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Stallard P, Whittle K, Moore E, Medina-Lara A, Morrish N, Cliffe B, Rhodes S, Taylor G. Clinical effectiveness and safety of adding a self-harm prevention app (BlueIce) to specialist mental health care for adolescents who repeatedly self-harm: A single blind randomised controlled trial (the BASH study). Psychiatry Res 2024; 339:116017. [PMID: 38875918 DOI: 10.1016/j.psychres.2024.116017] [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: 12/04/2023] [Revised: 06/04/2024] [Accepted: 06/08/2024] [Indexed: 06/16/2024]
Abstract
No randomised controlled trials have evaluated whether the addition of a smartphone app to usual child and adolescent mental health care (CAMHS) can reduce self-harm in adolescents (<18 years) with repeated self-harm. We enrolled 170 participants aged 12-17, receiving CAMHS treatment who had self-harmed ≥2 in the past 12 months. Participants were randomised via an independent web-based system (1:1, minimised for gender, age, self-harm frequency, and depression severity) to treatment as usual (TAU) or treatment as usual plus BlueIce (TAU+BI). BlueIce is a self-harm prevention app that includes techniques from CBT and DBT that was co-designed with adolescents who self-harm. The primary outcome was change from baseline to 12-weeks on the self-harm scale of the Risk Taking and Self-Harm Inventory for Adolescents (RTSHIA), analysed by intention to treat (ITT). Emergency department attendances or admissions for self-harm were assessed over 6-months via a review of clinical records. Both groups improved but there were no statistically significant between group differences at 12 weeks or 6 months on the self-harm scale of the RTSHIA. There were fewer emergency department attendances and admissions in those who received the app, a finding that approached statistical significance. BlueIce can be helpful in some important aspects by contributing to fewer emergency department admissions and attendances. TRIAL REGISTRATION: Trial registration number ISRCTN10541045.
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Affiliation(s)
- Paul Stallard
- Department for Health, University of Bath, UK; Child and Adolescent Mental Health Services, Oxford Health NHS Foundation Trust, UK.
| | - Kathryn Whittle
- Child and Adolescent Mental Health Services, Oxford Health NHS Foundation Trust, UK
| | - Emma Moore
- Child and Adolescent Mental Health Services, Oxford Health NHS Foundation Trust, UK
| | - Antonieta Medina-Lara
- Department of Public Health and Sport Sciences, Public Health Economics Group, University of Exeter, UK
| | - Nia Morrish
- Department of Public Health and Sport Sciences, Public Health Economics Group, University of Exeter, UK
| | | | - Shelley Rhodes
- Clinical Trials Unit, University of Exeter Medical School, Exeter, UK
| | - Gordon Taylor
- Department of Health & Community Sciences, University of Exeter Medical School, Exeter, UK
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Shuai R, Ahmed-Leitao F, Bloom J, Seedat S, Hogarth L. Brief online negative affect focused functional imagery training (FIT) improves four-week drinking outcomes in hazardous student drinkers: A pilot randomised controlled trial replication in South Africa. Addict Behav Rep 2024; 19:100540. [PMID: 38586438 PMCID: PMC10995806 DOI: 10.1016/j.abrep.2024.100540] [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: 07/05/2023] [Revised: 03/04/2024] [Accepted: 03/18/2024] [Indexed: 04/09/2024] Open
Abstract
Background Previous study has shown that functional imagery training (FIT) to utilise positive mental imagery in response to negative affect could improve alcohol-related outcomes. The current study aimed to replicate whether this negative affect focused FIT would improve alcohol-related outcomes in hazardous student drinkers in South Africa at four-week follow-up. Methods 50 hazardous student drinkers who reported drinking to cope with negative affect were randomised into two groups. The active group (n = 25) was trained online over two weeks to respond to personalised negative drinking triggers by retrieving a personalised adaptive strategy they might use to mitigate negative affect, whereas the control group (n = 25) received standard risk information about binge drinking. Outcome measures including alcohol consumption, drinking motives, anxiety and depression, self-efficacy and use of protective behavioural strategies were obtained at baseline and four-week follow-up. Results FIT effects were revealed by three significant group-by-timepoint interactions in a per-protocol analysis: there was a significant decrease in depressive symptoms, drinking to cope and drinking for social reasons from baseline to follow-up in the active group, but not the control group. No effects were observed on alcohol consumption, self-efficacy, protective behaviour strategies and anxiety. Conclusions Preliminary evidence supports that online negative affect focused FIT can improve depression as well as coping and social drinking motives in South African hazardous student drinkers who drank to cope, at four-week follow-up, suggesting that the principles of this FIT approach might be adapted and incorporated into a clinical intervention to test for efficacy in mitigating substance use problems.
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Affiliation(s)
- Ruichong Shuai
- School of Psychology, University of Exeter, Exeter, United Kingdom
| | - Fatima Ahmed-Leitao
- Department of Psychiatry, Stellenbosch University, Private Bag X1, Matieland, 7602, Stellenbosch, South Africa
| | - Jenny Bloom
- Department of Psychiatry, Stellenbosch University, Private Bag X1, Matieland, 7602, Stellenbosch, South Africa
| | - Soraya Seedat
- Department of Psychiatry, Stellenbosch University, Private Bag X1, Matieland, 7602, Stellenbosch, South Africa
| | - Lee Hogarth
- School of Psychology, University of Exeter, Exeter, United Kingdom
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Schmied E, Hack L, Connemann B, Sosic-Vasic Z, Kroener J. You're not alone: imagery rescripting for adolescents who self-harm. Front Psychol 2024; 15:1395603. [PMID: 38756496 PMCID: PMC11096576 DOI: 10.3389/fpsyg.2024.1395603] [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: 03/04/2024] [Accepted: 04/12/2024] [Indexed: 05/18/2024] Open
Abstract
Introduction Non-suicidal self-injury (NSSI), which refers to the deliberate act of causing harm to one's own body without the intent to commit suicide, occurs in 20% of youth. Interestingly, approximately 90% of individuals who engage in self-harm report intrusive mental imagery thereof shortly prior to the act of NSSI. Previous research has demonstrated that imagery rescripting (IR) is an effective technique to treat intrusive mental images and associated clinical symptoms, such as emotion dysregulation, in various psychiatric disorders. However, there is no research on IR for adolescents who self-harm. Therefore, the present study aims to investigate the efficacy and feasibility of a two-session short-intervention using IR to reduce NSSI and associated clinical symptoms in adolescents. The intervention was supported by an app-based digital health intervention (DHI). Methods A single case series A-B design with three post-assessments (1 week, 1 month, and 3 months post-intervention) was implemented. Seven adolescents received two treatment sessions of IR, supported by a DHI between sessions. NSSI (SITBI), emotion regulation (ERQ), emotional distress (BDI-II, STAI-T), self-efficacy (WIRKALL_r), and treatment satisfaction (BIKEP) were evaluated. Results There was an increase in adaptive emotion regulation strategies up to 3 months post-intervention. Furthermore, patients improved regarding their self-efficacy, depressiveness, anxiety, and NSSI symptomatology. The developed DHI was described as a helpful and supportive tool. Conclusion The intervention has shown initial evidence to be feasible and beneficial for adolescents conducting NSSI. The DHI has demonstrated to be a valuable tool in the treatment of self-harming youth.
