scholarly journals Are Changes in Beliefs About Rumination and in Emotion Regulation Skills Mediators of the Effects of Internet-Delivered Cognitive-Behavioral Therapy for Depression and Anxiety? Results from a Randomized Controlled Trial

2021 ◽  
Author(s):  
Angel Enrique ◽  
Nora Eilert ◽  
Rebecca Wogan ◽  
Caroline Earley ◽  
Daniel Duffy ◽  
...  
Keyword(s):  
Emotion Regulation ◽  
Behavioral Therapy ◽  
Controlled Trial ◽  
Secondary Analysis ◽  
Depression And Anxiety ◽  
Expressive Suppression ◽  
Mediation Analyses ◽  
Face To Face ◽  
Symptoms Of Depression ◽  
Trial Testing

Abstract Background Internet-delivered cognitive behavior therapy (iCBT) is effective in treating anxiety and depression. Research on how these interventions operate is scarce. This study explored whether emotion regulation skills and positive beliefs about rumination were affected by iCBT and if these constructs mediated changes in depression and anxiety. Methods This is a secondary analysis of a pragmatic randomized waitlist-controlled trial testing the effectiveness of supported iCBT. Adults with at least mild symptoms of depression or anxiety were included. Depression (PHQ-9), anxiety (GAD-7), positive beliefs about rumination (PBRS-A) and two emotion regulation skills: cognitive reappraisal (ERQ-A) and expressive suppression (ERQ-S), were measured at baseline and 8-weeks post-treatment. Results The analyses included 358 participants, 71% were female. Median age was 29. Linear mixed models showed statistically significant differences along ERQ-A in favor of the iCBT group (b = 1.83, SE = 0.82, p = .026). Mediation analyses showed reductions in depression (b = 0.31, SE = 0.15, p = 0.043) and anxiety symptoms (b = 0.27, SE = 0.14, p = 0.057) were partially mediated by gains in ERQ-A. No effects were observed for PBRS-A and ERQ-S. Conclusions These results align with findings from face-to-face therapy and add to the scarce literature on mediators of effects of iCBT, contributing to the understanding of how these interventions operate. Since mediator and outcome variables were measured at the same time, partial mediation results should be interpreted with caution since the study design did not account for temporality and therefore causality effects cannot be confirmed. Trial Registration ISRCTN91967124.

scholarly journals Computerized Cognitive Behavioral Therapy to Treat Emotional Distress After Stroke: A Feasibility Randomized Controlled Trial

2017 ◽  
Vol 4 (2) ◽  
pp. e16 ◽  
Author(s):  
Sara K Simblett ◽  
Matthew Yates ◽  
Adam P Wagner ◽  
Peter Watson ◽  
Fergus Gracey ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Cognitive Behavioral Therapy ◽  
Trial Design ◽  
Behavioral Therapy ◽  
Controlled Trial ◽  
Cognitive Behavioral ◽  
Depression And Anxiety ◽  
Active Comparator ◽  
Symptoms Of Depression ◽  
Randomized Controlled

Background Depression and anxiety are common complications following stroke. Symptoms could be treatable with psychological therapy, but there is little research on its efficacy. Objectives The aim of this study was to investigate (1) the acceptability and feasibility of computerized cognitive behavioral therapy (cCBT) to treat symptoms of depression and anxiety and (2) a trial design for comparing the efficacy of cCBT compared with an active comparator. Methods Of the total 134 people screened for symptoms of depression and anxiety following stroke, 28 were cluster randomized in blocks with an allocation ratio 2:1 to cCBT (n=19) or an active comparator of computerized cognitive remediation therapy (cCRT, n=9). Qualitative and quantitative feedback was sought on the acceptability and feasibility of both interventions, alongside measuring levels of depression, anxiety, and activities of daily living before, immediately after, and 3 months post treatment. Results Both cCBT and cCRT groups were rated as near equally useful (mean = 6.4 vs 6.5, d=0.05), while cCBT was somewhat less relevant (mean = 5.5 vs 6.5, d=0.45) but somewhat easier to use (mean = 7.0 vs 6.3, d=0.31). Participants tolerated randomization and dropout rates were comparable with similar trials, with only 3 participants discontinuing due to potential adverse effects; however, dropout was higher from the cCBT arm (7/19, 37% vs 1/9, 11% for cCRT). The trial design required small alterations and highlighted that future-related studies should control for participants receiving antidepressant medication, which significantly differed between groups (P=.05). Descriptive statistics of the proposed outcome measures and qualitative feedback about the cCBT intervention are reported. Conclusions A pragmatic approach is required to deliver computerized interventions to accommodate individual needs. We report a preliminary investigation to inform the development of a full randomized controlled trial for testing the efficacy of computerized interventions for people with long-term neurological conditions such as stroke and conclude that this is a potentially promising way of improving accessibility of psychological support.

scholarly journals Italia Ti Ascolto [Italy, I am listening]: an app-based group psychological intervention during the COVID-19 pandemic

