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Mengin AC, Nourry N, Severac F, Berna F, Bemmouna D, Costache ME, Fritsch A, Frey I, Ligier F, Engel N, Greth P, Khan A, Chauvet-Gelinier JC, Chabridon G, Haffen E, Nicolier M, Zinetti-Bertschy A, Vidailhet P, Weiner L. Efficacy of the my health too online cognitive behavioral therapy program for healthcare workers during the COVID-19 pandemic: A randomized controlled trial. Internet Interv 2024; 36:100736. [PMID: 38617386 PMCID: PMC11015127 DOI: 10.1016/j.invent.2024.100736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 02/23/2024] [Accepted: 03/16/2024] [Indexed: 04/16/2024] Open
Abstract
Background Healthcare workers' mental health has been impacted by the COVID-19 pandemic, emphasizing the need for mental health interventions in this population. Online cognitive behavioral therapy (CBT) is efficient to reduce stress and may reach numerous professionals. We developed "MyHealthToo", an online CBT program to help reduce stress among healthcare workers during the COVID-19 pandemic. Objective The aim of our study is to investigate the efficacy of an online CBT program on stress and mental health conditions among healthcare workers during a health crisis. Methods We performed a multicentric randomized controlled trial among 155 participants allocated either to the experimental or active control group (bibliotherapy). The primary outcome was the decrease of perceived stress scores (PSS-10) post-treatment. Secondary outcomes included depression, insomnia and PTSD symptoms along with self-reported resilience and ruminations. Assessments were scheduled pretreatment, mid-treatment (4 weeks), post-treatment (8 weeks), and at 1-month and 4-months follow-up. Results For both interventions, mean changes on the PSS-10 were significant post-therapy (W8), as at 1-month (W12) and 4-months (W24) follow-ups. The between-group comparison showed no difference at any time point (ps > 0.88). Work-related ruminations significantly decreased in the experimental group with a significant between-group difference at W8 (Δ = -1.83 [-3.57; -0.09], p = 0.04). Posttraumatic stress symptoms significantly decreased in the experimental group with a significant between-group difference at W12 (Δ = -1.41 [-2.68; -0.14], p = 0.03). The decrease in work-related ruminations at W8 mediated the decrease in posttraumatic stress symptoms at W12 (p = 0.048). Conclusion The "MyHealthToo" online CBT intervention may help reduce ruminations about work and posttraumatic stress symptoms among healthcare workers during a major health crisis. Work-related ruminations may represent a relevant target of online interventions to improve mental health among healthcare workers.
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Affiliation(s)
- Amaury C. Mengin
- Department of Psychiatry, Mental Health & Addictology, Strasbourg University Hospital, Strasbourg, France
- Regional Great East Center for Psychotraumatism, Strasbourg, France
- Strasbourg University, Faculty of Medicine, Strasbourg, France
- INSERM U1329, Strasbourg Translational NEuroscience and Psychiatry (STEP), Team Psychiatry, Strasbourg, France
- Fédération de Médecine Translationnelle de Strasbourg, France
| | - Nathalie Nourry
- Strasbourg University, Faculty of Medicine, Strasbourg, France
- Fédération de Médecine Translationnelle de Strasbourg, France
- Hôpitaux Universitaires de Strasbourg, Service de Pathologies Professionnelles et Médecine du Travail, Strasbourg, France
| | - François Severac
- Hôpitaux Universitaires de Strasbourg, Département de Santé Publique, GMRC, Strasbourg, France
- Université de Strasbourg, Laboratoire de Biostatistique et Informatique Médicale, iCUBE UMR, 7357 Illkirch, France
| | - Fabrice Berna
- Department of Psychiatry, Mental Health & Addictology, Strasbourg University Hospital, Strasbourg, France
- Strasbourg University, Faculty of Medicine, Strasbourg, France
- INSERM U1329, Strasbourg Translational NEuroscience and Psychiatry (STEP), Team Psychiatry, Strasbourg, France
- Fédération de Médecine Translationnelle de Strasbourg, France
| | - Doha Bemmouna
- Strasbourg University, Faculty of Psychology, Strasbourg, France
| | - Mădălina Elena Costache
- Strasbourg University, Faculty of Psychology, Strasbourg, France
- Laboratoire de Psychologie des Cognitions, Université de Strasbourg, Strasbourg, France
| | - Aurélie Fritsch
- Strasbourg University, Faculty of Psychology, Strasbourg, France