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Affiliation(s)
- Elisa Schmied
- Christophsbad Goeppingen, Department of Applied Psychotherapy and Psychiatry, Göppingen, Germany
- Medical Department, University of Ulm, Ulm, Germany
| | - Lisa Hack
- Christophsbad Goeppingen, Department of Applied Psychotherapy and Psychiatry, Göppingen, Germany
- Medical Department, University of Ulm, Ulm, Germany
| | | | - Zrinka Sosic-Vasic
- Christophsbad Goeppingen, Department of Applied Psychotherapy and Psychiatry, Göppingen, Germany
- Medical Department, University of Ulm, Ulm, Germany
| | - Julia Kroener
- Christophsbad Goeppingen, Department of Applied Psychotherapy and Psychiatry, Göppingen, Germany
- Medical Department, University of Ulm, Ulm, Germany
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Ji JL, Kyron M, Saulsman L, Becerra R, Lin A, Hasking P, Holmes EA. Picturing self-harm: Investigating flash-forward mental imagery as a proximal and modifiable driver of non-suicidal self-injury. Suicide Life Threat Behav 2024. [PMID: 38597460 DOI: 10.1111/sltb.13081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 02/28/2024] [Accepted: 03/25/2024] [Indexed: 04/11/2024]
Abstract
OBJECTIVES Non-suicidal self-injury (NSSI) is theorized to be reinforced by its emotional consequences. Mental images of NSSI are commonly reported as occurring prior to NSSI. Based on the known functional properties of anticipatory mental imagery as an emotional and motivational amplifier, this study investigated whether NSSI mental imagery constitutes a proximal and dynamic mechanism underpinning NSSI risk. METHOD An intensive ecological momentary assessment (EMA) study was conducted to track the occurrence and characteristics of NSSI mental imagery alongside NSSI urge and behavior in naturalistic settings. A sample of N = 43 individuals aged 17 to 24 with a history of repetitive NSSI completed EMA surveys seven times a day for 14 days. RESULTS Mental preoccupation in the form of NSSI mental imagery-based flash-forwards to the actions, bodily sensations, and emotional benefits of NSSI was found to occur when NSSI urge was high but not when urge was low. Critically, objective cross-panel analyses showed that higher frequencies of NSSI imagery occurrence predicted greater future NSSI urge and increased likelihood of acting on urge, over and above current urge. CONCLUSIONS Mental imagery of NSSI is not simply an epiphenomenal by-product of NSSI urge and may constitute a dynamic and proximal novel intervention target.
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Affiliation(s)
- Julie L Ji
- School of Psychology, University of Plymouth, Plymouth, UK
- School of Psychological Science, University of Western Australia, Perth, Western Australia, Australia
| | - Michael Kyron
- School of Psychological Science, University of Western Australia, Perth, Western Australia, Australia
| | - Lisa Saulsman
- School of Psychological Science, University of Western Australia, Perth, Western Australia, Australia
| | - Rodrigo Becerra
- School of Psychological Science, University of Western Australia, Perth, Western Australia, Australia
| | - Ashleigh Lin
- School of Population and Global Health, University of Western Australia, Perth, Western Australia, Australia
| | - Penelope Hasking
- Curtin enAble Institute, Curtin University, Perth, Western Australia, Australia
| | - Emily A Holmes
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Kroener J, Schaitz C, Sosic-Vasic Z. Prospective Mental Images: A Transdiagnostic Approach to Negative Affectivity and Mood Dysregulation among Borderline Personality Disorder and Depression. Behav Sci (Basel) 2024; 14:81. [PMID: 38392434 PMCID: PMC10886009 DOI: 10.3390/bs14020081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/10/2024] [Accepted: 01/19/2024] [Indexed: 02/24/2024] Open
Abstract
There is initial evidence that patients diagnosed with Borderline Personality Disorder (BPD) experience intrusive prospective mental images about non-suicidal self-injury (NSSI). These images, in turn, are associated with the conduct of NSSI. As the negative emotional valence of intrusive images has been established across clinical disorders, negative affectivity might play a key role linking mental imagery and psychopathology. Therefore, the present study aimed to investigate the possible mediating role of symptoms of depression as a proxy for negative affectivity linking intrusive prospective imagery to psychopathology in patients diagnosed with BPD. A total of 233 participants (84 diagnosed with MDD, 66 diagnosed with BPD, 83 healthy controls) completed questionnaires on negative affectivity (BDI-II) and prospective intrusive imagery (IFES-S). Before controlling for negative affectivity, there was a positive correlation between group and intrusive prospective imagery, indicating that healthy participants displayed lower amounts of intrusive prospective images in comparison to patients diagnosed with MDD or BPD. After entering negative affectivity as a mediator, the variable group was no longer associated with intrusive prospective images; however, negative affectivity showed a strong and positive relationship with the group on one side, and intrusive prospective imagery on the other, indicating that negative affectivity mediates the association between intrusive prospective images and clinical disorders. The presented findings point towards a mediating role of negative affectivity in the manifestation of intrusive prospective imagery, not only within BPD, but also in patients with MDD. The possibility of intrusive images acting as a transdiagnostic feature, where negative affectivity and mood dysregulation are at the core of the clinical disorder, are being discussed.
