Two birds with one stone.–Addressing depressive symptoms, emotional tension and worry improves tinnitus-related distress and affective pain perceptions in patients with chronic tinnitus

Background Psychological factors link the co-occurrence of tinnitus-related distress and pain perceptions in patients with chronic tinnitus. Objective This study examines, if treatment-related changes in these factors ameliorate both tinnitus-related distress and pain perceptions in a sample of patients with chronic tinnitus. Methods N = 1238 patients with chronic tinnitus provided pre- and post-treatment ratings of tinnitus-related distress and affective or sensory pain perceptions alongside measures of depressive symptoms and perceived stress. Treatment comprised an intensive tinnitus-specific multimodal treatment program. Using serial indirect-effects analyses, we examined association patterns between baseline values and change rates of those variables that were found to respond to treatment. Results Small effect sizes emerged for changes in tinnitus-related distress, affective (but not sensory) pain perceptions, depressive symptoms, emotional tension and worry. At pre- or post-treatment respectively, baseline values and change rates intercorrelated. Across timepoints, (1) baseline tinnitus-related distress and affective pain perceptions were positively associated with improvements in tinnitus-related distress, affective pain perceptions and depressive symptoms. (2) Baseline depressive symptoms or emotional tension mediated positive associations between baseline tinnitus-related distress and improvement in affective pain perceptions. (3) Change in depressive symptoms mediated the effect of baseline tinnitus-related distress on change in affective pain perceptions–partly through associated change in emotional tension or worry. Mood-independent aspects of emotional tension were negatively associated with improvement in affective pain perceptions. Conclusions Depressive symptoms, emotional tension and worry emerge as key predictors of treatment response and transdiagnostic treatment targets for alleviating tinnitus-related distress and functionally associated affective pain perceptions.

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Interpersonal Stress and Poor Health

European Psychologist ◽

10.1027/1016-9040/a000003 ◽

2010 ◽

Vol 15 (1) ◽

pp. 3-11 ◽

Cited By ~ 32

Author(s):

Mette M. Aanes ◽

Maurice B. Mittelmark ◽

Jørn Hetland

Keyword(s):

Psychological Distress ◽

Depressive Symptoms ◽

Social Relationships ◽

Indirect Effects ◽

Social Connectedness ◽

Somatic Symptoms ◽

Total Effect ◽

Subjective Feeling ◽

Interpersonal Stress ◽

The Relationship

This paper investigated whether the lack of social connectedness, as measured by the subjective feeling of loneliness, mediates the well-known relationship between interpersonal stress and psychological distress. Furthermore, a relationship between interpersonal stress and somatic symptoms was hypothesized. The study sample included 3,268 women and 3,220 men in Western Norway. The main findings were that interpersonal stress was significantly related to psychological distress as well as to somatic symptoms, both directly and indirectly via paths mediated by loneliness. The size of the indirect effects varied, suggesting that the importance of loneliness as a possible mediator differs for depressive symptoms, anxiety symptoms, and somatic symptoms. In the case of depressive symptoms, more than 75% of the total effect was mediated through loneliness, while in the case of somatic symptoms just over 40% of the total effect was mediated through loneliness. This study supports the hypotheses that social connectedness mediates a relationship between interpersonal stress and psychological distress. The study also provides the first link between interpersonal stress, as measured by the Bergen Social Relationships Scale, and somatic symptoms, extending earlier research on the relationship between interpersonal stress and psychological distress.

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Perceived stress and suicidal behaviors in college students: Conditional indirect effects of depressive symptoms and mental health stigma.

Stigma and Health ◽

10.1037/sah0000125 ◽

2019 ◽

Vol 4 (1) ◽

pp. 98-106 ◽

Cited By ~ 8

Author(s):

Jameson K. Hirsch ◽

Jessica Kelliher Rabon ◽

Esther E. Reynolds ◽

Alison L. Barton ◽

Edward C. Chang

Keyword(s):

Mental Health ◽

College Students ◽

Depressive Symptoms ◽

Perceived Stress ◽

Indirect Effects ◽

Mental Health Stigma ◽

Suicidal Behaviors ◽

Conditional Indirect Effects

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Long-term outcomes of psychological treatment for posttraumatic stress disorder: a systematic review and meta-analysis

Psychological Medicine ◽

10.1017/s003329172100163x ◽

2021 ◽

pp. 1-11

Author(s):

Maxi Weber ◽

Sarah Schumacher ◽

Wiebke Hannig ◽

Jürgen Barth ◽

Annett Lotzin ◽

...

