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Wuthrich VM, Dickson SJ, Pehlivan M, Chen JTH, Zagic D, Ghai I, Neelakandan A, Johnco C. Efficacy of low intensity interventions for geriatric depression and anxiety - A systematic review and meta-analysis. J Affect Disord 2024; 344:592-599. [PMID: 37858732 DOI: 10.1016/j.jad.2023.10.093] [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: 03/08/2023] [Revised: 10/13/2023] [Accepted: 10/14/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND This systematic review and meta-analysis examined the efficacy of low intensity psychological interventions for older adults (60+ years) with clinical anxiety and/or depressive disorders. METHOD Systematic review and meta-analysis of randomised control trials of low-intensity psychological interventions for anxiety and/or depression with an active or passive control condition (e.g., waitlist, treatment-as-usual or active control) in any setting. Low intensity psychological interventions (e.g., cognitive behaviour therapy [CBT]) targeted anxiety and/or depression as primary outcomes, were primarily self-help, and included support from trained practitioners/facilitators with <6 h total contact time (typically <30 min p/contact). RESULTS Seven studies consisting of 304 older adults (65-78 years, Mage = 70, SD = 4) were identified and six included in the meta-analysis of depression outcomes and three for anxiety. A random effects meta-analysis of group differences in symptom change from pre-post treatment found evidence favouring low intensity psychological interventions over passive control groups for the treatment of depressive and anxiety symptoms, with moderate effect sizes for depression (Cohen's d = -0.62) and large effect sizes for anxiety (Cohen's d = -0.84) at post-treatment. LIMITATIONS Results are limited by study design of included studies such that the efficacy of interventions compared to treatment-as-usual, non-CBT approaches, in adults >80 years and long-term effects are unknown. CONCLUSIONS There is some evidence supporting the clinical benefits of low intensity psychological interventions for depressive and anxiety symptoms in older adults compared to passive controls. More research is needed to examine efficacy compared to active control conditions, and among those over 80 years.
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Affiliation(s)
- Viviana M Wuthrich
- Macquarie University Lifespan Health & Wellbeing Research Centre, Macquarie University, Sydney 2109, Australia.
| | - Sophie J Dickson
- Macquarie University Lifespan Health & Wellbeing Research Centre, Macquarie University, Sydney 2109, Australia
| | - Melissa Pehlivan
- Macquarie University Lifespan Health & Wellbeing Research Centre, Macquarie University, Sydney 2109, Australia
| | - Jessamine T-H Chen
- Macquarie University Lifespan Health & Wellbeing Research Centre, Macquarie University, Sydney 2109, Australia
| | - Dino Zagic
- Macquarie University Lifespan Health & Wellbeing Research Centre, Macquarie University, Sydney 2109, Australia
| | - Ishaan Ghai
- Macquarie University Lifespan Health & Wellbeing Research Centre, Macquarie University, Sydney 2109, Australia
| | - Aswathi Neelakandan
- Macquarie University Lifespan Health & Wellbeing Research Centre, Macquarie University, Sydney 2109, Australia
| | - Carly Johnco
- Macquarie University Lifespan Health & Wellbeing Research Centre, Macquarie University, Sydney 2109, Australia
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Werson AD, Meiser-Stedman R, Laidlaw K. A meta-analysis of CBT efficacy for depression comparing adults and older adults. J Affect Disord 2022; 319:189-201. [PMID: 36113691 DOI: 10.1016/j.jad.2022.09.020] [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: 03/10/2021] [Revised: 09/03/2022] [Accepted: 09/11/2022] [Indexed: 11/16/2022]
Abstract
INTRODUCTION This meta-analysis investigates CBT treatment efficacy fordepression, and compares outcomes between adults (young and middle aged) and older adults (OA). METHODOLOGY Effect sizes (Hedges' g) were obtained from 37 peer-reviewed RCTs, 25 adult papers (participant n = 2948) and 12 OA papers (participant n = 551), and analysed with the random effects model. RESULTS No significant difference between age groups is reported in terms of CBT efficacy for depression compared to other treatments (Qbetween (1) = 0.06, p = .89), with the overall effect favouring CBT over any other treatments (g = 0.48, 95 % CI = 0.29-0.68). The same pattern of results was found when restricting studies to those which used active control conditions (Qbetween (1) = 0.03, p = .86) or passive control conditions (Q (1) = 2.45, p = .12). DISCUSSION No significant differences in efficacy for CBT treatment for depression are found when comparing adults and OA. CBT is as efficacious with OA as with adults.
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Affiliation(s)
- Alessa D Werson
- Norwich Medical School, University of East Anglia, United Kingdom; Department of Psychology: College of Life and Environmental Sciences, University of Exeter, United Kingdom.
| | - Richard Meiser-Stedman
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, United Kingdom
| | - Ken Laidlaw
- Department of Psychology: College of Life and Environmental Sciences, University of Exeter, United Kingdom
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Sharma D. Using developmental bibliotherapy design to improve self-management skills of post-graduate students. JOURNAL OF POETRY THERAPY 2022. [DOI: 10.1080/08893675.2022.2115696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Cremers G, Taylor E, Hodge L, Quigley A. Effectiveness and Acceptability of Low-intensity Psychological Interventions on the Well-being of Older Adults: A Systematic Review. Clin Gerontol 2022; 45:214-234. [PMID: 31507251 DOI: 10.1080/07317115.2019.1662867] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objectives: Growth in the older adult population and healthcare inequities mean there is a global need to increase access to early intervention in mental healthcare for older adults. This systematic review synthesized the evidence for the efficacy and acceptability of low-intensity psychological interventions (self-help, psychoeducation, bibliotherapy, internet cognitive-behavioral therapy: iCBT) for older adults with mild-to-moderate mental health problems.Methods: Ovid, EBSCOhost and ProQuest were searched for articles describing low-intensity psychological interventions. Pre and post outcome measures and a mean age of at least 50 (age range ≥40) were required for inclusion.Results: 26 articles (23 studies) described various interventions. Most studies were good quality and reported improvements in participant's mental health scores post intervention. Participants were more likely to be female, aged 60-70 and to be highly educated. Eight studies reported obtaining participant satisfaction ratings. Three studies included participants from rural areas.Conclusions: Low-intensity psychological interventions can be effective for older adults with mild-to-moderate mental health problems, but generalizability is constrained.Clinical Implications: Guided iCBT and bibliotherapy may be beneficial for adults in their 60s and 70s experiencing mild-to-moderate levels of depression. CBT may also be beneficial for reducing symptoms of mild-to-moderate anxiety. Providing the option of low-intensity psychological intervention, particularly iCBT, may help increase engagement with treatment.
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Affiliation(s)
- Gwendolyn Cremers
- Clinical Psychology, School of Health in Social Science, University of Edinburgh, Edinburgh, UK.,Psychological Services, NHS Borders, Melrose, UK
| | - Emily Taylor
- Clinical Psychology, School of Health in Social Science, University of Edinburgh, Edinburgh, UK
| | - Lorna Hodge
- Clinical Psychology, School of Health in Social Science, University of Edinburgh, Edinburgh, UK
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Using AI chatbots to provide self-help depression interventions for university students: A randomized trial of effectiveness. Internet Interv 2022; 27:100495. [PMID: 35059305 PMCID: PMC8760455 DOI: 10.1016/j.invent.2022.100495] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 12/14/2021] [Accepted: 01/04/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Depression impacts the lives of a large number of university students. Mobile-based therapy chatbots are increasingly being used to help young adults who suffer from depression. However, previous trials have short follow-up periods. Evidence of effectiveness in pragmatic conditions are still in lack. OBJECTIVE This study aimed to compare chatbot therapy to bibliotherapy, which is a widely accepted and proven-useful self-help psychological intervention. The main objective of this study is to add to the evidence of effectiveness for chatbot therapy as a convenient, affordable, interactive self-help intervention for depression. METHODS An unblinded randomized controlled trial with 83 university students was conducted. The participants were randomly assigned to either a chatbot test group (n = 41) to receive a newly developed chatbot-delivered intervention, or a bibliotherapy control group (n = 42) to receive a minimal level of bibliotherapy. A set of questionnaires was implemented as measurements of clinical variables at baseline and every 4 weeks for a period of 16 weeks, which included the Patient Health Questionnaire-9 (PHQ-9), the Generalized Anxiety Disorder scale (GAD-7), the Positive and Negative Affect Scale (PANAS). The Client Satisfaction Questionnaire-8 (CSQ-8) and the Working Alliance Inventory-Short Revised (WAI-SR) were used to measure satisfaction and therapeutic alliance after the intervention. Participants' self-reported adherence and feedback on the therapy chatbot were also collected. RESULTS Participants were all university students (undergraduate students (n = 31), postgraduate students (n = 52)). They were between 19 and 28 years old (mean = 23.08, standard deviation (SD) = 1.76) and 55.42% (46/83) female. 24.07% (20/83) participants were lost to follow-up. No significant group difference was found at baseline. In the intention-to-treat analysis, individuals in the chatbot test group showed a significant reduction in the PHQ-9 scores (F = 22.89; P < 0.01) and the GAD-7 scores (F = 5.37; P = 0.02). Follow-up analysis of completers suggested that the reduction of anxiety was significant only in the first 4 weeks. The WAI-SR scores in the chatbot group were higher compared to the bibliotherapy group (t = 7.29; P < 0.01). User feedback showed that process factors were more influential than the content factors. CONCLUSIONS The chatbot-delivered self-help depression intervention was proven to be superior to the minimal level of bibliotherapy in terms of reduction on depression, anxiety, and therapeutic alliance achieved with participants.
