ArticleLiterature Review

Psychoeducational treatment and prevention of depression: The "Coping with Depression" course thirty years later

Authors:
  • Kaiser Permanente Center for Health Research, Portland Oregon
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Abstract

The “Coping with Depression” course (CWD) is by the far the best studied psychoeducational intervention for the treatment and prevention of depression, and is used in routine practice in several countries. The CWD is a highly structured cognitive-behavioral intervention, which has been adapted for several goals, contexts, and target populations. The efficacy of the CWD has been examined in 25 randomized controlled trials. We conducted a meta-analysis of these studies. The 6 studies aimed at the prevention of new cases of major depression were found to result in a reduced risk of getting major depression of 38% (incidence rate ratio was 0.62). The 18 studies examining the CWD as a treatment of depression found a mean effect size (Cohen's d) of 0.28. Direct comparisons with other psychotherapies did not result in any indication that the CWD was less efficacious. The CWD is a flexible treatment which can easily be adapted for different populations and this may have led researchers to use this intervention for complex target groups, which in turn may have resulted in a lower mean effect size. The CWD has contributed considerably to the development and innovation of prevention and treatment of depression in many target populations.

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... compared to controls [30]. This d-score is comparable to that reported by Weisz, McCarty, & Valeri [31] (.34), and to the meta-analysis of the international "Coping with Depression" (CWD) course distributed to adolescents [32] (.35), but somewhat lower than reported by Klein, Jacobs, & Reinecke [33] (.59). One potential reason could be that Klein et al. [33] focused exclusively on RCT's involving adolescents with depressive diagnoses, while the others included studies of youths with varying degrees of depressive symptomatology. ...
... One potential reason could be that Klein et al. [33] focused exclusively on RCT's involving adolescents with depressive diagnoses, while the others included studies of youths with varying degrees of depressive symptomatology. We would thereby expect an effect comparable to Keles and Idsoe [30], Weisz et al. [31] and CWD [32]. ...
... The effect size was small to medium (d = −.31). As expected, our effect size was in accordance with the one from the meta-analysis of Keles and Idsoe [30] (.28), Weisz et al. [31] (.34) and to the meta-analysis of the "Coping with Depression" course distributed to adolescents (.35) [32]. The 6-point reduction on the CES-D score for the intervention group goes from about 33 at pre-test to slightly below 27 at post-test, indicating that the average score is below the cutoff suggested by Manson et al. [43]. ...
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Background The group-based CBT intervention, the Adolescent Coping with Depression Course (ACDC), has previously been evaluated within a quasi-experimental design, showing reduction in depressive symptoms compared to a benchmark of similar studies. The aim of our study was to investigate the effectiveness of ACDC within a randomized controlled (RCT) design. Method Thirty-five course/control leaders randomly assigned to provide ACDC or usual care (UC) recruited 133 adolescents allocated to ACDC and 95 to UC. ACDC participants received eight weekly sessions and two follow-up sessions about 3 and 6 weeks after the last session. UC participants received usual care as implemented at the different sites. Depressive symptoms were measured with the Center for Epidemiologic Studies Depression Scale for adolescents (CES-D), perfectionism with the revised version of the Dysfunctional Attitude Scale (DAS), and rumination with the revised version of the Ruminative Responses Scale (RRS). Attrition was considered missing at random (MAR) and handled with a full information maximum likelihood (FIML) procedure. Results Intention to treat analysis (ITT), including baseline scores and predictors of missing data as control or auxiliary variables, showed a small to medium reduction in depressive symptoms for the ACDC group compared to UC (d = −.31). Changes in perfectionism and rumination in favor of the intervention were also significant. Sensitivity analyses confirmed the findings from the ITT analyses. Conclusions The current study supports the effectiveness of this group-based CBT intervention. The intervention can hopefully result in clinically significant reductions in symptoms associated with depression among adolescents. Trial registration ISRCTN registry ISRCTN19700389. Registered 6 October 2015.
... 19 The intervention's format was informed by meta-analyses showing promising results for bibliotherapy, group-based prerecorded psycho educational self-help inter ventions and guided self-help in general. 20,21 The intervention builds on existing innovations in delivery of mental health interventions in humanitarian settings by relying on task sharing and addressing a broader range of mental health difficulties. At the same time, the intervention was designed to address challenges related to scale and access, by further reducing the burden and demand on a workforce of nonspecialists through a preformatted multimedia delivery package, and to more quickly reach larger numbers of people by being able to be delivered in workshops of 20-30 people. ...
... We predicted small-to-medium effect sizes at the 3-month follow-up, based on meta-analyses of similar self-help, psychoeducational interventions, and were interested in detecting an effect size of at least 0·20. 20,28 We used the PowerUp! Tool to estimate sample size, using an average cluster size of 42 individuals, 14 clusters (equal assumed), intracluster correlation of 0·012, 20% attrition, 80% power, an α of 0·05, and a two-tailed test. ...
... Identified effects were robustie, not moderated by trauma and gender-based violence exposure, length of time in settlement, or baseline levels of distress. Identified effect sizes were similar to psychoeducational courses evaluated in adversity-affected populations living in high-income countries (eg, the coping with depression course has a pooled effect size of d 0·28), 20 and some transdiagnostic interventions in conflict-affected low-resource settings. 12 Screening for moderate psychological distress resulted in neglible exclusion and de-facto implementation of Self-Help Plus as a universal intervention in these refugee settlements. ...
Article
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Background: Innovative solutions are required to provide mental health support at scale in low-resource humanitarian contexts. We aimed to assess the effectiveness of a facilitator-guided, group-based, self-help intervention (Self-Help Plus) to reduce psychological distress in female refugees. Methods: We did a cluster randomised trial in rural refugee settlements in northern Uganda. Participants were female South Sudanese refugees with at least moderate levels of psychological distress (cutoff ≥5 on the Kessler 6). The intervention comprised access to usual care and five 2-h audio-recorded stress-management workshops (20-30 refugees) led by briefly trained lay facilitators, accompanied by an illustrated self-help book. Villages were randomly assigned to either intervention (Self-Help Plus or enhanced usual care) on a 1:1 basis. Within 14 villages, randomly selected households were approached. Screening of women in households continued until 20-30 eligible participants were identified per site. The primary outcome was individual psychological distress, assessed using the Kessler 6 symptom checklist 1 week before, 1 week after, and 3 months after intervention, in the intention-to-treat population. All outcomes were measured at the individual (rather than cluster) level. Secondary outcomes included personally identified problems, post-traumatic stress, depression symptoms, feelings of anger, social interactions with other ethnic groups, functional impairment, and subjective wellbeing. Assessors were masked to allocation. This trial was prospectively registered at ISRCTN, number 50148022. Findings: Of 694 eligible participants (331 Self-Help Plus, 363 enhanced usual care), 613 (88%) completed all assessments. Compared with controls, we found stronger improvements for Self-Help Plus on psychological distress 3 months post intervention (β -1·20, 95% CI -2·33 to -0·08; p=0·04; d -0·26). We also found larger improvements for Self-Help Plus 3 months post-intervention for five of eight secondary outcomes (effect size range -0·30 to -0·36). Refugees with different trauma exposure, length of time in settlements, and initial psychological distress benefited similarly. With regard to safety considerations, the independent data safety management board responded to six adverse events, and none were evaluated to be concerns in response to the intervention. Interpretation: Self-Help Plus is an innovative, facilitator-guided, group-based self-help intervention that can be rapidly deployed to large numbers of participants, and resulted in meaningful reductions in psychological distress at 3 months among South Sudanese female refugees. Funding: Research for Health in Humanitarian Crises (R2HC) Programme.
... 19 The intervention's format was informed by meta-analyses showing promising results for bibliotherapy, group-based prerecorded psycho educational self-help inter ventions and guided self-help in general. 20,21 The intervention builds on existing innovations in delivery of mental health interventions in humanitarian settings by relying on task sharing and addressing a broader range of mental health difficulties. At the same time, the intervention was designed to address challenges related to scale and access, by further reducing the burden and demand on a workforce of nonspecialists through a preformatted multimedia delivery package, and to more quickly reach larger numbers of people by being able to be delivered in workshops of 20-30 people. ...
... We predicted small-to-medium effect sizes at the 3-month follow-up, based on meta-analyses of similar self-help, psychoeducational interventions, and were interested in detecting an effect size of at least 0·20. 20,28 We used the PowerUp! Tool to estimate sample size, using an average cluster size of 42 individuals, 14 clusters (equal assumed), intracluster correlation of 0·012, 20% attrition, 80% power, an α of 0·05, and a two-tailed test. ...
