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Hitchcock C, Funk J, Cummins R, Patel SD, Catarino A, Takano K, Dalgleish T, Ewbank M. A deep learning quantification of patient specificity as a predictor of session attendance and treatment response to internet-enabled cognitive behavioural therapy for common mental health disorders. J Affect Disord 2024; 350:485-491. [PMID: 38244796 DOI: 10.1016/j.jad.2024.01.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 01/09/2024] [Accepted: 01/14/2024] [Indexed: 01/22/2024]
Abstract
BACKGROUND Increasing an individual's ability to focus on concrete, specific detail, thus reducing the tendency toward overly broad, decontextualised generalisations about the self and world, is a target within cognitive behavioural therapy (CBT). However, empirical investigation of the impact of within-treatment specificity on treatment outcomes is scarce. We evaluated whether the specificity of patient dialogue predicted a) end-of-treatment symptoms and b) session completion for CBT for common mental health issues. METHODS This preregistered (https://osf.io/agr4t) study trained a deep learning model to score the specificity of patient dialogue in transcripts from 353,614 internet-enabled CBT sessions for common mental health disorders, delivered on behalf of UK NHS services. Data were from obtained from 65,030 participants (n = 47,308 female, n = 241 unstated) aged 18-94 years (M = 34.69, SD = 12.35). Depressive disorders were the most common (39.1 %) primary diagnosis. Primary outcome was end-of-treatment score on the Patient Health Questionnaire-9 (PHQ-9). Secondary outcome was number of sessions attended. RESULTS Linear mixed-effects models demonstrated that increased patient specificity significantly predicted lower post-treatment symptoms on the PHQ-9, although the size and direction of the effect varied depending on the type of therapeutic activity being completed. Effect sizes were consistently small. Higher patient specificity was associated with completing a greater number of sessions. LIMITATIONS We are unable to infer causation from our data. CONCLUSIONS Although effect sizes were small, an effect of specificity was observed across common mental health disorders. Further studies are needed to explore whether encouraging patient specificity during CBT may provide an enhancement of treatment attendance and treatment effects.
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Affiliation(s)
- Caitlin Hitchcock
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, United Kingdom; Melbourne School of Psychological Sciences, The University of Melbourne, Australia.
| | - Julia Funk
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, United Kingdom; Department of Psychology, Ludwig-Maximilians-Universität München, Germany
| | - Ronan Cummins
- Ieso Digital Health, Jeffreys Building, Cowley Rd, Milton, Cambridge, United Kingdom
| | - Shivam D Patel
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, United Kingdom
| | - Ana Catarino
- Ieso Digital Health, Jeffreys Building, Cowley Rd, Milton, Cambridge, United Kingdom
| | - Keisuke Takano
- Department of Psychology, Ludwig-Maximilians-Universität München, Germany
| | - Tim Dalgleish
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, United Kingdom
| | - Michael Ewbank
- Ieso Digital Health, Jeffreys Building, Cowley Rd, Milton, Cambridge, United Kingdom
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Kambara K, Kabir RS, Kira Y, Ogata A, Barnard PJ. Disambiguating the relationship between processing modes and mindfulness in Japan. Cogent Psychology 2023. [DOI: 10.1080/23311908.2022.2151726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
Affiliation(s)
- Kohei Kambara
- Faculty of Psychology, Doshisha University, Kyoto, Japan
| | - Russell S. Kabir
- Graduate School of Humanities and Social Sciences, Hiroshima University, Hiroshima, Japan
| | - Yugo Kira
- Department of Social and Clinical Psychology, Hijiyama University, Hiroshima, Japan
| | - Akiko Ogata
- Graduate School of Humanities and Social Sciences, Hiroshima University, Hiroshima, Japan
| | - Philip J. Barnard
- Honorary Member, MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
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Kambara K, Matsumoto M, Hako S, Shigematsu J, Yokoyama S, Ogata A. An intervention to promote concrete thinking style in young adults: Effects on depressive symptoms and its protective factors. J Behav Ther Exp Psychiatry 2023; 81:101857. [PMID: 37031477 DOI: 10.1016/j.jbtep.2023.101857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 02/21/2023] [Accepted: 03/31/2023] [Indexed: 04/11/2023]
Abstract
BACKGROUND AND OBJECTIVES Individuals with low concreteness-experiential thought (CET) tend to have exacerbated depressive symptoms. Interventions aimed at increasing CET have been shown to influence depressive symptoms. The present study examined the effects of increasing CET on depressive symptoms and its protective factors. METHODS A two-armed experimental intervention was conducted with 86 healthy university students in Japan. They were randomly allocated to the intervention and waitlist groups. Participants in the intervention group engaged in an unguided and web-based (UW) intervention to increase CET (UW-CET). This intervention included a one-off session, to explain the rationale behind increasing CET via a psychoeducation video, and a five-session training on CET over a week. We assessed depressive symptoms, thought styles, and protective factors, such as mindfulness and goal striving, both pre- and-post-assessment and at the one-month follow-up. RESULTS Participants in the intervention group had marginally increased CET in the follow-up assessments; however, participants in the waitlist group did not. Furthermore, participants in the intervention showed marginally increased mindfulness tendencies and strivings toward their personal goals, but their depressive symptoms were not affected. LIMITATIONS The present study did not include any active control conditions. Additionally, the sample consisted of only healthy university students. CONCLUSIONS The findings suggest that the UW-CET can marginally increase adaptive thinking, such as CET, and promote positive psychological aspects in healthy young adults; however, the effect is small. The findings may also help expand clinical implementations to prevent depression in young adults.
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Affiliation(s)
- Kohei Kambara
- Faculty of Psychology, Doshisha University, Kyotanabe City, Kyoto, Japan.
| | - Misuzu Matsumoto
- Graduate School of Education, Hiroshima University, Higashi-Hiroshima City, Hiroshima, Japan
| | - Suzuka Hako
- Graduate School of Humanities and Social Sciences, Hiroshima University, Higashi-Hiroshima City, Hiroshima, Japan
| | - Jun Shigematsu
- Department of Humanities, University of Toyama, Toyama City, Toyama, Japan
| | - Satoshi Yokoyama
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima City, Hiroshima, Japan
| | - Akiko Ogata
- Graduate School of Humanities and Social Sciences, Hiroshima University, Higashi-Hiroshima City, Hiroshima, Japan
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Joubert AE, Grierson AB, Li I, Sharrock MJ, Moulds ML, Werner-Seidler A, Stech EP, Mahoney AEJ, Newby JM. Managing Rumination and worry: A randomised controlled trial of an internet intervention targeting repetitive negative thinking delivered with and without clinician guidance. Behav Res Ther 2023; 168:104378. [PMID: 37595354 DOI: 10.1016/j.brat.2023.104378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 06/05/2023] [Accepted: 07/23/2023] [Indexed: 08/20/2023]
Abstract
BACKGROUND Rumination and worry, forms of repetitive negative thinking (RNT), are implicated in the onset, maintenance, severity, and relapse risk of depression and anxiety disorders. This randomised controlled trial evaluated an internet intervention targeting both rumination and worry in adults compared to treatment-as-usual (TAU) and compared treatment effects and adherence when delivered with and without clinician guidance. METHODS Adults (N = 137) with elevated RNT were randomly allocated to a 3-lesson clinician guided (n = 45) or self-help (n = 47) online program delivered over 6 weeks, or a TAU control group which waited 18 weeks to receive the program (n = 45). The clinician guided group received semi-structured phone support after each lesson. All three groups continued any pre-trial TAU. RNT, anxiety, depression, and psychological distress were assessed at baseline, post-treatment (week 7), and 3-month follow-up. RESULTS Intention-to-treat linear mixed models showed that participants in the self-help and clinician guided groups had significantly lower RNT, anxiety, depression, and distress at post-treatment and 3-month follow-up compared to TAU. Treatment effects were significantly larger in the clinician guided group compared to self-help (between-group gs = 0.41-0.97). No significant between-group differences were found in adherence/program completion (guided: 76%; self-guided: 79%) or treatment satisfaction (1-5 scale: guided: M = 4.17, SD = 1.20; self-guided: M = 3.89, SD = 0.93). Total time spent on clinician guidance was M = 48.64 min (SD = 21.28). CONCLUSION This brief online intervention for RNT is acceptable and efficacious in reducing RNT, anxiety, depression, and distress in both clinician guided and self-help formats. The program appeared most effective when delivered with clinician guidance. Larger definitive trials comparing guided and self-guided programs are needed. Australian and New Zealand Clinical Trials Registration number: ACTRN12620000959976.
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Affiliation(s)
- Amy E Joubert
- Clinical Research Unit for Anxiety and Depression (CRUfAD), St. Vincent's Hospital, Level 4 O'Brien Centre, 394- 404 Victoria Street, Darlinghurst, Sydney, New South Wales, 2010, Australia; School of Psychology, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Ashlee B Grierson
- Clinical Research Unit for Anxiety and Depression (CRUfAD), St. Vincent's Hospital, Level 4 O'Brien Centre, 394- 404 Victoria Street, Darlinghurst, Sydney, New South Wales, 2010, Australia; School of Psychiatry, UNSW Medicine, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Ian Li
- Clinical Research Unit for Anxiety and Depression (CRUfAD), St. Vincent's Hospital, Level 4 O'Brien Centre, 394- 404 Victoria Street, Darlinghurst, Sydney, New South Wales, 2010, Australia; School of Psychiatry, UNSW Medicine, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Maria J Sharrock
- Clinical Research Unit for Anxiety and Depression (CRUfAD), St. Vincent's Hospital, Level 4 O'Brien Centre, 394- 404 Victoria Street, Darlinghurst, Sydney, New South Wales, 2010, Australia; School of Psychiatry, UNSW Medicine, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Michelle L Moulds
- School of Psychology, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Aliza Werner-Seidler
- Black Dog Institute, The University of New South Wales, Sydney, NSW, 2052, Australia
| | - Eileen P Stech
- Black Dog Institute, The University of New South Wales, Sydney, NSW, 2052, Australia
| | - Alison E J Mahoney
- Clinical Research Unit for Anxiety and Depression (CRUfAD), St. Vincent's Hospital, Level 4 O'Brien Centre, 394- 404 Victoria Street, Darlinghurst, Sydney, New South Wales, 2010, Australia; School of Psychiatry, UNSW Medicine, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Jill M Newby
- School of Psychology, University of New South Wales, Sydney, NSW, 2052, Australia; Black Dog Institute, The University of New South Wales, Sydney, NSW, 2052, Australia.
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Watkins E, Newbold A, Tester-Jones M, Collins LM, Mostazir M. Investigation of Active Ingredients Within Internet-Delivered Cognitive Behavioral Therapy for Depression: A Randomized Optimization Trial. JAMA Psychiatry 2023; 80:942-951. [PMID: 37378962 PMCID: PMC10308300 DOI: 10.1001/jamapsychiatry.2023.1937] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 04/22/2023] [Indexed: 06/29/2023]
Abstract
Importance There is limited understanding of how complex evidence-based psychological interventions such as cognitive behavioral therapy (CBT) for depression work. Identifying active ingredients may help to make therapy more potent, brief, and scalable. Objective To test the individual main effects and interactions of 7 treatment components within internet-delivered CBT for depression to investigate its active ingredients. Design, Setting, and Participants This randomized optimization trial using a 32-condition, balanced, fractional factorial optimization experiment (IMPROVE-2) recruited adults with depression (Patient Health Questionnaire-9 [PHQ-9] score ≥10) from internet advertising and the UK National Health Service Improving Access to Psychological Therapies service. Participants were randomized from July 7, 2015, to March 29, 2017, with follow-up for 6 months after treatment until December 29, 2017. Data were analyzed from July 2018 to April 2023. Interventions Participants were randomized with equal probability to 7 experimental factors within the internet CBT platform, each reflecting the presence vs absence of specific treatment components (activity scheduling, functional analysis, thought challenging, relaxation, concreteness training, absorption, and self-compassion training). Main Outcomes and Measures The primary outcome was depression symptoms (PHQ-9 score). Secondary outcomes include anxiety symptoms and work, home, and social functioning. Results Among 767 participants (mean age [SD] age, 38.5 [11.62] years; range, 18-76 years; 635 women [82.8%]), 506 (66%) completed the 6-month posttreatment follow-up. On average, participants receiving internet-delivered CBT had reduced depression (pre-to-posttreatment difference in PHQ-9 score, -7.79 [90% CI, -8.21 to -7.37]; 6-month follow-up difference in PHQ-9 score, -8.63 [90% CI, -9.04 to -8.22]). A baseline score-adjusted analysis of covariance model using effect-coded intervention variables (-1 or +1) found no main effect on depression symptoms for the presence vs absence of activity scheduling, functional analysis, thought challenging, relaxation, concreteness training, or self-compassion training (posttreatment: largest difference in PHQ-9 score [functional analysis], -0.09 [90% CI, -0.56 to 0.39]; 6-month follow-up: largest difference in PHQ-9 score [relaxation], -0.18 [90% CI, -0.61 to 0.25]). Only absorption training had a significant main effect on depressive symptoms at 6-month follow-up (posttreatment difference in PHQ-9 score, 0.21 [90% CI, -0.27 to 0.68]; 6-month follow-up difference in PHQ-9 score, -0.54, [90% CI, -0.97 to -0.11]). Conclusions and Relevance In this randomized optimization trial, all components of internet-delivered CBT except absorption training did not significantly reduce depression symptoms relative to their absence despite an overall average reduction in symptoms. The findings suggest that treatment benefit from internet-delivered CBT probably accrues from spontaneous remission, factors common to all CBT components (eg, structure, making active plans), and nonspecific therapy factors (eg, positive expectancy), with the possible exception of absorption focused on enhancing direct contact with positive reinforcers. Trial Registration isrctn.org Identifier: ISRCTN24117387.