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Key Words
- AI Artificial Intelligence
- AI, Artificial Intelligence
- ANCONA, Analysis of Covariance
- ANOVA, Analysis of Variance
- CBT, Cognitive Behavioral Therapy
- CSQ-8, the Client Satisfaction Questionnaires-8
- DPO, Dialogue Policy Optimization
- DST, Dialogue Status Tracking
- GAD-7, the Generalized Anxiety Disorder Scale-7 (GAD-7)
- IPI, Internet-based Psychological Interventions
- ITT, Intent-to-Treat
- PANAS, the Positive and Negative Affect Schedule (PANAS) (Watson et al., 19s88)
- PHQ-9, the Patient Health Questionnaires-9
- Public health informatics
- SD, Standard Deviation
- WAI-SR, the Working Alliance Inventory-Short Revised
- mHealth
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Hoertel N, Rotenberg L, Schuster JP, Blanco C, Lavaud P, Hanon C, Hozer F, Teruel E, Manetti A, Costemale-Lacoste JF, Seigneurie AS, Limosin F. Generalizability of pharmacologic and psychotherapy trial results for late-life unipolar depression. Aging Ment Health 2021; 25:367-377. [PMID: 31726850 DOI: 10.1080/13607863.2019.1691146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Despite evidence of low representativeness of clinical trial results for depression in adults, the generalizability of clinical trial results for late-life depression is unknown. This study sought to quantify the representativeness of pharmacologic and psychotherapy clinical trial results for late-life unipolar depression. METHOD Data were derived from the 2004-2005 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a nationally representative sample of 34,653 adults from the United States population. To assess the generalizability of clinical trial results for late-life depression, we applied a standard set of eligibility criteria representative of pharmacologic and psychotherapy clinical trials to all individuals aged 65 years and older in NESARC with a DSM-IV diagnosis of MDE and no lifetime history of mania/hypomania (n = 273) and in a subsample of individuals seeking help for depression (n = 78). RESULTS More than four of ten respondents and about two of ten respondents would have been excluded by at least one exclusion criterion in a typical pharmacologic and psychotherapy efficacy trial, respectively. Similar results (i.e.41.1% and 25.9%, respectively) were found in the subsample of individuals seeking help for depression. Excess percentage of exclusion in typical pharmacologic studies was accounted for by the criterion "significant medical condition". We also found that populations typically included in pharmacologic and psychotherapy clinical trials for late-life unipolar depression may substantially differ. CONCLUSION Psychotherapy trial results may be representative of most patients with late-life unipolar depression in routine clinical practice. By contrast, pharmacologic clinical trials may not be readily generalizable to community samples.
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Affiliation(s)
- Nicolas Hoertel
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Corentin-Celton, Service de Psychiatrie, Issy-les-Moulineaux, France.,Université Paris Descartes, PRES Sorbonne Paris Cité, Paris, France.,Centre Psychiatrie et Neurosciences, Inserm Umr 894, Paris, France.,Université de Paris, Université Paris Descartes, Paris, France
| | - Léa Rotenberg
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Corentin-Celton, Service de Psychiatrie, Issy-les-Moulineaux, France
| | - Jean-Pierre Schuster
- Service of Old Age Psychiatry, Department of Psychiatry, Lausanne University Hospital, Prilly, Switzerland
| | - Carlos Blanco
- Division of Epidemiology, Services, and Prevention Research, National Institute on Drug Abuse, Bethesda, MD, USA
| | - Pierre Lavaud
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Corentin-Celton, Service de Psychiatrie, Issy-les-Moulineaux, France
| | - Cécile Hanon
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Corentin-Celton, Service de Psychiatrie, Issy-les-Moulineaux, France
| | - Franz Hozer
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Corentin-Celton, Service de Psychiatrie, Issy-les-Moulineaux, France
| | - Elisabeth Teruel
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Corentin-Celton, Service de Psychiatrie, Issy-les-Moulineaux, France
| | - Aude Manetti
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Corentin-Celton, Service de Psychiatrie, Issy-les-Moulineaux, France
| | | | - Anne-Sophie Seigneurie
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Corentin-Celton, Service de Psychiatrie, Issy-les-Moulineaux, France
| | - Frédéric Limosin
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Corentin-Celton, Service de Psychiatrie, Issy-les-Moulineaux, France.,Université Paris Descartes, PRES Sorbonne Paris Cité, Paris, France.,Centre Psychiatrie et Neurosciences, Inserm Umr 894, Paris, France.,Université de Paris, Université Paris Descartes, Paris, France
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7
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El Alili M, Schuurhuizen CSEW, Braamse AMJ, Beekman ATF, van der Linden MH, Konings IR, Dekker J, Bosmans JE. Economic evaluation of a combined screening and stepped-care treatment program targeting psychological distress in patients with metastatic colorectal cancer: A cluster randomized controlled trial. Palliat Med 2020; 34:934-945. [PMID: 32348700 PMCID: PMC7787671 DOI: 10.1177/0269216320913463] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Psychological distress is highly prevalent among patients with metastatic colorectal cancer. AIMS To perform an economic evaluation of a combined screening and treatment program targeting psychological distress in patients with metastatic colorectal cancer in comparison with usual care. DESIGN Societal costs were collected alongside a cluster randomized controlled trial for 48 weeks. A total of 349 participants were included. SETTING Participants were recruited from oncology departments at 16 participating hospitals in the Netherlands. METHODS Outcome measures were the Hospital Anxiety and Depression Scale and quality-adjusted life-years. Missing data were imputed using multiple imputation. Uncertainty was estimated using bootstrapping. Cost-effectiveness planes and cost-effectiveness acceptability curves were estimated to show uncertainty surrounding the cost-effectiveness estimates. Sensitivity analyses were performed to check robustness of results. RESULTS Between treatment arms, no significant differences were found in Hospital Anxiety and Depression Scale score (mean difference: -0.058; 95% confidence interval: -0.13 to 0.011), quality-adjusted life-years (mean difference: 0.042; 95% confidence interval: -0.015 to 0.099), and societal costs (mean difference: -1152; 95% confidence interval: -5058 to 2214). Cost-effectiveness acceptability curves showed that the probability of cost-effectiveness was 0.64 and 0.74 at willingness-to-pay values of €0 and €10,000 per point improvement on the Hospital Anxiety and Depression Scale, respectively. The probability that the intervention was cost-effective compared to usual care for quality-adjusted life-years was 0.64 and 0.79 at willingness-to-pay values of €0 and €20,000 per quality-adjusted life-year, respectively. CONCLUSION The intervention is dominant over usual care, primarily due to lower costs in the intervention group. However, there were no statistically significant differences in clinical effects and the uptake of the intervention was quite low. Therefore, widespread implementation cannot be recommended.
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Affiliation(s)
- Mohamed El Alili
- Department of Health Sciences, Faculty of Science, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Claudia S E W Schuurhuizen
- Department of Medical Oncology, Amsterdam UMC, Vrije Universtiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands.,Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research institute, Amsterdam, The Netherlands
| | - Annemarie M J Braamse
- Department of Medical Psychology, Amsterdam UMC, Academic Medical Center, Cancer Center Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Aartjan T F Beekman
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research institute, Amsterdam, The Netherlands
| | - Mecheline H van der Linden
- Department of Medical Psychology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Inge R Konings
- Department of Medical Oncology, Amsterdam UMC, Vrije Universtiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Joost Dekker
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research institute, Amsterdam, The Netherlands
| | - Judith E Bosmans
- Department of Health Sciences, Faculty of Science, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Abstract
UNLABELLED AimsThe aim of this study was to reanalyse the data from Cuijpers et al.'s (2018) meta-analysis, to examine Eysenck's claim that psychotherapy is not effective. Cuijpers et al., after correcting for bias, concluded that the effect of psychotherapy for depression was small (standardised mean difference, SMD, between 0.20 and 0.30), providing evidence that psychotherapy is not as effective as generally accepted. METHODS The data for this study were the effect sizes included in Cuijpers et al. (2018). We removed outliers from the data set of effects, corrected for publication bias and segregated psychotherapy from other interventions. In our study, we considered wait-list (WL) controls as the most appropriate estimate of the natural history of depression without intervention. RESULTS The SMD for all interventions and for psychotherapy compared to WL controls was approximately 0.70, a value consistent with past estimates of the effectiveness of psychotherapy. Psychotherapy was also more effective than care-as-usual (SMD = 0.31) and other control groups (SMD = 0.43). CONCLUSIONS The re-analysis reveals that psychotherapy for adult patients diagnosed with depression is effective.