Keyword(s):

Systematic Review ◽

Depressive Symptoms ◽

Stress Disorder ◽

Psychological Treatment ◽

Meta Analysis ◽

Effect Sizes ◽

Long Term Outcomes ◽

Psychological Treatments

Abstract Several types of psychological treatment for posttraumatic stress disorder (PTSD) are considered well established and effective, but evidence of their long-term efficacy is limited. This systematic review and meta-analysis aimed to investigate the long-term outcomes across psychological treatments for PTSD. MEDLINE, Cochrane Library, PTSDpubs, PsycINFO, PSYNDEX, and related articles were searched for randomized controlled trials with at least 12 months of follow-up. Twenty-two studies (N = 2638) met inclusion criteria, and 43 comparisons of cognitive behavioral therapy (CBT) were available at follow-up. Active treatments for PTSD yielded large effect sizes from pretest to follow-up and a small controlled effect size compared with non-directive control groups at follow-up. Trauma-focused treatment (TFT) and non-TFT showed large improvements from pretest to follow-up, and effect sizes did not significantly differ from each other. Active treatments for comorbid depressive symptoms revealed small to medium effect sizes at follow-up, and improved PTSD and depressive symptoms remained stable from treatment end to follow-up. Military personnel, low proportion of female patients, and self-rated PTSD measures were associated with decreased effect sizes for PTSD at follow-up. The findings suggest that CBT for PTSD is efficacious in the long term. Future studies are needed to determine the lasting efficacy of other psychological treatments and to confirm benefits beyond 12-month follow-up.

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Effectiveness of transdiagnostic seminars to support patients with common mental disorders: a multi-service practice research network study

Behavioural and Cognitive Psychotherapy ◽

10.1017/s1352465821000114 ◽

2021 ◽

pp. 1-13

Author(s):

Chris Gaskell ◽

Ryan Askey-Jones ◽

Martin Groom ◽

Jaime Delgadillo

Keyword(s):

Treatment Effect ◽

High Intensity ◽

Post Treatment ◽

Waiting List ◽

Effect Sizes ◽

Research Network ◽

Randomised Control Trial ◽

Practice Research ◽

Matched Sample ◽

Post Treatment Effect

Abstract Background: This was a multi-site evaluation of psycho-educational transdiagnostic seminars (TDS) as a pre-treatment intervention to enhance the effectiveness and utilisation of high-intensity cognitive behavioural therapy (CBT). Aims: To evaluate the effectiveness of TDS combined with high-intensity CBT (TDS+CBT) versus a matched sample receiving CBT only. Second, to determine the consistency of results across participating services which employed CBT+TDS. Finally, to determine the acceptability of TDS across patients with different psychological disorders. Method: 106 patients across three services voluntarily attended TDS while on a waiting list for CBT (TDS+CBT). Individual and pooled service pre–post treatment effect sizes were calculated using measures of depression, anxiety and functional impairment. Effectiveness and completion rates for TDS+CBT were compared with a propensity score matched sample from an archival dataset of cases who received high-intensity CBT only. Results: Pre–post treatment effect sizes for TDS+CBT were comparable to the matched sample. Recovery rates were greater for the group receiving TDS; however, this was not statistically significant. Greater improvements were observed during the waiting-list period for patients who had received TDS for depression (d = 0.49 compared with d = 0.07) and anxiety (d = 0.36 compared with d = 0.04). Conclusions: Overall, this new evidence found a trend for TDS improving symptoms while awaiting CBT across three separate IAPT services. The effectiveness of TDS now warrants further exploration through an appropriately sized randomised control trial.

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663 Improved Sleep After a Brief Intervention for Insomnia Mediates Improvements in Depression Symptoms During the COVID-19 Pandemic

SLEEP ◽

10.1093/sleep/zsab072.661 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A259-A259

Author(s):

Kathleen O’Hora ◽

Mateo Lopez ◽

Allison Morehouse ◽

Andrea Cordero ◽

Raquel Osorno ◽

...