- Laboratoire de Psychologie des Cognitions, Université de Strasbourg, Strasbourg, France
| | - Isabelle Frey
- Department of Psychiatry, Mental Health & Addictology, Strasbourg University Hospital, Strasbourg, France
| | - Fabienne Ligier
- PUPEA, Centre Psychothérapeutique de Nancy, Laxou; EA 4360 APEMAC, Université de Lorraine, Nancy, France
- Centre Psychothérapeutique de Nancy, Laxou, France
| | - Nadia Engel
- PUPEA, Centre Psychothérapeutique de Nancy, Laxou; EA 4360 APEMAC, Université de Lorraine, Nancy, France
- Centre Psychothérapeutique de Nancy, Laxou, France
| | - Philippe Greth
- Pôle de Psychiatrie et Santé Mentale du Groupe Hospitalier Mulhouse Sud Alsace, Mulhouse, France
| | - Anastasia Khan
- Pôle de Psychiatrie et Santé Mentale du Groupe Hospitalier Mulhouse Sud Alsace, Mulhouse, France
| | - Jean-Christophe Chauvet-Gelinier
- Service de Psychiatrie Adultes, Centre Hospitalier Universitaire Dijon-Bourgogne, Unité INSERM LNC-UMR 1231, Université de Bourgogne, Dijon, France
| | - Guillaume Chabridon
- Service de Psychiatrie Adultes, Centre Hospitalier Universitaire Dijon-Bourgogne, Unité INSERM LNC-UMR 1231, Université de Bourgogne, Dijon, France
| | - Emmanuel Haffen
- Service de Psychiatrie, CIC-1431 INSERM, CHU de Besançon, Laboratoire de Neurosciences, Université Bourgogne-Franche-Comté, Besançon, France
| | - Magali Nicolier
- Service de Psychiatrie, CIC-1431 INSERM, CHU de Besançon, Laboratoire de Neurosciences, Université Bourgogne-Franche-Comté, Besançon, France
| | - Anna Zinetti-Bertschy
- Department of Psychiatry, Mental Health & Addictology, Strasbourg University Hospital, Strasbourg, France
- Strasbourg University, Faculty of Psychology, Strasbourg, France
| | - Pierre Vidailhet
- Department of Psychiatry, Mental Health & Addictology, Strasbourg University Hospital, Strasbourg, France
- Regional Great East Center for Psychotraumatism, Strasbourg, France
- Strasbourg University, Faculty of Medicine, Strasbourg, France
- INSERM U1329, Strasbourg Translational NEuroscience and Psychiatry (STEP), Team Psychiatry, Strasbourg, France
- Fédération de Médecine Translationnelle de Strasbourg, France
| | - Luisa Weiner
- Department of Psychiatry, Mental Health & Addictology, Strasbourg University Hospital, Strasbourg, France
- Strasbourg University, Faculty of Psychology, Strasbourg, France
- Laboratoire de Psychologie des Cognitions, Université de Strasbourg, Strasbourg, France
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Axén I, Björk Brämberg E, Vaez M, Lundin A, Bergström G. Interventions for common mental disorders in the occupational health service: a systematic review with a narrative synthesis. Int Arch Occup Environ Health 2020; 93:823-838. [PMID: 32246230 PMCID: PMC7452923 DOI: 10.1007/s00420-020-01535-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 03/12/2020] [Indexed: 12/14/2022]
Abstract
Introduction Common mental disorders (CMD) are leading causes of decreased workability in Sweden and worldwide. Effective interventions to prevent or treat such disorders are important for public health. Objective To synthesize the research literature regarding occupational health service (OHS) interventions targeting prevention or reduction of CMD among employees. The effect on workability (sickness absence, return-to-work and self-reported workability) and on CMD symptoms was evaluated in a narrative analysis. Data sources The literature search was performed in four electronic databases in two searches, in 2014 and in 2017. Eligibility criteria (using PICO) Population: studies investigating employees at risk or diagnosed with CMD, as well as preventive workplace intervention targeting mental health. Intervention: studies where the recruitment or the intervention was delivered by the OHS or OHS personnel were included. Control: individuals or groups who did not receive the target intervention. Outcome: all types of outcomes concerning sickness absence and psychological health were included. Study quality was assessed using a Swedish AMSTAR-based checklist, and results from studies with low or medium risk of bias were narratively synthesized based on effect or absence thereof. Results Thirty-three studies were included and assessed for risk of bias. Twenty-one studies had low or medium risk of bias. In 18 studies, rehabilitation interventions were evaluated, 11 studies concerned interventions targeting employees at risk for developing CMD and four studies investigated preventive interventions. Work-focused cognitive behavioral