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Affiliation(s)
- Edward Watkins
- Sir Henry Wellcome Building for Mood Disorders Research, College of Life and Environmental Sciences, University of Exeter, Exeter, United Kingdom
| | - Alexandra Newbold
- Sir Henry Wellcome Building for Mood Disorders Research, College of Life and Environmental Sciences, University of Exeter, Exeter, United Kingdom
| | - Michelle Tester-Jones
- Sir Henry Wellcome Building for Mood Disorders Research, College of Life and Environmental Sciences, University of Exeter, Exeter, United Kingdom
| | | | - Mohammod Mostazir
- Sir Henry Wellcome Building for Mood Disorders Research, College of Life and Environmental Sciences, University of Exeter, Exeter, United Kingdom
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Gavric D, Cameron D, Waechter S, Moscovitch DA, McCabe RE, Rowa K. Just do something: An experimental investigation of brief interventions for reducing the negative impact of post-event processing in social anxiety disorder. J Anxiety Disord 2023; 98:102744. [PMID: 37478698 DOI: 10.1016/j.janxdis.2023.102744] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 06/02/2023] [Accepted: 07/12/2023] [Indexed: 07/23/2023]
Abstract
Post-Event Processing (PEP) is prevalent and problematic in Social Anxiety Disorder (SAD) but is typically not a direct target in evidence-based treatments such as cognitive behavioural therapy (CBT) for SAD. The primary aim of the current study was to examine the impact of several theoretically and empirically derived interventions for PEP in SAD, including concrete thinking, abstract thinking, and distraction in comparison to a control (i.e., do nothing) condition. Based on prior research, we hypothesized that the concrete and distract conditions would be associated with positive benefits, including reductions in PEP and improvements in self-perception, whereas the abstract and control conditions would not. The second aim of the study was to identify baseline variables that predict the trajectory of change in PEP over time. Participants (N=92) with a principal diagnosis of SAD completed a social stress task and were randomly assigned to one of four conditions. Participants completed measures at baseline, post-intervention/control, and at 1-week, and 1-month follow-up. Contrary to hypotheses, all three active conditions were similarly effective at reducing PEP and improving self-perceptions relative to the control condition. In the absence of an intervention, engagement in PEP remained high up to a month following the social stress task. Higher levels of baseline state anxiety, intolerance of uncertainty, and use of safety behaviours predicted greater PEP, even in the presence of an intervention. These results highlight the benefits of relatively brief interventions that disrupt the course of PEP for people with SAD. Such interventions can be easily incorporated into CBT protocols for SAD to enhance their effects.
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Affiliation(s)
- Dubravka Gavric
- Anxiety Treatment and Research Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON L8N 3K7, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON L8S 4L8, Canada.
| | - Duncan Cameron
- Anxiety Treatment and Research Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON L8N 3K7, Canada
| | - Stephanie Waechter
- Anxiety Treatment and Research Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON L8N 3K7, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - David A Moscovitch
- Department of Psychology and Centre for Mental Health Research and Treatment, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| | - Randi E McCabe
- Anxiety Treatment and Research Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON L8N 3K7, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Karen Rowa
- Anxiety Treatment and Research Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON L8N 3K7, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON L8S 4L8, Canada
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Marsh LC, Patel SD, Smith AJ, So M, Armstrong H, Elliott R, Watkins E, Moulds M, Dalgleish T, Hitchcock C. From basic science to clinical practice: Can cognitive behavioural therapy tasks be augmented with enhanced episodic specificity? Behav Res Ther 2023; 167:104352. [PMID: 37331240 DOI: 10.1016/j.brat.2023.104352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 02/28/2023] [Accepted: 06/02/2023] [Indexed: 06/20/2023]
Abstract
Individuals with depression typically remember their past in a generalised manner, at the cost of retrieving specific event memories. This may impair engagement with cognitive behavioural therapy (CBT) tasks that use concrete episodic information to challenge maladaptive beliefs, potentially limiting their therapeutic benefit. Study 1 demonstrated that an episodic specificity induction increased detail and specificity of autobiographical memory in people with major depression, relative to control conditions (N = 88). We therefore examined whether the induction enhanced the efficacy of CBT tasks that depend on episodic memory - cognitive reappraisal (Study 2, N = 30), evidence gathering (Study 2, N = 30), and planning behavioural experiments (Study 3a, N = 30). Across all three tasks, there were no significant differences in emotion- or belief-change between the specificity and control conditions. Although the induction temporarily enhanced specificity in depressed individuals, it did not significantly augment the efficacy of CBT tasks theorised to benefit from the use of specific mnemonic information.
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Affiliation(s)
- Laura C Marsh
- MRC Cognition and Brain Sciences Unit, University of Cambridge, UK
| | - Shivam D Patel
- MRC Cognition and Brain Sciences Unit, University of Cambridge, UK
| | - Alicia J Smith
- MRC Cognition and Brain Sciences Unit, University of Cambridge, UK
| | - Melody So
- MRC Cognition and Brain Sciences Unit, University of Cambridge, UK
| | | | - Rachel Elliott
- MRC Cognition and Brain Sciences Unit, University of Cambridge, UK
| | | | | | - Tim Dalgleish
- MRC Cognition and Brain Sciences Unit, University of Cambridge, UK
| | - Caitlin Hitchcock
- MRC Cognition and Brain Sciences Unit, University of Cambridge, UK; Melbourne School of Psychological Science, University of Melbourne, Australia.
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Funk J, Kopf-Beck J, Watkins E, Ehring T. Does an app designed to reduce repetitive negative thinking decrease depression and anxiety in young people? (RETHINK): a randomized controlled prevention trial. Trials 2023; 24:295. [PMID: 37098547 PMCID: PMC10129320 DOI: 10.1186/s13063-023-07295-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 04/05/2023] [Indexed: 04/27/2023] Open
Abstract
BACKGROUND The first onset of common mental health disorders, such as mood and anxiety disorders, mostly lies in adolescence or young adulthood. Hence, effective and scalable prevention programs for this age group are urgently needed. Interventions focusing on repetitive negative thinking (RNT) appear especially promising as RNT is an important transdiagnostic process involved in the development of depression and anxiety disorders. First clinical trials indeed show positive effects of preventative interventions targeting RNT on adult as well as adolescent mental health. Self-help interventions that can be delivered via a mobile phone app may have the advantage of being highly scalable, thus facilitating prevention on a large scale. This trial aims to investigate whether an app-based RNT-focused intervention can reduce depressive and anxiety symptoms in young people at risk for mental health disorders. METHODS The trial will be conducted in a sample (planned N = 351) of individuals aged 16-22 years with elevated levels of RNT but no current depression or anxiety disorder. In a randomized controlled between-subjects design, two versions of the app-based self-help intervention will be compared to a waiting list control condition. The full RNT-focused intervention encompasses a variety of RNT-reducing strategies, whereas the concreteness training intervention focuses on only one of these strategies, i.e., concrete thinking. The primary outcome (depressive symptoms) and secondary outcomes (anxiety symptoms and RNT) will be measured at pre-intervention, post-intervention (6 weeks after pre-intervention), and follow-up (18 weeks after pre-intervention). DISCUSSION This trial aims to find out whether targeting RNT via an app is an effective and feasible way of preventing depression and anxiety disorders in adolescents. Since app-based interventions are highly scalable, this trial might contribute to tackling challenges related to the increasing rates of mental health disorders among young people. TRIAL REGISTRATION https://www.drks.de , DRKS00027384. Registered on 21 February 2022-prospectively registered.
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Affiliation(s)
- Julia Funk
- Department of Psychology, LMU Munich, Munich, Germany.
| | | | - Edward Watkins
- Mood Disorders Centre, School of Psychology, University of Exeter, Exeter, UK
| | - Thomas Ehring
- Department of Psychology, LMU Munich, Munich, Germany
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Petersson EL, Forsén E, Björkelund C, Hammarbäck L, Hessman E, Weineland S, Svenningsson I. Examining the description of the concept "treatment as usual" for patients with depression, anxiety and stress-related mental disorders in primary health care research - A systematic review. J Affect Disord 2023; 326:1-10. [PMID: 36708952 DOI: 10.1016/j.jad.2023.01.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 01/10/2023] [Accepted: 01/21/2023] [Indexed: 01/26/2023]
Abstract
BACKGROUND In randomized controlled trials (RCTs) within medical research, applied interventions are compared to treatment-as-usual (TAU) as the control condition. The aim of the current study was to examine how the concept of TAU is described when used as control condition in RCTs evaluating treatments for depression, anxiety syndromes, and stress-related mental disorders in primary care. METHOD A systematic review of RCTs utilizing TAU as control group in the RCT in accordance with PRISMA standards was conducted. We used one multidisciplinary database (Scopus), one database focused on nursing (Cinahl), and one medical database (PubMed). The searches were conducted in November 2021 and May 2022. RESULTS The included 32 studies comprised of 7803 participants. The content of TAU was classified as follows: 1) Basic descriptions of TAU lacking a detailed account as well as reference to local or national guidelines, 2) Moderate description of TAU including reference to national or local guidelines or a detailed description 3) Advanced description of TAU including references to national guidelines and a detailed description containing five key concepts: early assessment, accessibility, psychological treatment, medication, somatic examination. 18 studies had basic, 11 moderate, and 3 advanced descriptions of TAU. LIMITATIONS The limitations were that only studies published in English were included. CONCLUSIONS The current study provides an assessment tool with three classification levels for TAU. The description of TAU is still insufficient in RCT studies conducted in primary care, which may affect the interpretation of results. In future research a detailed description of TAU is recommended.
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Affiliation(s)
- E-L Petersson
- Primary Health Care/School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden; Research, Education, Development & Innovation, Primary Health Care, Region Västra Götaland, Sweden
| | - E Forsén
- Research, Education, Development & Innovation, Primary Health Care, Region Västra Götaland, Sweden
| | - C Björkelund
- Primary Health Care/School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - L Hammarbäck
- Biomedical Library, Gothenburg University Library, University of Gothenburg, Gothenburg, Sweden
| | - E Hessman
- Biomedical Library, Gothenburg University Library, University of Gothenburg, Gothenburg, Sweden
| | - S Weineland
- Primary Health Care/School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden; Research, Education, Development & Innovation, Primary Health Care, Region Västra Götaland, Sweden; Department of Psychology, University of Gothenburg, Gothenburg, Sweden
| | - I Svenningsson
- Primary Health Care/School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden; Research, Education, Development & Innovation, Primary Health Care, Region Västra Götaland, Sweden.
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Robertson C, Carney J, Trudell S. Language about the future on social media as a novel marker of anxiety and depression: A big-data and experimental analysis. Current Research in Behavioral Sciences 2023. [DOI: 10.1016/j.crbeha.2023.100104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
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Rogiers R, Baeken C, Watkins ER, van den Abbeele D, Remue J, de Raedt R, Lemmens GMD. A Psychoeducational CBT-based Group Intervention ("Drop It") for Repetitive Negative Thinking: Theoretical Concepts and Treatment Processes. Int J Group Psychother 2022; 72:257-292. [PMID: 38446560 DOI: 10.1080/00207284.2022.2066535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Repetitive negative thinking (RNT)-such as worry and rumination-is an important transdiagnostic factor in the onset, course, and recurrence of depressive and anxiety disorders. This article describes a psychoeducational cognitive behavioral therapy (CBT)-based group intervention entitled "Drop It" that focuses exclusively on treating RNT in patients with major depressive disorder and/or generalized anxiety disorder. The theoretical concepts and treatment goals of the intervention are outlined. The organization and therapeutic processes of the different sessions are described and illustrated with statements of participants. Special attention is given to how the intervention capitalizes on the group structure and process to maximize the effectiveness of psychoeducation and CBT-based techniques. We also provide practical guidelines for clinicians treating patients with RNT.
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Abstract
Self-reflection is suggested to attenuate feelings, yet researchers disagree on whether adopting a distant or near perspective, or processing the experience abstractly or concretely, is more effective. Given the relationship between psychological distance and level of abstraction, we suggest the "construal-matching hypothesis": Psychological distance and abstraction differently influence emotion intensity, depending on whether the emotion's appraisal involves low-level or high-level construal. Two meta-analyses tested the effects of psychological distance (k = 230) and level-of-abstraction (k = 98) manipulations on emotional experience. A distant perspective attenuated emotional experience (g = 0.52) but with weaker effects for high-level (g = 0.29; for example, self-conscious emotions) than low-level emotions (g= 0.64; for example, basic emotions). Level of abstraction only attenuated the experience of low-level emotions (g = 0.2) and showed a reverse (nonsignificant) effect for high-level emotions (g = -0.13). These results highlight differences between distancing and level-of-abstraction manipulations and the importance of considering the type of emotion experienced in emotion regulation.