... Identified effects were robustie, not moderated by trauma and gender-based violence exposure, length of time in settlement, or baseline levels of distress. Identified effect sizes were similar to psychoeducational courses evaluated in adversity-affected populations living in high-income countries (eg, the coping with depression course has a pooled effect size of d 0·28), 20 and some transdiagnostic interventions in conflict-affected low-resource settings. 12 Screening for moderate psychological distress resulted in neglible exclusion and de-facto implementation of Self-Help Plus as a universal intervention in these refugee settlements. ...
... MindPower is a universal adaption of the Coping With Strain (CWS) course, which in itself is a modi cation of the Coping With Depression (CWD) course. CWD/CWS interventions have been tested for 30 years in several settings (16,17), ranging from treatment facilities for depression (18,19) and adolescents (20), to workplaces (21,22). However, most of these initiatives have targeted groups with an elevated risk. ...
... Also for RADS-2:SF we observed a small but signi cant increase throughout the study period, a signi cant baseline difference between IG1 and IG2, an increase in scores over the course period, and a markedly lower RADS-2:SF score among boys. (17,22). The traditional CWD/CWS courses have mainly targeted high risk groups for depression and been delivered within a health service context. ...
... However, in the present project, students and teachers were asked to give feedback on the course book before the implementation of the program. Furthermore, MindPower lasts for 90 minutes rather than two and a half hours as in traditional Coping With Depression/Coping with Strain-courses (17,21). This change was made by the designer of MindPower to ease the implementation of MindPower in schools. ...
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Background The previous decade has shown increased symptoms of depression and anxiety among adolescents. To promote mental health and reduce mental illness, the government of Norway has, as in other countries, pledged that all schools must incorporate life-skills education. We report results from an evaluation of MindPower, a modification of the Coping With Depression (CWD) course, delivered universally in the classroom to secondary high school students, aged 15-16 years, in one county in Norway. The aim of the study was to evaluate the effect of MindPower on symptoms of depression and anxiety. Methods We utilized a two-groups` delayed intervention design where 110 first year high school classes were randomized into one of two intervention groups (IG1 and IG2). IG1 participated in MindPower while IG2 served as a control group for four months until the intervention started also in this group. IG1 and IG2 responded to questionnaires before and after the eight weeks course, at the start of the first and the second booster session, and at the five months follow up. Questionnaires, including online versions of the Hopkins Symptom Checklist (SCL-8) and the Reynolds Adolescent Depression Scale (RADS-2:SF), were administered to 1673 out of a total of 2384 students. SCL-levels were also compared with those from a large population study (UngData). Results According to mixed model analyses, SCL-8 and RADS-2:SF showed significant baseline differences between IG1 and IG2. In IG1 and IG2, both SCL-8 and RADS-2:SF showed a small but significant increase in mean scores throughout the study period, with markedly lower mean scores among boys. The SCL-levels were first lower for both girls and boys and then after the completion of MindPower the SCL-levels, equal to the SCL-levels in UngData. Conclusions No effects of the intervention were found. This large universal school-based trial suffered from considerable drop-out of participants. Experiences from implementation and evaluation of universal mental health promotion and preventive school interventions are thoroughly discussed, including, preparation, resources, support, time, realistic expectations, teacher selection and training, implementation, and research designs and more. Several empirically based, practical advices are presented. Clinical Trial registration 27/08/2018. Registration number NCT03647826.
... Researchers have found dance to be a culturally relevant physical activity that is enjoyed by minority women in low-resourced communities (Feinberg et al., 2016;Schroeder et al., 2017). Despite these facts, current depression prevention programs in general have mostly targeted middle-aged to older adults (Centers for Disease Control and Prevention, 2020a), individuals of higher socioeconomic status (Lakes et al., 2016), children and adolescents, and clinical samples employing only one intervention component (Atkins et al., 2018;Cuijpers et al., 2009;Schroeder et al., 2017). Multicomponent interventions include several elements or treatment components that when combined contribute to improved outcomes (National Institute of Mental Health, 2020a; Wang et al., 2016). ...
... This study tests the effectiveness of a depression prevention, and physical activity pilot intervention designed for young to middle-aged adult mothers at risk that contains several evidenced-based components known to reduce depression risk in low-income and ethnic minority populations (Atkins et al., 2018;Cuijpers et al., 2009). If effective, this knowledge can be used to implement larger-scale interventions and design programs to reduce depression risk in vulnerable mothers who reside in under-resourced communities. ...
... Depression interventions have mainly focused on screening and treatment of individuals already depressed and have taken place mostly in clinical settings (Dwight-Johnson et al., 2011). Target populations for depression prevention have mainly been older adults (Centers for Disease Control and Prevention, 2020a), adolescents (Cuijpers et al., 2009), and higher-income individuals (Lakes et al., 2016). Studies that have explored the psychosocial health effects of physical activity group-dance interventions have primarily examined these effects in middle-aged to older adults (Atkins et al., 2018(Atkins et al., , 2019Murrock & Graor, 2016), or older adults in non-U.S. ...
Article
The purpose of this study was to develop a 12-week multicomponent, depression prevention pilot intervention and evaluate its feasibility and preliminary effects on improving levels and correlates of depressive symptoms, including anger, self-esteem perceived stress, social support, and racism. A quasi-experimental, mixed-methods design and a community-based participatory research (CBPR) approach was employed. University faculty, students and community residents collaborated at a low-income housing complex in a low-resourced, urban community. Fifteen low-income, ethnic minority mothers ages 23-46 years completed the intervention and evaluation surveys. Eight mothers participated in a focus group. The intervention included social group-dance, health education, and socialization. t-Tests, sign-tests, and thematic analysis was employed. Mothers identified barriers and facilitators of program engagement. Depressive symptoms were significantly reduced (t(14) = 2.41, p = .030). Self-esteem (t(14) = 2.28, p = .039) and social support levels (M = 4.5, p = .035) were significantly increased. This multicomponent intervention is feasible. Preliminary efficacy evidence was mixed.
... 15 Most of the available studies on selective or universal prevention have focused on preventing depression and related affective symptoms, but the findings are conflicting. [16][17][18][19] Among the specific types of selective or universal interventions, psychopharmacological treatments are rarely used, 20 whereas psychotherapy 21 and psychoeducation 22 are more frequent. Other interventions may include parent training, 23 physical activity, 24 or mindfulness-based interventions, 25 but their efficacy is, again, not fully established. ...
... A previous meta-analysis found significant reductions in anxiety symptoms after cognitive-behavioral interventions, but effect sizes were small. 345 Our meta-analysis showed that preventive interventions for affective symptoms were effective-especially psychoeducation, in line with previous meta-analyses, 22,342,346 which reported a small effect size for universal interventions for affective symptoms. 342 EMOTIONAL AND BEHAVIORAL PROBLEMS Our meta-analysis found that universal and selective interventions are equally effective for preventing emotional and behavioral problems, with a smaller effect size than the one found in a previous meta-analysis focusing on preventive parenting programs for emotional and behavioral problems on children. ...
Article
Background: Much is not known about the efficacy of interventions to prevent poor mental health outcomes in young people by targeting either the general population (universal prevention) or asymptomatic individuals with high risk of developing a mental disorder (selective prevention). Methods: We conducted a PRISMA/MOOSE-compliant systematic review and meta-analysis of Web of Science to identify studies comparing post-test efficacy (effect size [ES]; Hedges' g) of universal or selective interventions for poor mental health outcomes versus control groups, in samples with mean age <35 years (PROSPERO: CRD42018102143). Measurements included random-effects models, I2 statistics, publication bias, meta-regression, sensitivity analyses, quality assessments, number needed to treat, and population impact number. Results: 295 articles (447,206 individuals; mean age = 15.4) appraising 17 poor mental health outcomes were included. Compared to control conditions, universal and selective interventions improved (in descending magnitude order) interpersonal violence, general psychological distress, alcohol use, anxiety features, affective symptoms, other emotional and behavioral problems, consequences of alcohol use, posttraumatic stress disorder features, conduct problems, tobacco use, externalizing behaviors, attention-deficit/hyperactivity disorder features, and cannabis use, but not eating-related problems, impaired functioning, internalizing behavior, or sleep-related problems. Psychoeducation had the highest effect size for ADHD features, affective symptoms, and interpersonal violence. Psychotherapy had the highest effect size for anxiety features. Conclusion: Universal and selective preventive interventions for young individuals are feasible and can improve poor mental health outcomes.
... The manual was developed in the late 1970s (Lewinsohn et al., 1984) and has since then been adapted for several specific target populations. A meta-analysis of these studies was published earlier (Cuijpers, Munoz, et al., 2009). An intervention was coded for this treatment when it explicitly referred to this manual (although it could be adapted for the target population). ...