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Affiliation(s)
- Julia Kroener
- Department of Applied Psychotherapy and Psychiatry, Christophsbad Goeppingen, Jahnstraße 30, 73035 Goeppingen, Germany
- Department of Psychiatry and Psychotherapy III, University Clinic of Ulm, Leimgrubenweg 12-14, 89075 Ulm, Germany
| | - Caroline Schaitz
- Psychotherapeutic Outpatient Facility, Medical School Berlin, Rüdesheimer Straße 50, 14197 Berlin, Germany
| | - Zrinka Sosic-Vasic
- Department of Applied Psychotherapy and Psychiatry, Christophsbad Goeppingen, Jahnstraße 30, 73035 Goeppingen, Germany
- Department of Psychiatry and Psychotherapy III, University Clinic of Ulm, Leimgrubenweg 12-14, 89075 Ulm, Germany
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Luo M, Yue Y, Du N, Xiao Y, Chen C, Huan Z. Needs for mobile and internet-based psychological intervention in patients with self-injury and suicide-related behaviors: a qualitative systematic review. BMC Psychiatry 2024; 24:26. [PMID: 38178028 PMCID: PMC10768375 DOI: 10.1186/s12888-023-05477-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 12/24/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND In recent years, mobile psychological interventions have proven effective in reducing self-injury and suicide-related behaviors. Therefore, it is essential to continually enhance the user experience and address patients' needs to facilitate the development of mobile mental health interventions. Identifying patients with mobile mental health needs can be challenging for mental health professionals. To address this, we conducted a systematic review of qualitative research to synthesize the needs of patients engaged in self-injury and suicide-related behaviors for mobile and internet-based psychological interventions. METHODS This study adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (PRISMA) and the Enhancing Transparency in Reporting the Synthesis of Qualitative Research statement (ENTREQ). We explored 11 databases and synthesized the results using thematic analysis. RESULTS Sixteen qualitative and mixed-method studies were included. The study found that the needs of patients with self-injury and suicide-related behaviors for mobile psychological intervention included therapy, technology, culture, privacy, communication, emotional support, personalization, and self-management. Consistent with the Technology Acceptance Model (TAM), the needs of patients with self-injury and suicide-related behaviors are influenced by the perceived ease of use and perceived usefulness of the mobile intervention. However, the findings also highlight the importance and unmet needs of peer support, communication, self-management, and empowerment in using mobile psychological interventions for patients with self-injury and suicide-related behaviors. CONCLUSIONS Studies in this area have shown that the needs of patients with self-harm and suicide-related behaviors cover multiple stages, including basic therapeutic and technical needs and advanced emotional needs. This complexity makes it challenging to address the needs of patients engaged in self-injury and suicide-related behaviors through digital interventions. In the future, mental health professionals should be encouraged to participate in multidisciplinary collaborations to expand the use of digital interventions, enhancing remote self-management for patients and providing new strategies for the ongoing care of psychiatric patients. We registered the review protocol on PROSPERO (CRD42022324958).
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Affiliation(s)
- Meiqi Luo
- College of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yuchuan Yue
- The Fourth People's Hospital of Chengdu, Hospital Office, Sichuan Province, Chengdu, China.
| | - Na Du
- Psychosomatic Medical Center, The Fourth People's Hospital of Chengdu, Chengdu, 610036, China.
- Clinical Psychology Department, The Fourth People's Hospital of Chengdu, Chengdu, China.
| | - Yu Xiao
- Psychosomatic Medical Center, The Fourth People's Hospital of Chengdu, Chengdu, 610036, China
- Clinical Psychology Department, The Fourth People's Hospital of Chengdu, Chengdu, China
| | - Chunyan Chen
- College of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Zongsu Huan
- College of Nursing, Zunyi Medical University, Zunyi, China
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van den Berg KC, Voncken M, Hendrickson AT, Di Simplicio M, Regeer EJ, Rops L, Keijsers GPJ. Exploring aspects of self-reported emotional mental imagery in patients with bipolar disorder. J Behav Ther Exp Psychiatry 2023; 81:101861. [PMID: 37182427 DOI: 10.1016/j.jbtep.2023.101861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/28/2023] [Accepted: 04/29/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND AND OBJECTIVES CBT for patients with bipolar disorder has modest effects. Across disorders, mental imagery has been used to update CBT to increase effectiveness. In order to enhance CBT for bipolar disorder with imagery techniques, research is needed into emotional imagery quality and, related appraisals of imagery and their relationships with mood instability and subsequent behaviour in bipolar disorder. METHODS Patients with bipolar disorder (n = 106), unipolar depression (n = 51), creative imagery prone participants (n = 53) and participants without a history of a mood disorder (n = 135) completed the Dutch Imagery Survey (DImS), an online imagery survey, adapted from the Imagery Interview, assessing self-reported emotional imagery aspects. Imagery quality, appraisals and their self-perceived effects on emotion and behaviour were compared between groups. As unexpected differences within the bipolar group appeared, these were additionally explored. RESULTS Imagery appraisals but not imagery quality discriminated between the patient groups and non-patient groups Imagery was perceived as an emotional amplifier in all groups, but this was specifically apparent in bipolar manic and bipolar depressed groups. Only in the bipolar group imagery was experienced to amplify behavioural tendencies. LIMITATIONS Results need to be replicated using a larger sample of patients with BD who are currently manic or depressed. CONCLUSIONS Not only quality of imagery, but especially appraisals associated with imagery are differentiating between imagery prone people with and without mood disorder. Imagery amplifies emotion in all groups, but only in those patients with bipolar disorder currently manic or depressed did this influence behaviour.
