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de Ponti N, Matbouriahi M, Franco P, Harrer M, Miguel C, Papola D, Sicimoğlu A, Cuijpers P, Karyotaki E. The efficacy of psychotherapy for social anxiety disorder, a systematic review and meta-analysis. J Anxiety Disord 2024; 104:102881. [PMID: 38815481 DOI: 10.1016/j.janxdis.2024.102881] [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: 01/30/2024] [Revised: 04/19/2024] [Accepted: 05/22/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND Given the growth in research examining the effects of psychotherapy on social anxiety disorder (SAD), an up-to-date comprehensive meta-analysis in this field is needed. METHODS We selected studies from a database of randomized trials (RCTs) on psychotherapies for anxiety disorders (last updated search of PubMed, PsycINFO, Embase, and Cochrane (CENTRAL): 1 January 2024) We included RCTs comparing psychotherapy to a control condition for adults with SAD and conducted random effects meta-analyses to examine the efficacy of psychotherapy compared to control conditions at post-treatment. RESULTS Sixty-six RCTs were included with 5560 participants and 98 comparisons between psychotherapy and control groups. Psychotherapy was effective in reducing SAD symptoms, with a large effect size (g = 0.88; 95 % CI: 0.76 to 1.0; I2 = 74 %; 95 % CI: 69 to 79, NNT = 3.8). Effects remained robust across sensitivity analyses. However, there was evidence for significant risk of bias in the included trials. The multivariable meta-regression indicated significant differences in treatment delivery formats, type of recruitment strategy, target group, and number of sessions. CONCLUSION Psychotherapy is an effective treatment for SAD, with moderate to large effect sizes across all treatment types and formats. Future research is needed to determine the long-term effects.
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Affiliation(s)
- Nino de Ponti
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
| | - Minoo Matbouriahi
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Pamela Franco
- Department of Psychology, Pontificia Universidad Católica de Chile, Santiago, Chile; Millennium Institute for Research in Depression and Personality (MIDAP), Santiago, Chile
| | - Mathias Harrer
- Psychology & Digital Mental Health Care, Technical University Munich, Munich, Germany
| | - Clara Miguel
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Davide Papola
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA; WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Ayşesu Sicimoğlu
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Babes,-Bolyai University, International Institute for Psychotherapy, Cluj-Napoca, Romania; WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Eirini Karyotaki
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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Himle JA, LeBeau RT, Jester JM, Kilbourne AM, Weaver A, Brydon DM, Tucker KM, Hamameh N, Castriotta N, Craske MG. Work-Related Cognitive Behavioral Therapy for racially and economically diverse unemployed persons with social anxiety: A randomized clinical trial. J Anxiety Disord 2024; 104:102875. [PMID: 38763062 DOI: 10.1016/j.janxdis.2024.102875] [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: 12/18/2023] [Revised: 04/09/2024] [Accepted: 04/29/2024] [Indexed: 05/21/2024]
Abstract
Individuals with Social Anxiety Disorder (SAD) are at risk for employment problems. This multi-site trial examined the efficacy of Work-Related Cognitive Behavioral Therapy provided alongside vocational services as usual (WCBT+VSAU), a group-based treatment designed to improve mental health and employment outcomes for individuals with SAD. Vocational service-seeking participants with SAD (N = 250) were randomized to either WCBT+VSAU or VSAU-alone. Hypotheses were that participants randomized to WCBT+VSAU would report less social anxiety, less depression, and more hours worked than participants randomized to VSAU-alone. WCBT+VSAU participants had significantly greater improvements on the Liebowitz Social Anxiety Scale (LSAS; d=-.25, CI=-0.49 to -0.02, p = .03) at post-assessment compared to VSAU-alone. The conditions did not differ on any variable at later time points or on secondary outcomes. Unexpectedly, participants randomized to VSAU-alone experienced LSAS improvements, similar to WCBT+VASU at later timepoints. Baseline psychological flexibility (beta=-.098 [-0.19-0.008]) and depression (beta=-0.18 [-0.34-0.009]) moderated change in social anxiety. Participants with lower psychological flexibility and higher depression responded more strongly to WCBT+VSAU than VSAU-alone over the duration of the study, suggesting that WCBT+VSAU may particularly benefit those with greater psychopathology. Results indicate that vocational centers are promising settings for treating SAD and employment-focused refinements are likely needed to improve work outcomes.
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Affiliation(s)
- Joseph A Himle
- School of Social Work, University of Michigan, USA; Department of Psychiatry, Medical School, University of Michigan, USA.
| | - Richard T LeBeau
- Department of Psychology, University of California Los Angeles, USA
| | - Jennifer M Jester
- Department of Psychiatry, Medical School, University of Michigan, USA
| | - Amy M Kilbourne
- Department of Learning Health Sciences, Medical School, University of Michigan, USA; Quality Enhancement Research Initiative, US Department of Veterans Affairs, Washington, DC, USA
| | - Addie Weaver
- School of Social Work, University of Michigan, USA
| | | | | | | | - Natalie Castriotta
- University of California, San Diego, USA; VA San Diego Healthcare System, USA
| | - Michelle G Craske
- Department of Psychology, University of California Los Angeles, USA; Department of Psychiatry & Biobehavioral Sciences, USA
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3
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Slater D, Venning A, Matthews L, Iles R, Redpath P. Defining work-focused cognitive behavioural therapy (W-CBT) and whether it is effective at facilitating return to work for people experiencing mental health conditions: A systematic review and narrative synthesis. Health Psychol Open 2023; 10:20551029231217840. [PMID: 38028506 PMCID: PMC10676636 DOI: 10.1177/20551029231217840] [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] [Indexed: 12/01/2023] Open
Abstract
It is unclear what constitutes Work Focused Cognitive Behaviour Therapy (W-CBT). This review sought to define W-CBT and ascertain its effectiveness at facilitating return to work (RTW) for people experiencing mental health conditions. A systematic review and narrative synthesis were undertaken. Five databases were searched (Medline, ProQuest, PsychInfo, Scopus, and Web of Science). English publications with an intervention combining CBT with RTW were selected. Quality checklists from the Joanna Briggs Institute were applied. Searching yielded 16,863 results. 23 moderate-to-high quality studies from 25 articles were included (13 experimentally designed studies, 3 pilots/case studies and 7 reviews). Results indicated W-CBT is effective at facilitating RTW for mild-to-moderate mental health conditions. For a program to be labelled W-CBT it is recommended it is (1) a stand-alone intervention; (2) delivered with an understanding RTW is the goal; and, (3) the CBT components are always framed by matters, subjects and contexts related to work.
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Affiliation(s)
- Dylan Slater
- Discipline of Behavioural Health, College of Medicine & Public Health, Flinders University, Adelaide, SA, Australia
| | - Anthony Venning
- Discipline of Behavioural Health, College of Medicine & Public Health, Flinders University, Adelaide, SA, Australia
| | - Lynda Matthews
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Ross Iles
- Healthy Working Lives Research Group, School of Public Health and Preventive Medicine, Monash University, Clayton, VIC, Australia
| | - Paula Redpath
- Discipline of Behavioural Health, College of Medicine & Public Health, Flinders University, Adelaide, SA, Australia
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4
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Paul KI, Hollederer A. The Effectiveness of Health-Oriented Interventions and Health Promotion for Unemployed People-A Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6028. [PMID: 37297632 PMCID: PMC10252930 DOI: 10.3390/ijerph20116028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 05/15/2023] [Accepted: 05/15/2023] [Indexed: 06/12/2023]
Abstract
Background: Unemployment is known to have negative effects on mental and physical health. Yet, the effectiveness of interventions aimed at improving the health of unemployed people is unclear. Methods: We conducted a random-effects meta-analysis of extant intervention studies with at least two measurement points and a control group. A literature search in PubMed, Scopus, and PsycINFO in December 2021 identified 34 eligible primary studies with 36 independent samples. Results: For mental health, the average meta-analytic effect sizes for the comparison of the intervention group and the control group were significant and of small size after the intervention, d = 0.22; 95% CI [0.08, 0.36], as well as at follow-up, d = 0.11; 95% CI [0.07, 0.16]. Effects on self-assessed physical health status were small and marginally significant (p = 0.10) after the intervention: d = 0.09; 95% CI [-0.02, 0.20], and insignificant at follow-up. However, when job search training was not part of the intervention program (i.e., all available resources were used solely for health promotion), the average effect size for physical health was significant after the intervention, d = 0.17; 95% CI [0.07, 0.27]. Furthermore, the effects of physical activity promotion were significant and of small-to-medium size after the intervention, leading to increased levels of activity, d = 0.30; 95% CI [0.13, 0.47]. Conclusions: Population-based health promotion programs are recommended because even measures with small effect sizes can actually improve the health of a large group of unemployed people.