... This course is often used with difficult populations, such as alcoholics or juvenile delinquents with depression, because it can be easily adapted to different populations. In a separate metaanalysis of the "Coping with Depression" course that we conducted some time ago, we found that trials in which the course was directly compared with other interventions did not indicate significant differences with other therapies (Cuijpers, Munoz, Clarke, & Lewinsohn, 2009). This suggests that the course may not be less effective than other therapies. ...
Article
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Objective: In the past decades, many different types of psychotherapy for adult depression have been developed. Method: In this meta-analysis we examined the effects of 15 different types of psychotherapy using 385 comparisons between a therapy and a control condition: Acceptance and commitment therapy, mindfulness-based cognitive behavior therapy (CBT), guided self-help using a self-help book from David Burns, Beck’s CBT, the “Coping with Depression” course, two subtypes of behavioral activation, extended and brief problem-solving therapy, self-examination therapy, brief psychodynamic therapy, non-directive counseling, full and brief interpersonal psychotherapy, and life review therapy. Results: The effect sizes ranged from g = 0.38 for the “Coping with Depression” course to g = 1.10 for life review therapy. There was significant publication bias for most therapies. In 70% of the trials there was at least some risk of bias. After adjusting studies with low risk of bias for publication bias, only two types of therapy remained significant (the “Coping with Depression” course, and self-examination therapy). Conclusions: We conclude that the 15 types of psychotherapy may be effective in the treatment of depression. However, the evidence is not conclusive because of high levels of heterogeneity, publication bias, and the risk of bias in the majority of studies.
... Psychoeducational interventions typically provide factual didactic information and can also include interactive activities and consumer educators. Psychoeducational interventions have demonstrated utility in preventing major depressive disorder [35], decreasing symptom burden [35][36][37], decreasing the risk of depression relapse [37], improving the quality of life [36], and improving global functioning [37]. Mental Health First Aid (MHFA) is such an intervention and is recognized as a Substance Abuse and Mental Health Services Administration (SAMHSA) national evidence-based program. ...
... Psychoeducational interventions typically provide factual didactic information and can also include interactive activities and consumer educators. Psychoeducational interventions have demonstrated utility in preventing major depressive disorder [35], decreasing symptom burden [35][36][37], decreasing the risk of depression relapse [37], improving the quality of life [36], and improving global functioning [37]. Mental Health First Aid (MHFA) is such an intervention and is recognized as a Substance Abuse and Mental Health Services Administration (SAMHSA) national evidence-based program. ...
Article
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Background: In the United States, among those living with mental illness, 81% of African American (AA) young adults do not seek treatment compared with 66% of their white counterparts. Although the literature has identified unique culturally related factors that impact help seeking among AAs, limited information exists regarding the development and evaluation of interventions that incorporate these unique factors. Objective: This study aims to describe a study protocol designed to develop a culturally relevant, theory-based, psychoeducational intervention for AA young adults; to determine if exposure to the intervention impacts AA young adults' willingness to seek help; and to determine whether cultural factors and stigma add to the prediction of willingness to seek help. Methods: The Theory of Planned Behavior (TPB) and Barrera and Castro's framework for cultural adaptation of interventions were used as guiding frameworks. In stage 1 (information gathering), a literature review and three focus groups were conducted to identify salient cultural beliefs. Using stage 1 results, the intervention was designed in stage 2 (preliminary adaptation design), and in stage 3 (preliminary adaptation tests), the intervention was tested using pretest, posttest, and 3-month follow-up surveys. An experimental, mixed methods, prospective one-group intervention design was employed, and the primary outcomes were participants' willingness and intention to seek help for depression and actual help-seeking behavior. Results: This study was funded in May 2016 and approved by the University of Texas at Austin institutional review board. Data were collected from November 2016 to March 2016. Of the 103 students who signed up to participate in the study, 70 (67.9%) completed the pre- and posttest surveys. The findings are expected to be submitted for publication in 2020. Conclusions: The findings from this research are expected to improve clinical practice by providing empirical evidence as to whether a culturally relevant psychoeducational intervention is useful for improving help seeking among young AAs. It will also inform future research and intervention development involving the TPB and willingness to seek help by identifying the important factors related to willingness to seek help. Advancing this field of research may facilitate improvements in help-seeking behavior among AA young people and reduce the associated mental health disparities that apparently manifest early on. International registered report identifier (irrid): DERR1-10.2196/16267.
... Several RCT's have repeatedly shown that CWD-A is more effective than inactive control conditions [25][26][27][28][29][30][31] and treatment as usual 26 , However, these results are also inconclusive 32 . When comparing the results of several studies on CWD-A with an active control condition (which consisted of Care as usual, Interpersonal therapy or CWD-A plus a parent training) for adolescents diagnosed with a depression, a small-to-moderate effect size of 0.35 was found 33 . CWD-A is regarded as probably efficacious because studies were conducted by only one research group, solely within the American population and not with clinically referred adolescents 34 . ...
... We hypothesized that CBT would outperform TAU, but it did not. Previous research showed that the group manual of CWD-A outperformed TAU in several RCT's (n = 3) 33 . However, the finding of this study is in line with the results of a more recent meta-analysis showing that evidence-based protocols do not outperform usual care in clinically referred samples or in youths with a diagnosis, including depression 70 . ...
Article
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We examined if manualized cognitive behavioral therapy (CBT) was more effective than Treatment As Usual (TAU) for clinically depressed adolescents within routine care. This multisite Randomized controlled trail included 88 clinically depressed adolescents (aged 12-21 years) randomly assigned to CBT or TAU. Multiple assessments (pre-, post treatment and six-month follow-up) were done using semi-structured interviews, questionnaires and ratings and multiple informants. The primary outcome was depressive or dysthymic disorder based on the KSADS. Completers, CBT (n = 19) and TAU (n = 26), showed a significant reduction of affective diagnoses at post treatment (76% versus 76%) and after six months (90% versus 79%). Intention-to-treat analyses on depressive symptoms showed that 41.6% within CBT and 31.8% within the TAU condition was below clinical cut-off at post treatment and after six-months, respectively 61.4% and 47.7%. No significant differences in self-reported depressive symptoms between CBT and TAU were found. No prediction or moderation effects were found for age, gender, child/parent educational level, suicidal criteria, comorbidity, and severity of depression. We conclude that CBT did not outperform TAU in clinical practice in the Netherlands. Both treatments were found to be suitable to treat clinically referred depressed adolescents. CBT needs further improvement to decrease symptom levels below the clinical cut-off at post treatment.
... Similarly, recognizing the poor developmental and BPT outcomes associated with maternal depression (Owens et al., 2003), Chronis and colleagues (2006) evaluated an adaptation of the Coping with Depression Course (CWDC; Cuijpers et al., 2009), an evidence-based group CBT program for depression, in a sample of mothers of children with ADHD who had just engaged in an intensive summer treatment program for ADHD. As part of this preliminary evaluation study, Chronis and colleagues (2006) found treatment effects on depressive causal attributions of child behaviors and negative expectations regarding child behaviors. ...
... The integrated parenting intervention for ADHD ("IPI-A"; [removed for masked review]) is a 14-session treatment that integrates BPT following the Defiant Children manual (Barkley, 1997) and the Coping with Depression Course (CWDC; Cuijpers et al., 2009) to facilitate the use of CBT skills in the parenting context. See Table 2 for session topics. ...
Article
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More than half of mothers of children with ADHD have a lifetime history of major depressive disorder. Prior research has thus examined treatments integrating behavioral parent training (BPT) and cognitive-behavioral therapy (CBT) to target parent depressive symptoms that may contribute to negative parent/child behaviors. However, little is known about whether such interventions affect depressogenic cognitions of child behaviors and pathways by which these cognitions impact parenting. This study examined effects of the integrated parenting intervention for ADHD (IPI-A; a combination of group CBT for depression with BPT), and standard BPT on post-treatment child-blaming and child-crediting attributions, and maternal expectations of child compliance. We hypothesized that randomization to IPI-A would predict greater reductions in depressogenic cognitions of child behavior, relative to BPT. The current study also explored maternal attributions as mechanisms of change in observed parenting outcomes. Participants were 98 children (Mage = 8.78; 66% Male) with ADHD and their biological mothers with at least a mild level of depressive symptoms. Mothers in IPI-A reported significantly more post-treatment child-crediting attributions relative to those in BPT. Treatment group was not associated with post-treatment child-blaming attributions or expectations for child compliance. Exploratory mediation analyses demonstrated that post-treatment child-crediting attributions mediated the association between treatment condition and observed negative parenting at post-treatment. Specifically, mothers in IPI-A (vs. BPT) exhibited less negative parenting at post-treatment via more child-crediting attributions. These findings indicate that integrating CBT skills in BPT for child ADHD enhances outcomes on child-crediting attributions for mothers with elevated depressive symptoms.