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Affiliation(s)
- K C van den Berg
- Medical Psychiatric Research Group, Geestelijke Gezondheidszorg Eindhoven (GGzE), the Netherlands; Faculty of Psychology and Neuroscience, Department of Clinical Psychological Sciences, Maastricht University, the Netherlands.
| | - M Voncken
- Faculty of Psychology and Neuroscience, Department of Clinical Psychological Sciences, Maastricht University, the Netherlands
| | - A T Hendrickson
- Department of Cognitive Science and Artificial Intelligence, Tilburg University, the Netherlands
| | - M Di Simplicio
- Imperial College London, Division of Psychiatry, Department of Brain Sciences, UK
| | - E J Regeer
- Altrecht Institute for Mental Health Care, Utrecht, the Netherlands
| | - L Rops
- Medical Psychiatric Research Group, Geestelijke Gezondheidszorg Eindhoven (GGzE), the Netherlands
| | - G P J Keijsers
- Faculty of Psychology and Neuroscience, Department of Clinical Psychological Sciences, Maastricht University, the Netherlands; Behavioural Science Institute, Radboud University, Nijmegen, the Netherlands
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Hill RM, Hussain Z, Vieyra B, Gallagher A. Reporting Ethical Procedures in Suicide Prevention Research: Current Status and Recommendations. Arch Suicide Res 2023; 27:1373-1390. [PMID: 36415164 DOI: 10.1080/13811118.2022.2131493] [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] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Ethical concerns frequently arise in suicide prevention research regarding participant safety and confidentiality. Despite a substantial literature on managing and navigating ethical concerns in suicide research, little attention has been paid to the reporting of ethical procedures. Furthermore, standard procedures for reporting ethical risk management procedures have not been developed. METHOD A review of the current literature was performed to examine the current state of reporting of ethical procedures within suicide research. Articles published in 2020 (N = 263) from three suicide-focused publications were screened and then coded (n = 131) to identify reporting of procedures for the ethical conduct of research and suicide risk management steps taken by the research teams. RESULTS The majority of articles reported ethical review or approval (84.7%) and reported the use of an informed consent process (77.9%). Only 28.2% included risk mitigation procedures. Of those 29.7% of those articles reported conducting risk evaluation, 66.7% reported resource dissemination, and 51.4% reported an intervention. CONCLUSION As empirical support for brief interventions accrues, suicide prevention researchers should consider establishing standards for the reporting of procedures to ensure the safety of participants with suicidal risk.HighlightsReporting suicide safety protocols helps ensure high ethical standards in research.Fewer than 1/3 of articles reviewed reported risk mitigation procedures in 2020.Standard procedures for reporting safety protocols in suicide research are needed.
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Cairns AJJ, Kelly J, Taylor CDJ. Assessing the delivering of iMAgery-focused therapy for PSychosis (iMAPS) via telehealth. Psychol Psychother 2023; 96:678-696. [PMID: 37002818 DOI: 10.1111/papt.12463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 03/23/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVES To examine the feasibility and acceptability of a novel telehealth (video-conferencing software and telephone calls) imagery-based therapeutic intervention for people experiencing persecutory delusions. Utilising a multiple baseline case series design and exploring imagery-focused therapy for psychosis (iMAPS). DESIGN A non-concurrent A-B multiple baseline design was used. METHODS Participants experiencing persecutory delusions and self-reporting a psychosis or schizophrenia-spectrum diagnosis were recruited through online adverts. On completion of assessments, participants were randomly assigned to multiple baseline assessments, of between three and five sessions. Six therapy sessions followed, consisting of imagery formulation, safe-place imagery creation, compassionate imagery, imagery manipulation and rescripting. Participants completed pre- and post-measures and sessional measures via an online survey software or in semi-structured interviews. Two weeks post-intervention, a final measure was completed exploring any potential adverse effects of psychotherapy. RESULTS Five female participants completed all baseline and therapeutic sessions, suggesting the therapy was and mode of delivery was feasible and acceptable. Results indicate strong effect sizes across PANSS positive subscale and mood, as well as participants reporting a clinically significant change in at least one measure, for example, PSYRATS. All participants reported a reduction in the realness and compelling nature of distressing imagery. CONCLUSIONS Results suggest delivering a telehealth imagery-focused therapy is acceptable and feasibly delivered via telehealth. A control group and blinding of assessments would strengthen the methodological limitations present.
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Affiliation(s)
- Aimee J J Cairns
- Clinical Psychology, Lancaster University, Health Innovation Campus, Bailrigg, Lancaster, LA1 4YW, UK
| | - James Kelly
- Clinical Psychology, Lancaster University, Health Innovation Campus, Bailrigg, Lancaster, LA1 4YW, UK
- North Manchester General Hospital, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Christopher D J Taylor
- Community Mental Health Team, Pennine Care NHS Foundation Trust, Humphrey House, Angouleme Way, Bury, Bl9 0EQ, UK
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, Zochonis Building, Brunswick Street, Manchester, M13 9PL, UK
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Lawrence HR, Balkind EG, Ji JL, Burke TA, Liu RT. Mental imagery of suicide and non-suicidal self-injury: A meta-analysis and systematic review. Clin Psychol Rev 2023; 103:102302. [PMID: 37329877 PMCID: PMC10330912 DOI: 10.1016/j.cpr.2023.102302] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 01/27/2023] [Accepted: 06/07/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND The vast majority of research on, and clinical assessment of, cognitions related to suicide and non-suicidal self-injury (NSSI) has focused on verbal thoughts. And yet, mental imagery is more realistic and emotionally arousing than verbal thoughts. METHODS We conducted a systematic review and meta-analysis documenting the prevalence of suicidal and NSSI mental imagery and describing the content and characteristics of suicidal and NSSI mental imagery, links between suicidal and NSSI mental imagery and suicidal and NSSI behavior, and how to intervene on suicidal and NSSI mental imagery. Studies published through December 17, 2022 were identified through a systematic search of MEDLINE and PsycINFO. RESULTS Twenty-three articles were included. Prevalence rates of suicidal (73.56%) and NSSI (84.33%) mental imagery were high among clinical samples. Self-harm mental imagery commonly depicts engagement in self-harm behavior and is experienced as vivid, realistic, and preoccupying. When experimentally induced, self-harm mental imagery reduces physiological and affective arousal. Preliminary evidence suggests that suicidal mental imagery is associated with suicidal behavior. CONCLUSIONS Suicidal and NSSI mental imagery are highly prevalent and may be associated with heightened risk for self-harm behavior. Assessments and interventions for self-harm should consider incorporating and addressing suicidal and NSSI mental imagery to mitigate risk.