Keyword(s):

Depressive Symptoms ◽

Outcome Measures ◽

Symptom Severity ◽

Post Treatment ◽

Symptom Improvement ◽

Depression Symptoms ◽

Insomnia Symptom ◽

The Impact ◽

Insomnia Symptoms ◽

Rate Of Improvement

Abstract Introduction The COVID-19 Pandemic and mitigation efforts have led to drastic increases in acute insomnia symptoms, which left untreated may contribute to increased risk for other negative mental health outcomes, including depression. However, the impact of treating acute insomnia symptoms on future depression outcomes remains unknown. Moreover, whether sleep improvements as a result of an insomnia treatment mediate subsequent reduction of depression symptoms similarly remains unknown. Methods At this writing, 44 individuals experiencing insomnia symptoms (Insomnia Severity Index; ISI ≥ 10) that began during the COVID-19 pandemic have been randomized to receive a brief, telehealth Cognitive Behavioral Therapy for Insomnia (CBTI) waitlist control. Treatment was delivered in 4 sessions over a 5-week period. CBTI is the gold-standard behavioral intervention for chronic insomnia and has been applied successfully via telemedicine. Outcome measures were depressive symptoms as measured by the Patient Health Questionnare-9 (PHQ-9) minus the sleep item and insomnia symptom severity as measured by the ISI. Both outcome measures were collected at baseline (week 0), throughout treatment phase (weeks 2–6), and at the post-treatment (week 7). Linear mixed models determined the impact of treatment on depression and insomnia symptom severity. Mediation was tested using the MacArthur framework. Results There was a significant Group x Time interaction, with CBTI leading to a greater rate of improvement in ISI (b = -1.14, p < 0.001) and PHQ-9 (b = -0.61, p = 0.002) than the control. Critically, the rate of improvement in insomnia symptoms to the last session of treatment, was associated with the subsequent improvement in depressive symptoms post-treatment (b = 2.06, p = 0.017). In contrast, depressive symptom improvement was not associated with insomnia symptom improvement (b = 4.28, p = 0.102). Conclusion This preliminary data suggests that brief CBTI can reduce pandemic onset insomnia and other depressive symptoms. The preliminary mediation results further suggest that sleep may be an important treatment target for reducing situational depressive symptoms and supports the need to examine the physiological mechanisms of sleep using high-density EEG in a larger sample. Support (if any):

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Effectiveness of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders Among Veterans With Posttraumatic Stress Disorder: A Pilot Study

Behavior Modification ◽

10.1177/0145445517724539 ◽

2017 ◽

Vol 42 (2) ◽

pp. 210-230 ◽

Cited By ~ 7

Author(s):

Ruth L. Varkovitzky ◽

Andrew M. Sherrill ◽

Greg M. Reger

Keyword(s):

Posttraumatic Stress Disorder ◽

Emotion Regulation ◽

Depressive Symptoms ◽

Pilot Study ◽

Posttraumatic Stress ◽

Emotional Disorders ◽

Symptom Severity ◽

Stress Disorder ◽

Transdiagnostic Treatment ◽

Unified Protocol

Effective treatment options are needed for veterans who do not participate in trauma-focused psychotherapy. Research has yet to examine the effectiveness of transdiagnostic psychotherapy in veterans with posttraumatic stress disorder (PTSD) and co-occurring psychological disorders. This pilot study examined the effectiveness of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) delivered in a 16-week group format. We examined treatment outcomes in male and female veterans ( n = 52) in an outpatient specialty PTSD clinic at a large Veterans Affairs (VA) medical center. We hypothesized significant decreases in emotion regulation difficulty (Difficulties in Emotion Regulation Scale), PTSD symptom severity (PTSD Checklist for DSM-5), and depressive symptom severity (Patient Health Questionnaire–9). In addition, we hypothesized that reductions in emotion regulation difficulty across treatment would negatively predict PTSD and depressive symptoms at posttreatment. PTSD symptoms, depressive symptoms, and emotion regulation difficulty all evidenced significant improvements at the end of treatment relative to baseline ( ps < .001). In addition, reductions in emotion regulation across treatment were associated with lower PTSD and depressive symptoms at posttreatment ( ps < .001). This pilot study provides preliminary evidence supporting use of UP among veterans with PTSD and co-occurring disorders. Well-designed clinical trials evaluating efficacy of UP among veterans are needed.

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Effectiveness of Attachment-Based Family Therapy compared to Treatment as Usual for Depressed Adolescents in Community Mental Health Clinics

10.21203/rs.3.rs-16225/v7 ◽

2021 ◽

Author(s):

Luxsiya Waraan ◽

Erling W. Rognli ◽

Nikolai Olavi Czajkowski ◽

Marianne Aalberg ◽

Lars Mehlum

Keyword(s):