therapy and problem-solving skill interventions decreased time to first return-to-work among employees on sick leave for CMD in comparison with treatment-as-usual. However, effect on return to full-time work was not consistent, and these interventions did not consistently improve CMD symptoms. Selective interventions targeting employees at risk of CMD and preventive interventions for employees were heterogeneous, so replication of these studies is necessary to evaluate effect. Limitations Other workplace interventions outside the OHS may have been missed by our search. There was considerable heterogeneity in the included studies, and most studies were investigating measures targeting the individual worker. Interventions at the workplace/organizational level were less common. Conclusions and implication of key findings Return-to-work and improvement of CMD symptoms are poorly correlated and should be addressed simultaneously in future interventions. Further, interventions for CMD administered through the occupational health service require further study. Rehabilitative and preventive strategies should be evaluated with scientifically robust methods, to examine the effectiveness of such interventions.
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Affiliation(s)
- Iben Axén
- Unit of Intervention and Implementation Research for Worker Health, Institute of Environmental Medicine, Karolinska Institutet, 171 77, Stockholm, Sweden.
| | - Elisabeth Björk Brämberg
- Unit of Intervention and Implementation Research for Worker Health, Institute of Environmental Medicine, Karolinska Institutet, 171 77, Stockholm, Sweden
- Department of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Box 414, 405 30, Gothenburg, Sweden
| | - Marjan Vaez
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - Andreas Lundin
- Department for Public Health Sciences, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - Gunnar Bergström
- Unit of Intervention and Implementation Research for Worker Health, Institute of Environmental Medicine, Karolinska Institutet, 171 77, Stockholm, Sweden
- Department of Occupational Health Sciences and Psychology, University of Gävle Centre for Musculoskeletal Research, Kungsbäcksvägen 47, 801 76, Gävle, Sweden
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Hajarian Abhari Z, Karimi FZ, Taghizdeh Z, Mazloum SR, Asghari Nekah SM. Effects of counseling based on Gamble's approach on psychological birth trauma in primiparous women: a randomized clinical trial. J Matern Fetal Neonatal Med 2020; 35:668-676. [PMID: 32089025 DOI: 10.1080/14767058.2020.1730799] [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: 10/24/2022]
Abstract
Background: Psychological birth trauma has persistent adverse effects on the performance and health of women during and after childbirth. Therefore, Interventions to prevent and mitigate psychological birth trauma are of paramount importance.Objective: The present study aimed to investigate the effects of counseling based on Gamble's approach on psychological birth trauma in primiparous women.Materials and methods: This randomized clinical trial was conducted on 60 primiparous women referring to the health centers in Mashhad, Iran in 2018. In the intervention group, counseling was provided by an obstetrician based on Gamble's strategy to each participant in three sessions before delivery and one session postpartum. The participants in the control group only received routine prenatal care. Data were collected using demographic and obstetrics characteristics questionnaire and psychological birth trauma questionnaire. The data were analyzed using SPSS, version 21 and chi-square and independent t-test. p-value less than .05 was considered significant.Results: The mean age of the women in the intervention and control groups was 23.3 ± 3.9 and 24.4 ± 4.4, and the mean prenatal age upon delivery was 40.8 ± 5.7 and 39.8 ± 1.2 weeks respectively. The mean score of psychological birth trauma in the intervention (counseling) and control groups was 37.2 ± 10.4 and 47.6 ± 16.3, respectively, which was significantly lower in the intervention group (p = .003).Conclusion: According to the results, counseling based on Gamble's approach could reduce psychological birth trauma in primiparous women. Therefore, this effective, simple, cost-effective, and harmless approach could be employed to reduce intrapartum and postpartum maternal traumas and prevent adverse events for the mother and the newborn.