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Affiliation(s)
- Karsten Ingmar Paul
- School of Business, Economics, and Society, Friedrich-Alexander-Universität Erlangen-Nürnberg, 90403 Nürnberg, Germany
| | - Alfons Hollederer
- Department of Social Work and Social Welfare, The Faculty of Human Sciences, University of Kassel, 34127 Kassel, Germany
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5
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Arena AF, Mobbs S, Sanatkar S, Williams D, Collins D, Harris M, Harvey SB, Deady M. Mental health and unemployment: A systematic review and meta-analysis of interventions to improve depression and anxiety outcomes. J Affect Disord 2023; 335:450-472. [PMID: 37201898 DOI: 10.1016/j.jad.2023.05.027] [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: 12/02/2022] [Revised: 05/07/2023] [Accepted: 05/11/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Unemployment is associated with substantially greater depression and anxiety, constituting a considerable public health concern. The current review provides the most comprehensive synthesis to date, and first meta-analysis, of controlled intervention trials aimed at improving depression and anxiety outcomes during unemployment. METHODS Searches were conducted within PsycInfo, Cochrane Central, PubMed and Embase from their inception to September 2022. Included studies conducted controlled trials of interventions focused on improving mental health within unemployed samples, and reported on validated measures of depression, anxiety, or distress (mixed depression and anxiety). Narrative syntheses and random effects meta-analyses were conducted among prevention- and treatment-level interventions for each outcome. RESULTS A total of 39 articles reporting on 33 studies were included for review (sample sizes ranging from 21 to 1801). Both prevention and treatment interventions tended to be effective overall, with treatment interventions producing larger effect sizes than prevention interventions. The clearest evidence for particular intervention approaches emerged for prevention-level Cognitive Therapy/CBT, followed by prevention-level work-related interventions, although neither produced entirely consistent effects. LIMITATIONS Risk of bias was generally high across studies. Low numbers of studies within subgroups precluded any comparisons between long-term and short-term unemployment, limited comparisons among treatment studies, and reduced the power of meta-analyses. CONCLUSIONS Both prevention- and treatment-level mental health-focused interventions have merit for reducing symptoms of anxiety and depression among those experiencing unemployment. Cognitive Therapy/CBT and work-related interventions hold the most robust evidence base, which can inform both prevention and treatment strategies implemented by clinicians, employment services providers, and governments.
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Affiliation(s)
- Andrew F Arena
- Black Dog Institute, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.
| | - Sophia Mobbs
- Black Dog Institute, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Samineh Sanatkar
- Black Dog Institute, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Douglas Williams
- Black Dog Institute, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Daniel Collins
- Black Dog Institute, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Marnie Harris
- Black Dog Institute, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Samuel B Harvey
- Black Dog Institute, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Mark Deady
- Black Dog Institute, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
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6
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Weaver A, Zhang A, Xiang X, Felsman P, Fischer DJ, Himle JA. Entertain Me Well: An Entertaining, Tailorable, Online Platform Delivering CBT for Depression. COGNITIVE AND BEHAVIORAL PRACTICE 2023; 30:96-115. [PMID: 36741472 PMCID: PMC9889220 DOI: 10.1016/j.cbpra.2021.09.003] [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: 02/23/2021] [Accepted: 09/02/2021] [Indexed: 02/07/2023]
Abstract
Depression prevalence is high, impacting approximately 20% of Americans during their lifetime, and on the rise due to stress and loss associated with the COVID-19 pandemic. Despite the high prevalence of depression, unacceptable treatment access disparities persist. When depression goes untreated, it leads to substantial negative impacts in multiple life domains. Cognitive behavioral therapy (CBT), the gold-standard psychosocial treatment for depression, remains largely unavailable to individuals living with depression, particularly individuals who are members of underrepresented groups in our society. Digital mental health interventions (DMHI) have led to important advances in extending the reach of CBT for depression; however, they are underutilized and treatment engagement remains low. We sought to address some of the current gaps in DMHI by developing an online platform for delivering CBT for depression that is entertaining, simple and straightforward, and tailorable. First, this article introduces our online platform, Entertain Me Well (EMW) and its key innovations, including the use of an engaging, character-driven storyline presented as "episodes" within each session, as well as customizable content that allows for tailoring of text, images, and examples to create content most relevant to the target client population, context, or setting. Next, we describe two EMW depression treatment programs that have been tailored: one for delivery in the rural church setting, called Raising Our Spirits Together, and one tailored for delivery in dialysis centers, called Doing Better on Dialysis. Finally, we discuss future directions for the EMW platform, including the ability to create programs for other common mental health and health conditions, the development of additional character-driven storylines with greater treatment personalization, translation of content in multiple languages, and the use of additional technological innovation, such as artificial intelligence like natural language processing, to enhance platform interactivity.
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Affiliation(s)
- Addie Weaver
- Address correspondence to Addie Weaver, Ph.D., Assistant Professor, University of Michigan School of Social Work, 1080 S. University Ave., Ann Arbor, MI 48109
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7
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Marshall CA, Boland L, Westover LA, Goldszmidt R, Bengall J, Aryobi S, Isard R, Easton C, Gewurtz R. Effectiveness of employment-based interventions for persons experiencing homelessness: A systematic review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:2142-2169. [PMID: 35748222 DOI: 10.1111/hsc.13892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/26/2022] [Accepted: 06/04/2022] [Indexed: 06/15/2023]
Abstract
Employment is frequently desired by persons who experience homelessness yet is often elusive. Little is known about the range and effectiveness of employment-based interventions evaluated in existing literature on key psychosocial outcomes including employment participation, mental well-being, housing tenure, community integration and substance use. To identify and synthesise existing studies, we conducted a systematic review of effectiveness using the methodology proposed by the Joanna Briggs Institute (JBI) following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Following the removal of duplicates, we screened 13,398 titles and abstracts, and reviewed 79 studies at the full-text review stage using two independent raters. A total of 16 studies met criteria for inclusion in a narrative synthesis and were subjected to critical appraisal. The majority of studies were conducted in the US (n = 14; 87.5%) with other studies published in Canada (n = 1; 6.3%) and Australia (n = 1; 6.3%). Interventions evaluated in existing studies included combined substance use and vocational skills interventions (n = 7; 43.8%), supported employment (n = 6; 37.5%), and integrated supports including an employment component (n = 3; 18.8%). The effectiveness of these interventions on employment, mental well-being, housing tenure, community integration, and substance use is presented. Findings suggest that research evaluating employment interventions for persons who experience homelessness is in an early stage of development. Researchers and practitioners may consider collaborating with persons with lived experiences of homelessness and practitioners in co-designing and modifying existing approaches to target key outcomes more effectively. Policymakers may consider allocating resources to such initiatives to further the development of practice and research aimed at supporting persons who experience homelessness to secure and sustain employment during and following homelessness.
