Neurocognitive mechanisms of change following Preventive Cognitive Therapy for preventing relapse in depression: a randomized controlled trial.

Major Depressive Disorder (MDD) is a prevalent psychiatric disorder, characterized by high relapse risk. With every new episode, risk for relapse increases. This makes preventing relapse an important clinical target in limiting the personal and societal burden of MDD. Preventive Cognitive Therapy (PCT) is a protocolized psychological therapy which has shown to lower relapse risk. How PCT attains its effects needs further elucidation. Understanding the treatment mechanisms provides a window to identify critical target points to prevent depressive relapse. In this randomized controlled trial, 50 patients remitted from at least two depressive episodes in the past five years were randomized to eight sessions of PCT (n=25) or to a waiting list condition (n=25) in the context of the NEWPRIDE trial. Primary outcome measures were changes in brain activation during effortful emotion regulation and in biased processing, covering both negative and positive valence dimensions. All patients were assessed twice (baseline and three-month follow-up) for these outcome measures, as well as their diagnosis, symptomatology, cognitive and affective reactivity, and emotion regulation styles. Linear Mixed Models and Repeated Measures ANOVAs were conducted to objectify the immediate changes induced by the therapy in brain reactivity, and clinical and cognitive measures. Following PCT, patients showed decreased recruitment of dorsomedial prefrontal regions during upregulation of positive affect and stable recruitment of the pregenual anterior cingulate cortex during regulation of emotions over valences, compared to the waiting list. No effects on biased processing of emotional information were observed. Furthermore, PCT resulted in a lower increase of depressive symptomatology over three months as compared to the waiting list condition. Finally, PCT resulted in increased activation of positive thoughts following reading positive self-related scenarios, lower responsivity of negative affect to negative stimuli and increased successful application of cognitive reappraisal to modify affective states. These results suggest that PCT obtains its relapse preventing effects by targeting mechanisms that underpin regulation of mood. More specifically, changes in regulation of positive affect and content of positive cognitions may decrease negative mood and affect. This supports cross-valence compensatory models of cognitive therapy and suggests that strengthening and shifting cognition and affect to more positive content may guard against the activation of negative cognitions and affect in the face of daily hassles and life events.

Studying visual search without an eye tracker: an assessment of artificial foveation

Eye tracking is a useful tool for studying human cognition, both in the laboratory and in real-world applications. However, there are cases in which eye tracking is not possible, such as in high-security environments where recording devices cannot be introduced. After facing this challenge in our own work, we sought to test the effectiveness of using artificial foveation as an alternative to eye tracking for studying visual search performance. Two groups of participants completed the same list comparison task, which was a computer-based task designed to mimic an inventory verification process that is commonly performed by international nuclear safeguards inspectors. We manipulated the way in which the items on the inventory list were ordered and color coded. For the eye tracking group, an eye tracker was used to assess the order in which participants viewed the items and the number of fixations per trial in each list condition. For the artificial foveation group, the items were covered with a blurry mask except when participants moused over them. We tracked the order in which participants viewed the items by moving their mouse and the number of items viewed per trial in each list condition. We observed the same overall pattern of performance for the various list display conditions, regardless of the method. However, participants were much slower to complete the task when using artificial foveation and had more variability in their accuracy. Our results indicate that the artificial foveation method can reveal the same pattern of differences across conditions as eye tracking, but it can also impact participants’ task performance.

Development of the Top Tips Habit-Based Weight Loss App and Preliminary Indications of Its Usage, Effectiveness, and Acceptability: Mixed-Methods Pilot Study (Preprint)