Mental Health ◽

Depressive Symptoms ◽

Family Therapy ◽

Depression Scale ◽

Small Sample ◽

Post Treatment ◽

Treatment Manual ◽

Future Research ◽

Hamilton Depression Scale ◽

Treatment As Usual

Abstract Background: Major Depressive Disorder (MDD) is a disabling mood disorder, profoundly affecting a large number of adolescent’s quality of life. To date, no obvious treatment of choice for MDD in adolescents is available and progress in the treatment of depressed adolescents will have important public health implications. Attachment-Based Family Therapy (ABFT), as the only empirically supported family therapy model designed to treat adolescent depression, aims to repair interpersonal ruptures and rebuild an emotionally protective parent-child relationship. Objective: To study the effectiveness of ABFT compared with treatment as usual (TAU) delivered within child- and adolescent mental health services (CAMHS) to adolescents with MDD.Method: Sixty adolescents (86.7% girls), aged 13-18 years (M = 14.9, SD = 1.35), with MDD referred to two CAMHS were randomized to 16 weeks of ABFT or TAU. ABFT consisted of weekly therapy sessions (family/individual or both) according to the treatment manual. TAU was not monitored. Primary outcomes were assessed by blinded evaluators at baseline and post-treatment with the Hamilton Depression Scale (HAMD). Self-reported (Beck Depression Inventory-II, BDI-II) depressive symptoms were assessed at baseline, and after 4, 6, 8, 10,12, 14, and 16 weeks. Analyses were performed according to intent-to-treat principles. Results: At post-treatment, clinician-rated remission rates on the HAMD (5 % in ABFT and 3.33% in TAU, p =1, OR=1.54, Fisher’s exact test) and self-reported symptoms of depression on the BDI-II did not differ significantly between groups (X2[2, N = 60] =0.06 , p = 0.97). In both treatment groups participants reported significantly reduced depressive symptoms, but the majority (63.3 %) of adolescents were still in the clinical range after 16 weeks of treatment. Conclusion: ABFT was not superior to TAU. Remission and response rates were low in both groups, suggesting none of the treatments were effective in treating MDD in adolescents. Findings must be viewed in the context of the study’s small sample size, missing data, and implementation challenges. Continued efforts to improve treatment for MDD in outpatient clinics are warranted . Future research should examine moderators of and mechanisms for individual differences to treatment response, as well as the feasibility and cost-effectiveness of implementing treatment models which may require extensive training and expertise to yield clinically meaningful improvements in non-research settings. Trial Registration: Clinicaltrials.gov identifier: NCT01830088 https://clinicaltrials.gov/ct2/show/NCT01830088?term=Villab%C3%B8&draw=2&rank=1 Date of registration: April 12, 2013

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Central Sensitization in Neurological, Psychiatric, and Pain Disorders: A Multicenter Case-Controlled Study

Pain Research and Management ◽

10.1155/2021/6656917 ◽

2021 ◽

Vol 2021 ◽

pp. 1-8

Author(s):

Keisuke Suzuki ◽

Yasuo Haruyama ◽

Gen Kobashi ◽

Toshimi Sairenchi ◽

Koji Uchiyama ◽

...

Keyword(s):

Depressive Symptoms ◽

Central Sensitization ◽

Pain Severity ◽

Pain Interference ◽

Daily Activities ◽

Effect Sizes ◽

Medium Effect ◽

Controlled Study ◽

Severity Scores ◽

The Impact

Background. The role of central sensitization in refractory pain-related diseases has not yet been clarified. Methods. We performed a multicenter case-controlled study including 551 patients with various neurological, psychological, and pain disorders and 5,188 healthy controls to investigate the impact of central sensitization in these patients. Symptoms related to central sensitization syndrome (CSS) were assessed by the Central Sensitization Inventory (CSI) parts A and B. Patients were categorized into 5 groups based on CSI-A scores from subclinical to extreme. The Brief Pain Inventory (BPI), addressing pain severity and pain interference with daily activities, and the Patient Health Questionnaire (PHQ)-9, assessing depressive symptoms, were also administered. Results. CSI-A scores and CSI-B disease numbers were significantly greater in patients than in controls ( p < 0.001 ). Medium effect sizes (r = 0.37) for CSI-A scores and large effect sizes (r = 0.64) for CSI-B disease numbers were found between patients and control groups. Compared with the CSI-A subclinical group, the CSI-A mild, moderate, severe, and extreme groups had significantly higher BPI pain interference and severity scores, PHQ-9 scores, and CSS-related disease numbers based on ANCOVA. Greater CSI-B numbers resulted in higher CSI-A scores ( p < 0.001 ) and a higher odds ratio ( p for trend <0.001). CSS-related symptoms were associated with pain severity, pain interference with daily activities, and depressive symptoms in various pain-related diseases. Conclusions. Our findings suggest that CSS may participate in these conditions as common pathophysiology.