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Affiliation(s)
- Carrie Anne Marshall
- Social Justice in Mental Health Research Lab, Faculty of Health Sciences, School of Occupational Therapy, Western University, London, Ontario, Canada
| | - Leonie Boland
- Faculty of Health and Human Sciences, Occupational Therapy, Peninsula Allied Health Centre, University of Plymouth, Plymouth, UK
| | - Lee Ann Westover
- Teacher's College, Columbia University, New York City, New York, USA
| | - Rebecca Goldszmidt
- Social Justice in Mental Health Research Lab, Faculty of Health Sciences, School of Occupational Therapy, Western University, London, Ontario, Canada
| | - Jordana Bengall
- Social Justice in Mental Health Research Lab, Faculty of Health Sciences, School of Occupational Therapy, Western University, London, Ontario, Canada
| | - Suliman Aryobi
- Social Justice in Mental Health Research Lab, Faculty of Health Sciences, School of Occupational Therapy, Western University, London, Ontario, Canada
| | - Roxanne Isard
- Disciplinary Coordinator for the Faculty of Information & Media Studies & the Faculty of Education, Allyn & Betty Taylor Library, Western University, London, Ontario, Canada
| | - Corinna Easton
- Social Justice in Mental Health Research Lab, Faculty of Health Sciences, School of Occupational Therapy, Western University, London, Ontario, Canada
| | - Rebecca Gewurtz
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
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8
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Cureton JL, Leslie M, McMahon B, Lowe HE, Tovey B, Rumrill PD. Anxiety and employment discrimination: Implications for counseling and return to work practice. Work 2022; 73:1091-1102. [DOI: 10.3233/wor-223649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND: The most prevalent mental health diagnosis is anxiety disorder, which remains largely undertreated. OBJECTIVE: This investigation considered differences in workplace discrimination against adults with anxiety disorders during two eras of legal history: the original Americans with Disabilities Act (ADA, 1990-2008) and the ADA Amendments Act (ADAAA, 2009-present). METHOD: Research questions addressed differential (a) numbers and types of allegations (b) case resolutions, and (c) demographic characteristics of the charging parties. RESULTS: Results indicated substantially more allegations and merit-based resolutions filed by charging parties with anxiety disorders post-ADAAA. Furthermore, the post-ADAAA era revealed increases in allegations from women and people from non-white racial groups. CONCLUSION: These findings can inform advocacy and counseling and rehabilitation services for clients who experience anxiety.
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Affiliation(s)
- Jenny L. Cureton
- Department of Counselor Education and Supervision, Kent State University, Kent, OH, USA
| | - Mykal Leslie
- Department of Counselor Education and Supervision, Kent State University, Kent, OH, USA
| | - Brian McMahon
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, USA
| | - Hannah E. Lowe
- Department of Counselor Education and Supervision, Kent State University, Kent, OH, USA
| | - Bridget Tovey
- Department of Counselor Education and Supervision, Kent State University, Kent, OH, USA
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9
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O'Donnell LA, Brydon DM, González-Prendes A. Technological Advances in Cognitive-Behavioral Therapy and Clinical Practice: Challenges in an Evolving Field. Am J Psychother 2022; 75:186-190. [PMID: 36052453 DOI: 10.1176/appi.psychotherapy.20220003] [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: 11/30/2022]
Abstract
Technological innovations in cognitive-behavioral therapy (CBT) provide excellent opportunities for mental health clinicians to expand access to mental health treatment among culturally diverse and marginalized populations. This brief report highlights challenges that mental health clinicians encounter as they integrate technological innovations in CBT into their work with diverse clients and provides recommendations for addressing them. The authors identify five key challenges of using technology-driven CBT: development of the therapeutic alliance; potential fit for clients from culturally diverse backgrounds and marginalized groups; geographic and economic access; ethical and legal concerns; and competency in CBT practice, training, and supervision. Technological advances in CBT allow clinicians to treat more individuals from underserved communities. Existing challenges compel clinicians across disciplines to ensure that their practice is congruent with CBT practice values and ethics, policy, and research and that the best available CBT intervention can be integrated into all aspects of mental health practice.
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Affiliation(s)
- Lisa A O'Donnell
- School of Social Work, Wayne State University, Detroit (O'Donnell, González-Prendes); Graduate School of Social Work, University of Denver, Denver (Brydon)
| | - Daphne M Brydon
- School of Social Work, Wayne State University, Detroit (O'Donnell, González-Prendes); Graduate School of Social Work, University of Denver, Denver (Brydon)
| | - Antonio González-Prendes
- School of Social Work, Wayne State University, Detroit (O'Donnell, González-Prendes); Graduate School of Social Work, University of Denver, Denver (Brydon)
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10
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Weaver A, Landry C, Zhang A, McQuown L, Hahn J, Harrington M, Tucker KM, Holzworth J, Buys T, Smith FN, Grogan-Kaylor A, Pfeiffer PN, Kilbourne AM, Himle JA. Study protocol: A randomized controlled trial of Raising Our Spirits Together, an entertaining, group-based technology-assisted cognitive behavioral therapy for depression, tailored for rural adults and delivery by clergy. Contemp Clin Trials Commun 2022; 29:100952. [PMID: 35865278 PMCID: PMC9294258 DOI: 10.1016/j.conctc.2022.100952] [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: 07/21/2021] [Revised: 03/27/2022] [Accepted: 06/23/2022] [Indexed: 11/25/2022] Open
Abstract
This paper presents a methodological description of a randomized controlled trial (RCT) testing the effect of Raising Our Spirits Together (ROST), a technology-assisted cognitive behavioral therapy (T-CBT) for depression, tailored for the rural context and for delivery by clergy, compared to an enhanced control condition. Depression is among the most common mental health conditions; yet the majority of adults with depression do not receive needed treatment due to limited access to mental health professionals, treatment-associated costs, distance to care, and stigma. These barriers are particularly salient in rural areas of the United States. T-CBT with human support is an accessible and effective treatment for depression; however, currently available T-CBTs have poor completion rates due to the lack of tailoring and other features to support engagement. ROST is a T-CBT specifically tailored for the rural setting and delivery by clergy, who are preferred, informal providers. ROST also presents core CBT content in a simple, jargon-free manner that supports multiple learning preferences. ROST is delivered virtually in a small group format across 8 weekly sessions via videoconferencing software consistent with other clergy-based programs, such as Bible studies or self-help groups. In this study, adults with depressive symptoms recruited from two rural Michigan counties will be randomized to receive ROST versus an enhanced control condition (N = 84). Depressive symptoms post-treatment and at 3 months follow-up according to the Patient Health Questionnaire (PHQ-9) will be the primary outcome. Findings will determine whether ROST is effective for improving depression symptoms in underserved, under resourced rural communities.
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11
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Barnett P, Steare T, Dedat Z, Pilling S, McCrone P, Knapp M, Cooke E, Lamirel D, Dawson S, Goldblatt P, Hatch S, Henderson C, Jenkins R, K T, Machin K, Simpson A, Shah P, Stevens M, Webber M, Johnson S, Lloyd-Evans B. Interventions to improve social circumstances of people with mental health conditions: a rapid evidence synthesis. BMC Psychiatry 2022; 22:302. [PMID: 35484521 PMCID: PMC9047264 DOI: 10.1186/s12888-022-03864-9] [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: 07/23/2021] [Accepted: 03/16/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Poor social circumstances can induce, exacerbate and prolong symptoms of mental health conditions, while having a mental health condition can also lead to worse social outcomes. Many people with mental health conditions prioritise improvement in social and functional outcomes over reduction in clinical symptoms. Interventions that improve social circumstances in this population should thus be considered a priority for research and policy. METHODS This rapid evidence synthesis reports on randomised controlled trials of interventions to improve social circumstances across eight social domains (Housing and homelessness; money and basic needs; work and education; social isolation and connectedness; family, intimate and caring relationships; victimisation and exploitation; offending; and rights, inclusion and citizenship) in people with mental health conditions. Economic evaluations were also identified. A comprehensive, stepped search approach of the Cochrane library, MEDLINE, Embase, PsycINFO, Web of Science and Scopus was conducted. RESULTS One systematic review and 102 randomised controlled trials were included. We did not find RCT evidence for interventions to improve family, intimate and caring relationships and only one or two trials for each of improving money and basic needs, victimisation and exploitation, and rights, inclusion and citizenship. Evidence from successful interventions in improving homelessness (Housing First) and employment (Individual Placement and Support) suggests that high-intensity interventions which focus on the desired social outcome and provide comprehensive multidisciplinary support could influence positive change in social circumstances of people with mental health conditions. Objective social isolation could be improved using a range of approaches such as supported socialisation and social skills training but interventions to reduce offending showed few benefits. Studies with cost and cost-effectiveness components were generally supportive of interventions to improve housing and vocational outcomes. More research is needed to ensure that social circumstances accompanied by high risks of further exacerbation of mental health conditions are adequately addressed. CONCLUSIONS Although there is a large body of literature examining how to support some aspects of life for people with mental health conditions, more high-quality evidence is required in other social domains. Integration into mental health services of interventions targeting social circumstances could significantly improve a number of social outcomes.