... The WCF-MSS could be used not only with MDD patients but also with non-MDD high-risk groups, as the WCF-MSS logit score significantly correlated with SDS scores. Early-stage WCF-MSS-based MDD screening may enable effective and low-cost treatment (Andrews et al., 2004;Rush et al., 2006;Trivedi et al., 2006;Cuijpers et al., 2009). The WCF-MSS could be used to exclude malingering, as it enables screening without history taking. ...
Article
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Background To increase the consultation rate of potential major depressive disorder (MDD) patients, we developed a contact-type fingertip photoplethysmography-based MDD screening system. With the outbreak of SARS-CoV-2, we developed an alternative to contact-type fingertip photoplethysmography: a novel web camera-based contact-free MDD screening system (WCF-MSS) for non-contact measurement of autonomic transient responses induced by a mental task. Methods The WCF-MSS measures time-series interbeat intervals (IBI) by monitoring color tone changes in the facial region of interest induced by arterial pulsation using a web camera (1920 × 1080 pixels, 30 frames/s). Artifacts caused by body movements and head shakes are reduced. The WCF-MSS evaluates autonomic nervous activation from time-series IBI by calculating LF (0.04–0.15 Hz) components of heart rate variability (HRV) corresponding to sympathetic and parasympathetic nervous activity and HF (0.15–0.4 Hz) components equivalent to parasympathetic activities. The clinical test procedure comprises a pre-rest period (Pre-R; 140 s), mental task period (MT; 100 s), and post-rest period (Post-R; 120 s). The WCF-MSS uses logistic regression analysis to discriminate MDD patients from healthy volunteers via an optimal combination of four explanatory variables determined by a minimum redundancy maximum relevance algorithm: HF during MT (HF MT ), the percentage change of LF from pre-rest to MT (%ΔLF (Pre–R⇒ MT) ), the percentage change of HF from pre-rest to MT (%ΔHF (Pre–R⇒ MT) ), and the percentage change of HF from MT to post-rest (%ΔHF (MT⇒ Post–R) ). To clinically test the WCF-MSS, 26 MDD patients (16 males and 10 females, 20–58 years) were recruited from BESLI Clinic in Tokyo, and 27 healthy volunteers (15 males and 12 females, 18–60 years) were recruited from Tokyo Metropolitan University and RICOH Company, Ltd. Electrocardiography was used to calculate HRV variables as references. Result The WCF-MSS achieved 73% sensitivity and 85% specificity on 5-fold cross-validation. IBI correlated significantly with IBI from reference electrocardiography ( r = 0.97, p < 0.0001). Logit scores and subjective self-rating depression scale scores correlated significantly ( r = 0.43, p < 0.05). Conclusion The WCF-MSS seems a promising contact-free MDD screening apparatus. This method enables web camera built-in smartphones to be used as MDD screening systems.
... The evidence base for low-intensity interventions covers over 30 reviews and meta-analyses (Delgadillo, 2018). This includes, for example, evaluations of bibliotherapy (Cuijpers, 1997), technology assisted self-help (Karyotaki et al., 2017), guided self-help (Farrand & Woodford, 2013), and guided self-help to prevent the onset of depression (Cuijpers, Muñoz, Clarke, & Lewinsohn, 2009). Increasing access to evidence-based interventions in low/middle-income countries particularly emphasizes the role played by LI-CBT (Singla et al., 2017). ...
Article
Despite the vastly increased dissemination of the low-intensity (LI) version of cognitive behavior therapy (CBT) for the treatment of anxiety and depression, no valid and reliable indices of the LI-CBT clinical competencies currently exist. This research therefore sought to develop and evaluate two measures: the low-intensity assessment competency scale (LIAC) and the low-intensity treatment competency scale (LITC). Inductive and deductive methods were used to construct the competency scales and detailed rating manuals were prepared. Two studies were then completed. The first study used a quantitative, fully-crossed design and the second a multi-center, quantitative longitudinal design. In study one, novice, qualified, and expert LI-CBT practitioners rated an LI-CBT assessment session (using the LIAC) and an LI-CBT treatment session (using the LITC). Study two used the LIAC and LITC across four training sites to analyze the competencies of LI-CBT practitioners over time, across raters, and in relation to the actor/patients’ feedback concerning helpfulness, the alliance, and willingness to return. Both the LIAC and LITC were found to be single factor scales with good internal, test-retest reliability and reasonable inter-rater reliability. Both measures were sensitive to measuring change in clinical competence. The LIAC had good concurrent, criterion, discriminant, and predictive validity, while the LITC had good concurrent, criterion, and predictive validity, but limited discriminant validity. A score of 18 accurately delineated a minimum level of competence in LI-CBT assessment and treatment practice, with incompetent practice associated with patient disengagement. These observational ratings scales can contribute to the clinical governance of the burgeoning use of LI-CBT interventions for anxiety and depression in routine services and also in the methods of controlled studies.
... With regard to psychoeducation, it has been demonstrated that it is an effective therapy in the treatment of depression in adults [16,17] as it decreases depressive symptoms and risk of relapse/recurrence, and improves treatment compliance [17][18][19]. Adherence to psychoeducation interventions is high, according to some authors, with a reported attendance of 73-87% in all the group sessions [18,20]. Moreover, such therapy could be carried out in primary care by community nurses with previous training [18,20]. ...
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Background: Depressive disorders are the third leading cause of consultation in primary care, mainly in patients with chronic physical illnesses. Studies have shown the effectiveness of group psychoeducation in reducing symptoms in depressive individuals. Our primary aim is to evaluate the effectiveness of an intervention based on a psychoeducational program, carried out by primary care nurses, to improve the remission/response rate of depression in patients with chronic physical illness. Secondarily, to assess the cost-effectiveness of the intervention, its impact on improving control of the physical pathology and quality of life, and intervention feasibility. Methods/design: A multicenter, randomized, clinical trial, with two groups and one-year follow-up evaluation. Economic evaluation study. Subjects: We will assess 504 patients (252 in each group) aged > 50 years assigned to 25 primary healthcare centers (PHC) from Catalonia (urban, semi-urban, and rural). Participants suffer from major depression (Beck depression inventory: BDI-II 13-28) and at least one of the following: type 2 diabetes mellitus, chronic obstructive pulmonary disease, asthma, and/or ischemic cardiopathy. Patients with moderate/severe suicide risk or severe mental disorders are excluded. Participants will be distributed randomly into the intervention group (IG) and control (CG). Intervention: The IG will participate in the psychoeducational intervention: 12 sessions of 90 min, once a week led by two Primary Care (PC) nurses. The sessions will consist of health education regarding chronic physical illness and depressive symptoms. Main measurements: Clinical remission of depression and/or response to intervention (BDI-II). Secondary measurements: Improvement in control of chronic diseases (blood test and physical parameters), drug compliance (Morinsky-Green test and number of containers returned), quality of life (EQ-5D), medical service utilization (appointments and hospital admissions due to complications), and feasibility of the intervention (satisfaction and compliance). Evaluations will be blinded, and conducted at baseline, post-intervention, and 12 months follow-up. Discussion: Results could be informative for efforts to prevent depression in patients with a chronic physical illness. Trial registration: NCT03243799 (registration date August 9, 2017).
... Therefore, it is important that depression is detected at an early stage and is treated preventively. Programs based on the principles of Cognitive Behavioural Therapy (CBT) have proven to be the most effective and most applied in preventing depression among adolescents (e.g., [13]). Thus far, research has mainly focused on effectiveness of prevention programs as "packages" consisting of multiple CBT-components, rather than on the distinct CBT-components. ...
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Background: Both depressive disorder and subclinical depressive symptoms during adolescence are a major public health concern. Therefore, it is important that depression is detected at an early stage and is treated preventively. Prevention based on the principles of Cognitive Behavioural Therapy (CBT) has proven to be the most effective, however research has mainly focused on the effectiveness of "prevention packages" consisting of multiple CBT-components, rather than on the distinct CBT-components. This study will evaluate the relative effectiveness of four core components of CBT (cognitive restructuring (CR), behavioural activation (BA), problem solving (PS) and relaxation (RE)). In addition the relative (cost-)effectiveness of four different sequences of these components will be evaluated: (1) CR - BA - RE - PS, (2) BA - CR - RE - PS, (3) PS - GA - CR - RE and (4) RE - PS - BA - CR. Methods: We will perform a non-blinded multisite cluster randomized prevention microtrial with four parallel conditions consisting of the four sequences. The four sequences of components will be offered in groups of high school students with elevated depressive symptoms. For each CBT-component a module of three sessions is developed. Assessments will be conducted at baseline, after each CBT-component, prior to each session, at post-intervention and at 6-month follow-up. Potential moderators and mediators will be evaluated exploratively to shed light on for whom the (sequences of) CBT-components are most effective and how effects are mediated. Discussion: The potential value of the study is insight in the relative effectiveness of the four most commonly used CBT-components and four different sequences, and possible moderators and mediators in the prevention of depression among adolescents. This knowledge can be used to optimize and personalize CBT-programs. Trial registration: The study is registered in the Dutch Trial Register (Trial NL5584 / NTR6176) on October 13, 2016.