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Affiliation(s)
- Zahra Hajarian Abhari
- School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fatemeh Zahra Karimi
- Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Midwifery, School of Nursing and Midwifery, Mashhad University Medical of Medical Sciences, Mashhad, Iran
| | - Ziba Taghizdeh
- Department of Reproductive Health, Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Reza Mazloum
- Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyyed Mohsen Asghari Nekah
- Department of Education and Psychology of Exceptional Children, Department of Educational Sciences, Ferdowsi University of Mashhad, Mashhad, Iran
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Rennick-Egglestone S, Morgan K, Llewellyn-Beardsley J, Ramsay A, McGranahan R, Gillard S, Hui A, Ng F, Schneider J, Booth S, Pinfold V, Davidson L, Franklin D, Bradstreet S, Arbour S, Slade M. Mental Health Recovery Narratives and Their Impact on Recipients: Systematic Review and Narrative Synthesis. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2019; 64:669-679. [PMID: 31046432 PMCID: PMC6783672 DOI: 10.1177/0706743719846108] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Mental health recovery narratives are often shared in peer support work and antistigma campaigns. Internet technology provides access to an almost unlimited number of narratives, and yet little is known about how they affect recipients. The aim of this study was to develop a conceptual framework characterizing the impact of recovery narratives on recipients. METHOD A systematic review of evidence about the impact of mental health recovery narratives was conducted. Searches used electronic databases (n = 9), reference tracking, hand-searching of selected journals (n = 2), grey literature searching, and expert consultation (n = 7). A conceptual framework was generated through a thematic analysis of included articles, augmented by consultation with a Lived Experience Advisory Panel. RESULTS In total, 8137 articles were screened. Five articles were included. Forms of impact were connectedness, understanding of recovery, reduction in stigma, validation of personal experience, affective responses, and behavioural responses. Impact was moderated by characteristics of the recipient, context, and narrative. Increases in eating disorder behaviours were identified as a harmful response specific to recipients with eating disorders. CONCLUSIONS Mental health recovery narratives can promote recovery. Recovery narratives might be useful for clients with limited access to peers and in online interventions targeted at reducing social isolation in rural or remote locations, but support is needed for the processing of the strong emotions that can arise. Caution is needed for use with specific clinical populations. Protocol registration: Prospero-CRD42018090923.