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Affiliation(s)
- Tal Moran
- The Open University of Israel, Ra'anana, Israel.,Ghent University, Belgium
| | - Tal Eyal
- Ben-Gurion University of the Negev, Be'er Sheva, Israel
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13
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Schumm H, Krüger-Gottschalk A, Dyer A, Pittig A, Cludius B, Takano K, Alpers GW, Ehring T. Mechanisms of Change in Trauma-Focused Treatment for PTSD: The Role of Rumination. Behav Res Ther 2021; 148:104009. [PMID: 34823161 DOI: 10.1016/j.brat.2021.104009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/26/2021] [Accepted: 11/16/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Cognitive behavioral therapy (CBT) has been well established in the treatment of posttraumatic stress disorder (PTSD). In recent years, researchers have begun to investigate its underlying mechanisms of change. Dysfunctional cognitive content, i.e. excessively negative appraisals of the trauma or its consequences, has been shown to predict changes in PTSD symptoms over the course of treatment. However, the role of change in cognitive processes, such as trauma-related rumination, needs to be addressed. The present study investigates whether changes in rumination intensity precede and predict changes in symptom severity. We also explored the extent to which symptom severity predicts rumination. METHOD As part of a naturalistic effectiveness study evaluating CBT for PTSD in routine clinical care, eighty-eight patients with PTSD completed weekly measures of rumination and symptom severity. Lagged associations between rumination and symptoms in the following week were examined using linear mixed models. RESULTS Over the course of therapy, both ruminative thinking and PTSD symptoms decreased. Rumination was a significant predictor of PTSD symptoms in the following week, although this effect was at least partly explained by the time factor (e.g., natural recovery or inseparable treatment effects). Symptom severity predicted ruminative thinking in the following week even with time as an additional predictor. CONCLUSIONS The present study provides preliminary evidence that rumination in PTSD is reduced by CBT for PTSD but does not give conclusive evidence that rumination is a mechanism of change in trauma-focused treatment for PTSD.
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Affiliation(s)
- Hannah Schumm
- Department of Psychology, LMU Munich, Leopoldstr. 13, Munich, Germany.
| | | | - Anne Dyer
- ZISG Mannheim, Central Institute of Mental Health, J 5, 68159, Mannheim, Germany.
| | - Andre Pittig
- Translational Psychotherapy, Department of Psychology, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Nägelsbachstr. 49a, 91051, Erlangen, Germany.
| | - Barbara Cludius
- Department of Psychology, LMU Munich, Leopoldstr. 13, Munich, Germany.
| | - Keisuke Takano
- Department of Psychology, LMU Munich, Leopoldstr. 13, Munich, Germany.
| | - Georg W Alpers
- Department of Psychology, School of Social Sciences, University of Mannheim, L 13, 17, 68163, Mannheim, Germany.
| | - Thomas Ehring
- Department of Psychology, LMU Munich, Leopoldstr. 13, Munich, Germany.
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14
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Edge D, Newbold A, Ehring T, Rosenkranz T, Frost M, Watkins ER. Reducing worry and rumination in young adults via a mobile phone app: study protocol of the ECoWeB (Emotional Competence for Well-Being in Young Adults) randomised controlled trial focused on repetitive negative thinking. BMC Psychiatry 2021; 21:519. [PMID: 34674669 PMCID: PMC8532278 DOI: 10.1186/s12888-021-03536-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 10/12/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Promoting well-being and preventing poor mental health in young people is a major global priority. Building emotional competence skills via a mobile app may be an effective, scalable and acceptable way to do this. A particular risk factor for anxiety and depression is elevated worry and rumination (repetitive negative thinking, RNT). An app designed to reduce RNT may prevent future incidence of depression and anxiety. METHOD/DESIGN The Emotional Competence for Well-Being in Young Adults study developed an emotional competence app to be tested via randomised controlled trials in a longitudinal prospective cohort. This off-shoot study adapts the app to focus on targeting RNT (worry, rumination), known risk factors for poor mental health. In this study, 16-24 year olds in the UK, who report elevated worry and rumination on standardised questionnaires are randomised to (i) receive the RNT-targeting app immediately for 6 weeks (ii) a waiting list control who receive the app after 6 weeks. In total, the study will aim to recruit 204 participants, with no current diagnosis of major depression, bipolar disorder or psychosis, across the UK. Assessments take place at baseline (pre-randomisation), 6 and 12 weeks post-randomisation. Primary endpoint and outcome for the study is level of rumination assessed on the Rumination Response Styles Questionnaire at 6 weeks. Worry, depressive symptoms, anxiety symptoms and well-being are secondary outcomes. Compliance, adverse events and potentially mediating variables will be carefully monitored. DISCUSSION This trial aims to better understand the benefits of tackling RNT via an mobile phone app intervention in young people. This prevention mechanism trial will establish whether targeting worry and rumination directly via an app provides a feasible approach to prevent depression and anxiety, with scope to become a widescale public health strategy for preventing poor mental health and promoting well-being in young people. TRIAL REGISTRATION ClinicalTrials.gov , NCT04950257 . Registered 6 July 2021 - Retrospectively registered.
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Affiliation(s)
- Daniel Edge
- grid.8391.30000 0004 1936 8024Mood Disorders Centre, School of Psychology, University of Exeter, Exeter, EX4 4LN UK
| | - Alexandra Newbold
- grid.8391.30000 0004 1936 8024Mood Disorders Centre, School of Psychology, University of Exeter, Exeter, EX4 4LN UK
| | | | | | | | - Edward R. Watkins
- grid.8391.30000 0004 1936 8024Mood Disorders Centre, School of Psychology, University of Exeter, Exeter, EX4 4LN UK
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15
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Guzey M, Funk J, Kustermann J, Ehring T. The effect of concreteness training on peri-traumatic processing and intrusive memories following an analogue trauma. Behav Res Ther 2021; 147:103970. [PMID: 34592609 DOI: 10.1016/j.brat.2021.103970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 08/23/2021] [Accepted: 09/20/2021] [Indexed: 11/25/2022]
Abstract
High levels of rumination are a risk factor for developing posttraumatic stress disorder (PTSD). Theoretical models of rumination as well as earlier empirical findings suggest that the dysfunctional effects of rumination are due to an abstract processing style, and that a more concrete style of thinking has beneficial effects on mental well-being. The present study therefore examined whether concreteness training prior to watching a trauma film prevents analogue PTSD symptoms in the form of intrusive memories. Healthy participants either received concreteness training or were allocated to a no-intervention control condition, and watched a distressing film three days later. We examined differences in intrusive memories related to the film scenes between conditions, and tested whether concreteness training reduces the link between trait rumination and analogue PTSD symptoms. Furthermore, the interacting effect of concreteness training and trait rumination on peri-traumatic processing was investigated. In line with the hypotheses, concreteness training was associated with less frequent intrusive memories and moderated the association between trait rumination and intrusive memories as well as trait rumination and dissociation during the film. These findings lend support to the hypothesis that processing style contributes to the negative impact of rumination on posttraumatic stress symptoms. In addition, they provide preliminary evidence that concreteness training may be a promising intervention for the prevention of PTSD following trauma.
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Affiliation(s)
- Melike Guzey
- Ankara University, Department of Psychology, Turkey.
| | - Julia Funk
- LMU Munich, Department of Psychology, Germany.
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16
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Harvey AG, Callaway CA, Zieve GG, Gumport NB, Armstrong CC. Applying the Science of Habit Formation to Evidence-Based Psychological Treatments for Mental Illness. Perspect Psychol Sci 2021; 17:572-589. [PMID: 34495781 DOI: 10.1177/1745691621995752] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Habits affect nearly every aspect of our physical and mental health. Although the science of habit formation has long been of interest to psychological scientists across disciplines, we propose that applications to clinical psychological science have been insufficiently explored. In particular, evidence-based psychological treatments (EBPTs) are interventions targeting psychological processes that cause and/or maintain mental illness and that have been developed and evaluated scientifically. An implicit goal of EBPTs is to disrupt unwanted habits and develop desired habits. However, there has been insufficient attention given to habit-formation principles, theories, and measures in the development and delivery of EBTPs. Herein we consider whether outcomes following an EBPT would greatly improve if the basic science of habit formation were more fully leveraged. We distill six ingredients that are central to habit formation and demonstrate how these ingredients are relevant to EBPTs. We highlight practice points and an agenda for future research. We propose that there is an urgent need for research to guide the application of the science of habit formation and disruption to the complex "real-life" habits that are the essence of EBPTs.
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Affiliation(s)
| | | | - Garret G Zieve
- Department of Psychology, University of California, Berkeley
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17
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Gericke F, Ebert DD, Breet E, Auerbach RP, Bantjes J. A qualitative study of university students' experience of Internet‐based CBT for depression. Couns Psychother Res 2021. [DOI: 10.1002/capr.12465] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Franco Gericke
- Institute for Life Course Health Research Department of Global Health Faculty of Medicine and Health Sciences Stellenbosch University Stellenbosch South Africa
| | - David D. Ebert
- Psychology & Digital Mental Health Care, Department of Sport and Health Sciences Technical University Munich Munich Germany
| | - Elsie Breet
- Institute for Life Course Health Research Department of Global Health Faculty of Medicine and Health Sciences Stellenbosch University Stellenbosch South Africa
| | | | - Jason Bantjes
- Institute for Life Course Health Research Department of Global Health Faculty of Medicine and Health Sciences Stellenbosch University Stellenbosch South Africa
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18
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Riisager LHG, Christensen AB, Scharff FB, Arendt IMTP, Ismail I, Lau ME, Moeller SB. Patients' Experiences of Using a Self-help App for Posttraumatic Stress Disorder: Qualitative Study. JMIR Form Res 2021; 5:e26852. [PMID: 34346896 PMCID: PMC8374664 DOI: 10.2196/26852] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 02/23/2021] [Accepted: 05/16/2021] [Indexed: 01/19/2023] Open
Abstract
Background Posttraumatic stress disorder (PTSD) is a common disorder that requires more treatment options. Mobile health (mHealth) app interventions are promising for patients with PTSD, as they can provide easily accessible support, strategies, and information. However, knowledge about mHealth interventions is sparse and primarily based on quantitative studies. Objective The aim of this study is to qualitatively explore the experiences of patients with PTSD with regard to using an mHealth app as a stand-alone intervention before commencing psychotherapeutic treatment. Methods We conducted semistructured interviews with 14 participants 6 weeks after they received the app. The participants were all referred to PTSD treatment and were waiting to commence psychotherapeutic treatment. During this waiting time, the participants had no contact with the health staff. Interviews were transcribed and were analyzed using thematic analysis. Results A total of 3 themes were identified—the use of app, being a patient, and the overall evaluation of the app. The use of the app was described with the subtheme of habits, and the theme of being a patient included the subthemes of having negative experiences with the app and being a part of a research project. The use of the app encompassed how psychological factors and technical problems could interfere with the use of the app. The theme of being a patient depicted that the waiting time before starting treatment was long, and a subgroup of patients experienced feeling worse during this time, which they partly attributed to using the app. Several suggestions for change have been described in the overall evaluation of the app. Conclusions The findings in this study revealed that emotional arousal influenced the use of the app and that it was difficult for participants to establish a habit of using the app, thus reflecting the importance of supporting habit formation when implementing an mHealth app in mental health care services. This study makes an important contribution to the field of mHealth research, as it revealed that some participants had negative experiences resulting from using the app, thus reflecting the potential harm of having an mHealth app without the support of a clinician. It is therefore recommended to use a blended care treatment or an approach in which mental health care professionals prescribe an mHealth app for relevant patients to avoid increased suicidal risk.
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Affiliation(s)
- Lisa H G Riisager
- Unit for Psychotherapy Research, Stolpegaard Psychotherapy Centre, Mental Health Services Capital Region of Denmark, Gentofte, Denmark.,Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Anne Bryde Christensen
- Research Unit for Psychotherapy & Psychopathology, Mental Health Services West, Region Zealand, Slagelse, Denmark
| | - Frederik Bernt Scharff
- Unit for Psychotherapy Research, Stolpegaard Psychotherapy Centre, Mental Health Services Capital Region of Denmark, Gentofte, Denmark
| | - Ida-Marie T P Arendt
- Unit for Psychotherapy Research, Stolpegaard Psychotherapy Centre, Mental Health Services Capital Region of Denmark, Gentofte, Denmark
| | - Israa Ismail
- Unit for Psychotherapy Research, Stolpegaard Psychotherapy Centre, Mental Health Services Capital Region of Denmark, Gentofte, Denmark
| | - Marianne Engelbrecht Lau
- Unit for Psychotherapy Research, Stolpegaard Psychotherapy Centre, Mental Health Services Capital Region of Denmark, Gentofte, Denmark
| | - Stine Bjerrum Moeller
- Unit for Psychotherapy Research, Stolpegaard Psychotherapy Centre, Mental Health Services Capital Region of Denmark, Gentofte, Denmark.,Department of Psychology, University of Southern Denmark, Odense, Denmark
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19
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Roberts H, Jacobs RH, Bessette KL, Crowell SE, Westlund-Schreiner M, Thomas L, Easter RE, Pocius SL, Dillahunt A, Frandsen S, Schubert B, Farstead B, Kerig P, Welsh RC, Jago D, Langenecker SA, Watkins ER. Mechanisms of rumination change in adolescent depression (RuMeChange): study protocol for a randomised controlled trial of rumination-focused cognitive behavioural therapy to reduce ruminative habit and risk of depressive relapse in high-ruminating adolescents. BMC Psychiatry 2021; 21:206. [PMID: 33892684 PMCID: PMC8062943 DOI: 10.1186/s12888-021-03193-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 04/01/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Adolescent-onset depression often results in a chronic and recurrent course, and is associated with worse outcomes relative to adult-onset depression. Targeting habitual depressive rumination, a specific known risk factor for relapse, may improve clinical outcomes for adolescents who have experienced a depressive episode. Randomized controlled trials (RCTs) thus far have demonstrated that rumination-focused cognitive behavioral therapy (RFCBT) reduces depressive symptoms and relapse rates in patients with residual depression and adolescents and young adults with elevated rumination. This was also observed in a pilot RCT of adolescents at risk for depressive relapse. Rumination can be measured at the self-report, behavioral, and neural levels- using patterns of connectivity between the Default Mode Network (DMN) and Cognitive Control Network (CCN). Disrupted connectivity is a putative important mechanism for understanding reduced rumination via RFCBT. A feasibility trial in adolescents found that reductions in connectivity between DMN and CCN regions following RFCBT were correlated with change in rumination and depressive symptoms. METHOD This is a phase III two-arm, two-stage, RCT of depression prevention. The trial tests whether RFCBT reduces identified risk factors for depressive relapse (rumination, patterns of neural connectivity, and depressive symptoms) in adolescents with partially or fully remitted depression and elevated rumination. In the first stage, RFCBT is compared to treatment as usual within the community. In the second stage, the comparator condition is relaxation therapy. Primary outcomes will be (a) reductions in depressive rumination, assessed using the Rumination Response Scale, and (b) reductions in resting state functional magnetic resonance imaging connectivity of DMN (posterior cingulate cortex) to CCN (inferior frontal gyrus), at 16 weeks post-randomization. Secondary outcomes include change in symptoms of depression following treatment, recurrence of depression over 12 months post-intervention period, and whether engagement with therapy homework (as a dose measure) is related to changes in the primary outcomes. DISCUSSION RFCBT will be evaluated as a putative preventive therapy to reduce the risk of depressive relapse in adolescents, and influence the identified self-report, behavioral, and neural mechanisms of change. Understanding mechanisms that underlie change in rumination is necessary to improve and further disseminate preventive interventions. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03859297 , registered 01 March 2019.