... Una meta analisi del 2011 (Durlak et al. 2011) ha dimostrato che gli interventi volti a migliorare l'apprendimento emozionale nei bambini e negli adolescenti (dai 5 ai 18 anni) possono essere efficaci nel migliorare le capacità sociali ed emozionali e la performance accademica. Vi sono altresì pochi studi che hanno valutato l'efficacia di questi training sugli adulti: se, infatti, sono presenti nella letteratura scientifica diversi studi che dimostrano l'efficacia di programmi di intervento messi a punto per la prevenzione della depressione (Cuijpers et al. 2009) e del panico (Meulenbeek et al. 2010), e per la promozione della salute mentale (Fledderus et al. 2011) sia in campioni clinici che non clinici, pochi sono gli studi su popolazioni adulte che dimostrano l'efficacia di interventi specificatamente incentrati sul miglioramento delle capacità di regolazione delle emozioni. Ad esempio, Sobhi-Gharamaleki et al. (2015) hanno dimostrato l'efficacia di un training di regolazione delle emozioni per la riduzione di ansia, stress e sintomi depressivi in un campione di studenti universitari, rilevando come questi sintomi fossero significativamente ridotti nel gruppo che aveva svolto il training rispetto ai controlli; non è stata però dimostrata l'efficacia del training rispetto a cambiamenti nell'utilizzo di specifiche strategie di regolazione emotiva. ...
Article
Oggetto: La regolazione emotiva (RE) è fondamentale per il benessere psicofisico degli studenti universitari che spesso si trovano a fronteggiare situazioni stressanti e stimoli del tutto nuovi. In letteratura sono pochi gli studi che verifichino gli effetti di training specifici sulla RE con studenti universitari. L’obiettivo di questo studio è quello di misurare l’efficacia di un training di RE volto ad incrementare l’utilizzo della strategia di rivalutazione cognitiva e a ridurre l’utilizzo della soppressione espressiva, strategie di regolazione emotiva associate in letteratura rispettivamente ad outcome psicosociali positivi e negativi. L’obiettivo secondario, invece, è quello di misurare la sua efficacia nel ridurre i sintomi legati ad ansia, depressione e insonnia. Metodo: I punteggi dei questionari somministrati al pre e al post assessment sono analizzati confrontando il gruppo sperimentale di studenti universitari (n = 18) con un gruppo di controllo (n = 16). Risultati: I risultati evidenziano che il gruppo dei partecipanti al training di RE riportano punteggi significativamente più bassi al post training nella scala di soppressione espressiva rispetto ai controlli. Si registrano punteggi significativamente più bassi anche per i sintomi di ansia, seppure al pari dei controlli. Non emergono altri risultati significativi. Conclusioni: Questo studio pilota presenta interessanti risultati preliminari di efficacia, evidenziando la necessità di replicare lo studio in un campione più ampio per la sua potenziale applicazione a livello clinico e subclinico. Objective: Emotion Regulation (ER) plays a critical role in individual psychological and physical well-being, especially in college students who mismanage school-related stress and new stimuli. Only a few studies have attempted to determine the effectiveness of emotion regulation training with both adults and college students. The first aim of this study is to evaluate the effectiveness of ER training program in increasing the use of cognitive reappraisal and in decreasing the use of expressive suppression, two ER strategies respectively related to adaptive and maladaptive psychosocial outcomes. The secondary purpose is to examine the effect of the ER training on the reduction of anxiety, depression and insomnia symptoms. Method: The mean scores of pre-and post-assessment were analyzed by comparing the experimental group of students (N = 18) with a control group (N = 16) and controlling for gender. Results: Students who received ER training reported significant lower post-training scores on expressive suppression than controls. Significant lower post training symptoms of anxiety were observed, although scores did not differ between groups. No significant results emerged for the other investigated issues. Conclusion: This pilot study provided preliminary results on the ER training effectiveness, thus highlighting its potential clinical and subclinical application. It is recommended to replicate the study in a larger sample size using more sophisticated methods.
... [41]. Another meta-analysis reported that BA, often combined with CBT interventions, prevents depression in non-clinical populations [42]. In the CB model, thoughts, emotions, physical feelings, and behavior interact. ...
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Background: Depression is a major problem among nurses; hence, it is important to develop a primary prevention strategy to manage depression among nurses. This randomized controlled trial (RCT) study aims to investigate the effects of a newly developed internet-based cognitive behavioral therapy (iCBT) program on depressive symptoms, measured at baseline and three- and six-month follow-ups, among nurses in Japan. Methods: Nurses working at three university hospitals, one public hospital, and twelve private hospitals who meet inclusion criteria will be recruited and randomized either to the intervention group or the control group (planned N = 525 for each group). The newly developed iCBT program for nurses consists of six modules, which cover different components of cognitive behavioral therapy (CBT); transactional stress model (in module 1), self-monitoring skills (in module 2), behavioral activation skills (in module 3), cognitive restructuring skills (in modules 4 and 5), relaxation skills (in module 5), and problem-solving skills (in module 6). Participants in the intervention group will be asked to read these modules within 9 weeks. The primary outcome will be depressive symptoms as assessed by the Beck Depression Inventory-II (BDI-II) at baseline, three-, and six-month follow-ups. Discussion: The greatest strength of this study is that it is the first RCT to test the effectiveness of the iCBT program in improving depressive symptoms among nurses. A major limitation is that all measurements, including major depressive episodes, are self-reported and may be affected by situational factors at work and participants' perceptions. Trial registration: This trial was registered at the University Hospital Medical Information Network clinical trials registry (UMIN-CTR; ID = UMIN000033521 ) (Date of registration: August 1, 2018).
... However, in the present project, students and teachers were asked to give feedback on the course book before the implementation of the program. Furthermore, Mind-Power lasts for 90 min rather than two and a half hours as in traditional Coping With Depression/Coping with Strain-courses [23,24]. This change was made by the designer of MindPower to ease the implementation of MindPower in schools. ...
Article
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Background The previous decades have shown increased symptoms of depression and anxiety among adolescents. To promote mental health and reduce mental illness, the government of Norway has, as in other countries, pledged that all schools must incorporate life-skills education. We report results from an evaluation of MindPower, a modification of the Coping With Depression (CWD) course, delivered universally in the classroom to secondary high school students, aged 15–16 years, in one county in Norway. The aim of the study was to evaluate the effect of MindPower on symptoms of depression and anxiety. Methods We utilized a two-groups` delayed intervention design where 110 first year high school classes were randomized into one of two intervention groups (IG1 and IG2). IG1 participated in MindPower while IG2 served as a control group for four months until the intervention started also in this group. IG1 and IG2 responded to questionnaires before and after the eight weeks course, at the start of the first and the second booster session, and at the five months follow up. Questionnaires, including online versions of the Hopkins Symptom Checklist (SCL-8) and the Reynolds Adolescent Depression Scale (RADS-2:SF), were administered to 1673 out of a total of 2384 students. SCL-levels were also compared with those from a large population study (UngData). Results According to mixed model analyses, SCL-8 and RADS-2:SF showed significant baseline differences between IG1 and IG2. In IG1 and IG2, both SCL-8 and RADS-2:SF showed a small but significant increase in mean scores throughout the study period, with markedly lower mean scores among boys. The SCL-levels were first lower for both girls and boys and then after the completion of MindPower the SCL-levels, equal to the SCL-levels in UngData. Conclusions No effects of the intervention were found. This large universal school-based trial suffered from considerable drop-out of participants. Experiences from implementation and evaluation of universal mental health promotion and preventive school interventions are thoroughly discussed, including, preparation, resources, support, time, realistic expectations, teacher selection and training, implementation, research designs and more. Several empirically based, practical advices are presented. Clinical Trial registration 27/08/2018. Registration number NCT03647826.
... The behavioral health provider would take on a consultant role to deliver information or provide a brief intervention. This has been called a "toolbox," approach, that may be more well suited to intervention approaches with asymptomatic patients (Cuijpers, Muñoz, Clarke, & Lewinsohn, 2009;James & O'Donohue, 2009). This could include helping patients learn social skills, cognitive restructuring, and behavioral activation to increase pleasant events . ...