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Affiliation(s)
| | - Kate Morgan
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Joy Llewellyn-Beardsley
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Amy Ramsay
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Rose McGranahan
- Unit of Social and Community Psychiatry, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Steve Gillard
- Population Health Research Institute, St. George's University of London, London, UK
| | - Ada Hui
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Fiona Ng
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Justine Schneider
- School of Sociology and Social Policy, University of Nottingham, Nottingham, UK
| | - Susie Booth
- NEON Lived Experience Advisory Panel, Nottingham, UK
| | | | - Larry Davidson
- Yale School of Medicine, Yale University, New Haven, CT, USA
| | | | - Simon Bradstreet
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Simone Arbour
- Ontario Shores Centre for Mental Health Science, Ontario
| | - Mike Slade
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, UK
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Bergström G, Lohela-Karlsson M, Kwak L, Bodin L, Jensen I, Torgén M, Nybergh L. Preventing sickness absenteeism among employees with common mental disorders or stress-related symptoms at work: Design of a cluster randomized controlled trial of a problem-solving based intervention versus care-as-usual conducted at the Occupational Health Services. BMC Public Health 2017; 17:436. [PMID: 28494753 PMCID: PMC5427578 DOI: 10.1186/s12889-017-4329-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 04/26/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Common mental disorders (CMDs) are among the leading causes of sick leave in Sweden and other OECD countries. They result in suffering for the individual and considerable financial costs for the employer and for society at large. The occupational health service (OHS) can offer interventions in which both the individual and the work situation are taken into account. The aim of this paper is to describe the design of a study evaluating the effectiveness of an intervention given at the OHS to employees with CMDs or stress-related symptoms at work. In addition, intervention fidelity and its relation to the outcome will be assessed in a process analysis. METHODS The study is designed as a cluster randomized trial in which the participating OHS consultants are randomized into either delivering the intervention or performing care as usual. Employees with CMDs or stress-related symptoms at work are recruited consecutively by the OHS consultants. The intervention aims to improve the match between the employee and the job situation. Interviews are held individually with the employee and the nearest supervisor, after which a joint meeting with both the employee and the supervisor takes place. A participatory approach is applied by which the supervisor and the employee are guided by the OHS consultant and encouraged to actively take part in problem solving concerning the work situation. Outcomes will be assessed at baseline and at six and 12 months. A long-term follow-up at 3 years will also be performed. The primary outcome is registered sickness absence during a 1-year period after study inclusion. Secondary outcomes are mental health and work ability. The intervention's cost effectiveness, compared to treatment as usual, both for society and for the employer will be evaluated. A process evaluation by both the OHS consultants and the employee will be carried out. DISCUSSION The study includes analyses of the effectiveness of the intervention (clinical and economic) as well as an analysis of its implementation at the participating OHSs. Possible methodological challenges such as selection bias and risk of contamination between OHS consultants delivering the experimental condition and consultants giving usual care are discussed. TRIAL REGISTRATION ClinicalTrials NCT02563743 Sep 28 2015.
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Affiliation(s)
- G Bergström
- Division of Intervention and Implementation Research in Worker Health, Institute of Environmental Medicine, Karolinska Institutet, SE-171 77, Stockholm, Sweden. .,Centre for Occupational and Environmental Medicine, Stockholm County Council, SE-113 65, Stockholm, Sweden.
| | - M Lohela-Karlsson
- Division of Intervention and Implementation Research in Worker Health, Institute of Environmental Medicine, Karolinska Institutet, SE-171 77, Stockholm, Sweden
| | - L Kwak
- Division of Intervention and Implementation Research in Worker Health, Institute of Environmental Medicine, Karolinska Institutet, SE-171 77, Stockholm, Sweden
| | - L Bodin
- Division of Intervention and Implementation Research in Worker Health, Institute of Environmental Medicine, Karolinska Institutet, SE-171 77, Stockholm, Sweden
| | - I Jensen
- Division of Intervention and Implementation Research in Worker Health, Institute of Environmental Medicine, Karolinska Institutet, SE-171 77, Stockholm, Sweden
| | - M Torgén
- Department of Medical Science, Uppsala University, SE-751 85, Uppsala, Sweden
| | - L Nybergh