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Affiliation(s)
- Phoebe Barnett
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK. .,Department of Psychiatry, Mental Health Policy Research Unit, University College London, London, UK.
| | - Thomas Steare
- grid.83440.3b0000000121901201Department of Psychiatry, Mental Health Policy Research Unit, University College London, London, UK
| | - Zainab Dedat
- grid.83440.3b0000000121901201Department of Psychiatry, Mental Health Policy Research Unit, University College London, London, UK
| | - Stephen Pilling
- grid.83440.3b0000000121901201Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London, WC1E 7HB UK ,grid.452735.20000 0004 0496 9767National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK ,grid.450564.60000 0000 8609 9937Camden and Islington NHS Foundation Trust, London, UK
| | - Paul McCrone
- grid.36316.310000 0001 0806 5472Institute of Lifecourse Development, University of Greenwich, London, UK
| | - Martin Knapp
- grid.13063.370000 0001 0789 5319Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Eleanor Cooke
- grid.450564.60000 0000 8609 9937Camden and Islington NHS Foundation Trust and MH Policy Research Unit, London, UK
| | - Daphne Lamirel
- grid.83440.3b0000000121901201Department of Psychiatry, Mental Health Policy Research Unit, University College London, London, UK
| | - Sarah Dawson
- grid.5337.20000 0004 1936 7603Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
| | - Peter Goldblatt
- grid.83440.3b0000000121901201Department of Epidemiology & Public Health, Institute of Health Equity, University College London, London, UK
| | - Stephani Hatch
- grid.13097.3c0000 0001 2322 6764Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, Kings College London, London, UK ,grid.13097.3c0000 0001 2322 6764ESRC Centre for Society and Mental Health, Kings College London, London, UK
| | - Claire Henderson
- grid.13097.3c0000 0001 2322 6764Institute of Psychiatry, Psychology and Neuroscience, Health Services and Population Research Department, Kings College London, London, UK ,grid.37640.360000 0000 9439 0839South London and Maudsley NHS Foundation Trust, London, UK
| | - Rachel Jenkins
- grid.13097.3c0000 0001 2322 6764Institute of Psychiatry, Psychology and Neurology, Kings College London, London, UK
| | - T K
- grid.83440.3b0000000121901201Mental Health Policy Research Unit Lived Experience Working Group, Department of Psychiatry, University College London, London, UK
| | - Karen Machin
- grid.83440.3b0000000121901201Mental Health Policy Research Unit Lived Experience Working Group, Department of Psychiatry, University College London, London, UK
| | - Alan Simpson
- grid.83440.3b0000000121901201Department of Psychiatry, Mental Health Policy Research Unit, University College London, London, UK ,grid.13097.3c0000 0001 2322 6764Institute of Psychiatry, Psychology and Neuroscience, Health Services and Population Research Department, Kings College London, London, UK ,grid.13097.3c0000 0001 2322 6764Florence Nightingale Faculty of Nursing, Kings College London, Midwifery & Palliative care, London, UK
| | - Prisha Shah
- grid.83440.3b0000000121901201Mental Health Policy Research Unit Lived Experience Working Group, Department of Psychiatry, University College London, London, UK
| | - Martin Stevens
- grid.13097.3c0000 0001 2322 6764NIHR Policy Research Unit On Health and Social Care Workforce Research Unit, King’s College London, London, UK
| | - Martin Webber
- grid.5685.e0000 0004 1936 9668International Centre for Mental Health Social Research, Department of Social Policy and Social Work, University of York, York, England
| | - Sonia Johnson
- grid.83440.3b0000000121901201Department of Psychiatry, Mental Health Policy Research Unit, University College London, London, UK ,grid.450564.60000 0000 8609 9937Camden and Islington NHS Foundation Trust, London, UK
| | - Brynmor Lloyd-Evans
- grid.83440.3b0000000121901201Department of Psychiatry, Mental Health Policy Research Unit, University College London, London, UK
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Weaver A, Zhang A, Landry C, Hahn J, McQuown L, O’Donnell LA, Harrington MM, Buys T, Tucker KM, Pfeiffer P, Kilbourne AM, Grogan-Kaylor A, Himle JA. Technology-Assisted, Group-Based CBT for Rural Adults' Depression: Open Pilot Trial Results. RESEARCH ON SOCIAL WORK PRACTICE 2022; 32:131-145. [PMID: 35665316 PMCID: PMC9165685 DOI: 10.1177/10497315211044835] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE This pilot study assesses the association of Raising Our Spirits Together (ROST), a technology-assisted, group-based cognitive behavioral therapy for depression, with rural adults' depressive symptoms and anxiety. METHOD Nine adults from rural Michigan participated in an open pilot of ROST. Clergy facilitated pilot groups. The pilot began in February 2020 in-person. Due to COVID-19, the pilot was completed virtually. RESULTS Mean depressive symptom scores, based on the PHQ-9, significantly decreased from pre-treatment (M = 14.4) to post-treatment (M = 6.33; t (8) = 6.79; P < .001). Symptom reduction was maintained at 3-month follow-up (M = 8.00), with a significant pattern of difference in depressive symptoms over time (F(2) = 17.7; P < .001; eta-squared = .689). Similar patterns occurred for anxiety based on the GAD-7. Participants attended an average of 7.33 of 8 sessions. Fidelity ratings were excellent. DISCUSSION ROST is a potentially feasible intervention for rural adults' depressive symptoms. ROST offers a promising model for increasing treatment access and building capacity in rural areas.
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Affiliation(s)
- Addie Weaver
- University of Michigan School of Social Work, Ann Arbor, MI, USA
| | - Anao Zhang
- University of Michigan School of Social Work, Ann Arbor, MI, USA
| | - Caroline Landry
- University of Michigan School of Social Work, Ann Arbor, MI, USA
| | | | - Lynne McQuown
- Jonesville First Presbyterian Church, Jonesville, MI, USA
| | | | | | - Trevor Buys
- University of Michigan School of Social Work, Ann Arbor, MI, USA
| | | | - Paul Pfeiffer
- Department of Psychiatry, University of Michigan School of Medicine, Ann Arbor, MI, USA
- Department of Veterans Affairs, Ann Arbor, MI, USA
| | - Amy M. Kilbourne
- Department of Veterans Affairs, Ann Arbor, MI, USA
- Department of Learning Health Sciences, University of Michigan School of Medicine, Ann Arbor, MI, USA
- Quality Enhancement Research Initiative, U.S. Department of Veterans Affairs, Washington, DC, USA
| | | | - Joseph A. Himle
- University of Michigan School of Social Work, Ann Arbor, MI, USA
- Department of Psychiatry, University of Michigan School of Medicine, Ann Arbor, MI, USA
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Fadyl JK, Anstiss D, Reed K, Khoronzhevych M, Levack WMM. Effectiveness of vocational interventions for gaining paid work for people living with mild to moderate mental health conditions: systematic review and meta-analysis. BMJ Open 2020; 10:e039699. [PMID: 33122321 PMCID: PMC7597525 DOI: 10.1136/bmjopen-2020-039699] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 07/31/2020] [Accepted: 09/25/2020] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES To evaluate the effectiveness of vocational interventions to help people living with mild to moderate mental health conditions gain paid work. METHODS Systematic review of international, peer-reviewed literature. Development of the prepublished protocol and search strategy was done in consultation with stakeholder reference groups consisting of people with lived experience of long-term conditions, advocates and clinicians. We searched academic databases MEDLINE, EMBASE, PsychINFO, AMED, CINAHL, Proquest Dissertations and Theses database, and Business Source Complete for controlled trials comparing a specific vocational intervention against a control intervention or usual care, published between 1 January 2004 and 1 August 2019. Two authors independently screened search results, extracted data and appraised studies using the Cochrane risk of bias tool. RESULTS Eleven studies met inclusion criteria. Seven studies investigated Individual Placement and Support (IPS) modified for people who were not in intensive mental health treatment services. These studies occurred settings such as community vocational rehabilitation services, a housing programme and community mental health services. The studies provided very low quality evidence that people who receive IPS-style vocational rehabilitation are more likely to gain competitive employment than people who receive usual care (risk ratio 1.70, 95% CI 1.23 to 2.34, seven studies, 1611 participants). The remaining four studies considered cognitive behavioural therapy or specific vocational rehabilitation interventions designed to fit a unique context. There was insufficient evidence from these studies to draw conclusions regarding the effectiveness of non-IPS forms of vocational rehabilitation for people with mild to moderate mental health conditions. DISCUSSION The meta-analysis showed a clear intervention effect but low precision, and more high-quality studies are needed in this field. There is currently very low quality evidence that IPS-style intervention results in more participants in competitive employment compared with 'usual care' control groups in populations with mild to moderate mental health conditions.