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Affiliation(s)
- Hannah R Lawrence
- School of Psychological Science, Oregon State University, Corvallis, OR, United States of America.
| | - Emma G Balkind
- Suffolk University, Boston, MA, United States of America
| | - Julie L Ji
- School of Psychological Science, University of Western Australia, WA, Australia; School of Psychology, University of Plymouth, UK
| | - Taylor A Burke
- Massachusetts General Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America
| | - Richard T Liu
- Massachusetts General Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America
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Bear HA, Ayala Nunes L, DeJesus J, Liverpool S, Moltrecht B, Neelakantan L, Harriss E, Watkins E, Fazel M. Determination of Markers of Successful Implementation of Mental Health Apps for Young People: Systematic Review. J Med Internet Res 2022; 24:e40347. [DOI: 10.2196/40347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 08/12/2022] [Accepted: 09/28/2022] [Indexed: 11/10/2022] Open
Abstract
Background
Smartphone apps have the potential to address some of the current issues facing service provision for young people’s mental health by improving the scalability of evidence-based mental health interventions. However, very few apps have been successfully implemented, and consensus on implementation measurement is lacking.
Objective
This review aims to determine the proportion of evidence-based mental health and well-being apps that have been successfully adopted and sustained in real-world settings. A secondary aim is to establish if key implementation determinants such as coproduction, acceptability, feasibility, appropriateness, and engagement contribute toward successful implementation and longevity.
Methods
Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, an electronic search of 5 databases in 2021 yielded 18,660 results. After full-text screening, 34 articles met the full eligibility criteria, providing data on 29 smartphone apps studied with individuals aged 15 to 25 years.
Results
Of 34 studies, only 10 (29%) studies were identified that were evaluating the effectiveness of 8 existing, commercially available mental health apps, and the remaining 24 (71%) studies reported the development and evaluation of 21 newly developed apps, of which 43% (9/21) were available, commercially or otherwise (eg, in mental health services), at the time of enquiry. Most studies addressed some implementation components including adoption, acceptability, appropriateness, feasibility, and engagement. Factors including high cost, funding constraints, and lengthy research processes impeded implementation.
Conclusions
Without addressing common implementation drivers, there is considerable redundancy in the translation of mobile mental health research findings into practice. Studies should embed implementation strategies from the outset of the planned research, build collaborations with partners already working in the field (academic and commercial) to capitalize on existing interventions and platforms, and modify and evaluate them for local contexts or target problems and populations.
Trial Registration
PROSPERO CRD42021224365; https://tinyurl.com/4umpn85f
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Ledden S, Rains LS, Schlief M, Barnett P, Ching BCF, Hallam B, Günak MM, Steare T, Parker J, Labovitch S, Oram S, Pilling S, Johnson S. Current state of the evidence on community treatments for people with complex emotional needs: a scoping review. BMC Psychiatry 2022; 22:589. [PMID: 36064337 PMCID: PMC9442944 DOI: 10.1186/s12888-022-04171-z] [Citation(s) in RCA: 3] [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: 12/07/2021] [Accepted: 07/18/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Improving the quality of care in community settings for people with 'Complex Emotional Needs' (CEN-our preferred working term for services for people with a "personality disorder" diagnosis or comparable needs) is recognised internationally as a priority. Plans to improve care should be rooted as far as possible in evidence. We aimed to take stock of the current state of such evidence, and identify significant gaps through a scoping review of published investigations of outcomes of community-based psychosocial interventions designed for CEN. METHODS We conducted a scoping review with systematic searches. We searched six bibliographic databases, including forward and backward citation searching, and reference searching of relevant systematic reviews. We included studies using quantitative methods to test for effects on any clinical, social, and functioning outcomes from community-based interventions for people with CEN. The final search was conducted in November 2020. RESULTS We included 226 papers in all (210 studies). Little relevant literature was published before 2000. Since then, publications per year and sample sizes have gradually increased, but most studies are relatively small, including many pilot or uncontrolled studies. Most studies focus on symptom and self-harm outcomes of various forms of specialist psychotherapy: most result in outcomes better than from inactive controls and similar to other specialist psychotherapies. We found large evidence gaps. Adaptation and testing of therapies for significant groups (e.g. people with comorbid psychosis, bipolar disorder, post-traumatic stress disorder, or substance misuse; older and younger groups; parents) have for the most part only reached a feasibility testing stage. We found little evidence regarding interventions to improve social aspects of people's lives, peer support, or ways of designing effective services. CONCLUSIONS Compared with other longer term mental health problems that significantly impair functioning, the evidence base on how to provide high quality care for people with CEN is very limited. There is good evidence that people with CEN can be helped when specialist therapies are available and when they are able to engage with them. However, a much more methodologically robust and substantial literature addressing a much wider range of research questions is urgently needed to optimise treatment and support across this group.