- Division of Intervention and Implementation Research in Worker Health, Institute of Environmental Medicine, Karolinska Institutet, SE-171 77, Stockholm, Sweden
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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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In the Aftermath: Attitudes of Anesthesiologists to Supportive Strategies After an Unexpected Intraoperative Patient Death. Anesth Analg 2016; 122:1614-24. [PMID: 27101503 DOI: 10.1213/ane.0000000000001227] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Although most anesthesiologists will have 1 catastrophic perioperative event or more during their careers, there has been little research on their attitudes to assistive strategies after the event. There are wide-ranging emotional consequences for anesthesiologists involved in an unexpected intraoperative patient death, particularly if the anesthesiologist made an error. We used a between-groups survey study design to ask whether there are different attitudes to assistive strategies when a hypothetical patient death is caused by a drug error versus not caused by an error. First, we explored attitudes to generalized supportive strategies. Second, we examined our hypothesis that the presence of an error causing the hypothetical patient death would increase the perceived social stigma and self-stigma of help-seeking. Finally, we examined the strategies to assist help-seeking. METHODS An anonymous, mailed, self-administered survey was conducted with 1600 consultant anesthesiologists in Australia on the mailing list of the Australian and New Zealand College of Anaesthetists. The participants were randomized into "error" versus "no-error" groups for the hypothetical scenario of patient death due to anaphylaxis. Nonparametric, descriptive, parametric, and inferential tests were used for data analysis. P' is used where P values were corrected for multiple comparisons. RESULTS There was a usable response rate of 48.9%. When an error had caused the hypothetical patient death, participants were more likely to agree with 4 of the 5 statements about support, including need for time off (P' = 0.003), counseling (P' < 0.001), a formal strategy for assistance (P' < 0.001), and the anesthesiologist not performing further cases that day (P' = 0.047). There were no differences between groups in perceived self-stigma (P = 0.98) or social stigma (P = 0.15) of seeking counseling, whether or not an error had caused the hypothetical patient death. Finally, when an error had caused the patient death, participants were more likely to agree with 2 of the 5 statements about help-seeking, including the need for a formal, hospital-based process that provides information on where to obtain professional counseling (P' = 0.006) and the availability of after-hours counseling services (P' = 0.035). CONCLUSIONS Our participants were more likely to agree with assistive strategies such as not performing further work that day, time off, counseling, formal support strategies, and availability of after-hours counseling services, when the hypothetical patient death from anaphylaxis was due to an error. The perceived stigma toward attending counseling was not affected by the presence or absence of an error as the cause of the patient death, disproving our hypothesis.
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Mayo-Wilson E, Montgomery P. Media-delivered cognitive behavioural therapy and behavioural therapy (self-help) for anxiety disorders in adults. Cochrane Database Syst Rev 2013:CD005330. [PMID: 24018460 DOI: 10.1002/14651858.cd005330.pub4] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Anxiety disorders are the most common mental health problems. They are chronic and unremitting. Effective treatments are available, but access to services is limited. Media-delivered behavioural and cognitive behavioural interventions (self-help) aim to deliver treatment with less input from professionals compared with traditional therapies. OBJECTIVES To assess the effects of media-delivered behavioural and cognitive behavioural therapies for anxiety disorders in adults. SEARCH METHODS Published and unpublished studies were considered without restriction by language or date. The Cochrane Depression, Anxiety and Neurosis Review Group's Specialized Register (CCDANCTR) was searched all years to 1 January 2013. The CCDANCTR includes relevant randomised controlled trials from the following bibliographic databases: The Cochrane Library (all years), EMBASE (1974 to date), MEDLINE (1950 to date) and PsycINFO (1967 to date). Complementary searches were carried out on Ovid MEDLINE (1950 to 23 February 2013) and PsycINFO (1987 to February, Week 2, 2013), together with International trial registries (the trials portal of the World Health Organization (ICTRP) and ClinicalTrials.gov). Reference lists from previous meta-analyses and reports of randomised controlled trials were checked, and authors were contacted for unpublished data. SELECTION CRITERIA Randomised controlled trials of media-delivered behavioural or cognitive behavioural therapy in adults with anxiety disorders (other than post-traumatic stress disorder) compared with no intervention (including