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Linden M, Wasilewski J. Better patient knowledge and worse treatment outcome after written patient information in inpatient cognitive behaviour therapy as compared to non-informed patients. COGENT PSYCHOLOGY 2019. [DOI: 10.1080/23311908.2019.1612825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
- Michael Linden
- Research Group Psychosomatic Rehabilitation, Charité University Medicine Berlin, Berlin, Germany
| | - Janice Wasilewski
- Research Group Psychosomatic Rehabilitation, Charité University Medicine Berlin, Berlin, Germany
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Stress Management Training (SMT) Improves Coping of Tremor-Boosting Psychosocial Stressors and Depression in Patients with Parkinson's Disease: A Controlled Prospective Study. PARKINSONS DISEASE 2018; 2018:4240178. [PMID: 30510675 PMCID: PMC6230397 DOI: 10.1155/2018/4240178] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 08/19/2018] [Accepted: 09/24/2018] [Indexed: 11/29/2022]
Abstract
Background Stress reduction and relaxation exercises are therapeutically suggested to patients with Parkinson's disease (PD) and tremor, but data regarding efficacy or preferential methods are missing. Objective To investigate the effect of a standardized stress management training (SMT) according to Kaluza on coping with tremor-boosting psychosocial stress factors. Methods 8-week SMT was applied to 82 PD patients with tremor and 30 controls. Changes in stress-associated factors were measured applying four scales: Kaluza's “warning signs for stress” and “stress-amplifying thoughts” and Beck Depression Inventory (BDI) and quality of life (PDQ-8). Short-term outcome (8 weeks) was evaluated in both groups, and long-term outcome (3–6 months) was evaluated only in PD patients. Results At baseline, PDQ-8 was worse in PD patients compared to controls. PD patients improved significantly regarding short- and long-term outcome scores of “warning signs for stress,” “stress-amplifying thoughts,” and BDI scores, independently of disease severity or duration. Younger and male PD patients showed the best benefit. Controls improved comparably to PD patients but significantly only with respect to “stress-amplifying thoughts.” Retrospectively, 88% (29/33) of PD patients were rated SMT as helpful 12–18 months later. Self-practicing SMT exercises correlated significantly with subjectively better coping with tremor-related daily impairment and subjective short-term and long-term tremor reduction. Conclusion SMT should be a part of therapy of PD patients with tremor.
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Karimi Z, Haghshenas L, Mohtashami T, Dehkordi MA. Investigating the role of attachment styles, dysfunctional attitudes, and spirituality in predicting membership in addicted and non-addicted groups. Psych J 2018; 8:169-179. [PMID: 30468011 DOI: 10.1002/pchj.254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Revised: 09/02/2018] [Accepted: 09/25/2018] [Indexed: 11/07/2022]
Abstract
Drug addiction as a biological, psychological, and social issue affects all dimensions of one's life. The purpose of this study was to determine the role of attachment styles, dysfunctional attitudes, and spirituality in predicting membership in addicted and non-addicted groups. This was a cross-sectional study conducted on 60 addicted people and 60 non-addicted people. The Adult Attachment Scale of Hazan and Shaver, Allport Religious Orientation Scale, and the 26-item Dysfunctional Attitude Scale (DAS-26) were used to measure the variables. Based on the results, which were analyzed by logistic regression analysis, the variables of attachment style and dysfunctional attitude can significantly predict drug addiction (p < .001). However, avoidant attachment style and spirituality cannot predict readiness for addiction. The results of this study indicate the importance of safe and ambivalent attachment styles and dysfunctional attitudes. Thus, attending to these factors in studies and interventions related to the treatment of substance abuse disorders is essential.
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Affiliation(s)
- Zahra Karimi
- Department of Psychology, Faculty of Humanities, Payame Noor University, Tehran, Iran
| | - Leila Haghshenas
- Department of Psychology, Faculty of Humanities, Payame Noor University, Tehran, Iran
| | - Tayebeh Mohtashami
- Department of Psychology, Faculty of Humanities, Payame Noor University, Tehran, Iran
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12
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Positive Psychology for Overcoming Symptoms of Depression: A Pilot Study Exploring the Efficacy of a Positive Psychology Self-Help Book versus a CBT Self-Help Book. Behav Cogn Psychother 2018; 47:95-113. [PMID: 29692281 DOI: 10.1017/s1352465818000218] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Depression is an extremely common mental health disorder, with prevalence rates rising. Low-intensity interventions are frequently used to help meet the demand for treatment. Bibliotherapy, for example, is often prescribed via books on prescription schemes (for example 'Reading Well' in England) to those with mild to moderate symptomology. Bibliotherapy can effectively reduce symptoms of depression (Naylor et al., 2010). However, the majority of self-help books are based on cognitive behavioural therapy (CBT), which may not be suitable for all patients. Research supports the use of positive psychology interventions for the reduction of depression symptoms (Bolier et al., 2013) and as such self-help books from this perspective should be empirically tested. AIMS This study aimed to test the efficacy of 'Positive Psychology for Overcoming Depression' (Akhtar, 2012), a self-help book for depression that is based on the principles of positive psychology, in comparison with a CBT self-help book that is currently prescribed in England as part of the Reading Well books on prescription scheme. METHOD Participants (n = 115) who were not receiving treatment, but had symptoms of depression, read the positive psychology or the CBT self-help book for 8 weeks. Depression and well-being were measured at baseline, post-test and 1-month follow-up. RESULTS Results suggest that both groups experienced a reduction in depression and an increase in well-being, with no differences noted between the two books. CONCLUSIONS Future directions are discussed in terms of dissemination, to those with mild to moderate symptoms of depression, via books on prescription schemes.
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van Dijk SDM, Bouman R, Lam JCAE, den Held R, van Alphen SPJ, Oude Voshaar RC. Outcome of day treatment for older adults with affective disorders: An observational pre-post design of two transdiagnostic approaches. Int J Geriatr Psychiatry 2018; 33:510-516. [PMID: 28967157 DOI: 10.1002/gps.4791] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Accepted: 08/08/2017] [Indexed: 11/07/2022]
Abstract
OBJECTIVE First, to evaluate the outcome of 2 transdiagnostic day treatment programs. A 20-week psychotherapeutic day treatment (PDT) and an activating day treatment (ADT) program delivered in blocks of 4 weeks with a maximum of 24 weeks with respect to depression, anxiety, and hypochondriasis. Second, to explore the impact of cognitive impairment and personality pathology on treatment outcome. METHODS The course of depression (Inventory of Depressive Symptoms), anxiety (Geriatric Anxiety Inventory), and hypochondriasis (Whitley Index) were evaluated by linear mixed models adjusted for age, sex, level of education, and alcohol usage among 49 patients (mean age 65 years, 67% females) receiving PDT and among 61 patients (mean age 67.1, 61% females) receiving ADT. Pre-post effect-sizes were expressed as Cohen's d. Subsequently, cognitive impairment (no, suspected, established) and personality pathology (DSM-IV criteria as well as the Big Five personality traits) were examined as potential moderators of treatment outcome. RESULTS Among patients receiving PDT, large improvements were found for depression (d = 1.1) and anxiety (d = 1.2) but not for hypochondriasis (d = 0.0). Patients receiving ADT showed moderate treatment effects for depression (d = 0.6), anxiety (d = 0.6), as well as hypochondriasis (d = 0.6). Personality pathology moderates treatment outcome of neither PDT nor ADT. Cognitive impairment negatively interfered with the course of depressive symptoms among patients receiving PDT. CONCLUSIONS Transdiagnostic day treatment is promising for older adults with affective disorders with high feasibility.
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Affiliation(s)
- S D M van Dijk
- University Centre of Psychiatry, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - R Bouman
- University Centre of Psychiatry, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - J C A E Lam
- Martini Hospital, Groningen, The Netherlands
| | - R den Held
- University Centre of Psychiatry, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - S P J van Alphen
- Department of Clinical and Life Span Psychology, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - R C Oude Voshaar
- University Centre of Psychiatry, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
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Gualano MR, Bert F, Martorana M, Voglino G, Andriolo V, Thomas R, Gramaglia C, Zeppegno P, Siliquini R. The long-term effects of bibliotherapy in depression treatment: Systematic review of randomized clinical trials. Clin Psychol Rev 2017; 58:49-58. [PMID: 28993103 DOI: 10.1016/j.cpr.2017.09.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 09/19/2017] [Accepted: 09/21/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Literature shows bibliotherapy can be helpful for moderate depression treatment. The aim of this systematic review is to verify the long-term effects of bibliotherapy. METHODS After bibliographic research, we included RCTs articles about bibliotherapy programme treatment of depression published in English language between 1990 and July 2017. All RCTs were assessed with Cochrane's Risk of Bias tool. RESULTS Ten articles (reporting 8 studies involving 1347 subjects) out of 306 retrieved results were included. All studies analyze the effects of bibliotherapy after follow-up periods ranging from 3months to 3years and show quiet good quality in methods and analyses. The treatment was compared to standard treatments or no intervention in all studies. After long-term period follow-ups, six studies, including adults, reported a decrease of depressive symptoms, while four studies including young people did not show significant results. CONCLUSION Bibliotherapy appears to be effective in the reduction of adults depressive symptoms in the long-term period, providing an affordable prompt treatment that could reduce further medications. The results of the present review suggest that bibliotherapy could play an important role in the treatment of a serious mental health issue. Further studies should be conducted to strengthen the evidence of bibliotherapy's efficacy.