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Affiliation(s)
- Henrietta Roberts
- Mood Disorders Centre, School of Psychology, Sir Henry Wellcome Building for Mood Disorders Research, University of Exeter, Exeter, EX4 4LN, UK
| | | | - Katie L Bessette
- Department of Psychiatry, University of Utah, Salt Lake City, UT, 84108, USA
| | - Sheila E Crowell
- Department of Psychology, University of Utah, Salt Lake City, UT, 84108, USA
| | | | - Leah Thomas
- Department of Psychiatry, University of Utah, Salt Lake City, UT, 84108, USA
| | - Rebecca E Easter
- Department of Psychiatry, University of Utah, Salt Lake City, UT, 84108, USA
| | - Stephanie L Pocius
- Department of Psychiatry, University of Utah, Salt Lake City, UT, 84108, USA
| | - Alina Dillahunt
- Department of Psychiatry, University of Utah, Salt Lake City, UT, 84108, USA
| | - Summer Frandsen
- Department of Psychiatry, University of Utah, Salt Lake City, UT, 84108, USA
| | - Briana Schubert
- Department of Psychiatry, University of Utah, Salt Lake City, UT, 84108, USA
| | - Brian Farstead
- Department of Psychiatry, University of Utah, Salt Lake City, UT, 84108, USA
| | - Patricia Kerig
- Department of Psychology, University of Utah, Salt Lake City, UT, 84108, USA
| | - Robert C Welsh
- Department of Psychiatry, University of Utah, Salt Lake City, UT, 84108, USA
| | - David Jago
- Mood Disorders Centre, School of Psychology, Sir Henry Wellcome Building for Mood Disorders Research, University of Exeter, Exeter, EX4 4LN, UK
| | - Scott A Langenecker
- Department of Psychiatry, University of Utah, Salt Lake City, UT, 84108, USA
| | - Edward R Watkins
- Mood Disorders Centre, School of Psychology, Sir Henry Wellcome Building for Mood Disorders Research, University of Exeter, Exeter, EX4 4LN, UK.
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20
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Kuroda N, Burkey MD, Wissow LS. Discovering Common Elements of Empirically Supported Self-Help Interventions for Depression in Primary Care: a Systematic Review. J Gen Intern Med 2021; 36:869-80. [PMID: 33564943 DOI: 10.1007/s11606-020-06449-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 12/13/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Although the efficacy of self-help cognitive-behavioral therapy (CBT) for depression has been well established, its feasibility in primary care settings is limited because of time and resource constraints. The goal of this study was to identify common elements of empirically supported (i.e., proven effective in controlled research) self-help CBTs and frameworks for effective use in practice. METHODS Randomized controlled trials (RCTs) for self-help CBTs for depression in primary care were systematically identified in Pubmed, PsycINFO, and CENTRAL. The distillation and matching model approach was used to abstract commonly used self-help techniques (practice elements). Study contexts associated with unique combinations of intervention elements were explored, including total human support dose (total face-to-face, telephone, and personalized email contact time recommended by the protocol), effective symptom domain (depression vs. general psychological distress), and severity of depression targeted by the study. Relative contribution to intervention success was estimated for individual elements and human support by conditional probability (CP, proportion of the number of times each element appeared in a successful intervention to the number of times it was used in the interventions identified by the review). RESULTS Twenty-one interventions (12 successful) in 20 RCTs and 21 practice elements were identified. Cognitive restructuring, behavioral activation, and homework assignment were elements appearing in > 80% of successful interventions. The dose of human support was positively associated with the proportion of interventions that were successful in a significant linear fashion (CPs: interventions with no support, 0.20; 1-119 min of support, 0.60; 120 min of support, 0.83; p = 0.042). In addition, human support increased the probability of success for most of the extracted elements. Only social support activation, homework assignment, and interpersonal skills were highly successful (CPs ≥ 0.60) when minimal support was provided. DISCUSSION These findings suggest that human support is an important component in creating an evidence-informed brief self-help program compatible with primary care settings.
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21
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Weisberg RB, Gonsalves MA, Ramadurai R, Braham H, Fuchs C, Beard C. Development of a cognitive bias modification intervention for anxiety disorders in primary care. Br J Clin Psychol 2021; 61 Suppl 1:73-92. [PMID: 33629751 DOI: 10.1111/bjc.12281] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 11/30/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVES There is a great need for low-intensity, scalable treatments in primary care, where most anxious patients first present for treatment. We describe Stage IA treatment development and a Stage IB feasibility trial of cognitive bias modification (CBM) for transdiagnostic anxiety in primary care. METHODS The online intervention, Mental Habits, comprised eight sessions of a personalized CBM targeting attention and interpretation biases. Coaches assisted patients in using the website, monitored progress via a dashboard, and shared information with primary care providers. We evaluated Mental Habits in an open trial (N = 14) and a randomized controlled trial (RCT) (N = 40) in primary care patients with anxiety disorders. RESULTS We compared results to a priori benchmarks of clinically meaningful outcomes. In the open trial, Mental Habits met feasibility, acceptability, and efficacy benchmarks. In the pilot RCT, there was greater dropout at one study site which ultimately closed. In the intent-to-treat analyses, Mental Habits met the benchmark for self-report, but not the interview measure of anxiety. Symptom Tracking did not meet the benchmark for self-report or interview measures of anxiety. In per-protocol analyses, Mental Habits exceeded the benchmark for both self-report and interview measures, whereas Symptom Tracking met the benchmark for self-report. Interpretation bias improved in the Mental Habits group, but not in Symptom Tracking. No effects were observed for attention bias. CONCLUSION The online CBM intervention demonstrated good acceptability and, when delivered at a stable primary care clinic, preliminary effectiveness in primary care. A larger RCT is warranted to test effectiveness. PRACTITIONER POINTS A personalized, transdiagnostic Cognitive Bias Modification (CBM) intervention for anxiety in primary care is acceptable to primary care patients with social anxiety disorder, generalized anxiety disorder, and/or panic disorder /agoraphobia. With training and supervision from licensed mental health clinicians, bachelor's-level coaches can assist primary care patients to self-administer CBM. Offering a low-intensity, self-directed anxiety intervention in primary care can greatly expand the reach of anxiety treatment, with minimal need for additional resources. Interpretation bias may be an important clinical target for primary care patients with anxiety.
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Affiliation(s)
- Risa B Weisberg
- VA Boston Healthcare System, Massachusetts, USA.,Department of Psychiatry, Boston University School of Medicine, Massachusetts, USA.,Department of Family Medicine, Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Meghan A Gonsalves
- Neuroscience Graduate Program, Brown University, Providence, Rhode Island, USA
| | - Ramya Ramadurai
- Department of Psychiatry, McLean Hospital, Belmont, Massachusetts, USA
| | | | - Cara Fuchs
- Department of Psychiatry, Boston University School of Medicine, Massachusetts, USA.,Boston Medical Center, Massachusetts, USA
| | - Courtney Beard
- Department of Psychiatry, McLean Hospital, Belmont, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
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22
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Köhnen M, Dreier M, Seeralan T, Kriston L, Härter M, Baumeister H, Liebherz S. Evidence on Technology-Based Psychological Interventions in Diagnosed Depression: Systematic Review. JMIR Ment Health 2021; 8:e21700. [PMID: 33565981 PMCID: PMC7904404 DOI: 10.2196/21700] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 10/30/2020] [Accepted: 11/18/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Evidence on technology-based psychological interventions (TBIs) for the treatment of depression is rapidly growing and covers a broad scope of research. Despite extensive research in this field, guideline recommendations are still limited to the general effectiveness of TBIs. OBJECTIVE This study aims to structure evidence on TBIs by considering different application areas (eg, TBIs for acute treatment and their implementation in health care, such as stand-alone interventions) and treatment characteristics (eg, therapeutic rationale of TBIs) to provide a comprehensive evidence base and to identify research gaps in TBIs for diagnosed depression. Moreover, the reporting of negative events in the included studies is investigated in this review to enable subsequent safety assessment of the TBIs. METHODS Randomized controlled trials on adults diagnosed with unipolar depression receiving any kind of psychotherapeutic treatment, which was at least partly delivered by a technical medium, were eligible for inclusion in our preregistered systematic review. We searched for trials in CENTRAL (Cochrane Central Register of Controlled Trials; until August 2020), MEDLINE, PsycINFO, PSYNDEX, CINAHL; until the end of January 2018), clinical trial registers, and sources of gray literature (until the end of January 2019). Study selection and data extraction were conducted by 2 review authors independently. RESULTS Database searches resulted in 15,546 records, of which 241 publications were included, representing 83 completed studies and 60 studies awaiting classification (ie, preregistered studies, study protocols). Almost all completed studies (78/83, 94%) addressed the acute treatment phase, being largely either implemented as stand-alone interventions (66/83, 80%) or blended treatment approaches (12/83, 14%). Studies on TBIs for aftercare (4/83, 5%) and for bridging waiting periods (1/83, 1%) were scarce. Most TBI study arms (n=107) were guided (59/107, 55.1%), delivered via the internet (80/107, 74.8%), and based on cognitive behavioral treatment approaches (88/107, 79.4%). Almost all studies (77/83, 93%) reported information on negative events, considering dropouts from treatment as a negative event. However, reports on negative events were heterogeneous and largely unsystematic. CONCLUSIONS Research has given little attention to studies evaluating TBIs for aftercare and for bridging waiting periods in people with depression, even though TBIs are seen as highly promising in these application areas; thus, high quality studies are urgently needed. In addition, the variety of therapeutic rationales on TBIs has barely been represented by identified studies hindering the consideration of patient preferences when planning treatment. Finally, future studies should use specific guidelines to systematically assess and report negative events. TRIAL REGISTRATION International Prospective Register of Systematic Reviews (PROSPERO) CRD42016050413; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42016050413. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1136/bmjopen-2018-028042.
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Affiliation(s)
- Moritz Köhnen
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Mareike Dreier
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tharanya Seeralan
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Levente Kriston
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Harald Baumeister
- Department for Clinical Psychology and Psychotherapy, Ulm University, Ulm, Germany
| | - Sarah Liebherz
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Umegaki Y, Nakagawa A, Watkins E, Mullan E. A Rumination-Focused Cognitive-Behavioral Therapy Self-Help Program to Reduce Depressive Rumination in High-Ruminating Japanese Female University Students: A Case Series Study. Cognitive and Behavioral Practice 2021. [DOI: 10.1016/j.cbpra.2021.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Salmon K, Isler L, Jose P, Glynn R, Mitchell C, Dewhirst M, Buxton B, Gutenbrunner C, Reese E. Delving into the detail: Greater episodic detail in narratives of a critical life event predicts an increase in adolescent depressive symptoms across one year. Behav Res Ther 2021; 137:103798. [PMID: 33421894 DOI: 10.1016/j.brat.2020.103798] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 11/13/2020] [Accepted: 12/26/2020] [Indexed: 10/22/2022]
Abstract
Depressed people have reduced ability to recall specific autobiographical memories, yet the role of reduced memory specificity in the development of adolescent depression is unclear. Two reasons are the limited longitudinal studies with this age group and the dominant use of just one measure of memory specificity, the Autobiographical Memory Test (AMT; Williams & Broadbent, 1986). In the current one-year longitudinal study, community adolescents (N = 132, M = 16.13 years at Time 1) wrote about a life turning point, and their narratives were coded with respect to the amount of episodic and semantic detail. Participants also completed an adapted version of the Minimal Instructions AMT. Greater episodic detail in young people's turning point narrative was positively associated with depressive symptoms separately at Times 1 and 2, and uniquely predicted increases in depressive symptoms across the year. A non-positive valence of the turning point resolution also positively predicted Time 2 depressive symptoms. In contrast, specificity as assessed by the AMT did not predict such an increase. The results suggest that episodic detail in highly self-relevant narratives may be a sensitive predictor of increases in adolescent depressive symptoms across time. We consider excessive self focus and retrieval style as potential explanations of our findings.