attention/relaxation controls) or compared with face-to-face therapy. DATA COLLECTION AND ANALYSIS Both review authors independently screened titles and abstracts. Study characteristics and outcomes were extracted in duplicate. Outcomes were combined using random-effects models, and tests for heterogeneity and for small study bias were conducted. We examined subgroup differences by type of disorder, type of intervention provided, type of media, and recruitment methods used. MAIN RESULTS One hundred and one studies with 8403 participants were included; 92 studies were included in the quantitative synthesis. These trials compared several types of media-delivered interventions (with varying levels of support) with no treatment and with face-to-face interventions. Inconsistency and risk of bias reduced our confidence in the overall results. For the primary outcome of symptoms of anxiety, moderate-quality evidence showed medium effects compared with no intervention (standardised mean difference (SMD) 0.67, 95% confidence interval (CI) 0.55 to 0.80; 72 studies, 4537 participants), and low-quality evidence of small effects favoured face-to-face therapy (SMD -0.23, 95% CI -0.36 to -0.09; 24 studies, 1360 participants). The intervention was associated with greater response than was seen with no treatment (risk ratio (RR) 2.34, 95% CI 1.81 to 3.03; 21 studies, 1547 participants) and was not significantly inferior to face-to-face therapy in these studies (RR 0.78, 95 % CI 0.56 to 1.09; 10 studies, 575 participants), but the latter comparison included versions of therapies that were not as comprehensive as those provided in routine clinical practice. Evidence suggested benefit for secondary outcome measures (depression, mental-health related disability, quality of life and dropout), but this evidence was of low to moderate quality. Evidence regarding harm was lacking. AUTHORS' CONCLUSIONS Self-help may be useful for people who are not able or are not willing to use other services for people with anxiety disorders; for people who can access it, face-to-face cognitive behavioural therapy is probably clinically superior. Economic analyses were beyond the scope of this review.Important heterogeneity was noted across trials. Recent interventions for specific problems that incorporate clinician support may be more effective than transdiagnostic interventions (i.e. interventions for multiple disorders) provided with no guidance, but these issues are confounded in the available trials.Although many small trials have been conducted, the generalisability of their findings is limited. Most interventions tested are not available to consumers. Self-help has been recommended as the first step in the treatment of some anxiety disorders, but the short-term and long-term effectiveness of media-delivered interventions has not been established. Large, pragmatic trials are needed to evaluate and to maximise the benefits of self-help interventions.
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Affiliation(s)
- Evan Mayo-Wilson
- Research Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London, UK, WC1E 7HB
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Applebaum AJ, DuHamel KN, Winkel G, Rini C, Greene PB, Mosher CE, Redd WH. Therapeutic alliance in telephone-administered cognitive-behavioral therapy for hematopoietic stem cell transplant survivors. J Consult Clin Psychol 2012; 80:811-6. [PMID: 22468908 DOI: 10.1037/a0027956] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE A strong therapeutic alliance has been found to predict psychotherapeutic treatment success across a variety of therapeutic modalities and patient populations. However, only a few studies have examined therapeutic alliance as a predictor of psychotherapy outcome among cancer survivors, and none have examined this relation in telephone-administered cognitive-behavioral therapy (T-CBT). This study evaluated the extent to which therapeutic alliance affected psychotherapy outcomes in survivors of hematopoietic stem cell transplantation (HSCT), a treatment for some cancers. METHOD Forty-six patients enrolled in a randomized clinical trial of T-CBT for posttraumatic stress disorder (PTSD) completed a baseline assessment (including self-report measures of PTSD symptoms, depression, and general distress), 10 individual T-CBT sessions, and follow-up assessments at 6, 9, and 12 months post-baseline. Therapeutic alliance was assessed after the 3rd T-CBT session with the Working Alliance Inventory, which yields overall and subscale (task, bond, and goal) scores. RESULTS Analyses revealed that higher total therapeutic alliance scores prospectively predicted decreased depressive symptomatology; higher task scores predicted decreased overall distress, depressive symptomatology, symptoms of re-experiencing, and avoidance; and higher bond scores predicted decreased depressive symptomatology and symptoms of re-experiencing. CONCLUSIONS These results suggest that assessments of therapeutic alliance should be incorporated into routine clinical care, and therapeutic alliance should be specifically cultivated in interventions to maximize psychotherapeutic benefits involving vulnerable populations such as cancer survivors.