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Affiliation(s)
- M R Gualano
- Department of Public Health Sciences, University of Torino, Italy.
| | - F Bert
- Department of Public Health Sciences, University of Torino, Italy
| | - M Martorana
- Department of Public Health Sciences, University of Torino, Italy
| | - G Voglino
- Department of Public Health Sciences, University of Torino, Italy
| | - V Andriolo
- Department of Public Health Sciences, University of Torino, Italy
| | - R Thomas
- Department of Public Health Sciences, University of Torino, Italy
| | - C Gramaglia
- Institute of Psychiatry, Università del Piemonte Orientale, Novara, Italy
| | - P Zeppegno
- Institute of Psychiatry, Università del Piemonte Orientale, Novara, Italy
| | - R Siliquini
- Department of Public Health Sciences, University of Torino, Italy
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15
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Holvast F, Massoudi B, Oude Voshaar RC, Verhaak PFM. Non-pharmacological treatment for depressed older patients in primary care: A systematic review and meta-analysis. PLoS One 2017; 12:e0184666. [PMID: 28938015 PMCID: PMC5609744 DOI: 10.1371/journal.pone.0184666] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 08/28/2017] [Indexed: 12/22/2022] Open
Abstract
Background Late-life depression is most often treated in primary care, and it usually coincides with chronic somatic diseases. Given that antidepressants contribute to polypharmacy in these patients, and potentially to interactions with other drugs, non-pharmacological treatments are essential. In this systematic review and meta-analysis, we aimed to present an overview of the non-pharmacological treatments available in primary care for late-life depression. Method The databases of PubMed, PsychINFO, and the Cochrane Central Register of Controlled Trials were systematically searched in January 2017 with combinations of MeSH-terms and free text words for “general practice,” “older adults,” “depression,” and “non-pharmacological treatment”. All studies with empirical data concerning adults aged 60 years or older were included, and the results were stratified by primary care, and community setting. We narratively reviewed the results and performed a meta-analysis on cognitive behavioral therapy in the primary care setting. Results We included 11 studies conducted in primary care, which covered the following five treatment modalities: cognitive behavioral therapy, exercise, problem-solving therapy, behavioral activation, and bright-light therapy. Overall, the meta-analysis showed a small effect for cognitive behavioral therapy, with one study also showing that bright-light therapy was effective. Another 18 studies, which evaluated potential non-pharmacological interventions in the community suitable for implementation, indicated that bibliotherapy, life-review, problem-solving therapy, and cognitive behavioral therapy were effective at short-term follow-up. Discussion We conclude that the effects of several treatments are promising, but need to be replicated before they can be implemented more widely in primary care. Although more treatment modalities were effective in a community setting, more research is needed to investigate whether these treatments are also applicable in primary care. Trial registration PROSPERO CRD42016038442.
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Affiliation(s)
- Floor Holvast
- University of Groningen, University Medical Center Groningen, Department of General Practice, Groningen, the Netherlands
- * E-mail:
| | - Btissame Massoudi
- University of Groningen, University Medical Center Groningen, Department of General Practice, Groningen, the Netherlands
| | - Richard C. Oude Voshaar
- University of Groningen, University Medical Center Groningen, University Center of Psychiatry, Groningen, The Netherlands
| | - Peter F. M. Verhaak
- University of Groningen, University Medical Center Groningen, Department of General Practice, Groningen, the Netherlands
- NIVEL, Netherlands Institute of Health Services Research, Utrecht, the Netherlands
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Abstract
Introduction The growing elderly population calls mental health professionals to take measures concerning the treatment of the elderly mental disorders. Today in developed countries, bibliotherapy is used for the treatment of the most prevalent psychiatric disorders. Therefore, this study aimed to investigate the effects of audio book on the elderly mental health of Retirement Center of Shahid Beheshti University of Medical Sciences. Methods This experimental study was conducted on 60 elderly people participated in 8 audio book presentation sessions, and their mental health aspects were evaluated through mental health questionnaire (SCL-90-R). Data were analyzed using SPSS 24. Results Data analysis revealed that the mean difference of pretest and posttest of control group is less than 5.0, so no significant difference was observed in their mental health, but this difference was significant in the experimental group (more than 5.0). Therefore, a significant improvement in mental health and its dimensions have observed in elderly people participated in audio book sessions. This therapeutic intervention was effective on mental health dimensions of paranoid ideation, psychosis, phobia, aggression, depression, interpersonal sensitivity, anxiety, obsessive-compulsive and somatic complaints. Conclusion Considering the fact that our population is moving toward aging, the obtained results could be useful for policy makers and health and social planners to improve the health status of the elderly.
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Affiliation(s)
- Fereshteh Ameri
- Scientific Resources Management, Central Library and Archives, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Naser Vazifeshenas
- Scientific Resources Management, Central Library and Archives, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abbas Haghparast
- Scientific Resources Management, Central Library and Archives, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Neuroscience Research Center, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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17
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Pagano J, Kyle BN, Johnson TL. A Manual by Any Other Name: Identifying Psychotherapy Manuals for Resident Training. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2017; 41:44-50. [PMID: 27048607 DOI: 10.1007/s40596-016-0492-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 01/20/2016] [Indexed: 06/05/2023]
Affiliation(s)
- Joshua Pagano
- Body School of Medicine at East Carolina University, Greenville, NC, USA.
| | - Brandon N Kyle
- Body School of Medicine at East Carolina University, Greenville, NC, USA
| | - Toni L Johnson
- Body School of Medicine at East Carolina University, Greenville, NC, USA
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18
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King RJ, Orr JA, Poulsen B, Giacomantonio SG, Haden C. Understanding the Therapist Contribution to Psychotherapy Outcome: A Meta-Analytic Approach. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2016; 44:664-680. [DOI: 10.1007/s10488-016-0783-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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19
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Floyd M, Rohen N, Shackelford JAM, Hubbard KL, Parnell MB, Scogin F, Coates A. Two-Year Follow-Up of Bibliotherapy and Individual Cognitive Therapy for Depressed Older Adults. Behav Modif 2016; 30:281-94. [PMID: 16574815 DOI: 10.1177/0145445503261176] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study examined the stability of treatment gains after receiving either cognitive bibliotherapy or individual cognitive psychotherapy for depression in older adults. A 2-year follow-up of 23 participants from Floyd, Scogin, McKendree-Smith, Floyd, and Rokke (2004) was conducted by comparing pre-and posttreatment scores with follow-up scores on the Hamilton Rating Scale for Depression (HRSD) and the Geriatric Depression Scale (GDS). Results indicated that treatment gains from baseline to the 2-year follow-up period were maintained on the HRSD and GDS, and there was not a significant decline from posttreatment to follow-up. There were no significant differences between the treatments on the GDS or HRSD at the 2-year follow-up; however, bibliotherapy participants had significantly more recurrences of depression during the follow-up period.
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20
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Palaniappan M, Mintz L, Heatherly R. Bibliotherapy interventions for female low sexual desire: erotic fiction versus self-help. SEXUAL AND RELATIONSHIP THERAPY 2016. [DOI: 10.1080/14681994.2016.1158805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Longden E, Davis P, Billington J, Lampropoulou S, Farrington G, Magee F, Walsh E, Corcoran R. Shared Reading: assessing the intrinsic value of a literature-based health intervention. MEDICAL HUMANITIES 2015; 41:113-120. [PMID: 26070845 DOI: 10.1136/medhum-2015-010704] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/20/2015] [Indexed: 06/04/2023]
Abstract
Public health strategies have placed increasing emphasis on psychosocial and arts-based strategies for promoting well-being. This study presents preliminary findings for a specific literary-based intervention, Shared Reading, which provides community-based spaces in which individuals can relate with both literature and one another. A 12-week crossover design was conducted with 16 participants to compare benefits associated with six sessions of Shared Reading versus a comparison social activity, Built Environment workshops. Data collected included quantitative self-report measures of psychological well-being, as well as transcript analysis of session recordings and individual video-assisted interviews. Qualitative findings indicated five intrinsic benefits associated with Shared Reading: liveness, creative inarticulacy, the emotional, the personal and the group (or collective identity construction). Quantitative data additionally showed that the intervention is associated with enhancement of a sense of 'Purpose in Life'. Limitations of the study included the small sample size and ceiling effects created by generally high levels of psychological well-being at baseline. The therapeutic potential of reading groups is discussed, including the distinction between instrumental and intrinsic value within arts-and-health interventions.
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Affiliation(s)
- Eleanor Longden
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Philip Davis
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK Centre for Research into Reading, Literature and Society, University of Liverpool, Liverpool, UK
| | - Josie Billington
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK Centre for Research into Reading, Literature and Society, University of Liverpool, Liverpool, UK
| | | | | | - Fiona Magee
- School of English, University of Liverpool, Liverpool, UK
| | - Erin Walsh
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Rhiannon Corcoran
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
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22
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Eum Y, Yim J. Literature and art therapy in post-stroke psychological disorders. TOHOKU J EXP MED 2015; 235:17-23. [PMID: 25744067 DOI: 10.1620/tjem.235.17] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Stroke is one of the leading causes of morbidity and long-term disability worldwide, and post-stroke depression (PSD) is a common and serious psychiatric complication of stroke. PSD makes patients have more severe deficits in activities of daily living, a worse functional outcome, more severe cognitive deficits and increased mortality as compared to stroke patients without depression. Therefore, to reduce or prevent mental problems of stroke patients, psychological treatment should be recommended. Literature and art therapy are highly effective psychological treatment for stroke patients. Literature therapy divided into poetry and story therapy is an assistive tool that treats neurosis as well as emotional or behavioral disorders. Poetry can add impression to the lethargic life of a patient with PSD, thereby acting as a natural treatment. Story therapy can change the gloomy psychological state of patients into a bright and healthy story, and therefore can help stroke patients to overcome their emotional disabilities. Art therapy is one form of psychological therapy that can treat depression and anxiety in stroke patients. Stroke patients can express their internal conflicts, emotions, and psychological status through art works or processes and it would be a healing process of mental problems. Music therapy can relieve the suppressed emotions of patients and add vitality to the body, while giving them the energy to share their feelings with others. In conclusion, literature and art therapy can identify the emotional status of patients and serve as a useful auxiliary tool to help stroke patients in their rehabilitation process.