Article
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Behavioral health problems are involved in the majority of primary care visits. These behavior disorders (e.g., depression, anxiety, smoking, insomnia, etc.) are costly, burdensome to both the patient and the healthcare system, and result in greater medical utilization/cost and poorer future health outcomes. Integrated behavioral healthcare has been proposed as a model for more efficiently addressing the burden of behavioral health problems. While this model has demonstrated some promise in the treatment of behavioral health problems, as well as in the reduction in costs and improvement in healthcare outcomes, the primary prevention of behavioral health problems in this delivery model has been relatively neglected. The present paper discusses the potential value of incorporating the prevention of behavioral health problems into the annual physical/wellness checkup and proposes a detailed system for how this might be accomplished. Limitations, future research, and costs associated with increased prevention in a primary care context are discussed.
... The CWD program has been used with an array of diverse client populations and in many countries and has been tested in over 25 randomized controlled trials. It has also been shown to be an effective method to prevent depression (Cuijpers et al. 2009). ...
... Il programma di prevenzione universale proposto, parte dall'ipotesi che, promuovendo nei ragazzi che frequentano il primo superiore i fattori di protezione individuati (competenza sociale, cognitiva ed emotiva) e lavorando parallelamente con gli insegnanti per una maggiore diffusione della conoscenza del fenomeno della depressione in età giovanile, dovremmo attenderci da parte dei ragazzi la riduzione del rischio di depressione in linea con quanto evidenziato dalla ricerca: interventi di prevenzione riducono i tassi di depressione tra il 22% e il 38% (Cuijpers, van Straten, Smit, Mihalopoulos, Beekman, 2008;Muñoz, Beardslee, Leykin, 2012) e di depressione maggiore del 38% (Cuijpers, Muñoz, Clarke, Lewinsohn, 2009). ...
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Scopo della presente rassegna è l’analisi critica di alcuni programmi d’intervento psicosociale predisposti dagli studenti specializzandi della scuola del CRP di Roma per l’esame finale del corso quadriennale di Psicoterapia Cognitivo Comportamentale e Intervento Psicosociale. Ne sono stati scelti 33, rappresentativi per tematica, destinatari e per tipologia d’intervento. Psychomed, ISSN: 1828-1516
... A meta-analysis of 25 RCTs conducted on the depression course found an average d of .28 (Cuijpers, Muñoz, Clarke, & Lewinsohn, 2009). It proves scalable, free, and effective, but is below the typical efficacy of individual psychotherapy. ...
Article
Over the past 40 years, few breakthroughs have dramatically increased the impacts of psychotherapy. There have been new and exciting therapies, but the research does not convincingly demonstrate that any recent or more established therapies produce greater impacts than 40 years ago. Seven strategies from the transtheoretical model that have produced breakthroughs in health psychology/population health are analyzed to illustrate how they can similarly generate breakthroughs in mental health outcomes. The first three strategies can enhance impacts by increasing the percentage of troubled populations entering and completing best-practice treatments: reach, recruit, and retain. The fourth strategy accords higher value to synergy than to specificity by generating more benefits from whole-health therapies that briefly treat the small number of behaviors that account for a large percentage of chronic disabilities and premature deaths. The fifth breakthrough strategy creates multiple synergistic changes within individuals; changing one problem behavior promotes the probabilities that individuals will change a second problem (coaction). The sixth strategy increases impacts by complementing psychologists with tailored technology that extends their influence into homes, schools, workplaces, and communities. The seventh strategy calls on researchers to test their innovations against best practices and to benchmark outcomes, like those found with depression. We conclude by advancing a framework that can generate more inclusive and effective psychotherapies by integrating individual health care with population health practices. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
... A previous meta-analysis showed that CBT including BA could significantly reduce the risk of the onset of major depression (incidence rate ratio=0.62) [28]. Imacoco Care introduces how to relate behaviors/actions to feelings, how to maintain mental energy, and which activities lead to good feelings in the following lessons: (1) Tips for Keeping Your Mind Energized During Difficult Daily Life, (2) The Relationship Between What You Do or Don't Do and Your Feelings, (3) Reflecting on Your Life Patterns, (4) Think of a "Safe Activity" That Doesn't Fit Into the "Three Cs" (Crowded Places, Close Contact, Confined and Enclosed Spaces), (5) Let's Make Your Action Plan!, and (6) Reflections: Tips for Acting to Keep Energy in Your Life. ...
Article
Background: The prolonged coronavirus disease 2019 (COVID-19) pandemic has affected mental health among workers. Psychoeducational intervention via an Internet website could be effective for primary prevention of mental illness among workers in the current COVID-19 pandemic. Objective: The aim of this randomized controlled trial (RCT) was to examine the effect of a newly developed online psychoeducational website named "Imacoco Care" on reducing psychological distress and fear about COVID-19 infection among workers. Methods: Participants in the present study were recruited from registered members of a web survey company in Japan. Participants who fulfilled the eligibility criteria were randomly allocated to intervention or control groups. Participants in the intervention group were invited to access the Imacoco Care program within a month after the baseline survey. Kessler's Psychological Distress Scale (K6) and The Fear of COVID-19 Scale (FCV-19S) were obtained at baseline, 1-, and 3-month follow-ups. Results: A total of 1200 workers were randomly allocated to an intervention or control group (n = 600 for each). The Imacoco Care intervention group showed a significant favorable effect on K6 (p = 0.03) with a small effect size (d = -0.14), and an adverse effect on FCV-19S (p = 0.01) with a small effect size (d = 0.16) at 3-month follow-up. In the per-protocol analysis (including only participants who had read the Imacoco Care content at least one time), the Imacoco Care intervention group also showed a significant favorable effect on reducing K6 (p = 0.03), while an adverse effect on FCV-19S was not significant (p = 0.06) in the intervention group at 3-month follow-up. Conclusions: A web-based psychoeducation approach may be effective for improving psychological distress among workers; however, it may be important not only to distribute information but also to encourage active engagement with the content of the program to prevent adverse effects of psychoeducational intervention. Clinicaltrial: The University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR). The registration number is UMIN000042556 (https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000048548).
... Die ermittelte Prävalenzrate von 10,5% für ehrenamtliche Flücht-lingshelferInnen weist darauf hin, dass sowohl präventiv als auch begleitend und nachsorgend im Sinne der Psychoedukation im praktischen Feld über das Phänomen der Sekundären Traumatisierung umfassend aufgeklärt werden sollte. Denn Metaanalysen und systematische Reviews belegen, dass psychoedukative Maßnahmen an sich beeindruckende Effektstärken erreichen (Cuijpers et al. 2009), wobei Zielpersonen sowohl PatientInnen und Risikopersonen als auch Angehörige sein können (Mühlig/Jacobi 2011). Für posttraumatische Störungen bestehen bewährte psychoedukative Manuale (u.a. ...
Article
Zahlreiche ehrenamtliche HelferInnen engagieren sich derzeit für die Integration von Flüchtlingen. In Anlehnung an Studien zu Sekundärer Traumatisierung (ST) bei TraumatherapeutInnen wurde an N = 231 ehrenamtlichen FlüchtlingshelferInnen die Prävalenz von ST und deren Zusammenhang mit emotionaler Empathie als Risikofaktor sowie verschiedenen Copingstrategien als Risiko- und Schutzfaktoren anhand einer Online-Befragung untersucht. Die Prävalenz von ST lag bei 10,5%. Insbesondere emotional empathische FlüchtlingshelferInnen zeigten höhere Werte in ST. Dysfunktionale Copingstrategien verstärkten diesen Zusammenhang. Es konnten keine schützenden Copingstrategien identifiziert werden, sodass es diesbezüglich weiterer Forschung bedarf.
... Interventions delivered through computational software offer a scalable way of addressing some of these concerns because they can be delivered privately via computer or smart phone in the student's home or dorm room at a relatively low cost and at times that are convenient for the student. Interventions offered to everyone emphasizing mind health and optimal performance rather than need for treatment or offered as a course in psychological skills training could potentially avoid the inherent stigma associated with seeking help for psychological problems (Cuijpers et al., 2009). In addition to these possibilities, we are exploring a number of other innovative ways of increasing treatment uptake and retention (Ebert et al., 2019b) and expanding group psychoeducational intervention program to be delivered in a variety of settings and mediums. ...
Article
Research consistently documents high rates of mental health problems among college students and strong associations of these problems with academic role impairment. Less is known, though, about prevalence and effects of physical health problems in relation to mental health problems. The current report investigates this by examining associations of summary physical and mental health scores from the widely-used Short-Form 12 (SF-12) Health Survey with self-reported academic role functioning in a self-report survey of 3,855 first-year students from five universities in the northeastern United States (US; mean age 18.5; 53.0% female). The mean SF-12 physical component summary (PCS) score (55.1) was half a standard deviation above the benchmark US adult population mean. The mean SF-12 mental component summary (MCS) score (38.2) was more than a full standard deviation below the US adult population mean. Two-thirds of students (67.1%) reported at least mild and 10.5% severe health-related academic role impairment on a modified version of the Sheehan Disability Scale. Both PCS and MCS scores were significantly and inversely related to these impairment scores, but with nonlinearities and interactions and much stronger associations involving MCS than PCS. Simulation suggests that an intervention that improved the mental health of all students with scores below the MCS median to be at the median would result in a 61.3% reduction in the proportion of students who experienced severe health-related academic role impairment. Although low-cost scalable interventions exist to address student mental health problems, pragmatic trials are needed to evaluate the effectiveness of these interventions in reducing academic role impairment.