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Affiliation(s)
- Allison J Applebaum
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, 641 Lexington Ave., New York, NY 10022, USA.
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Bower P, Knowles S, Coventry PA, Rowland N. Counselling for mental health and psychosocial problems in primary care. Cochrane Database Syst Rev 2011; 2011:CD001025. [PMID: 21901675 PMCID: PMC7050339 DOI: 10.1002/14651858.cd001025.pub3] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The prevalence of mental health and psychosocial problems in primary care is high. Counselling is a potential treatment for these patients, but there is a lack of consensus over the effectiveness of this treatment in primary care. OBJECTIVES To assess the effectiveness and cost effectiveness of counselling for patients with mental health and psychosocial problems in primary care. SEARCH STRATEGY To update the review, the following electronic databases were searched: the Cochrane Collaboration Depression, Anxiety and Neurosis (CCDAN) trials registers (to December 2010), MEDLINE, EMBASE, PsycINFO and the Cochrane Central Register of Controlled Trials (to May 2011). SELECTION CRITERIA Randomised controlled trials of counselling for mental health and psychosocial problems in primary care. DATA COLLECTION AND ANALYSIS Data were extracted using a standardised data extraction sheet by two reviewers. Trials were rated for quality by two reviewers using Cochrane risk of bias criteria, to assess the extent to which their design and conduct were likely to have prevented systematic error. Continuous measures of outcome were combined using standardised mean differences. An overall effect size was calculated for each outcome with 95% confidence intervals (CI). Continuous data from different measuring instruments were transformed into a standard effect size by dividing mean values by standard deviations. Sensitivity analyses were undertaken to test the robustness of the results. Economic analyses were summarised in narrative form. There was no assessment of adverse events. MAIN RESULTS Nine trials were included in the review, involving 1384 randomised participants. Studies varied in risk of bias, although two studies were identified as being at high risk of selection bias because of problems with concealment of allocation. All studies were from primary care in the United Kingdom and thus comparability was high. The analysis found significantly greater clinical effectiveness in the counselling group compared with usual care in terms of mental health outcomes in the short-term (standardised mean difference -0.28, 95% CI -0.43 to -0.13, n = 772, 6 trials) but not in the long-term (standardised mean difference -0.09, 95% CI -0.27 to 0.10, n = 475, 4 trials), nor on measures of social function (standardised mean difference -0.09, 95% CI -0.29 to 0.11, n = 386, 3 trials). Levels of satisfaction with counselling were high. There was some evidence that the overall costs of counselling and usual care were similar. There were limited comparisons between counselling and other psychological therapies, medication, or other psychosocial interventions. AUTHORS' CONCLUSIONS Counselling is associated with significantly greater clinical effectiveness in short-term mental health outcomes compared to usual care, but provides no additional advantages in the long-term. Participants were satisfied with counselling. Although some types of health care utilisation may be reduced, counselling does not seem to reduce overall healthcare costs. The generalisability of these findings to settings outside the United Kingdom is unclear.
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Affiliation(s)
- Peter Bower
- University of ManchesterHealth Sciences Research Group, Manchester Academic Health Science CentreWilliamson BuildingOxford RoadManchesterUKM13 9PL
| | - Sarah Knowles
- University of ManchesterHealth Sciences Research Group, Manchester Academic Health Science CentreWilliamson BuildingOxford RoadManchesterUKM13 9PL
| | - Peter A Coventry
- University of ManchesterHealth Sciences Research Group, Manchester Academic Health Science CentreWilliamson BuildingOxford RoadManchesterUKM13 9PL
| | - Nancy Rowland
- British Association for Counselling and PsychotherapyBACP House15 St.John's Business ParkLutterworthUKLE17 4HB
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