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23
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Scogin F, Morthland M, DiNapoli EA, LaRocca M, Chaplin W. Pleasant Events, Hopelessness, and Quality of Life in Rural Older Adults. J Rural Health 2015; 32:102-9. [PMID: 26186696 DOI: 10.1111/jrh.12130] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE Rural older adults are susceptible to depression and reduced quality of life. This study explored contrasting explanations (behavioral vs cognitive route) for the relation of emotional distress with quality of life. METHODS This retrospective study included rural older adults (N = 134) with reduced quality of life and increased psychological symptoms. Multiple mediation analysis was conducted to test the indirect effect of engagement in pleasant events and hopelessness on the emotional distress and quality of life relation. FINDINGS Both engagement in pleasant events and hopelessness were found to partially mediate the relation between emotional distress and quality of life. CONCLUSIONS Targeting both hopelessness and engagement in pleasant events may be helpful in improving the quality of life of vulnerable, rural older adults.
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Affiliation(s)
- Forrest Scogin
- Department of Psychology, The University of Alabama, Tuscaloosa, Alabama
| | - Martin Morthland
- Department of Psychology, The University of Alabama, Tuscaloosa, Alabama
| | | | - Michael LaRocca
- Department of Psychology, The University of Alabama, Tuscaloosa, Alabama
| | - William Chaplin
- Department of Psychology, St. John's University, Queens, New York
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24
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Schuurhuizen CSEW, Braamse AMJ, Beekman ATF, Bomhof-Roordink H, Bosmans JE, Cuijpers P, Hoogendoorn AW, Konings IRHM, van der Linden MHM, Neefjes ECW, Verheul HMW, Dekker J. Screening and treatment of psychological distress in patients with metastatic colorectal cancer: study protocol of the TES trial. BMC Cancer 2015; 15:302. [PMID: 25903799 PMCID: PMC4407474 DOI: 10.1186/s12885-015-1313-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 04/09/2015] [Indexed: 12/22/2022] Open
Abstract
Background/Introduction Psychological distress occurs frequently in patients with cancer. Psychological distress includes mild and severe forms of both anxious and depressive mood states. Literature indicates that effective management of psychological distress seems to require targeted selection of patients (T), followed by enhanced care (E), and the application of evidence based interventions. Besides, it is hypothesized that delivering care according to the stepped care (S) approach results in an affordable program. The aim of the current study is to evaluate the (cost)-effectiveness of the TES program compared to usual care in reducing psychological distress in patients with metastatic colorectal cancer (mCRC). Methods This study is designed as a cluster randomized trial with 2 treatment arms: TES program for screening and treatment of psychological distress versus usual care. Sixteen hospitals participate in this study, recruiting patients with mCRC. Outcomes are evaluated at the beginning of chemotherapy and after 3, 10, 24, and 48 weeks. Primary outcome is the difference in treatment effect over time in psychological distress, assessed with the Hospital Anxiety and Depression Scale. Secondary outcomes include quality of life, patient evaluation of care, recognition and management of psychological distress, and societal costs. Discussion We created optimal conditions for an effective screening and treatment program for psychological distress in patients with mCRC. This involves targeted selection of patients, followed by enhanced and stepped care. Our approach will be thoroughly evaluated in this study. We expect that our results will contribute to the continuing debate on the (cost-) effectiveness of screening for and treatment of psychological distress in patients with cancer. Trial Registration This trial is registered in the Netherlands Trial Register NTR4034
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Affiliation(s)
- Claudia S E W Schuurhuizen
- Department of Medical Oncology, VU University Medical Center, Cancer Center Amsterdam, Amsterdam, the Netherlands. .,Department of Psychiatry and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands.
| | - Annemarie M J Braamse
- Department of Psychiatry and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands.
| | - Aartjan T F Beekman
- Department of Psychiatry and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands.
| | - Hanna Bomhof-Roordink
- Department of Psychiatry and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands.
| | - Judith E Bosmans
- VU University, Faculty of Health Science, Amsterdam, the Netherlands.
| | - Pim Cuijpers
- Department of Clinical Psychology, VU University, Amsterdam, the Netherlands.
| | - Adriaan W Hoogendoorn
- Department of Psychiatry and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands.
| | - Inge R H M Konings
- Department of Medical Oncology, VU University Medical Center, Cancer Center Amsterdam, Amsterdam, the Netherlands.
| | | | - Elisabeth C W Neefjes
- Department of Medical Oncology, VU University Medical Center, Cancer Center Amsterdam, Amsterdam, the Netherlands.
| | - Henk M W Verheul
- Department of Medical Oncology, VU University Medical Center, Cancer Center Amsterdam, Amsterdam, the Netherlands.
| | - Joost Dekker
- Department of Psychiatry and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands. .,Department of Rehabilitation Medicine, VU University Medical Center, PO Box 7057, 1007MB, Amsterdam, the Netherlands.
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Huang AX, Delucchi K, Dunn LB, Nelson JC. A systematic review and meta-analysis of psychotherapy for late-life depression. Am J Geriatr Psychiatry 2015; 23:261-73. [PMID: 24856580 DOI: 10.1016/j.jagp.2014.04.003] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Revised: 03/27/2014] [Accepted: 04/14/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To determine the efficacy of psychotherapy in late-life depression and to determine the effect of the type of control group on the magnitude of psychotherapy effects. DESIGN A systematic review and meta-analysis of randomized controlled psychotherapy trials for late-life depression. SETTING Outpatient clinics or in subjects' home. PARTICIPANTS Subjects aged 55 years or older with acute-phase depressive disorder. MEASUREMENTS Change in depressive symptoms was measured with validated scales. Standardized mean differences (SMD) were calculated for each therapy-control contrast, as meta-analytic summaries for contrasts using a similar control, and for all contrasts combined. RESULTS The search identified 27 trials with 37 therapy-control contrasts and 2,245 subjects. Trials utilized five types of control groups (waitlist, treatment-as-usual, attention, supportive therapy, placebo). In the combined contrasts, psychotherapy was effective (SMD: 0.73; 95% confidence interval [CI]: 0.51, 0.95; z=6.42, p<0.00001). The SMD varied widely (from 0.05 to 1.36) and significantly (χ2=35.67, df=4, p<0.00001) between subgroups by type of control. In five trials that compared psychotherapy with supportive therapy, the SMD was 0.39 (95% CI: 0.16, 0.61; z=3.37, p<0.0007; I2=0%). The SMD was 0.11 within the waitlist controls and 1.10 within the supportive therapy subgroup. CONCLUSIONS Psychotherapy is effective for late-life depression, but the magnitude of the effect varies widely with the type of control group. Supportive therapy appears to best control for the nonspecific elements of psychotherapy and is associated with considerable change itself, but few trials have utilized it as a control.
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Affiliation(s)
- Alice X Huang
- University of California, Department of Psychiatry and Langley Porter Psychiatric Institute, San Francisco, CA
| | - Kevin Delucchi
- University of California, Department of Psychiatry and Langley Porter Psychiatric Institute, San Francisco, CA
| | - Laura B Dunn
- University of California, Department of Psychiatry and Langley Porter Psychiatric Institute, San Francisco, CA; University of California, Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | - J Craig Nelson
- University of California, Department of Psychiatry and Langley Porter Psychiatric Institute, San Francisco, CA.
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Understanding the role of adjunctive nonpharmacological therapies in management of the multiple pathways to depression. Psychiatry Res 2014; 220 Suppl 1:S34-44. [PMID: 25539873 DOI: 10.1016/s0165-1781(14)70004-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 10/11/2014] [Indexed: 01/28/2023]
Abstract
Major depressive disorder (MDD) is a common disorder with a lifetime prevalence of 16.2% and the fourth highest cause of disability globally. It is hypothesized to be a syndromatic manifestation of multiple pathological processes leading to similar clinical manifestation. MDD is associated with at least three categories of peripheral hormone-type factors including neurotrophic factors, proinflammatory cytokines, and processes that impair regulation of the hypothalamic-pituitary-adrenocortical axis. Neuroimaging studies have identified functional abnormalities including subcortical systems associated with reward and emotion processing, medial prefrontal and anterior cingulate cortical regions and the lateral prefrontal cortical systems involved in cognitive control and voluntary emotion regulation. Studies investigating the effects of psychotherapy and pharmacotherapy on functional brain measures show normalization of brain function with return to euthymia. Nevertheless, approximately 50% of patients with MDD will not respond sufficiently and 60 to 70% will not achieve full remission with first-line pharmacotherapy, therefore clinicians strive to improve patient responses through the use of adjunct therapies. This review discusses recent research in the various biological processes associated with MDD as well as recent data in support of the use of adjunctive non-pharmacological therapies including psychotherapy, bibliotherapy, Internet therapy, "natural" or herbal approaches, exercise therapy, and somatic therapies.
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27
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Eum Y, Yim J, Choi W. Elderly health and literature therapy: a theoretical review. TOHOKU J EXP MED 2014; 232:79-83. [PMID: 24522118 DOI: 10.1620/tjem.232.79] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Recently, the problems of old age have been discussed in terms of two aspects: preventive and therapeutic approach. The previous studies on the preventive aspect have been mostly concerned with the educational preparation for successful approach to elderly, directing focus toward the transitional period of the old age. Most research into the therapeutic aspect on the elderly diseases has focused on organic mental disorders such as dementia and functional mental diseases such as depression. This study aims to suggest the preventive and new therapeutic possibility in old people through combining the elderly health with literature. First, the research results regarding the social background for the elderly problems indicate that geriatric diseases increase in proportion to the increase of the population. Secondly, for the literature therapy, it is initially required to seek a comprehensive understanding about the health of the elderly through the phased consideration for the elderly problems. Thirdly, for the treatment of geriatric diseases by using literature, it is necessary to develop more active and integrative literature therapy than passive bibliotherapy. Literature therapy is the use of literature in the treatment of people with emotional or mental illness. Fourthly, theoretical approach should be considered for the health of the elderly and the literature therapy. From a literary approach, the literature therapy can help the study on geriatric diseases such as dementia and depression. Thus, the program for the health of geriatric issues and literature therapy should be developed as the next step in the future.