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Affiliation(s)
- Sarah Ledden
- Division of Psychiatry, University College London, London, UK
| | - Luke Sheridan Rains
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
| | - Merle Schlief
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK.
| | - Phoebe Barnett
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Brian Chi Fung Ching
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
| | - Brendan Hallam
- Division of Psychiatry, University College London, London, UK
- Research Department of Primary Care & Population Health, University College London, London, UK
| | - Mia Maria Günak
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
- Department of Psychology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Thomas Steare
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
| | - Jennie Parker
- NIHR Mental Health Policy Research Unit Co-Production Group, University College London, London, UK
| | - Sarah Labovitch
- NIHR Mental Health Policy Research Unit Co-Production Group, University College London, London, UK
- West London NHS Trust, London, UK
| | - Sian Oram
- NIHR Mental Health Policy Research Unit, Department of Health Service and Population Research, King's College London, London, UK
| | - Steve Pilling
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
- National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | - Sonia Johnson
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
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13
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Shuai R, Bakou AE, Andrade J, Hides L, Hogarth L. Brief Online Negative Affect Focused Functional Imagery Training Improves 2-Week Drinking Outcomes in Hazardous Student Drinkers: a Pilot Randomised Controlled Trial. Int J Behav Med 2022; 29:346-356. [PMID: 34432263 PMCID: PMC9166857 DOI: 10.1007/s12529-021-10019-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND Negative affect plays an important role in motivating problematic alcohol use. Consequently, training imagery-based adaptive responses to negative affect could reduce problematic alcohol use. The current study tested whether personalised online functional imagery training (FIT) to utilise positive mental imagery in response to negative affect would improve drinking outcomes in hazardous negative affect drinking students. METHOD Participants were 52 hazardous student drinkers who drink to cope with negative affect. Participants in the active group (n = 24) were trained online over 2 weeks to respond to personalised negative drinking triggers by retrieving a personalised adaptive strategy they might use to mitigate negative affect, whereas participants in the control group (n = 28) received standard risk information about binge drinking at university. Measures of daily drinking quantity, drinking motives, self-efficacy and use of protective behavioural strategies were obtained at baseline and 2 weeks follow-up. RESULTS There were three significant interactions between group and time in a per-protocol analysis: the active intervention group showed increased self-efficacy of control over negative affect drinking and control over alcohol consumption and decreased social drinking motives from baseline to 2-week follow-up, relative to the control intervention group. There were no effects on drinking frequency. CONCLUSION These findings provide initial evidence that online training to respond to negative affect drinking triggers by retrieving mental imagery of adaptive strategies can improve drinking-related outcomes in hazardous, student, negative affect drinkers. The findings support the utility of FIT interventions for substance use.
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Affiliation(s)
- Ruichong Shuai
- School of Psychology, University of Exeter, Washington Singer Building, Perry Road, Exeter, EX4 4QG, UK
| | - Alexandra Elissavet Bakou
- School of Psychology, University of Exeter, Washington Singer Building, Perry Road, Exeter, EX4 4QG, UK
| | - Jackie Andrade
- School of Psychology, University of Plymouth, Plymouth, UK
| | - Leanne Hides
- School of Psychology, University of Queensland, Brisbane, Australia
| | - Lee Hogarth
- School of Psychology, University of Exeter, Washington Singer Building, Perry Road, Exeter, EX4 4QG, UK.
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14
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Chen M, Chan KL. Effectiveness of Digital Health Interventions on Unintentional Injury, Violence, and Suicide: Meta-Analysis. TRAUMA, VIOLENCE & ABUSE 2022; 23:605-619. [PMID: 33094703 DOI: 10.1177/1524838020967346] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Digital technologies are increasingly used in health-care delivery and are being introduced into work to prevent unintentional injury, violence, and suicide to reduce mortality. To understand the potential of digital health interventions (DHIs) to prevent and reduce these problems, we conduct a meta-analysis and provide an overview of their effectiveness and characteristics related to the effects. We searched electronic databases and reference lists of relevant reviews to identify randomized controlled trials (RCTs) published in or before March 2020 evaluating DHIs on injury, violence, or suicide reduction. Based on the 34 RCT studies included in the meta-analysis, the overall random effect size was 0.21, and the effect sizes for reducing suicidal ideation, interpersonal violence, and unintentional injury were 0.17, 0.24, and 0.31, respectively, which can be regarded as comparable to the effect sizes of traditional face-to-face interventions. However, there was considerable heterogeneity between the studies. In conclusion, DHIs have great potential to reduce unintentional injury, violence, and suicide. Future research should explore DHIs' successful components to facilitate future implementation and wider access.
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Affiliation(s)
- Mengtong Chen
- Department of Social Work, 26679Hong Kong Baptist University, Kowloon Tong, Hong Kong
| | - Ko Ling Chan
- Department of Applied Social Sciences, 26680The Hong Kong Polytechnic University, Hunghom, Hong Kong
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15
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Pile V, Williamson G, Saunders A, Holmes EA, Lau JYF. Harnessing emotional mental imagery to reduce anxiety and depression in young people: an integrative review of progress and promise. Lancet Psychiatry 2021; 8:836-852. [PMID: 34419188 DOI: 10.1016/s2215-0366(21)00195-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 04/23/2021] [Accepted: 05/12/2021] [Indexed: 11/15/2022]
Abstract
Emotional mental imagery is a powerful part of our mental landscape. Given its capacity to depict, process, and generate emotional events, mental imagery could have an important role in psychological therapies. This Series paper explores whether harnessing emotional mental imagery is meaningful to young people; ways in which interventions use emotional mental imagery; contextual and individual factors influencing intervention effectiveness; and mechanisms underpinning imagery techniques. We completed a systematic review of imagery interventions and consulted young people with lived experience (n=10) and leading international experts (n=7). The systematic search identified 86 papers covering a diverse range of imagery interventions. Across the seven categories of techniques reviewed, imagery rescripting for aversive memories, techniques targeting positive imagery, and imagery-enhanced protocols indicated the most potential. The report suggests that harnessing emotional mental imagery in psychological interventions could be a promising approach to reduce anxiety and depression and that mental health science could inform the development of new interventions and help to maximise intervention effectiveness.