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Affiliation(s)
- Joanna K Fadyl
- Centre for Person Centred Research, School of Clinical Sciences, AUT University, Auckland, New Zealand
| | - David Anstiss
- Centre for Person Centred Research, School of Clinical Sciences, AUT University, Auckland, New Zealand
| | - Kirk Reed
- Centre for Person Centred Research, School of Clinical Sciences, AUT University, Auckland, New Zealand
- School of Health and Social Development, Deakin University, Burwood, Victoria, Australia
| | - Mariya Khoronzhevych
- Department of Social Work, Child Welfare and Social Policy, Oslo Metropolitan University, Oslo, Norway
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Marshall CA, Boland L, Westover LA, Isard R, Gutman SA. A systematic review of occupational therapy interventions in the transition from homelessness. Scand J Occup Ther 2020; 28:171-187. [PMID: 32476575 DOI: 10.1080/11038128.2020.1764094] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Although systematic and scoping reviews have identified a range of interventions for persons experiencing homelessness, no known reviews have captured the range and quality of intervention studies aimed at supporting a transition from homelessness. OBJECTIVES To capture the range and quality of occupational therapy intervention studies aimed at supporting a transition to housing following homelessness. METHOD Using Joanna Briggs Institute (JBI) guidelines, we conducted a systematic review including a critical appraisal and narrative synthesis of experimental studies. RESULTS Eleven studies were included. Critical appraisal scores ranged from 33.3 to 88.9 of a possible score of 100 (Mdn = 62.5; IQR = 33.4). The majority of studies evaluated interventions for the development of life skills (n = 9; 81.8%), and all were conducted in the USA. Several of the included studies were exploratory evaluation and feasibility studies, and all were quasi-experimental in design. Only three studies (27.2%) incorporated a control group. Intervention strategies included (1) integrated group and individual life skills interventions (n = 6); (2) group-based life skills interventions (n = 3); and (3) psychosocial and consultative interventions (n = 2). CONCLUSIONS Research evaluating occupational therapy interventions aimed at supporting homeless individuals as they transition to housing is in an early stage of development. SIGNIFICANCE Implications for research and practice are discussed.
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Affiliation(s)
- Carrie Anne Marshall
- Occupational Therapy, Faculty of Health Sciences, Elborn College, Western University, London, ON, Canada
| | - Leonie Boland
- Occupational Therapy, Faculty of Health and Human Sciences, Peninsula Allied Health Centre, University of Plymouth, Plymouth, UK
| | | | - Roxanne Isard
- Faculty of Information & Media Studies & the Faculty of Social Sciences, Allyn & Betty Taylor Library, Western University, London, ON, Canada
| | - Sharon A Gutman
- Programs in Occupational Therapy, Rehabilitation and Regenerative Medicine, Columbia University, New York, NY, USA
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15
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Hult M, Lappalainen K, Saaranen TK, Räsänen K, Vanroelen C, Burdorf A. Health-improving interventions for obtaining employment in unemployed job seekers. Cochrane Database Syst Rev 2020; 1:CD013152. [PMID: 31912888 PMCID: PMC6956407 DOI: 10.1002/14651858.cd013152.pub2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Unemployment is associated with decreased health which may be a reason or a consequence of becoming unemployed. Decreased health can inhibit re-employment. OBJECTIVES To assess the effectiveness of health-improving interventions for obtaining employment in unemployed job seekers. SEARCH METHODS We searched (3 May 2018, updated 13 August 2019) the Cochrane Central Register of Controlled Trials, MEDLINE, Scopus, PsycINFO, CINAHL, SocINDEX, OSH Update, ClinicalTrials.gov, the WHO trials portal, and also reference lists of included studies and selected reviews. SELECTION CRITERIA We included randomised controlled trials (RCTs) of the effectiveness of health-improving interventions for obtaining employment in unemployed job seekers. The primary outcome was re-employment reported as the number or percentage of participants who obtained employment. Our secondary outcomes were health and work ability. DATA COLLECTION AND ANALYSIS Two authors independently screened studies, extracted outcome data, and assessed risk of bias. We pooled study results with random-effect models and reported risk ratios (RRs) with 95% confidence intervals (CIs) and assessed the overall quality of the evidence for each comparison using the GRADE approach. MAIN RESULTS We included 15 randomised controlled trials (16 interventions) with a total of 6397 unemployed participants. Eight studies evaluated therapeutic interventions such as cognitive behavioural therapy, physical exercise, and health-related advice and counselling and, in seven studies, interventions were combined using therapeutic methods and job-search training. Therapeutic interventions Therapeutic interventions compared to no intervention may increase employment at an average of 11 months follow-up but the evidence is very uncertain (RR = 1.41, 95% CI 1.07 to 1.87, n = 1142, 8 studies with 9 interventions, I² = 52%, very low-quality evidence). There is probably no difference in the effects of therapeutic interventions compared to no intervention on mental health (SMD 0.12, 95% CI -0.06 to 0.29, n = 530, 2 studies, low-quality evidence) and on general health (SMD 0.19, 95% CI -0.04 to 0.41, n = 318, 1 study, moderate-quality evidence). Combined interventions Combined interventions probably increase employment slightly compared to no intervention at an average of 10 months follow-up (RR 1.12, 95% CI 1.06 to 1.20, n = 4101, 6 studies, I² = 7%). There were no studies that measured work-ability, adverse events, or cost-effectiveness. AUTHORS' CONCLUSIONS Interventions combining therapeutic methods and job-search training probably have a small beneficial effect in increasing employment. Therapeutic interventions may have an effect on re-employment, but we are very uncertain. Therapeutic interventions may not improve health in unemployed job seekers. Large high-quality RCTs targeting short-term or long-term unemployed people are needed to increase the quality of the evidence. A cost-effectiveness assessment is needed of the small beneficial effects.
