish General Hospital, Montreal, QC, Canada
- Research Institute of the McGill University Health Center, McGill University, Montreal, QC, Canada
| | - Clare McVeigh
- School of Nursing and Midwifery, Queen’s University, Belfast, UK
| | - Marta Novak
- Department of Psychiatry, University Health Network, University of Toronto, ON, Canada
| | - Emilie Trinh
- Research Institute of the McGill University Health Center, McGill University, Montreal, QC, Canada
- Division of Nephrology, McGill University Health Centre, Montreal, QC, Canada
| | - Ahsan Alam
- Research Institute of the McGill University Health Center, McGill University, Montreal, QC, Canada
- Division of Nephrology, McGill University Health Centre, Montreal, QC, Canada
| | - Rita S. Suri
- Research Institute of the McGill University Health Center, McGill University, Montreal, QC, Canada
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal, QC, Canada
| | - Istvan Mucsi
- Division of Nephrology, McGill University Health Centre, Montreal, QC, Canada
- Transplant Inpatient Unit, Division of Nephrology, University Health Network, Toronto, ON, Canada
- Department of Medicine, University of Toronto, ON, Canada
| | | | - Helen Noble
- School of Nursing and Midwifery, Queen’s University, Belfast, UK
| | - Harmehr Sekhon
- Geri-PARTy Research Group, Jewish General Hospital, Montreal, QC, Canada
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Soham Rej
- Geri-PARTy Research Group, Jewish General Hospital, Montreal, QC, Canada
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Michael Lifshitz
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Department of Medicine, University of Toronto, ON, Canada
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Dual-Session Tokophobia Intervention, a Novel Ultrashort Cognitive Behavioral Therapy Protocol for Women Suffering From Tokophobia in the Third Term of Pregnancy. COGNITIVE AND BEHAVIORAL PRACTICE 2022. [DOI: 10.1016/j.cbpra.2022.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Takizawa Y, Murray J, Bambling M, Matsumoto Y, Ishimoto Y, Yamane T, Edirippulige S. Integrating neuroscientific knowledge into psychotherapy amongst Japanese psychotherapists: presence, benefits, needs and cultural barriers. ASIA PACIFIC JOURNAL OF COUNSELLING AND PSYCHOTHERAPY 2022. [DOI: 10.1080/21507686.2022.2035783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Yu Takizawa
- School of Psychology, University of Queensland, Brisbane, Australia
| | - Judith Murray
- School of Psychology/School of Nursing Midwifery and Social Work, University of Queensland, Brisbane, Australia
| | - Matthew Bambling
- School of Clinical Medicine, University of Queensland, Brisbane, Australia
| | - Yuki Matsumoto
- School of Human Life Sciences, Tokushima Bunri University, Tokushima, Japan
| | - Yuma Ishimoto
- Teacher Education Center, Tottori University, Tottori, Japan
| | - Takahiro Yamane
- Graduate School of Human Development and Environment, Kobe University, Kobe, Japan
| | - Sisira Edirippulige
- Centre for Health Services Research, Faculty of Medicine, University of Queensland, Brisbane, Australia
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Petrova N. New goals for depression therapy. Zh Nevrol Psikhiatr Im S S Korsakova 2022; 122:57-61. [DOI: 10.17116/jnevro202212211157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Wright HM, Fuessel-Hermann D, Pazdera M, Lee S, Ridge B, Kim JU, Konopacki K, Hilton L, Greensides M, Langenecker SA, Smith AJ. Preventative Care in First Responder Mental Health: Focusing on Access and Utilization via Stepped Telehealth Care. FRONTIERS IN HEALTH SERVICES 2022; 2:848138. [PMID: 36925868 PMCID: PMC10012773 DOI: 10.3389/frhs.2022.848138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 03/31/2022] [Indexed: 11/13/2022]
Abstract
First responders are at high risk for disorders that arise from repeat exposure to stress and trauma (Post Traumatic Stress Disorder, depression, and problematic alcohol use). Although mental health treatments are available, first responders often do not access them, anchored by barriers that include: lack of knowledge, stigma, negative experience with mental health providers, and time-based burdens. In this study, we designed an intervention to address these barriers, extending a Planned-Action framework. Step 1 involved self-report screening for four mental health risks (PTSD, depression, anxiety, and alcohol use risk), delivered to all personnel electronically, who were free to either consent and participate or opt-out. The detection of risk(s) in Step 1 led to scheduling a Step 2 telehealth appointment with a trained clinician. We report descriptive statistics for participation/attrition/utilization in Steps 1 and 2, rates of risk on four mental health variables, and rate of adherence to follow-up treatment recommendations. Step 1: In total, 53.3% of personnel [229 of 429 full-time employees (221 males; eight females; 95% White; 48% paramedic or Emergency Medical Technician; 25% captain; 19% engineer; 7% other)] initially opted-in by consenting and completing the brief remote screening survey. Among those who opted-in and completed (n = 229), 43% screened positive for one or more of the following mental health risks: PTSD (7.9%); depression (9.6%); anxiety (13.5%); alcohol use (36.7%). Step 2: A maximum of three attempts were made to schedule "at risk" individuals into Step 2 (n = 99). Among the 99 who demonstrated a need for mental health treatment (by screening positive for one or more risk), 56 (56.6%) engaged in the telehealth appointment. Of the 56 who participated in Step 2 clinical appointments, 38 were recommended for further intervention (16.6% of full-time personnel who participated). Among the 38 firefighters who were recommended to seek further mental health services, 29 were adherent/followed through (76.3% of those who received recommendations for further services). Taken together, evidence-based, culturally conscious, stepped care models delivered via the virtual/telehealth medium can promote access, utilization, and cost-effective mental health services for first responders. Implications are for informing larger, more rigorous dissemination and implementation efforts.
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Affiliation(s)
- Hannah M Wright
- Department of Psychiatry, University of Utah School of Medicine, Huntsman Mental Health Institute, Salt Lake City, UT, United States
| | | | - Myah Pazdera
- Department of Psychiatry, University of Utah School of Medicine, Huntsman Mental Health Institute, Salt Lake City, UT, United States
| | - Somi Lee
- Department of Psychiatry, University of Utah School of Medicine, Huntsman Mental Health Institute, Salt Lake City, UT, United States
| | - Brook Ridge
- Department of Psychiatry, University of Utah School of Medicine, Huntsman Mental Health Institute, Salt Lake City, UT, United States
| | - Joseph U Kim
- Department of Psychiatry, University of Utah School of Medicine, Huntsman Mental Health Institute, Salt Lake City, UT, United States.,Salt Lake City Veterans Affairs (VA) Medical Center, Salt Lake City, UT, United States
| | - Kelly Konopacki
- Department of Psychiatry, University of Utah School of Medicine, Huntsman Mental Health Institute, Salt Lake City, UT, United States
| | - Layne Hilton
- United Fire Authority, Salt Lake City, UT, United States
| | | | - Scott A Langenecker
- Department of Psychiatry, University of Utah School of Medicine, Huntsman Mental Health Institute, Salt Lake City, UT, United States
| | - Andrew J Smith
- Department of Psychiatry, University of Utah School of Medicine, Huntsman Mental Health Institute, Salt Lake City, UT, United States.,Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, United States.,Lyda Hill Institute for Human Resilience, University of Colorado, Colorado Springs, CO, United States
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44
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Palacios JE, Enrique A, Mooney O, Farrell S, Earley C, Duffy D, Eilert N, Harty S, Timulak L, Richards D. Durability of treatment effects following internet-delivered cognitive behavioural therapy for depression and anxiety delivered within a routine care setting. Clin Psychol Psychother 2022; 29:1768-1777. [PMID: 35466486 PMCID: PMC9790710 DOI: 10.1002/cpp.2743] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 04/11/2022] [Accepted: 04/12/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To investigate post-treatment relapse and remission rates 3, 6 and 9 months after completion of an acute phase of a clinician-supported internet-delivered cognitive-behavioural therapy (iCBT) for anxiety and depressive symptoms, within a routine care setting. METHOD Secondary analysis from a 12-month pragmatic randomized-controlled trial delivered within the Improving Access to Psychological Therapies (IAPT) programme in England. Participants in the intervention arm were included if they met criteria for reliable recovery from depression (PHQ-9) and anxiety (GAD-7) at post-treatment assessment. Survival analysis was used to assess durability of treatment effects and determine predictors to relapse at 3-, 6- and 9-month follow-up. Hazard ratios predicting time-to-relapse were estimated with semi-parametric Cox proportional hazards model. RESULTS Of the 241 participants in the intervention arm, 89 participants met the criteria for reliable recovery from depression and anxiety at the post-treatment assessment. Of these 89 eligible cases, 29.2% relapsed within the 9-month period, with 70.8% remaining in remission at 9 months post-treatment. Of those who relapsed, 53.8% experienced a relapse of depression and anxiety; 7.7% experienced a relapse of depression only; and 38.4% experienced a relapse of anxiety only. Younger age, having a long-term condition, and residual symptoms of anxiety at end-of-treatment were all significant predictors of relapse. CONCLUSIONS This study is the first to explore the remission and relapse rates after an acute phase of iCBT treatment, within a routine, stepped-care setting. The results add to the scarce literature on the durability of the effects of iCBT treatment in routine care settings, where patients are not typically followed up after receiving a completed course of treatment.