BACKGROUND The Ten Top Tips (10TT) is an intervention based on the habit formation theory that promotes a set of weight management behaviors alongside advice about repetition in a consistent context. Overall, 3 studies have demonstrated that the 10TT can support individuals to lose weight when delivered in a leaflet format. Delivery of 10TT via new technology such as a mobile app could potentially improve its effectiveness and make it more convenient, appealing, and wide reaching. OBJECTIVE This study aimed to provide preliminary indications of the usage, effectiveness, and acceptability of an Android app of the 10TT intervention (Top Tips only app) and a second version including self-regulatory strategies for dealing with tempting foods (Top Tips plus app). METHODS The 3-month pilot randomized adults with overweight or obesity to (1) Top Tips only app, (2) Top Tips plus app, or (3) waiting list condition. Automated data from app users were collected. Validated questionnaires assessed self-regulatory skills, weight loss (kg), and behaviors at baseline and 3 months. Users’ feedback on their experience using the app was assessed using open questions. RESULTS A total of 81 participants took part in the pilot; 28 participants were randomized to the Top Tips only app, 27 to the Top Tips plus app, and 26 to the waiting list condition. On average, participants viewed a mean of 43.4 (SD 66.9) screens during a mean of 24.5 (SD 44.07) log-ins and used the app for 124.2 (SD 240.2) min over the 3-month period. Participants randomized to the Top Tips only app reported the greatest improvement in self-regulatory skills (mean 0.59, SD 1.0), weight loss (mean 4.5 kg, SD 5.2), and adherence to the target behaviors (mean 0.59, SD 0.49) compared with the Top Tips plus (meanself-regulation 0.15, SD 0.42; meanweight −1.9, SD 3.9; and meanbehaviors 0.29, SD 0.29) and waiting list condition (meanself-regulation −0.02, SD 0.29; meanweight −0.01, SD 0.51; and meanbehaviors 0.08, SD 0.38). Participants who reported the largest improvements, on average, viewed pages 2 to 3 times more, had 2 to 3 times more log-ins, logged their weight 2 to 3 times more, and achieved the tips more than those who reported smaller changes in these outcomes. According to users’ feedback, engagement with the app could be increased by making the app more interactive and allowing more tailoring. CONCLUSIONS This study suggests that the Top Tips app could potentially be a useful intervention for promoting eating self-regulatory skills, weight loss, and weight management behaviors among adults with overweight or obesity. Future research should develop the app further based on user feedback and test it in larger sample sizes. CLINICALTRIAL ISRCTN Registry ISRCTN10470937; http://www.isrctn.com/ISRCTN10470937 (Archived by Webcite at http://www.webcitation.org/76j6rQibI)

Prolonged exposure and EMDR for PTSDv. a PTSD waiting-list condition: effects on symptoms of psychosis, depression and social functioning in patients with chronic psychotic disorders

BackgroundIn patients with psychotic disorders, the effects of psychological post-traumatic stress disorder (PTSD) treatment on symptoms of psychosis, depression and social functioning are largely unknownMethodIn a single-blind randomized controlled trial (RCT) 155 outpatients in treatment for psychosis (61.3% schizophrenic disorder, 29% schizoaffective disorder) were randomized to eight sessions prolonged exposure (PE;n= 53) or eye movement desensitization and reprocessing (EMDR) (n= 55), or a waiting-list condition (WL,n= 47) for treatment of their co-morbid PTSD. Measures were performed on (1) psychosis: severity of delusions (PSYRATS-DRS), paranoid thoughts (GPTS), auditory verbal hallucinations (PSYRATS-AHRS), and remission from psychotic disorder (SCI-SR-PANSS); (2) depression (BDI-II); (3) social functioning (PSP). Outcomes were compared at baseline, post-treatment, 6-month follow-up and over all data points.ResultsBoth PE and EMDR were significantly associated with less severe paranoid thoughts post-treatment and at 6-month follow-up, and with more patients remitting from schizophrenia, at post-treatment (PE and EMDR) and over time (PE). Moreover, PE was significantly associated with a greater reduction of depression at post-treatment and at 6-month follow-up. Auditory verbal hallucinations and social functioning remained unchanged.ConclusionsIn patients with chronic psychotic disorders PE and EMDR not only reduced PTSD symptoms, but also paranoid thoughts. Importantly, in PE and EMDR more patients accomplished the status of their psychotic disorder in remission. Clinically, these effects are highly relevant and provide empirical support to the notion that delivering PTSD treatment to patients with psychotic disorders and PTSD deserves increasing recognition and acceptance among clinicians.