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Affiliation(s)
- Marja Hult
- University of Eastern FinlandKuopioFinland
| | | | - Terhi K Saaranen
- University of Eastern FinlandDepartment of Nursing ScienceP.O.Box 1627KuopioFinland70211
| | - Kimmo Räsänen
- University of Eastern FinlandInstitute of Public Health and Clinical Nutrition, Occupational Health UnitPO Box 1627KuopioFinland70211
| | - Christophe Vanroelen
- Vrije Universiteit BrusselInterface Demography, Department of SociologyPleinlaan 2BrusselsBelgium1050
| | - Alex Burdorf
- Erasmus Medical CenterDepartment of Public HealthPO Box 2040RotterdamNetherlands3000 CA
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Hyun M, Bae SH, Noh D. Systematic review and meta-analyses of randomized control trials of the effectiveness of psychosocial interventions for homeless adults. J Adv Nurs 2019; 76:773-786. [PMID: 31773744 DOI: 10.1111/jan.14275] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 10/30/2019] [Accepted: 11/19/2019] [Indexed: 11/26/2022]
Abstract
AIMS To evaluate the effect of psychosocial interventions for homeless adults on their psychosocial outcomes. DESIGN A systematic review and meta-analyses were performed for critical appraisal and synthesis of the included studies. DATA SOURCES A systematic search of studies published before 10 September 2018 was performed using PubMed, Cochrane Library, EMBASE, PsycINFO, and CINAHL. REVIEW METHODS The review included randomized controlled trials conducting psychosocial interventions and assessing psychosocial outcomes for homeless adults. After systematically describing study and intervention characteristics, we conducted meta-analyses by the type of outcome and subgroup meta-analyses by the type of intervention and outcome. Fourteen studies were included in this review and 11 were included in the meta-analyses. RESULTS A significant effect of psychosocial interventions in reducing anxiety and enhancing mental health status among homeless adults was noted. CONCLUSION The meta-analyses showed that psychosocial interventions may reduce anxiety and enhance the mental health status of homeless people. Specifically, we suggest that relaxation response training may be effective in improving anxiety and mental health status and cognitive behavioural therapy may reduce anxiety. IMPACT Although psychosocial interventions for homeless persons have been implemented for a decade, their impact for psychosocial outcomes among homeless adults has not been evaluated. This review suggest that psychosocial interventions may improve anxiety and mental health status among homeless adults. The findings of the present study may provide directions for developing psychosocial interventions to help vulnerable homeless adults in managing psychological outcomes.
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Affiliation(s)
- Myungsun Hyun
- Institute of Nursing Science, College of Nursing, Ajou University, Suwon, South Korea
| | - Sun Hyoung Bae
- Institute of Nursing Science, College of Nursing, Ajou University, Suwon, South Korea
| | - Dabok Noh
- College of Nursing, Eulji University, Seongnam-si, South Korea
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17
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Himle JA, LeBeau RT, Weaver A, Brydon DM, Bybee D, Kilbourne AM, Rose RD, Tucker KM, Kim R, Perez M, Smith FN, Sinco BR, Levine S, Hamameh N, Golenberg Z, McKiver M, Wierzbicki PT, Hasratian AM, Craske MG. Study protocol: A multisite trial of Work-Related Cognitive behavioral therapy for unemployed persons with social anxiety. Contemp Clin Trials Commun 2019; 16:100464. [PMID: 31701038 PMCID: PMC6831710 DOI: 10.1016/j.conctc.2019.100464] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 10/01/2019] [Accepted: 10/09/2019] [Indexed: 01/04/2023] Open
Abstract
This paper provides a methodological description of a multi-site, randomized controlled trial (RCT) of a cognitive-behavioral intervention for enhancing employment success among unemployed persons whose employment efforts have been undermined by social anxiety disorder (SAD). SAD is a common and impairing condition, with negative impacts on occupational functioning. In response to these documented employment-related impairments, in a previous project, we produced and tested an eight-session work-related group cognitive-behavioral therapy provided alongside vocational services as usual (WCBT + VSAU). WCBT is delivered by vocational service professionals and is designed in a context and style that overcomes accessibility and stigma-related obstacles with special focus on employment-related targets. Our previous project found that WCBT + VSAU significantly improved social anxiety, depression, and a range of employment-related outcomes compared to a control group of socially anxious job-seekers who received vocational services as usual without WCBT (VSAU-alone). Participants in this study were all homeless, primarily African American job-seekers with high levels of psychiatric comorbidity and limited education and employment histories. The present, two-region study addresses whether WCBT + VSAU enhances job placement, job retention and mental health outcomes in a larger sample assessed over an extended follow-up period. In addition, this trial evaluates whether the effects of WCBT + VSAU generalize to a new population of urban-based, racially diverse job-seekers with vocational and educational histories that differ from our original sample. This study also investigates the system-effects of WCBT + VSAU in a new site that will be informative for broad implementation of WCBT + VSAU. Finally, this project involves a refined, technology-assisted form of WCBT + VSAU designed to be delivered more easily by vocational services professionals.
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Affiliation(s)
- Joseph A Himle
- School of Social Work, University of Michigan, USA.,Department of Psychiatry, Medical School, University of Michigan, USA
| | - Richard T LeBeau
- Department of Psychology, University of California Los Angeles, USA
| | - Addie Weaver
- School of Social Work, University of Michigan, USA
| | | | - Deborah Bybee
- Department of Psychology, Michigan State University, USA
| | - Amy M Kilbourne
- Department of Psychiatry, Medical School, University of Michigan, USA.,Department of Learning Health Sciences, Medical School, University of Michgan, USA
| | - Raphael D Rose
- Department of Psychology, University of California Los Angeles, USA
| | | | - Richard Kim
- Department of Psychology, University of California Los Angeles, USA
| | - Marcelina Perez
- Department of Psychology, University of California Los Angeles, USA
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18
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Zhang A, Borhneimer LA, Weaver A, Franklin C, Hai AH, Guz S, Shen L. Cognitive behavioral therapy for primary care depression and anxiety: a secondary meta-analytic review using robust variance estimation in meta-regression. J Behav Med 2019; 42:1117-1141. [PMID: 31004323 DOI: 10.1007/s10865-019-00046-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 04/10/2019] [Indexed: 01/02/2023]
Abstract
Cognitive-behavioral therapy (CBT) is well supported for treating depressive and anxiety disorders. Trials of CBT for anxiety and depression in primary care have increased over the past decade, yet only one meta-analysis, published in 2015, examined this topic and the scope of that review is relatively narrow. This study conducted a systematic review and meta-analysis of primary care based CBT for depression and anxiety. A search of seven electronic databases, six professional websites, and reference lists from articles meeting inclusion criteria was conducted for studies published between 1900 and November 2018. Fifty-seven eligible studies (including 10,701 participants; 221 effect sizes) of randomized controlled trials were eligible and included for meta-analysis using robust variance estimation in meta-regression. Outcome indicators were depression and anxiety measures. An overall significant treatment effect, d = 0.400, 95% CI (0.235, 0.566), p < 0.001, of CBT for depression and anxiety disorders in primary care was identified. Subgroup analyses indicated significant treatment effect for: (1) depressive (d = 0.425, p < 0.001) and anxiety (d = 0.393, p < 0.01) outcomes, (2) studies conducted inside primary care (d = 0.412, p < 0.001), (3) studies using individual-based CBT (d = 0.412, p < 0.001), (4) studies without primary care physician involvement (d = 0.395, p < 0.001), and (5) studies using both tele-health (d = 0.563, p < 0.001) and in-person CBT (d = 0.363, p < 0.001). The percentage of White participants, treatment composition (CBT only versus CBT + other approaches), and treatment duration were significant moderators. Implications for clinical practice are discussed based on both moderator and subgroup analysis results.