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Affiliation(s)
- Jorge E. Palacios
- SilverCloud ScienceSilverCloud HealthDublinIreland,E‐mental Health Research Group, School of Psychology, Aras an PhiarsaighTrinity College DublinDublinIreland
| | - Angel Enrique
- SilverCloud ScienceSilverCloud HealthDublinIreland,E‐mental Health Research Group, School of Psychology, Aras an PhiarsaighTrinity College DublinDublinIreland
| | - Olwyn Mooney
- SilverCloud ScienceSilverCloud HealthDublinIreland
| | | | | | - Daniel Duffy
- SilverCloud ScienceSilverCloud HealthDublinIreland
| | - Nora Eilert
- SilverCloud ScienceSilverCloud HealthDublinIreland,E‐mental Health Research Group, School of Psychology, Aras an PhiarsaighTrinity College DublinDublinIreland
| | | | - Ladislav Timulak
- E‐mental Health Research Group, School of Psychology, Aras an PhiarsaighTrinity College DublinDublinIreland
| | - Derek Richards
- SilverCloud ScienceSilverCloud HealthDublinIreland,E‐mental Health Research Group, School of Psychology, Aras an PhiarsaighTrinity College DublinDublinIreland
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45
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A Patient Stratification Approach to Identifying the Likelihood of Continued Chronic Depression and Relapse Following Treatment for Depression. J Pers Med 2021; 11:jpm11121295. [PMID: 34945767 PMCID: PMC8703621 DOI: 10.3390/jpm11121295] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 11/15/2021] [Accepted: 11/17/2021] [Indexed: 01/26/2023] Open
Abstract
Background: Subgrouping methods have the potential to support treatment decision making for patients with depression. Such approaches have not been used to study the continued course of depression or likelihood of relapse following treatment. Method: Data from individual participants of seven randomised controlled trials were analysed. Latent profile analysis was used to identify subgroups based on baseline characteristics. Associations between profiles and odds of both continued chronic depression and relapse up to one year post-treatment were explored. Differences in outcomes were investigated within profiles for those treated with antidepressants, psychological therapy, and usual care. Results: Seven profiles were identified; profiles with higher symptom severity and long durations of both anxiety and depression at baseline were at higher risk of relapse and of chronic depression. Members of profile five (likely long durations of depression and anxiety, moderately-severe symptoms, and past antidepressant use) appeared to have better outcomes with psychological therapies: antidepressants vs. psychological therapies (OR (95% CI) for relapse = 2.92 (1.24–6.87), chronic course = 2.27 (1.27–4.06)) and usual care vs. psychological therapies (relapse = 2.51 (1.16–5.40), chronic course = 1.98 (1.16–3.37)). Conclusions: Profiles at greater risk of poor outcomes could benefit from more intensive treatment and frequent monitoring. Patients in profile five may benefit more from psychological therapies than other treatments.