2021 ◽  
Vol 24 (1) ◽  
Author(s):  
Laura Antonia Lucia Parolin ◽  
Ilaria Maria Antonietta Benzi ◽  
Erika Fanti ◽  
Alberto Milesi ◽  
Pietro Cipresso ◽  
...  
Keyword(s):  
Social Support ◽  
Emotion Regulation ◽  
Perceived Social Support ◽  
Psychological Intervention ◽  
Emotion Regulation Strategies ◽  
Expressive Suppression ◽  
Psychological Variables ◽  
Symptoms Of Depression ◽  
Intervention Protocol ◽  
Regulation Strategies

The onset of the coronavirus disease 2019 (COVID-19) pandemic impacted individuals’ psychological wellbeing resulting in heightened perceived stress, anxiety, and depression. However, a significant issue in accessing psychological care during a lockdown is the lack of access to in-person interventions. In this regard, research has shown the efficacy and utility of psychological app-based interventions. ‘Italia Ti Ascolto’ (ITA) has been developed as a population tailored internet-based intervention to offer an online professional solution for psychological support needs. The ITA app is available on iOS and Android systems. Users completed a baseline assessment on emotion regulation strategies (cognitive reappraisal and expressive suppression), psychological stress, anxiety, depression, and perceived social support. Participants could select among several one-hour long clinical groups held by expert psychotherapists. After every session, people were asked to complete a quick users’ satisfaction survey. Our contribution presents ITA’s intervention protocol and discusses preliminary data on psychological variables collected at baseline. Data showed significant associations between emotion regulation strategies, symptoms of depression and anxiety, and level of stress. Moreover, the role of perceived social support is considered. Future developments and implications for clinical practice and treatment are discussed.

scholarly journals Blended Care-Cognitive Behavioral Therapy for Depression and Anxiety in Real-World Settings: Pragmatic Retrospective Study (Preprint)

2020 ◽  
Author(s):  
Anita Lungu ◽  
Janie Jihee Jun ◽  
Okhtay Azarmanesh ◽  
Yan Leykin ◽  
Connie E-Jean Chen
Keyword(s):  
Cognitive Behavioral Therapy ◽  
Real World ◽  
Behavioral Therapy ◽  
Anxiety Symptoms ◽  
Cognitive Behavioral ◽  
Depression And Anxiety ◽  
Symptoms Of Depression ◽  
Care Intervention ◽  
Blended Care ◽  
Over Time

BACKGROUND The past few decades saw considerable advances in research and dissemination of evidence-based psychotherapies, yet available treatment resources are not able to meet the high need for care for individuals suffering from depression or anxiety. Blended care psychotherapy, which combines the strengths of therapist-led and internet interventions, can narrow this gap and be clinically effective and efficient, but has rarely been evaluated outside of controlled research settings. OBJECTIVE This study evaluated the effectiveness of a blended care intervention (video-based cognitive behavior therapy and internet intervention) under real-world conditions. METHODS This is a pragmatic retrospective cohort analysis of 385 participants with clinical range depression and/or anxiety symptoms at baseline, measured using Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7), who enrolled in blended care psychotherapy treatment. Participants resided in the United States and had access to the blended care intervention as a mental health benefit offered through their employers. Levels of depression and anxiety were tracked throughout treatment. Hierarchical linear modeling was used to examine the change in symptoms over time. The effects of age, gender, and providers on participants’ symptom change trajectories were also evaluated. Paired sample t-tests were also conducted, and rates of positive clinical change and clinically significant improvement were calculated. RESULTS The average depression and anxiety symptoms at 6 weeks after the start of treatment were 5.94 and 6.57, respectively. There were significant linear effects of time on both symptoms of depression and anxiety (β=–.49, <i>P</i>&lt;.001 and β=–.64, <i>P</i>&lt;.001). The quadratic effect was also significant for both symptoms of depression and anxiety (β=.04, P&lt;.001 for both), suggesting a decelerated decrease in symptoms over time. Approximately 73% (n=283) of all 385 participants demonstrated reliable improvement, and 83% (n=319) recovered on either the PHQ-9 or GAD-7 measures. Large effect sizes were observed on both symptoms of depression (Cohen d=1.08) and of anxiety (d=1.33). CONCLUSIONS Video blended care cognitive behavioral therapy interventions can be effective and efficient in treating symptoms of depression and anxiety in real-world conditions. Future research should investigate the differential and interactive contribution of the therapist-led and digital components of care to patient outcomes to optimize care.

Improved Mood Boosts Memory Training Gains in Older Adults With Subjective Memory Complaints: A Randomized Controlled Trial

2021 ◽  
Author(s):  
Shufei Yin ◽  
Xinyi Zhu ◽  
Rui Li ◽  
Lijuan Huo ◽  
Weicong Ren ◽  
...  
Keyword(s):  
Older Adults ◽  
Group Counseling ◽  
Controlled Trial ◽  
Memory Performance ◽  
Anxiety And Depression ◽  
Memory Training ◽  
Depression And Anxiety ◽  
Subjective Memory ◽  
Post Intervention ◽  
Symptoms Of Depression