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Affiliation(s)
- Anao Zhang
- School of Social Work, University of Michigan, 1080 S. University Ave., School of Social Work Building, Ann Arbor, MI, 48109, USA.
| | - Lindsay A Borhneimer
- School of Social Work, University of Michigan, 1080 S. University Ave., School of Social Work Building, Ann Arbor, MI, 48109, USA
| | - Addie Weaver
- School of Social Work, University of Michigan, 1080 S. University Ave., School of Social Work Building, Ann Arbor, MI, 48109, USA
| | - Cynthia Franklin
- Steve Hicks School of Social Work, The University of Texas at Austin, Austin, TX, USA
| | - Audrey Hang Hai
- Steve Hicks School of Social Work, The University of Texas at Austin, Austin, TX, USA
| | - Samantha Guz
- School of Social Service Administration, The University of Chicago, Chicago, IL, USA
| | - Li Shen
- Department of Sociology and Social Work, Shanghai Normal University, Shanghai, China
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19
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Hellström L, Madsen T, Nordentoft M, Bech P, Eplov LF. Trajectories of Return to Work Among People on Sick Leave with Mood or Anxiety Disorders: Secondary Analysis from a Randomized Controlled Trial. JOURNAL OF OCCUPATIONAL REHABILITATION 2018; 28:666-677. [PMID: 29282650 DOI: 10.1007/s10926-017-9750-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Purpose The return to work (RTW) of people with mood and anxiety disorders is a heterogeneous process. We aimed to identify prototypical trajectories of RTW over a two-year period in people on sick leave with mood and anxiety disorders, and investigate if socio-demographic or clinical factors predicted trajectory membership. Methods We used data from the randomized IPS-MA trial (n = 283), evaluating a supported employment intervention for participants with recently diagnosed mood or anxiety disorders. Information on "weeks in employment in the past 6 months" was measured after 1/2, 1, 1 ½ and 2 years, using data from a nationwide Danish register (DREAM). Latent growth mixture modelling analysis was carried out to identify trajectories of RTW and logistic regression analyses were used to estimate predictors for trajectory membership. Results Four trajectory classes of RTW were identified; non-RTW [70% (196/283)] (practically no return to work); delayed-RTW [19% (56/283)] (6 months delay before full RTW); rapid-unstable-RTW [7% (19/283)] (members rapidly returned to work, but only worked half the time); and the smallest class, rapid-RTW [4% (12/283)] (members rapidly reached full employment, but later experienced a decrease in weeks of employment). Self-reported disability score according to the SDS, not living with a partner, and readiness to change on the CQ scale were found to be significantly associated with RTW. Conclusion The trajectories identified support that many do not benefit from vocational rehabilitation, or experience difficulties sustaining employment; enhanced support of this patient group is still warranted.Trial registration: http://www.clinicaltrials.gov (Identifier: NCT01721824).
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Affiliation(s)
- Lone Hellström
- Copenhagen University Hospital, Mental Health Centre Copenhagen, Kildegårdsvej 28, 2900, Hellerup, Denmark.
- Research Unit, Copenhagen University Hospital, Mental Health Centre Copenhagen, Kildegårdsvej 28, 2900, Hellerup, Denmark.
| | - Trine Madsen
- Copenhagen University Hospital, Mental Health Centre Copenhagen, Kildegårdsvej 28, 2900, Hellerup, Denmark
| | - Merete Nordentoft
- Copenhagen University Hospital, Mental Health Centre Copenhagen, Kildegårdsvej 28, 2900, Hellerup, Denmark
| | - Per Bech
- Psychiatric Research Unit, Mental Health Centre North Zealand, University of Copenhagen, Dyrehavevej 48, 3400, Hillerød, Denmark
| | - Lene Falgaard Eplov
- Copenhagen University Hospital, Mental Health Centre Copenhagen, Kildegårdsvej 28, 2900, Hellerup, Denmark
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20
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Øverland S, Grasdal AL, Reme SE. Long-term effects on income and sickness benefits after work-focused cognitive-behavioural therapy and individual job support: a pragmatic, multicentre, randomised controlled trial. Occup Environ Med 2018; 75:703-708. [DOI: 10.1136/oemed-2018-105137] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 06/11/2018] [Accepted: 06/25/2018] [Indexed: 11/04/2022]
Abstract
BackgroundThere is moderate quality evidence that integrating work-directed interventions and components from psychological therapies reduces sickness absence in the medium term. We aimed to extend this evidence by examining objectively ascertained income and work participation status up to 4 years after an intervention to improve outcomes among people who struggle with work from common mental disorder.MethodsThe intervention combined components from cognitive behavioural therapy with principles from supported employment, and compared its efficacy with usual care. Outcomes were derived from registry data with no attrition, in a pragmatic multisite randomised controlled trial (N=1193).ResultsThe intervention group had higher income, higher work participation and more months without receiving benefits over the 10-month to 46-month long-term follow-up period after end of treatment, but differences were not statistically significant. For the group on long-term benefits at inclusion, effect sizes were larger and statistically significant.ConclusionThere were no statistically significant differences between the two groups in the primary outcome in the total population. In a secondary analysis for the subgroup most at risk of permanent work exclusion, long-term outcomes were favourable in the intervention group compared with usual care. The results support integrated work and health services for people on the severe end of work participation challenges.Trial registration numberNCT01146730.
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Abstract
Mental disorders have been linked to unemployment among veterans. Improving mental health conditions, such as depression, can improve veteran employment outcomes. This study compared mental health treatment among unemployed Operation Enduring Freedom (OEF; in Afghanistan) and Operation Iraqi Freedom (OIF; in Iraq) veterans and veterans from other service eras. The study included 3165 unemployed veterans from six Veterans Affairs medical centers with a positive screen that indicates a possible mental disorder. Chi-squared tests and logistic regression analyses assessed whether veteran era was associated with mental health treatment. Unemployed OEF/OIF veterans were less likely to receive psychotropic medication and four or more psychotherapy sessions compared to veterans from other eras. Multivariable analyses controlling for age found associations based on younger age rather than era. Younger unemployed veterans received fewer mental health services, which is concerning because reducing mental health symptoms may increase employment and employment may reduce symptoms, which are key factors in reintegration into civilian life.
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22
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Hellström L, Bech P, Hjorthøj C, Nordentoft M, Lindschou J, Eplov LF. Effect on return to work or education of Individual Placement and Support modified for people with mood and anxiety disorders: results of a randomised clinical trial. Occup Environ Med 2017; 74:717-725. [PMID: 28546319 DOI: 10.1136/oemed-2016-104248] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 03/27/2017] [Accepted: 04/13/2017] [Indexed: 11/04/2022]
Abstract
OBJECTIVES The effect of Individual Placement and Support (IPS) on return to work or education among people with mood or anxiety disorders is unclear, while IPS increases return to work for people with severe mental illness. We examined the effect of IPS modified for people with mood and anxiety disorders (IPS-MA) on return to work and education compared with services as usual (SAU). METHODS In a randomised clinical superiority trial, 326 participants with mood and anxiety disorders were centrally randomised to IPS-MA, consisting of individual mentor support and career counselling (n=162) or SAU (n=164). The primary outcome was competitive employment or education at 24 months, while weeks of competitive employment or education, illness symptoms and level of functioning, and well-being were secondary outcomes. RESULTS After 24 months, 44.4% (72/162) of the participants receiving IPS-MA had returned to work or education compared with 37.8% (62/164) following SAU (OR=1.34, 95% CI: 0.86 to 2.10, p=0.20). We found no difference in mean number of weeks in employment or education (IPS-MA 32.4 weeks vs SAU 26.7 weeks, p=0.14), level of depression (Hamilton Depression 6-Item Scale score IPS-MA 5.7 points vs SAU 5.0 points, p=0.12), level of anxiety (Hamilton Anxiety 6-Item Scale score IPS-MA 5.8 points vs SAU 5.1 points, p=0.17), level of functioning (Global Assessment of Functioning IPS-MA 59.1 points vs SAU 59.5 points, p=0.81) or well-being measured by WHO-Five Well-being Index (IPS-MA 49.6 points vs SAU 48.5 points, p=0.83) at 24 months. CONCLUSION The modified version of IPS, IPS-MA, was not superior to SAU in supporting people with mood or anxiety disorders in return to work at 24 months. TRIAL REGISTRATION NUMBER NCT01721824.