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46
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Roy A, Hoge EA, Abrante P, Druker S, Liu T, Brewer JA. Clinical Efficacy and Psychological Mechanisms of an App-Based Digital Therapeutic for Generalized Anxiety Disorder: Randomized Controlled Trial. J Med Internet Res 2021; 23:e26987. [PMID: 34860673 PMCID: PMC8686411 DOI: 10.2196/26987] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 04/06/2021] [Accepted: 09/29/2021] [Indexed: 01/27/2023] Open
Abstract
Background Current treatments for generalized anxiety disorder (GAD) often yield suboptimal outcomes, partly because of insufficient targeting of underlying psychological mechanisms (eg, avoidance reinforcement learning). Mindfulness training (MT) has shown efficacy for anxiety; yet, widespread adoption has been limited, partly because of the difficulty in scaling in-person–based delivery. Digital therapeutics are emerging as potentially viable treatments; however, very few have been empirically validated. Objective The aim of this study is to test the efficacy and mechanism of an app-delivered MT that was designed to target a potential mechanism of anxiety (reinforcement learning), based on which previous studies have shown concern regarding feedback and the perpetuation of anxiety through negative reinforcement. Methods Individuals with GAD were recruited using social media advertisements and randomized during an in-person visit to receive treatment as usual (n=33) or treatment as usual+app−delivered MT (Unwinding Anxiety; n=32). The latter was composed of 30 modules to be completed over a 2-month period. Associated changes in outcomes were assessed using self-report questionnaires 1 and 2 months after treatment initiation. Results We randomized 65 participants in this study, and a modified intent-to-treat approach was used for analysis. The median number of modules completed by the MT group was 25.5 (IQR 17) out of 30; 46% (13/28) of the participants completed the program. In addition, the MT group demonstrated a significant reduction in anxiety (GAD-7) compared with the control group at 2 months (67% vs 14%; median change in GAD-7: –8.5 [IQR 6.5] vs –1.0 [IQR 5.0]; P<.001; 95% CI 6-10). Increases in mindfulness at 1 month (nonreactivity subscale) mediated decreases in worry at 2 months (Penn State Worry Questionnaire; P=.02) and decreases in worry at 1 month mediated reductions in anxiety at 2 months (P=.03). Conclusions To our knowledge, this is the first report on the efficacy and mechanism of an app-delivered MT for GAD. These findings demonstrate the clinical efficacy of MT as a digital therapeutic for individuals with anxiety (number needed to treat=1.6). These results also link recent advances in our mechanistic understanding of anxiety with treatment development, showing that app-delivered MT targets key reinforcement learning pathways, resulting in tangible, clinically meaningful reductions in worry and anxiety. Evidence-based, mechanistically targeted digital therapeutics have the potential to improve health at a population level at a low cost. Trial Registration ClinicalTrials.gov NCT03683472; https://clinicaltrials.gov/ct2/show/NCT03683472
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Affiliation(s)
- Alexandra Roy
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States
| | - Elizabeth A Hoge
- Department of Psychiatry, Georgetown University Medical Center, Washington, DC, United States
| | - Pablo Abrante
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States
| | - Susan Druker
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | - Tao Liu
- Department of Biostatistics, Brown University School of Public Health, Providence, RI, United States
| | - Judson A Brewer
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States
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47
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Healey A, Verhey R, Mosweu I, Boadu J, Chibanda D, Chitiyo C, Wagenaar B, Senra H, Chiriseri E, Mboweni S, Araya R. Economic threshold analysis of delivering a task-sharing treatment for common mental disorders at scale: the Friendship Bench, Zimbabwe. EVIDENCE-BASED MENTAL HEALTH 2021; 25:47-53. [PMID: 34794967 PMCID: PMC9046737 DOI: 10.1136/ebmental-2021-300317] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 10/15/2021] [Indexed: 11/20/2022]
Abstract
Background Task-sharing treatment approaches offer a pragmatic approach to treating common mental disorders in low-income and middle-income countries (LMICs). The Friendship Bench (FB), developed in Zimbabwe with increasing adoption in other LMICs, is one example of this type of treatment model using lay health workers (LHWs) to deliver treatment. Objective To consider the level of treatment coverage required for a recent scale-up of the FB in Zimbabwe to be considered cost-effective. Methods A modelling-based deterministic threshold analysis conducted within a ‘cost-utility’ framework using a recommended cost-effectiveness threshold. Findings The FB would need to treat an additional 3413 service users (10 per active LHW per year) for its scale-up to be considered cost-effective. This assumes a level of treatment effect observed under clinical trial conditions. The associated incremental cost-effectiveness ratio was $191 per year lived with disability avoided, assuming treatment coverage levels reported during 2020. The required treatment coverage for a cost-effective outcome is within the level of treatment coverage observed during 2020 and remained so even when assuming significantly compromised levels of treatment effect. Conclusions The economic case for a scaled-up delivery of the FB appears convincing in principle and its adoption at scale in LMIC settings should be given serious consideration. Clinical implications Further evidence on the types of scale-up strategies that are likely to offer an effective and cost-effective means of sustaining required levels of treatment coverage will help focus efforts on approaches to scale-up that optimise resources invested in task-sharing programmes.