A pilot feasibility study of a peer-led mindfulness program for medical students

Background: Mindfulness meditation has gained momentum in medical circles for bolstering wellbeing and other facets of professionalism. This study evaluated the feasibility and benefits of a peer-led mindfulness meditation program (MMP) on medical student wellness and professionalism.Method: Pre-clerkship students were recruited and randomized to the 8-week MMP or wait-list. Feasibility outcomes included ease of recruitment, program attendance and homework compliance. Other outcomes included self-reported psychological distress, empathy, self-compassion, mindfulness, altruism and program satisfaction.Results: The MMP decreased levels of stress and enhanced mindfulness, self-compassion and altruism from baseline to post-study. Changes were not significant for the wait-list condition. Although satisfaction with the MMP was high compliance was suboptimal.Conclusions: A peer-led MMP is feasible and may be a promising approach to enhance medical student wellbeing. Further research is needed to explore strategies to improve program compliance in this student population.

Sleep Ameliorating Effects of Acupuncture in a Psychiatric Population

The interest of psychiatric patients for complementary medicine, such as acupuncture, is stable, but effect studies in psychiatry remain scarce. In this pilot study, the effects of 3 months of acupuncture treatment on sleep were evaluated and compared between a group of patients with schizophrenia (n=16) and a group with depression (n=16). Healthy controls were included in order to establish reference values (n=8). Patients with schizophrenia and depression were randomly assigned to either a waiting list or a treatment condition. The Pittsburgh Sleep Quality Inventory was completed before and after the acupuncture treatment (individualized and according to traditional Chinese medicine principles) or the waiting list condition. Both acupuncture groups showed significant lower scores on the sleep inventory, which was not the case for the waiting list condition. Moreover, it was found that the effectiveness of the acupuncture treatment was higher in the patients with schizophrenia than in the patients with depression. Acupuncture seems able to improve sleep in this convenient sample of patients with long-lasting psychiatric problems and may be a suitable and cost-effective add-on treatment for this group, particularly if conducted group-wise.

Effects of Cognitive Behavior Therapy in Severely Fatigued Disease-Free Cancer Patients Compared With Patients Waiting for Cognitive Behavior Therapy: A Randomized Controlled Trial

Purpose Persistent fatigue is a long-term adverse effect experienced by 30% to 40% of patients cured of cancer. The main objective of this randomized controlled trial was to show the effectiveness of cognitive behavior therapy (CBT) especially designed for fatigue in cancer survivors. Patients and Methods A total of 112 cancer survivors with somatically unexplained fatigue were allocated randomly to immediate cognitive behavior therapy or to a waiting list condition for therapy. Both conditions were assessed two times, at baseline and 6 months later. The primary outcome variables were fatigue severity (Checklist Individual Strength) and functional impairment (Sickness Impact Profile). Data were analyzed by intention to treat. Results Analyses were based on 50 patients in the intervention condition and 48 patients in the waiting list condition. Patients in the intervention condition reported a significantly greater decrease than patients in the waiting list condition in fatigue severity (difference, 13.3; 95% CI, 8.6 to 18.1) and in functional impairment (difference, 383.2; 95% CI, 197.1 to 569.2). Clinically significant improvement for the CBT group compared with the waiting list group was seen in fatigue severity (54% v 4% of the patients, respectively) and in functional impairment (50% v 18% of the patients, respectively). Conclusion Cognitive behavior therapy has a clinically relevant effect in reducing fatigue and functional impairments in cancer survivors.

The Efficacy of Acupuncture in the Treatment of Major Depression in Women

The effectiveness of acupuncture as a treatment for major depression was examined in 38 women, randomly assigned to one of three treatment groups. Specific treatment involved acupuncture treatments for symptoms of depression; nonspecific treatment involved acupuncture for symptoms that were not clearly part of depression; a wait-list condition involved waiting without treatment for 8 weeks. The nonspecific and wait-list conditions were followed by specific treatment. Five women terminated treatment prematurely, 4 prior to the completion of the first 8 weeks. Following treatments specifically designed to address depression, 64% of the women ( n = 33) experienced full remission. A comparison of the acute effect of the three 8-week treatment conditions ( n = 34) showed that patients receiving specific acupuncture treatments improved significantly more than those receiving the placebo-like nonspecific acupuncture treatments, and marginally more than those in the wait-list condition. Results from this small sample suggest that acupuncture can provide significant symptom relief in depression, at rates comparable to those of psychotherapy or pharmacotherapy. Acupuncture may hold sufficient promise to warrant a larger scale clinical trial.