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Abstract P314: Physical Activity-Mediated Associations of Perceived Neighborhood Violence and Problems on Depressive Symptoms Among Jackson Heart Study Participants

Circulation ◽

10.1161/circ.141.suppl_1.p314 ◽

2020 ◽

Vol 141 (Suppl_1) ◽

Author(s):

Kosuke Tamura ◽

Steven D Langerman ◽

Stephanie L Orstad ◽

Sam J Neally ◽

Marcus R Andrews ◽

...

Keyword(s):

Physical Activity ◽

Depressive Symptoms ◽

Social Cohesion ◽

Indirect Effects ◽

Epidemiological Studies ◽

Jackson Heart Study ◽

Neighborhood Violence ◽

Community Based ◽

Heart Study ◽

Study Participants

Introduction: Little is known about whether links between perceived neighborhood social environment (PNSE) and depressive symptoms are mediated by physical activity (PA) levels. Hypothesis: We tested the hypotheses that total PA mediates relations between PNSE and depressive symptoms. Methods: We used Jackson Heart Study (JHS) baseline data. JHS is a prospective, community-based study of African Americans in the Jackson, MS (valid samples=2082; M age 52.4 years; 64% female). PNSE variables included neighborhood violence, problems (higher value=more violence or problems), and social cohesion (higher value=more cohesion). Depressive symptoms were measured by the Center for Epidemiological Studies Depression (CES-D) scale. Validated total PA, based on active living, sport, and work indices, was tested as the mediator. Linear regressions with bootstrap-generated 95% bias-corrected confidence intervals (BC CIs) were estimated using SAS 9.4 to test for significant unstandardized indirect effects, controlling for all covariates. Results: Participants had a mean depressive symptoms score of 10.8 ( SD =8.1). Neighborhood violence and problems were indirectly related to depressive symptoms via total PA ( β for indirect effects=.21, 95% BC CI =.02, .48 and .13, 95% BC CI =.01, .32, respectively). That is, higher violence and problems were related to lower total PA. In turn, higher total PA was associated with lower depressive symptoms ( Figure 1 ). Neighborhood violence and problems also were directly related to depressive symptoms ( p <.05). Yet, social cohesion was not indirectly or directly related to depressive symptoms. Conclusions: Higher perceived neighborhood violence and problems were positively related to depressive symptoms. These associations may be explained in part via lower total PA levels. Future interventions to reduce depressive symptoms attributed to neighborhood issues should consider PA promotion in conjunction with community efforts to reduce neighborhood violence and problems.

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Facilitating access to iCBT: a randomized controlled trial assessing a translated version of an empirically validated program using a minimally monitored delivery model

Behavioural and Cognitive Psychotherapy ◽

10.1017/s135246581900047x ◽

2019 ◽

Vol 48 (2) ◽

pp. 185-202

Author(s):

Miguel Robichaud ◽

France Talbot ◽

Nickolai Titov ◽

Blake F. Dear ◽

Heather D. Hadjistavropoulos ◽

...

Keyword(s):

Treatment Group ◽

Outcome Measures ◽

Primary Outcome ◽

Controlled Trial ◽

Post Treatment ◽

Effect Sizes ◽

Anxiety And Depression ◽

Control Group ◽

Access To Treatment ◽

Delivery Model

AbstractBackground:Despite its established efficacy, access to internet-delivered CBT (iCBT) remains limited in a number of countries. Translating existing programs and using a minimally monitored model of delivery may facilitate its dissemination across countries.Aims:This randomized control trial aims to evaluate the efficacy of an iCBT transdiagnostic program translated from English to French and offered in Canada using a minimally monitored delivery model for the treatment of anxiety and depression.Method:Sixty-three French speakers recruited in Canada were randomized to iCBT or a waiting-list. A French translation of an established program, the Wellbeing Course, was offered over 8 weeks using a minimally monitored delivery model. Primary outcome measures were the Generalized Anxiety Disorder-7 (GAD-7) and the Patient Health Questionnaire-9 (PHQ-9), which were obtained pre-treatment, post-treatment and at 3-month follow-up.Results:Mixed-effects models revealed that participants in the treatment group had significantly lower PHQ-9 and GAD-7 scores post-treatment than controls with small between-groups effect sizes (d = 0.34 and 0.37, respectively). Within-group effect sizes on primary outcome measures were larger in the treatment than control group. Clinical recovery rates on the PHQ-9 and GAD-7 were significantly higher among the treatment group (40 and 56%, respectively) than the controls (13 and 16%, respectively).Conclusions:The provision of a translated iCBT program using a minimally monitored delivery model may improve patients’ access to treatment of anxiety and depression across countries. This may be an optimal first step in improving access to iCBT before sufficient resources can be secured to implement a wider range of iCBT services.

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