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Affiliation(s)
- Andrew Healey
- Health Services and Population Research, King's College London, London, UK
| | - Ruth Verhey
- Friendship Bench, Harare, Zimbabwe.,Research Support Trust, Department of Community Medicine, University of Zimbabwe, Harare, Zimbabwe
| | - Iris Mosweu
- Department of Health Policy, London School of Economics, London, UK
| | - Janet Boadu
- Health Services and Population Research, King's College London, London, UK
| | - Dixon Chibanda
- Friendship Bench, Harare, Zimbabwe.,Research Support Trust, Department of Community Medicine, University of Zimbabwe, Harare, Zimbabwe
| | | | - Brad Wagenaar
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Hugo Senra
- Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), University of Coimbra, Coimbra, Portugal.,School of Health and Social Care, University of Essex, Colchester, UK
| | | | | | - Ricardo Araya
- Health Services and Population Research, King's College London, London, UK
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48
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Bennetts A. How does yoga practice and therapy yield psychological benefits? A review and model of transdiagnostic processes. Complement Ther Clin Pract 2021; 46:101514. [PMID: 34837807 DOI: 10.1016/j.ctcp.2021.101514] [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: 07/19/2021] [Revised: 10/12/2021] [Accepted: 11/14/2021] [Indexed: 11/03/2022]
Abstract
Interest in yoga as an intervention for psychological wellbeing has increased in recent years, with literature investigating beneficial effects in a variety of presentations and settings. The theoretical understanding of this benefit has previously focused on physiological changes involved in yoga practice, however interest has turned to the potential psychological mechanisms eliciting psychological wellbeing. The current paper builds on previous theory and argues that yoga practice targets transdiagnostic psychological processes; mechanisms that feature commonly across a wide range of presentations, thus reducing distress and increasing wellbeing across clinical and non-clinical populations. Features of yoga practice are discussed in relation to these transdiagnostic processes and the features of modern talking therapies. A new model is proposed positing specific aspects of yoga practice correlate with specific transdiagnostic processes to elicit psychological change and argues that the mechanisms by which change occurs are directly compared with the changes observed in talking therapies. The implications for future research and the potential for this to support the commissioning of holistic approaches in clinical practice are discussed.
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Affiliation(s)
- Alison Bennetts
- School of Psychology, The University of Southampton, Southampton, England, SO17 1BJ, UK.
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49
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Moriarty AS, Robertson L, Mughal F, Cook N, Gilbody S, McMillan D, Chew-Graham CA, Ali S, Hetrick SE, Churchill R, Meader N. Interventions for preventing relapse or recurrence of major depressive disorder in adults in a primary care setting: a network meta-analysis. Hippokratia 2021. [DOI: 10.1002/14651858.cd014832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Andrew S Moriarty
- Mental Health and Addiction Research Group, Department of Health Sciences; University of York; York UK
- Hull York Medical School; University of York; York UK
| | - Lindsay Robertson
- Cochrane Common Mental Disorders; University of York; York UK
- Centre for Reviews and Dissemination; University of York; York UK
| | - Faraz Mughal
- School of Medicine; Keele University; Keele UK
- Unit of Academic Primary Care; Warwick Medical School, University of Warwick; Coventry UK
| | - Natalie Cook
- Tees, Esk and Wear Valleys NHS Foundation Trust; York UK
| | - Simon Gilbody
- Mental Health and Addiction Research Group, Department of Health Sciences; University of York; York UK
- Hull York Medical School; University of York; York UK
| | - Dean McMillan
- Mental Health and Addiction Research Group, Department of Health Sciences; University of York; York UK
| | | | - Shehzad Ali
- Mental Health and Addiction Research Group, Department of Health Sciences; University of York; York UK
| | - Sarah E Hetrick
- Department of Psychological Medicine, Faculty of Medical and Health Sciences; The University of Auckland; Auckland New Zealand
- Children and Young People Satellite, Cochrane Common Mental Disorders; The University of Auckland; Auckland New Zealand
| | - Rachel Churchill
- Cochrane Common Mental Disorders; University of York; York UK
- Centre for Reviews and Dissemination; University of York; York UK
| | - Nicholas Meader
- Cochrane Common Mental Disorders; University of York; York UK
- Centre for Reviews and Dissemination; University of York; York UK
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50
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Clarke J. Some very important people are depressed. Get over it! A three-part narrative review of depression memoirs in the public sphere. Part 3: the new depressives and the challenge of stigma. PSYCHOANALYTIC PSYCHOTHERAPY 2021. [DOI: 10.1080/02668734.2021.1953117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Jeremy Clarke
- Clinical Director, Albany Trust & Research Associate, Centre for Philosophy of Natural and Social Sciences, London School of Economics and Political Science, UK
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