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Arean PA, Niu G. Choosing treatment for depression in older adults and evaluating response. Clin Geriatr Med 2014; 30:535-51. [PMID: 25037294 DOI: 10.1016/j.cger.2014.04.005] [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: 10/25/2022]
Abstract
An update is provided on the current information regarding late life depression with regard to assessment, clinical implications, and treatment recommendations. Several treatments are considered evidence-based, but when deployed into field trials, the efficacy of these treatments falls short. It is thought that the lower impact in community trials is due in large part to patient, clinical, environmental, socio-economic, and cognitive correlates that influence treatment response. The aim is to assist providers in making decisions about what type of treatment to recommend based on a sound assessment of these clinical correlates.
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Affiliation(s)
- Patricia A Arean
- Department of Psychiatry, University of California, San Francisco, 401 Parnassus Avenue, San Francisco, CA 94143, USA.
| | - Grace Niu
- Department of Psychiatry, University of California, San Francisco, 401 Parnassus Avenue, San Francisco, CA 94143, USA
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Cuijpers P, Karyotaki E, Pot AM, Park M, Reynolds CF. Managing depression in older age: psychological interventions. Maturitas 2014; 79:160-9. [PMID: 24973043 DOI: 10.1016/j.maturitas.2014.05.027] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 05/27/2014] [Accepted: 05/28/2014] [Indexed: 01/16/2023]
Abstract
The number of studies on psychological treatments of depression in older adults has increased considerably in the past years. Therefore, we conducted an updated meta-analysis of these studies. A total of 44 studies comparing psychotherapies to control groups, other therapies or pharmacotherapy could be included. The overall effect size indicating the difference between psychotherapy and control groups was g=0.64 (95% CI: 0.47-0.80), which corresponds with a NNT of 3. These effects were maintained at 6 months or longer post randomization (g=0.27; 95%CI: 0.16-0.37). Specific types of psychotherapies that were found to be effective included cognitive behavior therapy (g=0.45; 95% CI: 0.29-0.60), life review therapy (g=0.59; 95% CI: 0.36-0.82) and problem-solving therapy (g=0.46; 95% CI: 0.18-0.74). Treatment compared to waiting list control groups resulted in larger effect sizes than treatments compared to care-as-usual and other control groups (p<0.05). Studies with lower quality resulted in higher effect sizes than high-quality studies (p<0.05). Direct comparisons between different types of psychotherapy suggested that cognitive behavior therapy and problem-solving therapy may be more effective than non-directive counseling and other psychotherapies may be less effective than other therapies. This should be considered with caution, however, because of the small number of studies. There were not enough studies to examine the long-term effects of psychotherapies and to compare psychotherapy with pharmacotherapy or combined treatments. We conclude that it is safe to assume that psychological therapies in general are effective in late-life depression, and this is especially well-established for cognitive behavior therapy and problem-solving therapy.
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Affiliation(s)
- Pim Cuijpers
- Department of Clinical Psychology, VU University Amsterdam, The Netherlands; EMGO Institute for Health and Care Research, The Netherlands.
| | - Eirini Karyotaki
- Department of Clinical Psychology, VU University Amsterdam, The Netherlands; EMGO Institute for Health and Care Research, The Netherlands
| | - Anne Margriet Pot
- Department of Clinical Psychology, VU University Amsterdam, The Netherlands; EMGO Institute for Health and Care Research, The Netherlands; Trimbos Institute, Netherlands Institute of Mental Health and Addiction, The Netherlands; School of Psychology, University of Queensland, Australia
| | - Mijung Park
- University of Pittsburgh School of Nursing, United States
| | - Charles F Reynolds
- University of Pittsburgh Schools of Medicine and Graduate School of Public Health, United States
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Pilot of the brief behavioral activation treatment for depression in latinos with limited english proficiency: preliminary evaluation of efficacy and acceptability. Behav Ther 2014; 45:102-15. [PMID: 24411118 PMCID: PMC4103902 DOI: 10.1016/j.beth.2013.10.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Revised: 09/12/2013] [Accepted: 10/07/2013] [Indexed: 11/24/2022]
Abstract
Latinos with limited English proficiency (LEP) experience multiple barriers to accessing efficacious mental health treatments. Using a stage model of behavior therapy research, this Stage I investigation evaluated the Brief Behavioral Activation Treatment for Depression (BATD), an intervention that may be well equipped to address existing treatment barriers. A sample of 10 Latinos with LEP and depressive symptomatology participated in a 10-session, direct (i.e., literal) Spanish-language translation of BATD, with no other cultural modifications. Participants were assessed at each session for depressive symptomatology and for the proposed BATD mechanisms: activity engagement and environmental reward. One month after treatment, participants were reassessed and interviewed to elicit feedback about BATD. Hierarchical linear model analyses were used to measure BATD outcomes. Results showed depressive symptomatology decreased (p<.001), while both activation (p=.04) and environmental reward (p=.02) increased over the course of BATD. Increases in activation corresponded concurrently with decreases in depression (p=.01), while environmental reward preceded decreases in depressive symptomatology (all p's ≤ .04). Follow-up analyses revealed sustained clinical gains in depression and activation, and an increase in environmental reward at follow-up. Participant interviews conducted 1 month after treatment conclusion indicated that BATD is an acceptable treatment for our sample of interest. Despite the limitations inherent in a study restricted to a sample of 10, preliminary outcomes of this Stage I research suggest that members of this otherwise underserved group showed improvements in depressive symptomatology and are willing to participate in and adhere to BATD. The study's positive outcomes suggest that a Stage II randomized clinical trial is a logical next step.
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CBT Guided Self-Help Compares Favourably to Gold Standard Therapist-Administered CBT and Shows Unique Benefits Over Traditional Treatment. BEHAVIOUR CHANGE 2013. [DOI: 10.1017/bec.2013.22] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
CBT guided self-help (CBTgsh) can produce treatment outcomes comparable to therapist-administered CBT (CBTta) for the treatment of anxiety and depression. The efficacy of CBTgsh compared to gold standard CBTta, however, remains to be examined. The current article addresses this issue, as well as how CBTgsh may have unique benefits over CBTta. It further highlights ways in which CBTgsh may be used for disorders of increasing severity, using eating disorders and personality pathology for illustrative purposes. A literature review of PsycINFO, PsyARTICLES, and PubMED was conducted to identify relevant studies published since 1990. Studies directly comparing CBTgsh to gold standard CBTta for anxiety and depression, as well as bulimia nervosa, revealed no significant differences between the two interventions. Furthermore, CBTgsh may have unique benefits by encouraging continued improvement over time. Innovative eating disorder studies also show that CBTgsh can be used for more severe disorders as a supplementary treatment, and produces treatment outcomes superior to CBTta or treatment as usual alone. Based on these findings, CBTgsh applications to personality pathology are suggested. Traditional stepped care models, as they pertain to CBTgsh, may gain to be broadened both in their focus and methods of delivery.
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How much psychotherapy is needed to treat depression? A metaregression analysis. J Affect Disord 2013; 149:1-13. [PMID: 23528438 DOI: 10.1016/j.jad.2013.02.030] [Citation(s) in RCA: 140] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Revised: 02/18/2013] [Accepted: 02/19/2013] [Indexed: 11/20/2022]
Abstract
BACKGROUND Although psychotherapies are effective in the treatment of adult depression it is not clear how this treatment effect is related to amount, frequency and intensity of therapy. METHODS To fill this gap in knowledge, the present metaregression analysis examined the association between the effects of psychotherapy for adult depression and several indicators of amount, frequency and intensity of therapy. The analysis included 70 studies (92 comparisons) with 5403 patients, in which individual psychotherapy was compared with a control group (e.g. waiting list, care-as-usual). RESULTS There was only a small association between number of therapy sessions and effect size, and this association was no longer significant when the analysis adjusted for other characteristics of the studies. The multivariable analyses also found no significant association with the total contact time or duration of the therapy. However, there was a strong association between number of sessions per week and effect size. An increase from one to two sessions per week increased the effect size with g=0.45, while keeping the total number of treatment sessions constant. DISCUSSION More research is needed to establish the robustness of this finding. Based on these findings, it may be advisable to concentrate psychotherapy sessions within a brief time frame.
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Abstract
OBJECTIVE To be used in conjunction with 'Pharmacological management of unipolar depression' [Malhi et al. Acta Psychiatr Scand 2013;127(Suppl. 443):6-23] and 'Lifestyle management of unipolar depression' [Berk et al. Acta Psychiatr Scand 2013;127(Suppl. 443):38-54]. To provide clinically relevant recommendations for the use of psychological treatments in depression derived from a literature review. METHOD Medical databases including MEDLINE and PubMed were searched for pertinent literature, with an emphasis on recent publications. RESULTS Structured psychological treatments such as cognitive behaviour therapy and interpersonal therapy (IPT) have a robust evidence base for efficacy in treating depression, even in severe cases of depression. However, they may not offer benefit as quickly as antidepressants, and maximal efficacy requires well-trained and experienced therapists. These therapies are effective across the lifespan and may be preferred where it is desired to avoid pharmacotherapy. In some instances, combination with pharmacotherapy may enhance outcome. Psychological therapy may have more enduring protective effects than medication and be effective in relapse prevention. Newer structured psychological therapies such as mindfulness-based cognitive therapy and acceptance and commitment therapy lack an extensive outcome literature, but the few published studies yielding positive outcomes suggest they should be considered options for treatment. CONCLUSION Cognitive behaviour therapy and IPT can be effective in alleviating acute depression for all levels of severity and in maintaining improvement. Psychological treatments for depression have demonstrated efficacy across the lifespan and may present a preferred treatment option in some groups, for example, children and adolescents and women who are pregnant or postnatal.