Abstract Objective: Older adults with subjective memory complaints (SMC) have a higher risk of dementia and commonly demonstrate symptoms of depression and anxiety. The study aimed to examine the effect of a memory training program for individuals with SMC, and whether memory training combined with group counseling aimed at alleviating depression and anxiety would boost memory training gains.Design: A three-armed, double-blind, randomized controlled trial.Setting and Participants: Community-dwelling older adults with SMC, aged ≥ 60 years.Methods: Participants (n = 124) were randomly assigned to memory training (MT), group counseling (GC), or GC+MT intervention. The GT+MT group received 4-hour group counseling followed by a 4-week memory training, while the MT group attended reading and memory training, and the GC group received group counseling and health lectures. Cognitive function and symptoms of depression and anxiety were assessed at baseline, mid-, and post-intervention. The GC+MT group and GC group had resting-state functional magnetic resonance imaging at mid- and post-intervention.Results: After group counseling, the GC+MT and GC groups showed reduced symptoms of anxiety and depression, compared to the MT group. Memory training enhanced memory performance in both MT and GC+MT groups, but the GC+MT group demonstrated larger memory improvement (Cohen’s d = 0.96) than the MT group (Cohen’s d = 0.62). Amygdala-hippocampus connectivity was associated with improved mood and memory gains.Conclusion and Implications: Group counseling reduced symptoms of anxiety and depression, and memory training enhanced memory performance. Specifically, improved mood induced larger memory training effects. The results suggest that it may need to include treatment for depression and anxiety in memory intervention for older adults with SMC.Trial Registration: ChiCTR-IOR-15006165 in the Chinese Clinical Trial Registry.

Effectiveness of Prompt Mental Health Care: Preliminary results from a randomized controlled trial

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
M Knapstad ◽  
L V Lervik ◽  
S M M Saether ◽  
L E Aaroe ◽  
O R F Smith
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Randomized Controlled Trial ◽  
Mental Health Care ◽  
Controlled Trial ◽  
Sensitivity Analyses ◽  
Depression And Anxiety ◽  
Symptoms Of Depression ◽  
Randomized Controlled

Abstract Background Prompt Mental Health Care (PMHC) service is a Norwegian initiative, adapted from the English ‘Improved Access to Psychological Therapy’ (IAPT), aimed at improving access to primary care treatment for anxiety and depression. Thus far, both PMHC and IAPT have been evaluated by cohort studies only. Albeit yielding promising results, the extent to which these are attributable to the treatment thus remains unsettled. This study investigates the effectiveness of PMHC compared to treatment as usual (TAU) at six months follow-up. Methods Randomized controlled trial with parallel assignment in two PMHC sites from November 2015 to March 2018. Participants were 681 adults (aged ≥18 years) considered for admission to PMHC due to anxiety and/or mild to moderate depression. These were randomly assigned on a 70:30 ratio. Main outcomes were recovery rates and changes in symptoms of depression and anxiety between baseline and follow-up. Primary outcome data were available for 73%/67% in the PMHC/TAU group. Sensitivity analyses based on observed patterns of missingness were conducted. Results A reliable recovery rate of 58.5% was observed in the PMHC group and 31.9% in the TAU group, yielding a between-group effect size (ES) of 0.61 [95% CI 0.37-0.85, p&lt;.001]. The differences in degree of improvement between PMHC and TAU yielded an ES of -0.88 [95% CI -1.23-0.43, p &lt; 0.001] for symptoms of depression and -0.60 [95% CI -0.90-0.30, p &lt; 0.001] for symptoms of anxiety in favour of PMHC. All sensitivity analyses pointed in the same direction with small variations in point estimates. Findings were slightly more robust for depressive than anxiety symptoms. Conclusions The PMHC treatment was substantially more effective than TAU in alleviating symptoms of anxiety and depression. This adaptation of IAPT is considered a viable supplement to existing health services to increase access of effective treatment for adults who suffer from anxiety and mild to moderate depression. Key messages This study is the first to evaluate the effectiveness of an IAPT-like treatment model in terms of a randomized controlled trial. Prompt Mental Health Care was substantially more effective than TAU in alleviating symptoms of depression and anxiety at 6-months follow-up.

Mental distress in mothers of young children in Harrogate

1984 ◽  
Vol 14 (2) ◽  
pp. 391-399 ◽  
Author(s):  
Ian Berg ◽  
Alan Butler ◽  
Jackson Houston ◽  
Ralph McGuire
Keyword(s):  
General Practice ◽  
Depressive Symptoms ◽  
Young Children ◽  
Mental Distress ◽  
Controlled Trial ◽  
Personal Relationships ◽  
Depression And Anxiety ◽  
Symptoms Of Depression

SynopsisTwo hundred and forty women with young children who were patients in a Harrogate general practice were studied. About a third of them were found to be suffering from ‘mental distress’. Younger mothers were more affected. The number and spacing of their children were not related to symptoms of depression and anxiety, but poor personal relationships and difficulties getting out and about were so related, despite relatively affluent circumstances. Children of distressed mothers were more inclined to be disturbed. A controlled trial using amitryptyline involving 25 of the women suggested that this drug can improve depressive symptoms under these circumstances and that the improvement is likely to be maintained over the course of a year.

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