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Affiliation(s)
- Victoria Pile
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Department of Psychology, Royal Holloway, University of London, Egham, UK.
| | - Grace Williamson
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Aleks Saunders
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Emily A Holmes
- Department of Psychology, Uppsala University, Uppsala, Sweden; Division of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Jennifer Y F Lau
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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16
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Wainer AL, Arnold ZE, Leonczyk C, Valluripalli Soorya L. Examining a stepped-care telehealth program for parents of young children with autism: a proof-of-concept trial. Mol Autism 2021; 12:32. [PMID: 33964979 PMCID: PMC8105688 DOI: 10.1186/s13229-021-00443-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 04/30/2021] [Indexed: 12/15/2022] Open
Abstract
Background Intervention during the first years of life for children with autism spectrum disorder (ASD) may have the strongest impact on long-term brain development and functioning. Yet, barriers such as a shortage of trained professionals contribute to significant delays in service. The goal of this proof-of-concept study was to explore strategies that support timely and equitable deployment of ASD-specific interventions. Methods This 15-week, randomized proof-of-concept study explored the acceptability of a digital parent mediated intervention online reciprocal imitation training (RIT; a naturalistic developmental behavioral intervention) and compared it to a treatment as usual (TAU) control on parent and child outcomes. Eligible children were between 18 and 60 months, met the cutoff for ASD on the Autism Diagnostic Observation Schedule-2nd Edition and demonstrate significant social imitation deficits. Primary outcomes include the acceptability of RIT (Scale of Treatment Perceptions) and the feasibility of the Online RIT digital intervention (online RIT attributes). Secondary outcomes included parent fidelity (RIT parent fidelity form) and parental self-efficacy (Early Intervention Parenting Self-Efficacy Scale). Exploratory outcome measures included child social communication (Social Communication Checklist), child imitation skills (Unstructured Imitation Assessment), and family quality of life (Beach Center Family Quality of Life Scale). Results Twenty participants were randomized in a 1:1 fashion. The acceptability and feasibility of RIT and the Online RIT digital intervention were rated highly. Among the secondary outcomes, there were significant group differences in parent fidelity (p < .001) and self-efficacy (p = .029). On exploratory outcomes, there were group differences in child social communication (p = .048). There were no significant group differences in imitation ability (p = .05) or family quality of life (p = .22). Limitations There are several limitations with this study, including the small sample size as well as lack of data on enactment and website engagement. This study was not able to address questions related to which variables predict program engagement and treatment response, which will be critical for determining which families may benefit from such a stepped-care delivery model. Conclusions Overall, the Online RIT program delivered in a stepped-care format shows strong acceptability and holds promise as an innovative delivery model. Trial registration ClinicalTrials.gov, NCT04467073. Registered 10 July 2020- Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04467073
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Affiliation(s)
- Allison L Wainer
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, 1645 W. Jackson Blvd., Suite 603, Chicago, IL, 60612, USA.
| | - Zachary E Arnold
- Department of Psychology, University of Alabama At Birmingham, 1300 University Blvd., Birmingham, AL, 35233, USA
| | - Caroline Leonczyk
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, 1645 W. Jackson Blvd., Suite 603, Chicago, IL, 60612, USA
| | - Latha Valluripalli Soorya
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, 1645 W. Jackson Blvd., Suite 603, Chicago, IL, 60612, USA
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17
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Cliffe B, Tingley J, Greenhalgh I, Stallard P. mHealth Interventions for Self-Harm: Scoping Review. J Med Internet Res 2021; 23:e25140. [PMID: 33929329 PMCID: PMC8122298 DOI: 10.2196/25140] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 01/19/2021] [Accepted: 03/16/2021] [Indexed: 12/18/2022] Open
Abstract
Background Self-harm is a growing issue with increasing prevalence rates; however, individuals who self-harm do not often receive treatment. Mobile health (mHealth) interventions are a possible solution to some of the barriers that individuals face when seeking support, and they have also been found to be effective in improving mental health. Thus far, reviews of mHealth interventions for self-harm have been limited by study type. Therefore, we determined that a broader scoping review will provide a more exhaustive understanding of mHealth interventions for self-harm. Objective This scoping review aims to identify mHealth interventions for self-harm within the literature, understand the types and features of interventions that have been developed and evaluated, highlight research findings around mHealth interventions for self-harm, and determine what outcomes are typically used to assess the efficacy of interventions. Methods A search was conducted using Embase, PubMed, PsycINFO, PsycEXTRA, Web of Science, and the Cochrane Library. Studies were included if they described an mHealth intervention designed to have a direct (ie, if the intervention was designed for self-harm or for people who self-harm) or indirect (ie, if self-harm was measured as an outcome) treatment effect and if the paper was available in English. There were no exclusion criteria based on the study design. Results A total of 36 papers were included in the review, and most of them were randomized controlled trials published within the last 4 years. The interventions were mostly smartphone apps and calling or texting services, with 62% (21/34) having underlying therapeutic models to inform the intervention content. They were generally shown to be promising and appealing, but only 5 were widely available for use. Outcomes focused on a reduction of self-harm and suicidality, mood, and the users’ experiences of the intervention. Samples were typically nondiverse, and there was limited variety in the study designs and in the measurements of self-harm recovery. Conclusions Promising and appealing mHealth interventions have been developed but are not widely available. Research could benefit from greater diversity as well as a broader and more nuanced understanding of recovery from self-harm.