... In international surveys, including both longitudinal studies (Spence, Sheffield, & Donovan, 2005) and reviews of universal preventive interventions in depression (Cuijpers, van Straten, Smit, Mihalopoulos, & Beekman, 2008;Cuijpers, Munoz, Clarke, & Lewinsohn, 2009;Durlak, & Wells, 1997;Horowitz, 2006;Merry, McDowell, Hetrick, Bir, & Muller, 2009) and mental health, the relevant comparable effect sizes vary, where such are reported, between 0.26 to 0.57 (Lipsey, & Wilson, 1993;Merry et al. 2009;Weist, & Albus, 2004;Weisz, Sandler, Durlak, & Anton, 2005). The dependent variables in the study encompass changing, self-perception, behavior, coping, problem solving, school and mental health climate, and referrals. ...
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In the research project in my doctoral thesis I wanted to test the effects of a short preventive mental health program in secondary school. In 2007 there was established a longitudinal study with a test group and a control group (N=1671), built upon Solomon's design. Data was collected through questionnaires prior to intervention and at 1, 6, 12, and 24 months after the intervention. Effect sizes on the various indices are estimated in terms of (a) differences in improvements of total percentage scores and (b) Cohen's d. From t0 to t1, t2 and t3 the intervention group showed significantly greater progress in 6 out of 7 knowledge indexes, and 12 months after the intervention we found significant effects in reduction of mental health problems.
... Results found the program was feasible to administer by peers as measured by session completion and fidelity checklists, and acceptable for delivery based upon interviews with peers and caregiver and peer satisfaction forms by a non-mental health workforce (Acri et al., 2015) In 2016, the authors partnered with a child welfare organization that wanted to improve their current method of detection and referral for caregivers at risk for depression, which was an unstandardized process in which case managers questioned caregivers about their emotional health and provided a referral in the community to conduct an assessment. As described below, SEE contains active strategies linked to the remission of depressive symptoms and barriers to help seeking in the literature, including psychoeducation about depression and problem solving perceived obstacles to mental health treatment (e.g., Cuijpers, Muñoz, Clarke, & Lewinsohn, 2009;Mynors-Wallis, Gath, Day, & Baker, 2000). The justification for this study was as follows: (1) child welfare-involved caregivers evidence high rates of depression yet are unlikely to be engage in treatment; (2) caregiver depression negatively impacts the caregiver, child and family; and, (3) remittance of depression is associated with multiple benefits to the health and wellbeing of family members. ...
Article
Caregivers involved in the child welfare system are at heightened risk for depression, which has innumerable, deleterious effects upon the family. Screening and active outreach can facilitate identification and service use, yet there are considerable obstacles to detection and help-seeking. The purpose of this study was to examine the impact of a peer-delivered detection and active outreach program upon depression and engagement in mental health services. Twenty-four caregivers participated in this four-session intervention (Mage? = ?32.5?±?7.46 years). Caregivers evidenced significant reductions in depressive from baseline to posttest and from baseline to follow-up; scores moved from clinically significant levels of depressive symptoms (M = 26.33) to the subclinical range (M = 14.4 at follow-up). A notable increase in treatment engagement over time, as well as the stability of caregivers involved in treatment was detected. Finally, the number of perceived barriers to help seeking were similar among caregivers who were engaged versus not engaged in services. The findings suggest that the active components of the intervention, when delivered by a peer, can effectively reduce depressive symptoms among high-risk caregivers.
... Common mental disorders (CMDs) such as depression and anxiety disorders are highly prevalent, disabling and costly with diminished quality of life, medical morbidity and mortality (1)(2)(3). It is estimated that every year almost one in five people among the general population worldwide suffers from CMDs (4)(5). ...
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Background There is a strong stigma attached to mental disorders preventing those affected from getting psychological help. The consequences of stigma are worse for racial and/or ethnic minorities who often experience other social adversities such as poverty and discrimination within policies and institutions. This is the first systematic review and meta-analysis summarizing the evidence on the impact of differences in mental illness stigma between racial minorities and majorities. Methods This systematic review and meta-analysis included cross-sectional studies comparing mental illness stigma between racial minorities and majorities. Systematic searches were conducted in the bibliographic databases of PubMed, PsycINFO and EMBASE until 20th December 2018. Outcomes were extracted from published reports, meta-analyses and meta-regression analyses were conducted in CMA software. Results After screening 2,787 abstracts, 29 studies with 193,418 participants (N=35,836 in racial minorities) were eligible for analyses. Racial minorities showed more stigma than racial majorities (g=0.20 (95% CI: 0.12~0.27) for common mental disorders. Sensitivity analyses showed robustness of these results. Multivariate meta-regression analyses pointed to the possible moderating role of the number of studies with high risk of bias on the effect size. Racial minorities have more stigma for common mental disorders when compared with majorities. Limitations included moderate to high risk of bias, high heterogeneity, few studies in most comparisons, and the use of non-standardized outcome measures. Conclusions An important clinical implication of these findings would be to tailor anti-stigma strategies according to specific racial and/or ethnic backgrounds with the intention to improve mental health outreach. These limitations suggest a need for more high quality research on stigma. Key words: stigma; mental illness stigma; common mental disorders; racial minorities
... Common mental disorders (CMDs) such as depression and anxiety disorders are highly prevalent, disabling and costly with diminished quality of life, medical morbidity and mortality (1)(2)(3). It is estimated that every year almost one in ve people among the general population worldwide suffers from CMDs (4)(5). ...
Preprint
Full-text available
Background There is a strong stigma attached to mental disorders preventing those affected from getting psychological help. The consequences of stigma are worse for racial and/or ethnic minorities compared to racial and/or ethnic majorities since the former often experience other social adversities such as poverty and discrimination within policies and institutions. This is the first systematic review and meta-analysis summarizing the evidence on the impact of differences in mental illness stigma between racial minorities and majorities. Methods This systematic review and meta-analysis included cross-sectional studies comparing mental illness stigma between racial minorities and majorities. Systematic searches were conducted in the bibliographic databases of PubMed, PsycINFO and EMBASE until 20 th December 2018. Outcomes were extracted from published reports, and meta-analyses, and meta-regression analyses were conducted in CMA software. Results After screening 2,787 abstracts, 29 studies with 193,418 participants (N=35,836 in racial minorities) were eligible for analyses. Racial minorities showed more stigma than racial majorities (g=0.20 (95% CI: 0.12~0.27) for common mental disorders. Sensitivity analyses showed robustness of these results. Multivariate meta-regression analyses pointed to the possible moderating role of the number of studies with high risk of bias on the effect size. Racial minorities have more stigma for common mental disorders when compared with majorities. Limitations included moderate to high risk of bias, high heterogeneity, few studies in most comparisons, and the use of non-standardized outcome measures. Conclusions Mental illness stigma is higher among ethnic minorities than majorities. An important clinical implication of these findings would be to tailor anti-stigma strategies related with mental illnesses according to specific racial and/or ethnic backgrounds with the intention to improve mental health outreach.
... To obtain objective testing criteria, we examined current guidelines and manuals that are established in the treatment of depression, including the S3 and National Health Care guideline on unipolar depression [59,60], Beck's manual for CBT [61], and the "Coping with Depression" course [62]. ...
Article
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Background Web-based interventions for depression have been widely tested for usability and functioning. However, the few studies that have addressed the therapeutic quality of these interventions have mainly focused on general aspects without consideration of specific quality factors related to particular treatment components. Clinicians and scientists are calling for standardized assessment criteria for web-based interventions to enable effective and trustworthy patient care. Therefore, an extensive evaluation of web-based interventions at the level of individual treatment components based on therapeutic guidelines and manuals is needed. Objective The objective of this study was to evaluate the quality of unguided web-based interventions for depression at the level of individual treatment components based on their adherence to current gold-standard treatment guidelines and manuals. Methods A comprehensive online search of popular app stores and search engines in January 2018 revealed 11 desktop programs and 17 smartphone apps that met the inclusion criteria. Programs and apps were included if they were available for German users, interactive, unguided, and targeted toward depression. All programs and apps were tested by three independent researchers following a standardized procedure with a predefined symptom trajectory. During the testing, all web-based interventions were rated with a standardized list of criteria based on treatment guidelines and manuals for depression. Results Overall interrater reliability for all raters was substantial with an intraclass correlation coefficient of 0.73 and Gwet AC1 value of 0.80. The main features of web-based interventions included mood tracking (24/28, 86%), psychoeducation (21/28, 75%), cognitive restructuring (21/28, 75%), crisis management (20/28, 71%), behavioral activation (19/29, 68%), and relaxation training (18/28, 64%). Overall, therapeutic meaningfulness was rated higher for desktop programs (mean 4.13, SD 1.17) than for smartphone apps (mean 2.92, SD 1.46). Conclusions Although many exercises from manuals are included in web-based interventions, the necessary therapeutic depth of the interventions is often not reached, and risk management is frequently lacking. There is a need for further research targeting general principles for the development and evaluation of therapeutically sound web-based interventions for depression.