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Affiliation(s)
- Karen Salmon
- Victoria University of Wellington, PO Box 600, Wellington, New Zealand.
| | - Laina Isler
- Victoria University of Wellington, PO Box 600, Wellington, New Zealand
| | - Paul Jose
- Victoria University of Wellington, PO Box 600, Wellington, New Zealand
| | - Ruth Glynn
- Victoria University of Wellington, PO Box 600, Wellington, New Zealand
| | | | - Mary Dewhirst
- Victoria University of Wellington, PO Box 600, Wellington, New Zealand
| | - Belinda Buxton
- Victoria University of Wellington, PO Box 600, Wellington, New Zealand
| | | | - Elaine Reese
- University of Otago, PO Box 56, Dunedin, New Zealand
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Abstract
Can cultural representations be used to therapeutic effect in the treatment of mood disorders like depression and anxiety? This article develops a theoretical framework that outlines how this might be achieved by way of mid-level cultural metrics that allow otherwise heterogeneous forms of representation to be grouped together. Its prediction is that abstract representations-as measured by Shannon entropy-will impact positively on anxiety, where concrete representations will positively impact on depression. The background to the prediction comes from construal level theory, a branch of social psychology that deals with the effects of abstraction on psychological distance; the types of cultural representations analysed include image, narrative and film. With a view to evaluating the hypothesis, the article surveys the empirical literature in art therapy, creative bibliotherapy and cinema therapy.
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Affiliation(s)
- James Carney
- Arts & Humanities/Centre for Culture and Evolution, Brunel University London, Uxbridge UB8 3PH, UK
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Van den Bergh O, Brosschot J, Critchley H, Thayer JF, Ottaviani C. Better Safe Than Sorry: A Common Signature of General Vulnerability for Psychopathology. Perspect Psychol Sci 2020; 16:225-246. [DOI: 10.1177/1745691620950690] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Several labels, such as neuroticism, negative emotionality, and dispositional negativity, indicate a broad dimension of psychopathology. However, largely separate, often disorder-specific research lines have developed that focus on different cognitive and affective characteristics that are associated with this dimension, such as perseverative cognition (worry, rumination), reduced autobiographical memory specificity, compromised fear learning, and enhanced somatic-symptom reporting. In this article, we present a theoretical perspective within a predictive-processing framework in which we trace these phenotypically different characteristics back to a common underlying “better-safe-than-sorry” processing strategy. This implies information processing that tends to be low in sensory-perceptual detail, which allows threat-related categorical priors to dominate conscious experience and for chronic uncertainty/surprise because of a stagnated error-reduction process. This common information-processing strategy has beneficial effects in the short term but important costs in the long term. From this perspective, we suggest that the phenomenally distinct cognitive and affective psychopathological characteristics mentioned above represent the same basic processing heuristic of the brain and are only different in relation to the particular type of information involved (e.g., in working memory, in autobiographical memory, in the external and internal world). Clinical implications of this view are discussed.
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Affiliation(s)
| | - Jos Brosschot
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University
| | - Hugo Critchley
- Department of Neuroscience, Brighton and Sussex Medical School, University of Sussex
| | - Julian F. Thayer
- Department of Psychological Science, University of California, Irvine
| | - Cristina Ottaviani
- Department of Psychology, Sapienza University of Rome
- Laboratorio di Neuroimmagini Funzionali, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Fondazione Santa Lucia, Rome, Italy
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Köhnen M, Kriston L, Härter M, Baumeister H, Liebherz S. Effectiveness and acceptance of technology-based psychological interventions for the acute treatment of unipolar depression: a systematic review and meta-analysis (Preprint). J Med Internet Res 2020; 23:e24584. [PMID: 36260395 PMCID: PMC8386371 DOI: 10.2196/24584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 02/08/2021] [Accepted: 04/04/2021] [Indexed: 11/13/2022] Open
Abstract
Background Evidence on technology-based psychological interventions (TBIs) for the acute treatment of depression is rapidly growing. Despite extensive research in this field, there is a lack of research determining effectiveness and acceptance of TBIs considering different application formats in people with a formally diagnosed depressive disorder. Objective The goal of the review was to investigate the effectiveness and acceptance of TBIs in people with diagnosed depression with particular focus on application formats (stand-alone interventions, blended treatments, collaborative and/or stepped care interventions). Methods Studies investigating adults with diagnosed unipolar depressive disorders receiving any kind of psychotherapeutic treatment delivered (at least partly) by a technical medium and conducted as randomized controlled trials (RCTs) were eligible for inclusion. We searched CENTRAL (Cochrane Central Register of Controlled Trials; August 2020), MEDLINE, PsycINFO, PSYNDEX, CINAHL (January 2018), clinical trial registers, and sources of grey literature (January 2019). Two independent authors decided about study inclusion and extracted data. We performed random effects meta-analyses to synthesize the data. Results Database searches resulted in 15,546 records of which 78 completed studies were included. TBIs delivered as stand-alone interventions showed positive effects on posttreatment depression severity when compared to treatment as usual (SMD –0.44, 95% CI –0.73 to –0.15, k=10; I²=86%), attention placebo (SMD –0.51, 95% CI –0.73 to –0.30; k=12; I²=66%), and waitlist controls (SMD –1.01, 95% CI –1.23 to –0.79; k=19; I²=73%). Superior long-term effects on depression severity were shown when TBIs were compared to treatment as usual (SMD –0.24, 95% CI –0.41 to –0.07; k=6; I²=48%) attention placebo (SMD –0.23, 95% CI –0.40 to –0.07; k=7; I²=21%) and waitlist controls (SMD –0.74, 95% CI –1.31 to –0.18; k=3; I²=79%). TBIs delivered as blended treatments (providing a TBI as an add-on to face-to-face treatment) yielded beneficial effects on posttreatment depression severity (SMD –0.27, 95% CI –0.48 to –0.05; k=8; I²=53%) compared to face-to-face treatments only. Additionally, TBIs delivered within collaborative care trials were more effective in reducing posttreatment (SMD –0.20, 95% CI –0.36 to –0.04; k=2; I²=0%) and long-term (SMD –0.23, 95% CI –0.39 to –0.07; k=2; I²=0%) depression severity than usual care. Dropout rates did not differ between the intervention and control groups in any comparison (all P≥.09). Conclusions We found that TBIs are effective not only when delivered as stand-alone interventions but also when they are delivered as blended treatments or in collaborative care trials for people with diagnosed depression. Our results may be useful to inform routine care, since we focused specifically on different application formats, formally diagnosed patients, and the long-term effectiveness of TBIs. Trial Registration PROSPERO International Prospective Register of Systematic Reviews CRD42016050413; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42016050413 International Registered Report Identifier (IRRID) RR2-10.1136/bmjopen-2018-028042
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Affiliation(s)
- Moritz Köhnen
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Levente Kriston
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Harald Baumeister
- Department for Clinical Psychology and Psychotherapy, University of Ulm, Ulm, Germany
| | - Sarah Liebherz
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Newbold A, Warren FC, Taylor RS, Hulme C, Burnett S, Aas B, Botella C, Burkhardt F, Ehring T, Fontaine JRJ, Frost M, Garcia-Palacios A, Greimel E, Hoessle C, Hovasapian A, Huyghe VEI, Lochner J, Molinari G, Pekrun R, Platt B, Rosenkranz T, Scherer KR, Schlegel K, Schulte-Korne G, Suso C, Voigt V, Watkins ER. Promotion of mental health in young adults via mobile phone app: study protocol of the ECoWeB (emotional competence for well-being in Young adults) cohort multiple randomised trials. BMC Psychiatry 2020; 20:458. [PMID: 32962684 PMCID: PMC7510072 DOI: 10.1186/s12888-020-02857-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 09/03/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Promoting well-being and preventing poor mental health in young people is a major global priority. Building emotional competence (EC) skills via a mobile app may be an effective, scalable and acceptable way to do this. However, few large-scale controlled trials have examined the efficacy of mobile apps in promoting mental health in young people; none have tailored the app to individual profiles. METHOD/DESIGN The Emotional Competence for Well-Being in Young Adults cohort multiple randomised controlled trial (cmRCT) involves a longitudinal prospective cohort to examine well-being, mental health and EC in 16-22 year olds across 12 months. Within the cohort, eligible participants are entered to either the PREVENT trial (if selected EC scores at baseline within worst-performing quartile) or to the PROMOTE trial (if selected EC scores not within worst-performing quartile). In both trials, participants are randomised (i) to continue with usual practice, repeated assessments and a self-monitoring app; (ii) to additionally receive generic cognitive-behavioural therapy self-help in app; (iii) to additionally receive personalised EC self-help in app. In total, 2142 participants aged 16 to 22 years, with no current or past history of major depression, bipolar disorder or psychosis will be recruited across UK, Germany, Spain, and Belgium. Assessments take place at baseline (pre-randomisation), 1, 3 and 12 months post-randomisation. Primary endpoint and outcome for PREVENT is level of depression symptoms on the Patient Health Questionnaire-9 at 3 months; primary endpoint and outcome for PROMOTE is emotional well-being assessed on the Warwick-Edinburgh Mental Wellbeing Scale at 3 months. Depressive symptoms, anxiety, well-being, health-related quality of life, functioning and cost-effectiveness are secondary outcomes. Compliance, adverse events and potentially mediating variables will be carefully monitored. CONCLUSIONS The trial aims to provide a better understanding of the causal role of learning EC skills using interventions delivered via mobile phone apps with respect to promoting well-being and preventing poor mental health in young people. This knowledge will be used to develop and disseminate innovative evidence-based, feasible, and effective Mobile-health public health strategies for preventing poor mental health and promoting well-being. TRIAL REGISTRATION ClinicalTrials.gov ( www.clinicaltrials.org ). Number of identification: NCT04148508 November 2019.
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Affiliation(s)
- A. Newbold
- grid.8391.30000 0004 1936 8024Mood Disorders Centre, School of Psychology, Sir Henry Wellcome Building for Mood Disorders Research, University of Exeter, Exeter, EX4 4LN UK
| | - F. C. Warren
- grid.8391.30000 0004 1936 8024College of Medicine and Health, University of Exeter, Exeter, UK
| | - R. S. Taylor
- grid.8391.30000 0004 1936 8024College of Medicine and Health, University of Exeter, Exeter, UK ,grid.8756.c0000 0001 2193 314XMRC/CSO Social and Public Health Sciences Unit & Robertson Centre for Biostatistics, Institute of Health and Well Being, University of Glasgow, Glasgow, UK
| | - C. Hulme
- grid.8391.30000 0004 1936 8024College of Medicine and Health, University of Exeter, Exeter, UK
| | - S. Burnett
- grid.8391.30000 0004 1936 8024Mood Disorders Centre, School of Psychology, Sir Henry Wellcome Building for Mood Disorders Research, University of Exeter, Exeter, EX4 4LN UK
| | - B. Aas
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, LMU, Munich, Germany
| | - C. Botella
- grid.9612.c0000 0001 1957 9153Universitat Jaume I, Castelló de la Plana, Spain ,grid.413448.e0000 0000 9314 1427CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Madrid, Spain
| | | | - T. Ehring
- grid.5252.00000 0004 1936 973XDepartment of Psychology, LMU Munich, Munich, Germany
| | - J. R. J. Fontaine
- grid.5342.00000 0001 2069 7798Department of Work, Organization and Society, Ghent University, Ghent, Belgium
| | - M. Frost
- Monsenso ApS, Copenhagen, Denmark
| | - A. Garcia-Palacios
- grid.9612.c0000 0001 1957 9153Universitat Jaume I, Castelló de la Plana, Spain ,grid.413448.e0000 0000 9314 1427CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Madrid, Spain
| | - E. Greimel
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, LMU, Munich, Germany
| | - C. Hoessle
- grid.5252.00000 0004 1936 973XDepartment of Psychology, LMU Munich, Munich, Germany
| | - A. Hovasapian
- grid.5342.00000 0001 2069 7798Department of Work, Organization and Society, Ghent University, Ghent, Belgium
| | - VEI Huyghe
- grid.5342.00000 0001 2069 7798Department of Work, Organization and Society, Ghent University, Ghent, Belgium
| | - J. Lochner
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, LMU, Munich, Germany ,grid.5252.00000 0004 1936 973XDepartment of Psychology, LMU Munich, Munich, Germany
| | - G. Molinari
- grid.413448.e0000 0000 9314 1427CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Madrid, Spain
| | - R. Pekrun
- grid.411958.00000 0001 2194 1270Department of Psychology, University of Essex, UK, and Institute for Positive Psychology and Education, Australian Catholic University, Sydney, Australia
| | - B. Platt
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, LMU, Munich, Germany
| | - T. Rosenkranz
- grid.5252.00000 0004 1936 973XDepartment of Psychology, LMU Munich, Munich, Germany
| | - K. R. Scherer
- grid.8591.50000 0001 2322 4988University of Geneva, Geneva, Switzerland
| | - K. Schlegel
- grid.5734.50000 0001 0726 5157University of Bern, Bern, Switzerland
| | - G. Schulte-Korne
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, LMU, Munich, Germany
| | - C. Suso
- grid.9612.c0000 0001 1957 9153Universitat Jaume I, Castelló de la Plana, Spain
| | - V. Voigt
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, LMU, Munich, Germany
| | - E. R. Watkins
- grid.8391.30000 0004 1936 8024Mood Disorders Centre, School of Psychology, Sir Henry Wellcome Building for Mood Disorders Research, University of Exeter, Exeter, EX4 4LN UK
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Watkins ER, Roberts H. Reflecting on rumination: Consequences, causes, mechanisms and treatment of rumination. Behav Res Ther 2020; 127:103573. [DOI: 10.1016/j.brat.2020.103573] [Citation(s) in RCA: 129] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 11/23/2019] [Accepted: 01/24/2020] [Indexed: 12/11/2022]
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Abstract
A large amount of research time and resources are spent trying to develop or improve psychological therapies. However, treatment development is challenging and time-consuming, and the typical research process followed-a series of standard randomized controlled trials-is inefficient and sub-optimal for answering many important clinical research questions. In other areas of health research, recognition of these challenges has led to the development of sophisticated designs tailored to increase research efficiency and answer more targeted research questions about treatment mechanisms or optimal delivery. However, these innovations have largely not permeated into psychological treatment development research. There is a recognition of the need to understand how treatments work and what their active ingredients might be, and a call for the use of innovative trial designs to support such discovery. One approach to unpack the active ingredients and mechanisms of therapy is the factorial design as exemplified in the Multiphase Optimization Strategy (MOST) approach. The MOST design allows identification of the active components of a complex multi-component intervention (such as CBT) using a sophisticated factorial design, allowing the development of more efficient interventions and elucidating their mechanisms of action. The rationale, design, and potential advantages of this approach will be illustrated with reference to the IMPROVE-2 study, which conducts a fractional factorial design to investigate which elements (e.g., thought challenging, activity scheduling, compassion, relaxation, concreteness, functional analysis) within therapist-supported internet-delivered CBT are most effective at reducing symptoms of depression in 767 adults with major depression. By using this innovative approach, we can first begin to work out what components within the overall treatment package are most efficacious on average allowing us to build an overall more streamlined and potent therapy. This approach also has potential to distinguish the role of specific versus non-specific common treatment components within treatment.