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Affiliation(s)
- Bethany Cliffe
- Department for Health, University of Bath, Bath, United Kingdom
| | - Jessica Tingley
- Child and Adolescent Mental Health Services, Oxford Health NHS Foundation Trust, Bristol, United Kingdom
| | - Isobel Greenhalgh
- Child and Adolescent Mental Health Services, Oxford Health NHS Foundation Trust, Bristol, United Kingdom
| | - Paul Stallard
- Department for Health, University of Bath, Bath, United Kingdom.,Child and Adolescent Mental Health Services, Oxford Health NHS Foundation Trust, Bristol, United Kingdom
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18
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Witt KG, Hetrick SE, Rajaram G, Hazell P, Taylor Salisbury TL, Townsend E, Hawton K. Psychosocial interventions for self-harm in adults. Cochrane Database Syst Rev 2021; 4:CD013668. [PMID: 33884617 PMCID: PMC8094743 DOI: 10.1002/14651858.cd013668.pub2] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Self-harm (SH; intentional self-poisoning or self-injury regardless of degree of suicidal intent or other types of motivation) is a growing problem in most counties, often repeated, and associated with suicide. There has been a substantial increase in both the number of trials and therapeutic approaches of psychosocial interventions for SH in adults. This review therefore updates a previous Cochrane Review (last published in 2016) on the role of psychosocial interventions in the treatment of SH in adults. OBJECTIVES To assess the effects of psychosocial interventions for self-harm (SH) compared to comparison types of care (e.g. treatment-as-usual, routine psychiatric care, enhanced usual care, active comparator) for adults (aged 18 years or older) who engage in SH. SEARCH METHODS We searched the Cochrane Common Mental Disorders Specialised Register, the Cochrane Library (Central Register of Controlled Trials [CENTRAL] and Cochrane Database of Systematic reviews [CDSR]), together with MEDLINE, Ovid Embase, and PsycINFO (to 4 July 2020). SELECTION CRITERIA We included all randomised controlled trials (RCTs) comparing interventions of specific psychosocial treatments versus treatment-as-usual (TAU), routine psychiatric care, enhanced usual care (EUC), active comparator, or a combination of these, in the treatment of adults with a recent (within six months of trial entry) episode of SH resulting in presentation to hospital or clinical services. The primary outcome was the occurrence of a repeated episode of SH over a maximum follow-up period of two years. Secondary outcomes included treatment adherence, depression, hopelessness, general functioning, social functioning, suicidal ideation, and suicide. DATA COLLECTION AND ANALYSIS We independently selected trials, extracted data, and appraised trial quality. For binary outcomes, we calculated odds ratio (ORs) and their 95% confidence intervals (CIs). For continuous outcomes, we calculated mean differences (MDs) or standardised mean differences (SMDs) and 95% CIs. The overall quality of evidence for the primary outcome (i.e. repetition of SH at post-intervention) was appraised for each intervention using the GRADE approach. MAIN RESULTS We included data from 76 trials with a total of 21,414 participants. Participants in these trials were predominately female (61.9%) with a mean age of 31.8 years (standard deviation [SD] 11.7 years). On the basis of data from four trials, individual cognitive behavioural therapy (CBT)-based psychotherapy may reduce repetition of SH as compared to TAU or another comparator by the end of the intervention (OR 0.35, 95% CI 0.12 to 1.02; N = 238; k = 4; GRADE: low certainty evidence), although there was imprecision in the effect estimate. At longer follow-up time points (e.g., 6- and 12-months) there was some evidence that individual CBT-based psychotherapy may reduce SH repetition. Whilst there may be a slightly lower rate of SH repetition for dialectical behaviour therapy (DBT) (66.0%) as compared to TAU or alternative psychotherapy (68.2%), the evidence remains uncertain as to whether DBT reduces absolute repetition of SH by the post-intervention assessment. On the basis of data from a single trial, mentalisation-based therapy (MBT) reduces repetition of SH and frequency of SH by the post-intervention assessment (OR 0.35, 95% CI 0.17 to 0.73; N = 134; k = 1; GRADE: high-certainty evidence). A group-based emotion-regulation psychotherapy may also reduce repetition of SH by the post-intervention assessment based on evidence from two trials by the same author group (OR 0.34, 95% CI 0.13 to 0.88; N = 83; k = 2; moderate-certainty evidence). There is probably little to no effect for different variants of DBT on absolute repetition of SH, including DBT group-based skills training, DBT individual skills training, or an experimental form of DBT in which participants were given significantly longer cognitive exposure to stressful events. The evidence remains uncertain as to whether provision of information and support, based on the Suicide Trends in At-Risk Territories (START) and the SUicide-PREvention Multisite Intervention Study on Suicidal behaviors (SUPRE-MISS) models, have any effect on repetition of SH by the post-intervention assessment. There was no evidence of a difference for psychodynamic psychotherapy, case management, general practitioner (GP) management, remote contact interventions, and other multimodal interventions, or a variety of brief emergency department-based interventions. AUTHORS' CONCLUSIONS Overall, there were significant methodological limitations across the trials included in this review. Given the moderate or very low quality of the available evidence, there is only uncertain evidence regarding a number of psychosocial interventions for adults who engage in SH. Psychosocial therapy based on CBT approaches may result in fewer individuals repeating SH at longer follow-up time points, although no such effect was found at the post-intervention assessment and the quality of evidence, according to the GRADE criteria, was low. Given findings in single trials, or trials by the same author group, both MBT and group-based emotion regulation therapy should be further developed and evaluated in adults. DBT may also lead to a reduction in frequency of SH. Other interventions were mostly evaluated in single trials of moderate to very low quality such that the evidence relating to the use of these interventions is inconclusive at present.
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Affiliation(s)
- Katrina G Witt
- Orygen, Parkville, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Sarah E Hetrick
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Gowri Rajaram
- Orygen, Parkville, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Philip Hazell
- Speciality of Psychiatry, University of Sydney School of Medicine, Sydney, Australia
| | - Tatiana L Taylor Salisbury
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Ellen Townsend
- Self-Harm Research Group, School of Psychology, University of Nottingham, Nottingham, UK
| | - Keith Hawton
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, Oxford, UK
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19
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Mental Imagery in the Science and Practice of Cognitive Behaviour Therapy: Past, Present, and Future Perspectives. Int J Cogn Ther 2021. [DOI: 10.1007/s41811-021-00102-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
AbstractMental imagery has a long history in the science and practice of cognitive behaviour therapy (CBT), stemming from both behavioural and cognitive traditions. The past decade or so has seen a marked increase in both scientific and clinical interest in mental imagery, from basic questions about the processes underpinning mental imagery and its roles in everyday healthy functioning, to clinical questions about how dysfunctions in mental imagery can cause distress and impairment, and how mental imagery can be used within CBT to effect therapeutic change. This article reflects on the current state of mental imagery in the science and practice of CBT, in the context of past developments and with a view to future challenges and opportunities. An ongoing interplay between the various strands of imagery research and the many clinical innovations in this area is recommended in order to realise the full therapeutic potential of mental imagery in CBT.
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