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Affiliation(s)
- Lone Hellström
- Copenhagen University Hospital, Mental Health Center Copenhagen, Hellerup, Denmark
| | - Per Bech
- Psychiatric Research Unit, Mental Health Centre North Zealand, University of Copenhagen, Hellerup, Denmark
| | - Carsten Hjorthøj
- Copenhagen University Hospital, Mental Health Center Copenhagen, Hellerup, Denmark
| | - Merete Nordentoft
- Copenhagen University Hospital, Mental Health Center Copenhagen, Hellerup, Denmark
| | - Jane Lindschou
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen, Denmark
| | - Lene Falgaard Eplov
- Copenhagen University Hospital, Mental Health Center Copenhagen, Hellerup, Denmark
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Cuijpers P, Cristea IA, Karyotaki E, Reijnders M, Huibers MJH. How effective are cognitive behavior therapies for major depression and anxiety disorders? A meta-analytic update of the evidence. World Psychiatry 2016; 15:245-258. [PMID: 27717254 PMCID: PMC5032489 DOI: 10.1002/wps.20346] [Citation(s) in RCA: 266] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
We report the current best estimate of the effects of cognitive behavior therapy (CBT) in the treatment of major depression (MDD), generalized anxiety disorder (GAD), panic disorder (PAD) and social anxiety disorder (SAD), taking into account publication bias, the quality of trials, and the influence of waiting list control groups on the outcomes. In our meta-analyses, we included randomized trials comparing CBT with a control condition (waiting list, care-as-usual or pill placebo) in the acute treatment of MDD, GAD, PAD or SAD, diagnosed on the basis of a structured interview. We found that the overall effects in the 144 included trials (184 comparisons) for all four disorders were large, ranging from g=0.75 for MDD to g=0.80 for GAD, g=0.81 for PAD, and g=0.88 for SAD. Publication bias mostly affected the outcomes of CBT in GAD (adjusted g=0.59) and MDD (adjusted g=0.65), but not those in PAD and SAD. Only 17.4% of the included trials were considered to be high-quality, and this mostly affected the outcomes for PAD (g=0.61) and SAD (g=0.76). More than 80% of trials in anxiety disorders used waiting list control groups, and the few studies using other control groups pointed at much smaller effect sizes for CBT. We conclude that CBT is probably effective in the treatment of MDD, GAD, PAD and SAD; that the effects are large when the control condition is waiting list, but small to moderate when it is care-as-usual or pill placebo; and that, because of the small number of high-quality trials, these effects are still uncertain and should be considered with caution.
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Affiliation(s)
- Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
| | - Ioana A Cristea
- Department of Clinical Psychology and Psychotherapy, Babes-Bolyai University, Cluj-Napoca, Romania
| | - Eirini Karyotaki
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
| | - Mirjam Reijnders
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
| | - Marcus J H Huibers
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA
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24
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Himle JA, Weaver A, Bybee D, O'Donnell L, Vlnka S, Laviolette W, Steinberger E, Golenberg Z, Levine DS. Employment barriers, skills, and aspirations among unemployed job seekers with and without social anxiety disorder. Psychiatr Serv 2014; 65:924-30. [PMID: 24733524 PMCID: PMC4198508 DOI: 10.1176/appi.ps.201300201] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE The literature has consistently demonstrated that social anxiety disorder has substantial negative impacts on occupational functioning. However, to date, no empirical work has focused on understanding the specific nature of vocational problems among persons with social anxiety disorder. This study examined the association between perceived barriers to employment, employment skills, and job aspirations and social anxiety among adults seeking vocational rehabilitation services. METHODS Data from intake assessments (June 2010-December 2011) of 265 low-income, unemployed adults who initiated vocational rehabilitation services in urban Michigan were examined to assess perceived barriers to employment, employment skills, job aspirations, and demographic characteristics among participants who did or did not screen positive for social anxiety disorder. Bivariate and multiple logistic regression analyses were performed. RESULTS After adjustment for other factors, the multiple logistic regression analysis revealed that perceiving more employment barriers involving experience and skills, reporting fewer skills related to occupations requiring social skills, and having less education were significantly associated with social anxiety disorder. Participants who screened positive for social anxiety disorder were significantly less likely to aspire to social jobs. CONCLUSIONS Employment-related characteristics that were likely to have an impact on occupational functioning were significantly different between persons with and without social anxiety problems. Identifying these differences in employment barriers, skills, and job aspirations revealed important information for designing psychosocial interventions for treatment of social anxiety disorder. The findings underscored the need for vocational services professionals to assess and address social anxiety among their clients.
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Affiliation(s)
- Joseph A Himle
- Dr. Himle, Dr. Weaver, Ms. O'Donnell, Ms. Vlnka, and Dr. Levine are with the Department of Psychiatry, University of Michigan, Ann Arbor (e-mail: ). Dr. Bybee is with the Department of Community Psychology, Michigan State University, East Lansing. Mr. Laviolette, Mr. Steinberger, and Ms. Golenberg are with JVS Detroit, Detroit, Michigan
| | - Addie Weaver
- Dr. Himle, Dr. Weaver, Ms. O'Donnell, Ms. Vlnka, and Dr. Levine are with the Department of Psychiatry, University of Michigan, Ann Arbor (e-mail: ). Dr. Bybee is with the Department of Community Psychology, Michigan State University, East Lansing. Mr. Laviolette, Mr. Steinberger, and Ms. Golenberg are with JVS Detroit, Detroit, Michigan
| | - Deborah Bybee
- Dr. Himle, Dr. Weaver, Ms. O'Donnell, Ms. Vlnka, and Dr. Levine are with the Department of Psychiatry, University of Michigan, Ann Arbor (e-mail: ). Dr. Bybee is with the Department of Community Psychology, Michigan State University, East Lansing. Mr. Laviolette, Mr. Steinberger, and Ms. Golenberg are with JVS Detroit, Detroit, Michigan
| | - Lisa O'Donnell
- Dr. Himle, Dr. Weaver, Ms. O'Donnell, Ms. Vlnka, and Dr. Levine are with the Department of Psychiatry, University of Michigan, Ann Arbor (e-mail: ). Dr. Bybee is with the Department of Community Psychology, Michigan State University, East Lansing. Mr. Laviolette, Mr. Steinberger, and Ms. Golenberg are with JVS Detroit, Detroit, Michigan
| | - Sarah Vlnka
- Dr. Himle, Dr. Weaver, Ms. O'Donnell, Ms. Vlnka, and Dr. Levine are with the Department of Psychiatry, University of Michigan, Ann Arbor (e-mail: ). Dr. Bybee is with the Department of Community Psychology, Michigan State University, East Lansing. Mr. Laviolette, Mr. Steinberger, and Ms. Golenberg are with JVS Detroit, Detroit, Michigan
| | - Wayne Laviolette
- Dr. Himle, Dr. Weaver, Ms. O'Donnell, Ms. Vlnka, and Dr. Levine are with the Department of Psychiatry, University of Michigan, Ann Arbor (e-mail: ). Dr. Bybee is with the Department of Community Psychology, Michigan State University, East Lansing. Mr. Laviolette, Mr. Steinberger, and Ms. Golenberg are with JVS Detroit, Detroit, Michigan
| | - Edward Steinberger
- Dr. Himle, Dr. Weaver, Ms. O'Donnell, Ms. Vlnka, and Dr. Levine are with the Department of Psychiatry, University of Michigan, Ann Arbor (e-mail: ). Dr. Bybee is with the Department of Community Psychology, Michigan State University, East Lansing. Mr. Laviolette, Mr. Steinberger, and Ms. Golenberg are with JVS Detroit, Detroit, Michigan
| | - Zipora Golenberg
- Dr. Himle, Dr. Weaver, Ms. O'Donnell, Ms. Vlnka, and Dr. Levine are with the Department of Psychiatry, University of Michigan, Ann Arbor (e-mail: ). Dr. Bybee is with the Department of Community Psychology, Michigan State University, East Lansing. Mr. Laviolette, Mr. Steinberger, and Ms. Golenberg are with JVS Detroit, Detroit, Michigan
| | - Debra Siegel Levine
- Dr. Himle, Dr. Weaver, Ms. O'Donnell, Ms. Vlnka, and Dr. Levine are with the Department of Psychiatry, University of Michigan, Ann Arbor (e-mail: ). Dr. Bybee is with the Department of Community Psychology, Michigan State University, East Lansing. Mr. Laviolette, Mr. Steinberger, and Ms. Golenberg are with JVS Detroit, Detroit, Michigan
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