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Affiliation(s)
- L Lampe
- CADE Clinic, Department of Psychiatry, Royal North Shore Hospital, Sydney, NSW, Australia.
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Moss K, Scogin F, Di Napoli E, Presnell A. A self-help behavioral activation treatment for geriatric depressive symptoms. Aging Ment Health 2012; 16:625-35. [PMID: 22304676 DOI: 10.1080/13607863.2011.651435] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
This study investigated behavioral activation (BA) bibliotherapy as a treatment for late-life depressive symptoms. BA bibliotherapy was administered using Addis and Martell's Overcoming depression one step at a time as a stand-alone treatment that was completed by participants (N=26) over a 4-week period [Addis, M.E., & Martell, C.R. (2004). Overcoming depression one step at a time. Oakland, CA: New Harbinger Publications, Inc.]. Results of an immediate intervention group were compared with those of a delayed treatment control group and treatment response for both groups was evaluated at 1-month follow-up. Primary outcome results showed that symptoms on a clinician-rated measure of depressive symptoms, Hamilton Rating Scale for Depression, were significantly lower at post-treatment for those who received immediate BA bibliotherapy compared with those who were in the delayed treatment control condition. However, self-reported depressive symptoms (a secondary outcome measured via the Geriatric Depression Scale), were not significantly different at this period. Because study control was lost after the delayed treatment group received the intervention, within-subjects analyses examining both treatment groups combined showed that clinician-rated depressive symptoms significantly decreased from pre-treatment to both post-treatment and 1-month follow-up. Self-reported depressive symptoms were significantly lower from pre-treatment to 1-month follow-up. These findings suggest that BA may be useful in treating mild or subthreshold depressive symptoms in an older adult population.
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Affiliation(s)
- Kathryn Moss
- Department of Psychology, University of Alabama, Tuscaloosa, AL, USA
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Gould RL, Coulson MC, Howard RJ. Cognitive behavioral therapy for depression in older people: a meta-analysis and meta-regression of randomized controlled trials. J Am Geriatr Soc 2012; 60:1817-30. [PMID: 23003115 DOI: 10.1111/j.1532-5415.2012.04166.x] [Citation(s) in RCA: 111] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To review the effectiveness of cognitive behavioral therapy (CBT) for depression in older people, together with factors associated with its efficacy. DESIGN Online literature databases and registers were searched for randomized controlled trials (RCTs) of CBT for depression in older people. Random-effects meta-analysis and meta-regression were conducted. SETTING Studies involving participants from the community and inpatient and outpatient clinical settings were included in the meta-analysis. PARTICIPANTS Older people with major or minor depression, dysthymia, or depressive symptoms. MEASUREMENTS Evidence-based outcome measures of depression. RESULTS Four hundred eighty-five studies were identified, of which 23 were included. At the end of the intervention, CBT was significantly more effective at reducing depressive symptoms (irrespective of whether rated by clinicians or participants) than treatment as usual (TAU) or being on a waiting list but not than active controls. The same pattern of results was found for 6-month follow-up. At all other time-points, pooled effect sizes in favor of CBT were nonsignificant. Clinician-rated outcome measures resulted in larger effect sizes in favor of CBT than self-rated measures. No significant differences in efficacy were found between CBT and other treatment (pharmacotherapy and other psychotherapies). Meta-regression analyses revealed four factors that predicted effect sizes for comparisons between CBT and control conditions, including whether concurrent pharmacotherapy was allowed. CONCLUSION CBT for depression in older people is more effective than waiting list or TAU, but greater efficacy than active controls or other treatment has not been demonstrated. More high-quality RCTs comparing CBT with active controls need to be conducted before firm conclusions can be drawn about the efficacy of CBT for depression in older people. Other treatment approaches that could be contrasted with or augment CBT (e.g., pharmacotherapy) also need to be explored further.
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Affiliation(s)
- Rebecca L Gould
- Department of Old Age Psychiatry, Institute of Psychiatry, King's College London, London, UK.
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Moldovan R, Cobeanu O, David D. Cognitive Bibliotherapy for Mild Depressive Symptomatology: Randomized Clinical Trial of Efficacy and Mechanisms of Change. Clin Psychol Psychother 2012; 20:482-93. [DOI: 10.1002/cpp.1814] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2011] [Revised: 07/11/2012] [Accepted: 07/12/2012] [Indexed: 12/14/2022]
Affiliation(s)
- Ramona Moldovan
- Babes-Bolyai University; Department of Clinical Psychology and Psychotherapy; Cluj-Napoca Romania
| | - Oana Cobeanu
- Babes-Bolyai University; Department of Clinical Psychology and Psychotherapy; Cluj-Napoca Romania
| | - Daniel David
- Babes-Bolyai University; Department of Clinical Psychology and Psychotherapy; Cluj-Napoca Romania
- Mount Sinai School of Medicine; Oncological Sciences Department; New York USA
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Abstract
Primary care settings present important opportunities for the detection and management of depression in older adults. In this article, the authors review the common barriers to effective treatment of geriatric depression, identify treatment strategies that can substantially improve the effectiveness of treatment in this setting, and highlight the opportunities for addressing health disparities in geriatric depression care. The importance of engaging and supporting family caregivers of depressed older adults and the 3 strategic areas to improve the treatment of geriatric depression in primary care are also discussed.
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Psychosocial interventions for late-life major depression: evidence-based treatments, predictors of treatment outcomes, and moderators of treatment effects. Psychiatr Clin North Am 2011; 34:377-401, viii. [PMID: 21536164 PMCID: PMC3099466 DOI: 10.1016/j.psc.2011.03.001] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
This systematic review evaluates the efficacy of psychosocial interventions for the acute treatment of late-life depression and identifies predictors of treatment outcomes and moderators of treatment effects. Problem-solving therapy, cognitive behavioral therapy, and treatment initiation and participation program have supportive evidence of efficacy, pending replication. Although the data on predictors of treatment outcomes and moderators of treatment effects are preliminary, it appears that baseline anxiety and stress level, personality disorders, endogenous depression, and reduced self-rated health predict worse depression outcomes. Future research may examine the moderating effects of baseline depression severity and identify other clinical or demographic moderators.
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McKenna G, Hevey D, Martin E. Patients' and providers' perspectives on bibliotherapy in primary care. Clin Psychol Psychother 2011; 17:497-509. [PMID: 20146202 DOI: 10.1002/cpp.679] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Bibliotherapy is a form of self-administered treatment in which structured materials provide a means to alleviate distress. Although the treatment has evidence of effectiveness, evaluations of bibliotherapy have typically focused on outcomes, and the perspectives of both the client and the service provider have been understudied. In the present study, eleven users of a bibliotherapy scheme were interviewed regarding their experiences of bibliotherapy. In addition, five referring practitioners to the scheme were also interviewed. Thematic analyses revealed three super-ordinate themes in the transcripts: participants' personal experiences of the bibliotherapy scheme factors that facilitate change and the influence of the professionals involved. The implications of these findings for bibliotherapy schemes are considered.
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Affiliation(s)
- Grainne McKenna
- School of Psychology, Trinity College Dublin, Dublin, Ireland
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How effective is bibliotherapy for very old adults with subthreshold depression? A randomized controlled trial. Am J Geriatr Psychiatry 2011; 19:256-65. [PMID: 20808151 DOI: 10.1097/jgp.0b013e3181ec8859] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Depressive symptoms are common among elderly primary care patients, and because they encounter considerable barriers in seeking help and they often resist referral to specialized mental health facilities, it is important to look for easily accessible interventions within the primary care setting. Bibliotherapy, which has been found to be effective among younger populations, might be an attractive option. In this study, the authors investigated the effectiveness of bibliotherapy for depressive symptomatology in very old adults. DESIGN Randomized controlled trial. After a 3-month period of "watchful waiting," the participants were randomly assigned to a bibliotherapy group or a usual care group. SETTING Thirty-three general practices in the north-western region of the Netherlands. PARTICIPANTS One hundred seventy community-dwelling adults, aged 75 and older, with subthreshold depression. INTERVENTION The bibliotherapy intervention consisted of an information leaflet and a self-help manual "Coping with Depression" adapted for the elderly. MEASUREMENTS Outcome measures after 3 months were a) change in depressive symptoms according to the Center for Epidemiologic Studies Depression Scale (CES-D) and b) the proportion of participants who scored a significant improvement on the CES-D. RESULTS One hundred forty-six (85.9%) of the 170 participants completed the baseline and follow-up measurements. The authors did not find any clinically relevant and statistically significant differences between the intervention group and the control group in the severity of the depressive symptoms. CONCLUSION Bibliotherapy as a stand-alone intervention for the elderly (aged 75 years and older) did not reduce depressive symptoms more than usual care. This might indicate that bibliotherapy can only be effective for patients who are motivated and acknowledge their depression.