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Affiliation(s)
- Edward R Watkins
- College of Life and Environmental Sciences, University of Exeter, Exeter, United Kingdom
| | - Alexandra Newbold
- College of Life and Environmental Sciences, University of Exeter, Exeter, United Kingdom
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Cova F, Garcia F, Oyanadel C, Villagran L, Páez D, Inostroza C. Adaptive Reflection on Negative Emotional Experiences: Convergences and Divergence Between the Processing-Mode Theory and the Theory of Self-Distancing Reflection. Front Psychol 2019; 10:1943. [PMID: 31551854 PMCID: PMC6734160 DOI: 10.3389/fpsyg.2019.01943] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 08/07/2019] [Indexed: 11/13/2022] Open
Abstract
Reflecting on negative emotional experiences can be adaptive but it can also maintain or intensify detrimental emotional states. Which factors determine whether reflection can have one consequence or another is unclear. This study focused on two research programs that have concentrated on this topic in the last decades: processing-mode theory (PMT) and self-distancing theory (SDT). The article described and contrasted both programs and their findings. The promising results that PMT and SDT have achieved in identifying the differences between the forms of adaptive and maladaptive reflection are highlighted. Likewise, the disconcerting contradictions observed between both programs that make integrating the findings difficult are indicated. The PMT states that adaptive reflection is concrete, and it is focused on the how of the experience. The SDT states that adaptive reflection is self-distanced and focused on the global meaning of the experience. The article finishes by indicating possible explanations for these apparent contradictions and outlines the challenges to be solved to improve comprehension of the topic.
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Affiliation(s)
- Félix Cova
- Departamento de Psicología, Universidad de Concepción, Concepción, Chile
| | - Felipe Garcia
- Facultad de Ciencias Sociales y Comunicación, Universidad Santo Tomas, Concepción, Chile
| | - Cristian Oyanadel
- Departamento de Psicología, Universidad de Concepción, Concepción, Chile
| | - Loreto Villagran
- Departamento de Psicología, Universidad de Concepción, Concepción, Chile
| | - Dario Páez
- Facultad de Psicología, Universidad del País Vasco, Leioa, Spain
- Facultad de Educación y Ciencias Sociales, Universidad Andres Bello, Concepción, Chile
| | - Carolina Inostroza
- Departamento de Psicología, Universidad de Concepción, Concepción, Chile
- Departamento de Psiquiatría y Salud Mental, Universidad de Concepción, Concepción, Chile
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Dineen-Griffin S, Garcia-Cardenas V, Williams K, Benrimoj SI. Helping patients help themselves: A systematic review of self-management support strategies in primary health care practice. PLoS One 2019; 14:e0220116. [PMID: 31369582 PMCID: PMC6675068 DOI: 10.1371/journal.pone.0220116] [Citation(s) in RCA: 190] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 07/09/2019] [Indexed: 12/11/2022] Open
Abstract
Background Primary health professionals are well positioned to support the delivery of patient self-management in an evidence-based, structured capacity. A need exists to better understand the active components required for effective self-management support, how these might be delivered within primary care, and the training and system changes that would subsequently be needed. Objectives (1) To examine self-management support interventions in primary care on health outcomes for a wide range of diseases compared to usual standard of care; and (2) To identify the effective strategies that facilitate positive clinical and humanistic outcomes in this setting. Method A systematic review of randomized controlled trials evaluating self-management support interventions was conducted following the Cochrane handbook & PRISMA guidelines. Published literature was systematically searched from inception to June 2019 in PubMed, Scopus and Web of Science. Eligible studies assessed the effectiveness of individualized interventions with follow-up, delivered face-to-face to adult patients with any condition in primary care, compared with usual standard of care. Matrices were developed that mapped the evidence and components for each intervention. The methodological quality of included studies were appraised. Results 6,510 records were retrieved. 58 studies were included in the final qualitative synthesis. Findings reveal a structured patient-provider exchange is required in primary care (including a one-on-one patient-provider consultation, ongoing follow up and provision of self-help materials). Interventions should be tailored to patient needs and may include combinations of strategies to improve a patient’s disease or treatment knowledge; independent monitoring of symptoms, encouraging self-treatment through a personalized action plan in response worsening symptoms or exacerbations, psychological coping and stress management strategies, and enhancing responsibility in medication adherence and lifestyle choices. Follow-up may include tailored feedback, monitoring of progress with respect to patient set healthcare goals, or honing problem-solving and decision-making skills. Theoretical models provided a strong base for effective SMS interventions. Positive outcomes for effective SMS included improvements in clinical indicators, health-related quality of life, self-efficacy (confidence to self-manage), disease knowledge or control. An SMS model has been developed which sets the foundation for the design and evaluation of practical strategies for the construct of self-management support interventions in primary healthcare practice. Conclusions These findings provide primary care professionals with evidence-based strategies and structure to deliver SMS in practice. For this collaborative partnership approach to be more widely applied, future research should build on these findings for optimal SMS service design and upskilling healthcare providers to effectively support patients in this collaborative process.
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Affiliation(s)
- Sarah Dineen-Griffin
- Graduate School of Health, University of Technology Sydney, Sydney, Australia
- * E-mail:
| | | | - Kylie Williams
- Graduate School of Health, University of Technology Sydney, Sydney, Australia
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Cook L, Mostazir M, Watkins E. Reducing Stress and Preventing Depression (RESPOND): Randomized Controlled Trial of Web-Based Rumination-Focused Cognitive Behavioral Therapy for High-Ruminating University Students. J Med Internet Res 2019; 21:e11349. [PMID: 31094331 PMCID: PMC6536298 DOI: 10.2196/11349] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 03/15/2019] [Accepted: 03/24/2019] [Indexed: 12/18/2022] Open
Abstract
Background Prevention of depression is a priority to reduce its global disease burden. Targeting specific risk factors, such as rumination, may improve prevention. Rumination-focused Cognitive Behavioral Therapy (RFCBT) was developed to specifically target depressive rumination. Objective The primary objective of this study was to test whether guided Web-based RFCBT (i-RFCBT) would prevent the incidence of major depression relative to usual care in UK university students. The secondary objective was to test the feasibility and estimated effect sizes of unguided i-RFCBT. Methods To address the primary objective, a phase III randomized controlled trial was designed and powered to compare high risk university students (N=235), selected with elevated worry/rumination, recruited via an open access website in response to circulars within universities and internet advertisements, randomized to receive either guided i-RFCBT (interactive Web-based RFCBT, supported by asynchronous written Web-based support from qualified therapists) or usual care control. To address the secondary objective, participants were also randomized to an adjunct arm of unguided (self-administered) i-RFCBT. The primary outcome was the onset of a major depressive episode over 15 months, assessed with structured diagnostic interviews at 3 (postintervention), 6, and 15 months post randomization, conducted by telephone, blind to the condition. Secondary outcomes of symptoms of depression and anxiety and levels of worry and rumination were self-assessed through questionnaires at baseline and the same follow-up intervals. Results Participants were randomized to guided i-RFCBT (n=82), unguided i-RFCBT (n=76), or usual care (n=77). Guided i-RFCBT reduced the risk of depression by 34% relative to usual care (hazard ratio [HR] 0.66, 95% CI 0.35 to 1.25; P=.20). Participants with higher levels of baseline stress benefited most from the intervention (HR 0.43, 95% CI 0.21 to 0.87; P=.02). Significant improvements in rumination, worry, and depressive symptoms were found in the short-to-medium term. Of the 6 modules, guided participants completed a mean of 3.46 modules (SD 2.25), with 46% (38/82) being compliant (completing ≥4 modules). Similar effect sizes and compliance rates were found for unguided i-RFCBT. Conclusions Guided i-RFCBT can reduce the onset of depression in high-risk young people reporting high levels of worry/rumination and stress. The feasibility study argues for formally testing unguided i-RFCBT for prevention: if the observed effect sizes are robustly replicated in a phase III trial, it has potential as a scalable prevention intervention. Trial Registration ISRCTN Registry ISRCTN12683436; https://www.isrctn.com/ISRCTN12683436 (Archived by WebCite at http://www.webcitation.org/77fqycyBX) International Registered Report Identifier (IRRID) RR2-10.1186/s13063-015-1128-9
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Affiliation(s)
- Lorna Cook
- SMART Lab, Mood Disorders Centre, School of Psychology, University of Exeter, Exeter, United Kingdom
| | - Mohammod Mostazir
- College of Life and Environmental Sciences (CLES), School of Psychology, University of Exeter, Exeter, United Kingdom
| | - Edward Watkins
- SMART Lab, Mood Disorders Centre, School of Psychology, University of Exeter, Exeter, United Kingdom
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Rosenfeld EA, Kennedy K, Farchione TJ, Roberts JE. Cleansing the Attentional Palate: A Preliminary Test of a Novel Approach to Facilitate Disengagement From Rumination. J Cogn Psychother 2019; 33:128-139. [PMID: 32746388 DOI: 10.1891/0889-8391.33.2.128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Resource allocation theory suggests that rumination depletes cognitive resources that could be directed toward task-relevant processes. We propose a new approach to the treatment of rumination that specifically targets this misappropriation of cognitive resources, wherein individuals engage in an attentionally demanding task in order to interrupt the ruminative cycle. We argue that this strategy would serve to free cognitive resources from rumination and facilitate performance on other tasks. Thus, the present study served as an initial test of this novel approach. This study employed a within-subjects design, in which participants were 30 college students who completed self-report measures of baseline mood state, anxiety, depression, and trait rumination. Subsequently, they underwent sad mood and rumination inductions followed by random assignment to either a low attentional demand disengagement strategy (DS) followed by a high attentional demand DS or vice versa. Reading comprehension was assessed at baseline and following each of the two DSs. The high attentional demand DS condition was associated with better performance on the reading comprehension task compared to the low attentional demand DS condition. These results provide initial support for our novel approach to targeting rumination and demonstrate that attentionally demanding DSs may successfully free cognitive resources that might otherwise be consumed by rumination. Thus, future research into attentionally demanding DSs that interrupt ruminative cycles is warranted. This approach could be a useful adjunct for interventions targeting disorders driven by rumination, such as depression.
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Affiliation(s)
| | | | | | - John E Roberts
- Department of Psychology, University at Buffalo, Buffalo, New York
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Arditte Hall KA, Davison EH, Galovski TE, Vasterling JJ, Pineles SL. Associations Between Trauma-Related Rumination and Symptoms of Posttraumatic Stress and Depression in Treatment-Seeking Female Veterans. J Trauma Stress 2019; 32:260-268. [PMID: 31009555 DOI: 10.1002/jts.22385] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 11/07/2018] [Accepted: 11/15/2018] [Indexed: 12/12/2022]
Abstract
Trauma-related rumination is a cognitive style characterized by repetitive negative thinking about the causes, consequences, and implications of a traumatic experience. Frequent trauma-related rumination has been linked to posttraumatic stress disorder (PTSD) and depression in civilian samples but has yet to be examined among military veterans. This study extended previous research by examining trauma-related rumination in female veterans who presented to a Veterans Affairs women's trauma recovery clinic (N = 91). The study had two main aims: (a) to examine associations between trauma-related rumination and specific PTSD symptoms, adjusting for the overlap between trauma-related rumination and other relevant cognitive factors, such as intrusive trauma memories and self-blame cognitions; and (b) to assess associations between trauma-related rumination, PTSD, and depression, adjusting for symptom comorbidity. At intake, patients completed a semistructured interview and self-report questionnaires. Primary diagnoses were confirmed via medical record review. Trauma-related rumination was common, with more than 80% of patients reporting at least sometimes engaging in this cognitive style in the past week. After adjusting for other relevant cognitive factors, trauma-related rumination was significantly associated with several specific PTSD symptoms, rp s = .33-.48. Additionally, the severity of trauma-related rumination was associated with overall PTSD symptom severity, even after adjusting for comorbid depression symptoms, rp 2 = .35. In contrast, the association between trauma-related rumination and depressive symptom severity was not significant after adjusting for comorbid PTSD symptoms, rp 2 = .008. These results highlight trauma-related rumination as a unique contributing factor to the complex clinical presentation for a subset of trauma-exposed veterans.
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Affiliation(s)
- Kimberly A Arditte Hall
- VA National Center for PTSD, Boston, Massachusetts, USA.,Boston University School of Medicine, Boston, Massachusetts, USA.,VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Eve H Davison
- VA National Center for PTSD, Boston, Massachusetts, USA.,Boston University School of Medicine, Boston, Massachusetts, USA.,VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Tara E Galovski
- VA National Center for PTSD, Boston, Massachusetts, USA.,Boston University School of Medicine, Boston, Massachusetts, USA.,VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Jennifer J Vasterling
- VA National Center for PTSD, Boston, Massachusetts, USA.,Boston University School of Medicine, Boston, Massachusetts, USA.,VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Suzanne L Pineles
- VA National Center for PTSD, Boston, Massachusetts, USA.,Boston University School of Medicine, Boston, Massachusetts, USA.,VA Boston Healthcare System, Boston, Massachusetts, USA
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Kircaburun K, Griffiths MD, Billieux J. Trait emotional intelligence and problematic online behaviors among adolescents: The mediating role of mindfulness, rumination, and depression. Personality and Individual Differences 2019; 139:208-13. [DOI: 10.1016/j.paid.2018.11.024] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Wild J, El-Salahi S, Tyson G, Lorenz H, Pariante CM, Danese A, Tsiachristas A, Watkins E, Middleton B, Blaber A, Ehlers A. Preventing PTSD, depression and associated health problems in student paramedics: protocol for PREVENT-PTSD, a randomised controlled trial of supported online cognitive training for resilience versus alternative online training and standard practice. BMJ Open 2018; 8:e022292. [PMID: 30598484 PMCID: PMC6318590 DOI: 10.1136/bmjopen-2018-022292] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Emergency workers dedicate their lives to promoting public health and safety, yet suffer higher rates of post-traumatic stress disorder (PTSD) and major depression (MD) compared with the general population. They also suffer an associated increased risk for physical health problems, which may be linked to specific immunological and endocrine markers or changes in relevant markers. Poor physical and mental health is costly to organisations, the National Health Service and society. Existing interventions aimed at reducing risk of mental ill health in this population are not very successful. More effective preventative interventions are urgently needed. We first conducted a large-scale prospective study of newly recruited student paramedics, identifying two cognitive factors (rumination and resilience appraisals) that predicted episodes of PTSD and MD over a 2-year period. We then developed internet-delivered cognitive training for resilience (iCT-R), a supported online intervention, to modify cognitive predictors. This protocol is for a randomised controlled trial to evaluate the efficacy of the resilience intervention. METHODS AND ANALYSIS 570 student paramedics will be recruited from participating universities. They will be randomly allocated to iCT-R or to supported online training of an alternative, widely available intervention or to training-as-usual. Follow-up will occur after the intervention/standard practice period and at 6, 12 and 24 months. Primary outcomes include rates of PTSD and MD and subsydnromal PTSD and MD, measured by the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, fifth edition, the Patient-Health Questionnaire-9 and the Post-traumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, fifth edition. Secondary outcomes include measures of resilience, rumination, anxiety, psychological distress, well-being, salivary cortisol, plasma levels of C-reactive protein, smoking and alcohol use, weight gain, sleep problems, health-related quality of life, health resource utilisation and productivity. ETHICS AND DISSEMINATION The Medical Sciences Inter-Divisional Research Ethics Committee at the University of Oxford granted approval, reference: R44116/RE001. The results will be published in a peer-reviewed journal. Access to raw data and participant information will be available only to members of the research team. TRIAL REGISTRATION NUMBER ISRCTN16493616; Pre-results.
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Affiliation(s)
- Jennifer Wild
- Department of Experimental Psychology, Oxford Centre for Anxiety Disorders and Trauma, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Shama El-Salahi
- Department of Experimental Psychology, Oxford Centre for Anxiety Disorders and Trauma, University of Oxford, Oxford, UK
| | - Gabriella Tyson
- Department of Experimental Psychology, Oxford Centre for Anxiety Disorders and Trauma, University of Oxford, Oxford, UK
| | - Hjördis Lorenz
- Department of Experimental Psychology, Oxford Centre for Anxiety Disorders and Trauma, University of Oxford, Oxford, UK
| | - Carmine M Pariante
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Andrea Danese
- Department of Social, Genetic and Developmental Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Apostolos Tsiachristas
- Nuffield Department of Population Health, Health Economics Research Centre, University of Oxford, Oxford, UK
| | - Edward Watkins
- Sir Henry Wellcome Building for Mood Disorders Research, School of Psychology College of Life and Environmental Sciences, University of Exeter, Exeter, UK
| | - Benita Middleton
- Faculty of Health and Medical Sciences, University of Surrey, Surrey, UK
| | - Amanda Blaber
- School of Health Sciences, University of Brighton, Brighton, UK
| | - Anke Ehlers
- Department of Experimental Psychology, Oxford Centre for Anxiety Disorders and Trauma, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
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Skodzik T, Adelt MH, Nossek VA, Kuck ST, Ehring T. Does a novel training in mental imagery reduce pathological worry? Behav Res Ther 2018; 109:56-67. [DOI: 10.1016/j.brat.2018.07.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 07/17/2018] [Accepted: 07/23/2018] [Indexed: 11/30/2022]
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Abstract
BACKGROUND More than half of patients who present with depressive disorders also have elevated comorbid anxiety symptoms. Given the high comorbidity between these disorders, it is important to understand the extent that psychotherapies for depression additionally ameliorate symptoms of anxiety. METHODS Systematic searches were conducted in PubMed, PSYCinfo, EMBASE, and the Cochrane Registry of Controlled Trials. Included studies were randomized controlled trials that compared psychotherapy compared with a control condition for the treatment of adults with a primary diagnosis or elevated symptoms of depression and that examined the effects of treatment on anxiety outcomes. Acute phase depression and anxiety (continuous measure) outcomes were extracted. Effect sizes were calculated by subtracting the average post-treatment scores of the psychotherapy group from the average post-treatment scores of the comparison group divided by the pooled standard deviation. RESULTS Fifty-two studies of varying quality met the inclusion criteria. Pooled effect sizes showed that anxiety outcomes were significantly lower in the psychotherapy conditions than in control conditions at post-treatment [g = 0.52; 95% confidence interval (CI) 0.44-0.60; NNT (numbers-needed-to-treat) = 3.50]. Moderate heterogeneity was observed (I2 = 55%, 95% CI 40-66). Bivariate metaregression analysis revealed a significant association between depression and anxiety effect sizes at post-treatment Longer-term follow-ups of up to 14 months post-baseline showed indications for a small lasting effect of psychotherapy on anxiety outcomes (g = 0.27). CONCLUSIONS This meta-analysis provides evidence that psychotherapy aimed at depression can also reduce anxiety symptoms in relation to control conditions.
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Affiliation(s)
- Erica Weitz
- Department of Clinical, Neuro and Developmental Psychology,EMGO Institute for Health and Care Research,Vrije Universiteit Amsterdam,Van der Boechorststraat 1, 1081 BT Amsterdam,The Netherlands
| | - Annet Kleiboer
- Department of Clinical, Neuro and Developmental Psychology,EMGO Institute for Health and Care Research,Vrije Universiteit Amsterdam,Van der Boechorststraat 1, 1081 BT Amsterdam,The Netherlands
| | - Annemieke van Straten
- Department of Clinical, Neuro and Developmental Psychology,EMGO Institute for Health and Care Research,Vrije Universiteit Amsterdam,Van der Boechorststraat 1, 1081 BT Amsterdam,The Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology,EMGO Institute for Health and Care Research,Vrije Universiteit Amsterdam,Van der Boechorststraat 1, 1081 BT Amsterdam,The Netherlands
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Dey S, Joormann J, Moulds ML, Newell BR. The relative effects of abstract versus concrete rumination on the experience of post-decisional regret. Behav Res Ther 2018; 108:18-28. [DOI: 10.1016/j.brat.2018.06.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 06/02/2018] [Accepted: 06/21/2018] [Indexed: 11/27/2022]
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Spinhoven P, Klein N, Kennis M, Cramer AO, Siegle G, Cuijpers P, Ormel J, Hollon SD, Bockting CL. The effects of cognitive-behavior therapy for depression on repetitive negative thinking: A meta-analysis. Behav Res Ther 2018; 106:71-85. [DOI: 10.1016/j.brat.2018.04.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 04/02/2018] [Accepted: 04/16/2018] [Indexed: 10/17/2022]
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43
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Erten MN, Brown AD. Memory Specificity Training for Depression and Posttraumatic Stress Disorder: A Promising Therapeutic Intervention. Front Psychol 2018; 9:419. [PMID: 29666598 PMCID: PMC5892288 DOI: 10.3389/fpsyg.2018.00419] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 03/13/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Mina N Erten
- Department of Psychology, Sarah Lawrence College, Bronxville, NY, United States
| | - Adam D Brown
- Department of Psychology, Sarah Lawrence College, Bronxville, NY, United States.,Department of Psychiatry, New York University School of Medicine, New York, NY, United States
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Hitchcock C, Gormley S, O’Leary C, Rodrigues E, Wright I, Griffiths K, Gillard J, Watson P, Hammond E, Werner-Seidler A, Dalgleish T. Study protocol for a randomised, controlled platform trial estimating the effect of autobiographical Memory Flexibility training (MemFlex) on relapse of recurrent major depressive disorder. BMJ Open 2018; 8:e018194. [PMID: 29382674 PMCID: PMC5829844 DOI: 10.1136/bmjopen-2017-018194] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Major depressive disorder (MDD) is a chronic condition. Although current treatment approaches are effective in reducing acute depressive symptoms, rates of relapse are high. Chronic and inflexible retrieval of autobiographical memories, and in particular a bias towards negative and overgeneral memories, is a reliable predictor of relapse. This randomised controlled single-blind trial will determine whether a therapist-guided self-help intervention to ameliorate autobiographical memory biases using Memory Flexibility training (MemFlex) will increase the experience of depression-free days, relative to a psychoeducation control condition, in the 12 months following intervention. METHODS AND ANALYSIS Individuals (aged 18 and above) with a diagnosis of recurrent MDD will be recruited when remitted from a major depressive episode. Participants will be randomly allocated to complete 4 weeks of a workbook providing either MemFlex training, or psychoeducation on factors that increase risk of relapse. Assessment of diagnostic status, self-report depressive symptoms, depression-free days and cognitive risk factors for depression will be completed post-intervention, and at 6 and 12 months follow-up. The cognitive target of MemFlex will be change in memory flexibility on the Autobiographical Memory Test- Alternating Instructions. The primary clinical endpoints will be the number of depression-free days in the 12 months following workbook completion, and time to depressive relapse. ETHICS AND DISSEMINATION Ethics approval has been granted by the NHS National Research Ethics Committee (East of England, 11/H0305/1). Results from this study will provide a point-estimate of the effect of MemFlex on depressive relapse, which will be used to inform a fully powered trial evaluating the potential of MemFlex as an effective, low-cost and low-intensity option for reducing relapse of MDD. TRIAL REGISTRATION NUMBER NCT02614326.
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Affiliation(s)
- Caitlin Hitchcock
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - Siobhan Gormley
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - Cliodhna O’Leary
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - Evangeline Rodrigues
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - Isobel Wright
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - Kirsty Griffiths
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - Julia Gillard
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - Peter Watson
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - Emily Hammond
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
- Psychology, University of Exeter, Exeter, UK
| | | | - Tim Dalgleish
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
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Kaplan DM, Palitsky R, Carey AL, Crane TE, Havens CM, Medrano MR, Reznik SJ, Sbarra DA, O'Connor MF. Maladaptive repetitive thought as a transdiagnostic phenomenon and treatment target: An integrative review. J Clin Psychol 2018; 74:1126-1136. [DOI: 10.1002/jclp.22585] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 11/13/2017] [Accepted: 11/20/2017] [Indexed: 01/15/2023]
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Grafton B, MacLeod C, Rudaizky D, Holmes EA, Salemink E, Fox E, Notebaert L. Confusing procedures with process when appraising the impact of cognitive bias modification on emotional vulnerability †. Br J Psychiatry 2017; 211:266-271. [PMID: 29092835 DOI: 10.1192/bjp.bp.115.176123] [Citation(s) in RCA: 118] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Revised: 03/06/2017] [Accepted: 03/22/2017] [Indexed: 11/23/2022]
Abstract
If meta-analysis is to provide valuable answers, then it is critical to ensure clarity about the questions being asked. Here, we distinguish two important questions concerning cognitive bias modification research that are not differentiated in the meta-analysis recently published by Cristea et al (2015) in this journal: (1) do the varying procedures that investigators have employed with the intention of modifying cognitive bias, on average, significantly impact emotional vulnerability?; and (2) does the process of successfully modifying cognitive bias, on average, significantly impact emotional vulnerability? We reanalyse the data from Cristea et al to address this latter question. Our new analyses demonstrate that successfully modifying cognitive bias does significantly alter emotional vulnerability. We revisit Cristea et al's conclusions in light of these findings.