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Cho EJ, Chang HR. A Study on the Effectiveness of Bibliotherapy Program to Reduce Stress of the Elderly. ACTA ACUST UNITED AC 2010. [DOI: 10.3743/kosim.2010.27.4.259] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Betzalel N, Shechtman Z. Bibliotherapy Treatment for Children With Adjustment Difficulties: A Comparison of Affective and Cognitive Bibliotherapy. JOURNAL OF CREATIVITY IN MENTAL HEALTH 2010. [DOI: 10.1080/15401383.2010.527816] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Cuijpers P, Donker T, van Straten A, Li J, Andersson G. Is guided self-help as effective as face-to-face psychotherapy for depression and anxiety disorders? A systematic review and meta-analysis of comparative outcome studies. Psychol Med 2010; 40:1943-1957. [PMID: 20406528 DOI: 10.1017/s0033291710000772] [Citation(s) in RCA: 516] [Impact Index Per Article: 36.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Although guided self-help for depression and anxiety disorders has been examined in many studies, it is not clear whether it is equally effective as face-to-face treatments.MethodWe conducted a meta-analysis of randomized controlled trials in which the effects of guided self-help on depression and anxiety were compared directly with face-to-face psychotherapies for depression and anxiety disorders. A systematic search in bibliographical databases (PubMed, PsycINFO, EMBASE, Cochrane) resulted in 21 studies with 810 participants. RESULTS The overall effect size indicating the difference between guided self-help and face-to-face psychotherapy at post-test was d=-0.02, in favour of guided self-help. At follow-up (up to 1 year) no significant difference was found either. No significant difference was found between the drop-out rates in the two treatments formats. CONCLUSIONS It seems safe to conclude that guided self-help and face-to-face treatments can have comparable effects. It is time to start thinking about implementation in routine care.
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Affiliation(s)
- P Cuijpers
- Department of Clinical Psychology, VU University Amsterdam, The Netherlands.
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Welch T, Welch M, Baer J, Dias J, Gurney C, Van Dale B, Lockie M, Millar K, Noon J, Psiurski S. Removed But Not Out of Reach: Seniors with Depression in Smaller Center, Rural, and Remote Communities. Psychiatr Ann 2010. [DOI: 10.3928/00485713-20101123-05] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Wilkins VM, Kiosses D, Ravdin LD. Late-life depression with comorbid cognitive impairment and disability: nonpharmacological interventions. Clin Interv Aging 2010; 5:323-31. [PMID: 21228897 PMCID: PMC3010167 DOI: 10.2147/cia.s9088] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2010] [Indexed: 11/23/2022] Open
Abstract
Less than half of older adults with depression achieve remission with antidepressant medications, and rates of remission are even poorer for those with comorbid conditions. Psychosocial interventions have been effective in treating geriatric depression, either alone or better yet, in combination with antidepressant medications. Traditional strategies for nonpharmacological treatment of late-life depression do not specifically address the co-occurring cognitive impairment and disability that is prevalent in this population. Newer therapies are recognizing the need to simultaneously direct treatment efforts in late-life depression towards the triad of depressive symptoms, cognitive dysfunction, and functional disability that is so often found in geriatric depression, and this comprehensive approach holds promise for improved treatment outcomes.
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Affiliation(s)
- Victoria M Wilkins
- Department of Psychiatry, Weill Medical College of Cornell University, White Plains, NY, USA
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Braamse AMJ, van Meijel B, Visser O, van Oppen P, Boenink AD, Eeltink C, Cuijpers P, Huijgens PC, Beekman ATF, Dekker J. Distress and quality of life after autologous stem cell transplantation: a randomized clinical trial to evaluate the outcome of a web-based stepped care intervention. BMC Cancer 2010; 10:361. [PMID: 20609251 PMCID: PMC2913960 DOI: 10.1186/1471-2407-10-361] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2009] [Accepted: 07/07/2010] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Psychological distress (i.e. depression and anxiety) is a strong predictor of functional status and other aspects of quality of life in autologous stem cell transplantation following high-dose chemotherapy. Treatment of psychological distress is hypothesized to result in improvement of functional status and other aspects of quality of life. The aim is to evaluate the outcome of stepped care for psychological distress on functional status and other aspects of quality of life in patients with hematological malignancy treated with autologous stem cell transplantation. METHODS/DESIGN The study is designed as a randomized clinical trial with 2 treatment arms: a stepped care intervention program versus care as usual. Patients are randomized immediately pre transplant. Stepped care and care as usual are initiated after a 6 weeks buffer period. Outcome is evaluated at 13, 30, and 42 weeks post transplant.In the experimental group, the first step includes an Internet-based self-help program. If psychological distress persists after the self-help intervention, the second step of the program is executed, i.e. a diagnostic evaluation and a standardized interview, yielding a problem analysis. Based on this information, a contract is made with the patient and treatment is provided consisting of individual face-to-face counseling, medication, or referral to other services. Care as usual comprises an interview with the patient, on ad hoc basis; emotional support and advice, on ad hoc basis; if urgent problems emerge, the patient is referred to other services.Primary outcome variables are psychological distress and functional status. Data are analyzed according to the intention to treat-principle. DISCUSSION This study has several innovative characteristics. First, the outcome of the intervention for psychological distress in patients with hematological malignancy treated with autologous stem cell transplantation is evaluated in a randomized controlled study. Second, the impact of the intervention on functional status is evaluated: it is hypothesized that reduction of psychological distress results in improved functional status. Furthermore, the intervention concerns an Internet-based treatment in the first step. Finally, the intervention is characterized by an emphasis on self-management, efficiency, and a multi-disciplinary approach with nurses taking up a central role. TRIAL REGISTRATION NTR1770.
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Affiliation(s)
- Annemarie MJ Braamse
- Department of Psychiatry and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
| | - Berno van Meijel
- Inholland University, Research Group Mental Health Nursing, Amsterdam, the Netherlands
| | - Otto Visser
- Department of Hematology, VU University Medical Center, Amsterdam, the Netherlands
| | - Patricia van Oppen
- Department of Psychiatry and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
| | - Annette D Boenink
- Department of Psychiatry and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
| | - Corien Eeltink
- Department of Hematology, VU University Medical Center, Amsterdam, the Netherlands
| | - Pim Cuijpers
- Department of Clinical Psychology, FPP, EMGO Institute for Health and Care Research, VU University, Amsterdam, the Netherlands
| | - Peter C Huijgens
- Department of Hematology, VU University Medical Center, Amsterdam, the Netherlands
| | - Aartjan TF Beekman
- Department of Psychiatry and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
| | - Joost Dekker
- Department of Psychiatry and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
- Department of Clinical Psychology, FPP, EMGO Institute for Health and Care Research, VU University, Amsterdam, the Netherlands
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Peng XD, Huang CQ, Chen LJ, Lu ZC. Cognitive behavioural therapy and reminiscence techniques for the treatment of depression in the elderly: a systematic review. J Int Med Res 2009; 37:975-82. [PMID: 19761679 DOI: 10.1177/147323000903700401] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Psychotherapy, including cognitive behavioural therapy (CBT), reminiscence and general psychotherapy (GPT), is viewed as effective treatment for depression, but its efficacy in older people is not well defined. This systematic review included 14 randomized controlled trials that assessed the efficacy of psychotherapy for treating depression in elderly people (> or = 55 years). The results of this meta-analysis showed that, compared with placebo, psychotherapy was more effective in reducing depression scores (standardized mean difference -0.92; 95% confidence interval -1.21, -0.36). Subgroup analysis showed that CBT, reminiscence and GPT were all more effective than placebo; psychotherapy as an adjunct to antidepressant medication did not increase effectiveness. There was no significant difference between CBT and reminiscence in improving depression. A higher drop-out rate was observed in studies that did not include psychotherapy versus those that did, although this difference was not statistically significant. Thus, various general formats of psychotherapy are effective for treating depression in older people, although psychotherapy does not significantly increase the effectiveness of anti-depressant medication.
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Affiliation(s)
- X-D Peng
- State Key Laboratory of Biotherapy and Cancer Centre, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan, China
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Abstract
Religion is important to most older adults, and research generally finds a positive relationship between religion and mental health. Among psychotherapies used in the treatment of anxiety and depression in older adults, cognitive-behavioral therapy (CBT) has the strongest evidence base. Incorporation of religion into CBT may increase its acceptability and effectiveness in this population. This article reviews studies that have examined the effects of integrating religion into CBT for depression and anxiety. These studies indicate that improvement in depressive and anxiety symptoms occurs earlier in treatment when CBT incorporates religion, although effects are equivalent at follow-up. The authors present recommendations for integrating religious beliefs and behaviors into CBT based on empirical literature concerning which aspects of religion affect mental health. A case example is also included that describes the integration of religion into CBT for an older man with cognitive impairment experiencing comorbid generalized anxiety disorder and major depressive disorder. It is recommended that clinicians consider the integration of religion into psychotherapy for older adults with depression or anxiety and that studies be conducted to examine the added benefit of incorporating religion into CBT for the treatment of depression and anxiety in older adults.
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Liu ETH, Chen WL, Li YH, Wang CH, Mok TJ, Huang HS. Exploring the Efficacy of Cognitive Bibliotherapy and a Potential Mechanism of Change in the Treatment of Depressive Symptoms Among the Chinese: A Randomized Controlled Trial. COGNITIVE THERAPY AND RESEARCH 2008. [DOI: 10.1007/s10608-008-9228-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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