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Affiliation(s)
- Ben Grafton
- Ben Grafton, PhD, Centre for the Advancement of Research on Emotion, School of Psychology, University of Western Australia; Colin MacLeod, PhD, Centre for the Advancement of Research on Emotion, School of Psychology, University of Western Australia, School of Psychology, Babes-Bolyai University, Romania; Daniel Rudaizky, PhD, Centre for the Advancement of Research on Emotion, School of Psychology, University of Western Australia; Emily A. Holmes, PhD, Medical Research Council, Cognition and Brain Sciences Unit, Cambridge, UK, and Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden; Elske Salemink, PhD, Developmental Psychology, University of Amsterdam, Amsterdam, The Netherlands; Elaine Fox, PhD, Oxford Centre for Emotion and Affective Neuroscience, and Department of Experimental Psychology, University of Oxford, UK; Lies Notebaert, PhD, Centre for the Advancement of Research on Emotion, School of Psychology, University of Western Australia
| | - Colin MacLeod
- Ben Grafton, PhD, Centre for the Advancement of Research on Emotion, School of Psychology, University of Western Australia; Colin MacLeod, PhD, Centre for the Advancement of Research on Emotion, School of Psychology, University of Western Australia, School of Psychology, Babes-Bolyai University, Romania; Daniel Rudaizky, PhD, Centre for the Advancement of Research on Emotion, School of Psychology, University of Western Australia; Emily A. Holmes, PhD, Medical Research Council, Cognition and Brain Sciences Unit, Cambridge, UK, and Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden; Elske Salemink, PhD, Developmental Psychology, University of Amsterdam, Amsterdam, The Netherlands; Elaine Fox, PhD, Oxford Centre for Emotion and Affective Neuroscience, and Department of Experimental Psychology, University of Oxford, UK; Lies Notebaert, PhD, Centre for the Advancement of Research on Emotion, School of Psychology, University of Western Australia
| | - Daniel Rudaizky
- Ben Grafton, PhD, Centre for the Advancement of Research on Emotion, School of Psychology, University of Western Australia; Colin MacLeod, PhD, Centre for the Advancement of Research on Emotion, School of Psychology, University of Western Australia, School of Psychology, Babes-Bolyai University, Romania; Daniel Rudaizky, PhD, Centre for the Advancement of Research on Emotion, School of Psychology, University of Western Australia; Emily A. Holmes, PhD, Medical Research Council, Cognition and Brain Sciences Unit, Cambridge, UK, and Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden; Elske Salemink, PhD, Developmental Psychology, University of Amsterdam, Amsterdam, The Netherlands; Elaine Fox, PhD, Oxford Centre for Emotion and Affective Neuroscience, and Department of Experimental Psychology, University of Oxford, UK; Lies Notebaert, PhD, Centre for the Advancement of Research on Emotion, School of Psychology, University of Western Australia
| | - Emily A Holmes
- Ben Grafton, PhD, Centre for the Advancement of Research on Emotion, School of Psychology, University of Western Australia; Colin MacLeod, PhD, Centre for the Advancement of Research on Emotion, School of Psychology, University of Western Australia, School of Psychology, Babes-Bolyai University, Romania; Daniel Rudaizky, PhD, Centre for the Advancement of Research on Emotion, School of Psychology, University of Western Australia; Emily A. Holmes, PhD, Medical Research Council, Cognition and Brain Sciences Unit, Cambridge, UK, and Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden; Elske Salemink, PhD, Developmental Psychology, University of Amsterdam, Amsterdam, The Netherlands; Elaine Fox, PhD, Oxford Centre for Emotion and Affective Neuroscience, and Department of Experimental Psychology, University of Oxford, UK; Lies Notebaert, PhD, Centre for the Advancement of Research on Emotion, School of Psychology, University of Western Australia
| | - Elske Salemink
- Ben Grafton, PhD, Centre for the Advancement of Research on Emotion, School of Psychology, University of Western Australia; Colin MacLeod, PhD, Centre for the Advancement of Research on Emotion, School of Psychology, University of Western Australia, School of Psychology, Babes-Bolyai University, Romania; Daniel Rudaizky, PhD, Centre for the Advancement of Research on Emotion, School of Psychology, University of Western Australia; Emily A. Holmes, PhD, Medical Research Council, Cognition and Brain Sciences Unit, Cambridge, UK, and Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden; Elske Salemink, PhD, Developmental Psychology, University of Amsterdam, Amsterdam, The Netherlands; Elaine Fox, PhD, Oxford Centre for Emotion and Affective Neuroscience, and Department of Experimental Psychology, University of Oxford, UK; Lies Notebaert, PhD, Centre for the Advancement of Research on Emotion, School of Psychology, University of Western Australia
| | - Elaine Fox
- Ben Grafton, PhD, Centre for the Advancement of Research on Emotion, School of Psychology, University of Western Australia; Colin MacLeod, PhD, Centre for the Advancement of Research on Emotion, School of Psychology, University of Western Australia, School of Psychology, Babes-Bolyai University, Romania; Daniel Rudaizky, PhD, Centre for the Advancement of Research on Emotion, School of Psychology, University of Western Australia; Emily A. Holmes, PhD, Medical Research Council, Cognition and Brain Sciences Unit, Cambridge, UK, and Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden; Elske Salemink, PhD, Developmental Psychology, University of Amsterdam, Amsterdam, The Netherlands; Elaine Fox, PhD, Oxford Centre for Emotion and Affective Neuroscience, and Department of Experimental Psychology, University of Oxford, UK; Lies Notebaert, PhD, Centre for the Advancement of Research on Emotion, School of Psychology, University of Western Australia
| | - Lies Notebaert
- Ben Grafton, PhD, Centre for the Advancement of Research on Emotion, School of Psychology, University of Western Australia; Colin MacLeod, PhD, Centre for the Advancement of Research on Emotion, School of Psychology, University of Western Australia, School of Psychology, Babes-Bolyai University, Romania; Daniel Rudaizky, PhD, Centre for the Advancement of Research on Emotion, School of Psychology, University of Western Australia; Emily A. Holmes, PhD, Medical Research Council, Cognition and Brain Sciences Unit, Cambridge, UK, and Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden; Elske Salemink, PhD, Developmental Psychology, University of Amsterdam, Amsterdam, The Netherlands; Elaine Fox, PhD, Oxford Centre for Emotion and Affective Neuroscience, and Department of Experimental Psychology, University of Oxford, UK; Lies Notebaert, PhD, Centre for the Advancement of Research on Emotion, School of Psychology, University of Western Australia
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Stevens ES, Jendrusina AA, Legrand AC, Nahin ER, Kaufman MG, Borkovec TD, Behar E. The Effects of Worry and Relaxation on Flexibility During Cognitive Restructuring. Behav Modif 2017; 42:838-863. [DOI: 10.1177/0145445517732272] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Worry is associated with inflexibility in cognitive, emotional, and physiological functioning. In addition, worry’s negative valence and abstract level of construal are rigid characteristics that contribute to its nonadaptive consequences. Relaxation and cognitive therapy aim to increase flexibility in chronic worriers, and may have greater efficacy when administered in combination. We examined the extent to which relaxation enhances and/or worry inhibits cognitive flexibility during a cognitive restructuring exercise in which participants generated alternative predictions for their worries. Participants ( n = 189) were randomly assigned to engage in relaxation, worry, or neutral thinking prior to cognitive restructuring. We measured the number and perceived likelihood of alternative predictions generated by participants, and coded those alternative predictions for their degree of positive valence, negative valence, and level of construal (abstractness to concreteness). Worry and relaxation did not lead to different numbers or perceived likelihood of alternative predictions. However, compared with participants with minimal symptoms of generalized anxiety disorder (GAD), those with elevated symptoms of GAD who engaged in prior worry generated alternative predictions characterized by greater negative valence and more abstractness (i.e., less concreteness). We also found that greater negative valence of alternative predictions was associated with more abstractness, whereas greater positive valence of alternative predictions was associated with more concreteness. These findings suggest that after engaging in worry, individuals with GAD may be less able to flexibly shift from the use of nonadaptive characteristics (negative valence, abstractness) associated with feared outcomes to the use of more adaptive characteristics (positive valence, concreteness) when considering alternative predictions.
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Affiliation(s)
| | | | | | | | | | | | - Evelyn Behar
- University of Illinois at Chicago, Chicago, IL, USA
- Hunter College, City University of New York, NY, USA
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Jones NP, Fournier JC, Stone LB. Neural correlates of autobiographical problem-solving deficits associated with rumination in depression. J Affect Disord 2017; 218:210-216. [PMID: 28477499 PMCID: PMC5505343 DOI: 10.1016/j.jad.2017.04.069] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 04/25/2017] [Accepted: 04/28/2017] [Indexed: 01/03/2023]
Abstract
BACKGROUND Analytical rumination can be characterized as negative thoughts focused on searching for answers to personal problems. Failure to think concretely during autobiographical problem-solving (APS) is hypothesized to drive the inability of ruminators to generate effective solutions. Clarifying the brain correlates underlying APS deficits in depressed ruminators may identify novel biological targets for treatment. METHOD Forty participants (22 unmedicated depressed and 18 never-depressed adults) ranging in rumination engaged in APS and negative self-referential processing (NSP) of negative trait adjectives during fMRI. We contrasted activation during APS with activation during NSP to isolate regions contributing to APS. RESULTS Rumination was associated with having generated fewer solutions during APS and with a failure to recruit the angular gyrus (AG) and the medial frontal gyrus (MFG) during APS. Rumination was associated with greater MFG activation during NSP and stronger connectivity between the AG and the rostrolateral prefrontal cortex (RLPFC) during APS relative to NSP. Findings were not driven by clinical status. LIMITATIONS The use of an extreme groups approach can result in overestimation of effects sizes. CONCLUSIONS Ruminators fail to recruit regions with the default network (DN) that support APS. In particular, a failure to recruit the AG during APS may drive the abstract thinking style previously shown to explain depressed ruminator's difficulty generating concrete solutions. Targeting this mechanism directly may reduce rumination.
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Affiliation(s)
- Neil P Jones
- Department of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, 3811 O'Hara St., Pittsburgh, PA 15216, USA.
| | - Jay C Fournier
- Department of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, 3811 O'Hara St., Pittsburgh, PA 15216, USA
| | - Lindsey B Stone
- Department of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, 3811 O'Hara St., Pittsburgh, PA 15216, USA
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McGowan SK, Stevens ES, Behar E, Judah MR, Mills AC, Grant DM. Concreteness of idiographic worry and anticipatory processing. J Behav Ther Exp Psychiatry 2017; 54:195-203. [PMID: 27575635 DOI: 10.1016/j.jbtep.2016.08.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 08/06/2016] [Accepted: 08/09/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVES Worry and anticipatory processing are forms of repetitive negative thinking (RNT) that are associated with maladaptive characteristics and negative consequences. One key maladaptive characteristic of worry is its abstract nature (Goldwin & Behar, 2012; Stöber & Borkovec, 2002). Several investigations have relied on inductions of worry that are social-evaluative in nature, which precludes distinctions between worry and RNT about social-evaluative situations. The present study examined similarities and distinctions between worry and anticipatory processing on potentially important maladaptive characteristics. METHODS Participants (N = 279) engaged in idiographic periods of uninstructed mentation, worry, and anticipatory processing and provided thought samples during each minute of each induction. Thought samples were assessed for concreteness, degree of verbal-linguistic activity, and degree of imagery-based activity. RESULTS Both worry and anticipatory processing were characterized by reduced concreteness, increased abstraction of thought over time, and a predominance of verbal-linguistic activity. However, worry was more abstract, more verbal-linguistic, and less imagery-based relative to anticipatory processing. Finally, worry demonstrated reductions in verbal-linguistic activity over time, whereas anticipatory processing demonstrated reductions in imagery-based activity over time. LIMITATIONS Worry was limited to non-social topics to distinguish worry from anticipatory processing, and may not represent worry that is social in nature. Generalizability may also be limited by use of an undergraduate sample. CONCLUSIONS Results from the present study provide support for Stöber's theory regarding the reduced concreteness of worry, and suggest that although worry and anticipatory processing share some features, they also contain characteristics unique to each process.
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Affiliation(s)
| | | | - Evelyn Behar
- University of Illinois at Chicago, United States
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Skodzik T, Leopold A, Ehring T. Effects of a training in mental imagery on worry: A proof-of-principle study. J Anxiety Disord 2017; 45:24-33. [PMID: 27915122 DOI: 10.1016/j.janxdis.2016.11.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 10/12/2016] [Accepted: 11/24/2016] [Indexed: 10/20/2022]
Abstract
Worry is characterized by a predominance of verbal thinking and relatively little mental imagery. This cognitive bias of verbal and abstract processing has been found to impair emotional processing of worry topics so that worrisome thoughts are maintained. On the other hand, engaging in mental imagery during the worry process fosters emotional processing of worry themes. In the present study, we examined whether training high worriers (n=71) to use more mental imagery in their everyday lives is an effective intervention to reduce pathological worry. Results indicated that our novel training in mental imagery (TMI) led to a significant reduction of worry and impairment, assessed both one and five weeks after the training. Furthermore, in highly anxious participants TMI had beneficial effects on controllability of worry, state anxiety, and positive mood. Theoretical and clinical implications of our findings and methodological limitations of this proof-of-principle study are discussed.
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Affiliation(s)
- Timo Skodzik
- University of Muenster, Department of Clinical Psychology and Psychotherapy, Fliednerstraße 21, 48149 Muenster, Germany.
| | - Alexandra Leopold
- University of Muenster, Department of Clinical Psychology and Psychotherapy, Fliednerstraße 21, 48149 Muenster, Germany
| | - Thomas Ehring
- University of Muenster, Department of Clinical Psychology and Psychotherapy, Fliednerstraße 21, 48149 Muenster, Germany; LMU Munich, Department of Psychology, Leopoldstr. 13, 80802 Munich, Germany
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