... Treatments include traditional face-to-face and online cognitive-behavioral therapies (Cuijpers, Muñoz, Clarke, & Lewinsohn, 2009;Muñoz, Cuijpers, Smit, Barrera, & Leykin, 2010;Newman, Castonguay, Jacobson, & Moore, 2015), interpersonal psychotherapy (Young, Mufson, & Davies, 2006), and problem-solving therapy (Nezu & Perri, 1989) for persons at-risk for or diagnosed with MDD. With knowledge of the factors intervening between perceived childhood parental affection and adulthood MDD, we can make greater strides toward prevention and use the current study findings to power that notion forward. ...
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Background: Parenting theories propose that lack of childhood parental affection confers increased vulnerability to heightened adulthood depression. However, only a few prospective studies have examined this topic, and no studies included mediators of the childhood parental affection-adulthood depression connection. Objective: This study examined parenting, and interpersonal theories by determining if participants' (n= 2,825) mid-life marital instability mediated their perceived childhood parental affection predicting depressive symptoms in adulthood across 18 years. Methods: Childhood maternal and paternal affection (Parental Support Scale) was measured at Time 1 (T1). Depressive symptoms (Composite International Diagnostic Interview-Short Form) were measured at T1, Time 2 (T2), and Time 3 (T3), spaced approximately nine years apart. Marital instability (Marital Instability Index) was measured at T1 and T2. Structural equation modeling analyses were conducted to test whether perceived childhood parental affection would independently negatively predict T3 depressive symptoms, and if participants' mid-life marital instability mediated those relations. All analyses adjusted for prior levels of mediator and outcome variables. Results: Lower perceived childhood maternal and paternal affection predicted higher T3 depressive symptoms. Lower childhood maternal and paternal affection predicted higher T2 marital instability. Greater marital instability in turn predicted elevated T3 depression. Individuals' marital instability mediated those associations, by accounting for 17-20% of the total effects. Conclusion: Findings highlight the importance of perceived childhood parental affection to nurture a strong marital bond to reduce the odds of developing major depressive disorder in middle-to-late adulthood.
... As such, self-report is likely to be affected by social desirability effects 9 . The repeated application of self-report questionnaires might even exert a psychoeducational effect 10 . Other systematic biases which might impact on the validity of self-reports are known, such as memory or recency effects in depression 11,12 . ...
Article
Psychological interventions are first-line treatments of depression. Despite a rich theoretical background, the mediators of treatment effects remain only partially understood: it has been difficult to precisely delineate the targets psychological interventions engage, and even more difficult to differentiate amongst the targets engaged by different psychological interventions. Here, we outline these issues and discuss a surprisingly understudied approach, namely the study of cognitive and computational tasks to measure psychological treatment targets. Such tasks benefit from substantial advances in cognitive neuroscience over the past two decades, and have excellent face validity. We discuss two candidate tasks for back-translation and conclude with a critical evaluation of potential problems associated with this neuro-cognitive approach.
... A meta-analysis of 25 RCTs conducted on the depression course found an average d of .28 (Cuijpers, Muñoz, Clarke, & Lewinsohn, 2009). It proves scalable, free, and effective, but is below the typical efficacy of individual psychotherapy. ...
... On the other side, several studies in healthy participants found a risk reduction of up to 38% for developing a major depressive disorder, when psychoeducational interventions were administered (e.g. Cuijpers et al. 2009), helping participants to detect and handle symptoms before they exacerbate. Taken together, this underlines the importance as well as the ethical obligation of a monitoring and support system in research studies. ...
... Use of TAU instead of waitlist group as comparator has already been shown to diminish treatment effects in internet-based depression treatment (Richards and Richardson, 2012). In addition, psychoeducational programs for depression prevention and treatment have been shown to be similarly effective to other psychotherapies in reducing both onset of depression and depressive symptoms severity across different populations (Cuijpers et al., 2009). This raises the question if any preventive intervention aiming to reduce subthreshold to clinical depression in this target group would be able to exceed the effect of the TAU comparator enhanced with the psychoeducational information material in the long-term. ...
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Objective Evidence of long-term stability for positive mental health effects of internet-based interventions (IBIs) for depression prevention is still scarce. We evaluate long-term effectiveness of a depression prevention program in green professions (i.e. agriculture, horticulture, forestry). Methods This pragmatic RCT (n = 360) compares a tailored IBI program to enhanced treatment as usual (TAU+) in green professions with at least subthreshold depression (PHQ ≥ 5). Intervention group (IG) received one of six IBIs shown previously to efficaciously reduce depressive symptoms. We report 6- and 12-month follow-up measures for depression, mental health and intervention-related outcomes. Intention-to-treat and per-protocol regression analyses were conducted for each measurement point and complemented by latent growth modeling. Results After 6 months, depression severity (β = −0.30, 95%-CI: −0.52; −0.07), insomnia (β = −0.22, 95%-CI: −0.41; −0.02), pain-associated disability (β = −0.26, 95%-CI: −0.48; −0.04) and quality of life (β = 0.29, 95%-CI: 0.13; 0.45) in IG were superior to TAU+. Onset of possible depression was not reduced. After 12 months, no intervention effects were found. Longitudinal modeling confirmed group effects attenuating over 12 months for most outcomes. After 12 months, 55.56% of IG had completed at least 80% of their IBI. Conclusions Stability of intervention effects along with intervention adherence was restricted. Measures enhancing long-term effectiveness of IBIs for depression health promotion are indicated in green professions. Trial registration German Clinical Trial Registration: DRKS00014000. Registered: 09 April 2018.
... The patients were invited to participate in a brief version of the 'Coping with Depression' course, which is a highly structured intervention for depression that was first developed by Lewinsohn and colleagues (Lewinsohn et al., 1984). The course and its modifications are effective in alleviating depression symptoms (e.g., Cuijpers et al., 2009). A total of 126 patients accepted the invitation and were enrolled in the study. ...
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Background : Patients with depression often experience difficulties with completing homework assignments during cognitive-behavioral therapy (CBT). In the present study, we investigated the effects of a specific placebo which aimed at improving the practice of a daily relaxation exercise during a four-week outpatient program. Methods : A total of 126 patients diagnosed with major depressive disorder were randomly assigned to one of three groups: ‘Coping with Depression’ course, ‘Coping with Depression’ course with additional daily placebo treatment, and waiting-list group. The placebo (sunflower oil) was introduced as a natural medicine to help the patients focus on their inner strengths and to mobilize their bodies’ natural healing powers. The placebo was taken orally before the daily relaxation exercise. Results : The placebo improved homework quantity and quality (both p < .001). The placebo group practiced more often and experienced greater relaxation effects than the no-placebo group. Additionally, the placebo group showed a greater reduction of depression symptoms (p < .001). Limitations : The primary limitation of the study is the lack of a psychophysiological measure of relaxation. Conclusions : Placebos can be used to leverage CBT effects in patients with depression.
... Common mental disorders (CMDs) such as depression and anxiety disorders are highly prevalent, disabling and costly with diminished quality of life, medical morbidity and mortality [1][2][3]. It is estimated that every year almost one in five people among the general population worldwide suffers from CMDs [4,5]. ...
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Background: There is a strong stigma attached to mental disorders preventing those affected from getting psychological help. The consequences of stigma are worse for racial and/or ethnic minorities compared to racial and/or ethnic majorities since the former often experience other social adversities such as poverty and discrimination within policies and institutions. This is the first systematic review and meta-analysis summarizing the evidence on the impact of differences in mental illness stigma between racial minorities and majorities. Methods: This systematic review and meta-analysis included cross-sectional studies comparing mental illness stigma between racial minorities and majorities. Systematic searches were conducted in the bibliographic databases of PubMed, PsycINFO and EMBASE until 20th December 2018. Outcomes were extracted from published reports, and meta-analyses, and meta-regression analyses were conducted in CMA software. Results: After screening 2787 abstracts, 29 studies with 193,418 participants (N = 35,836 in racial minorities) were eligible for analyses. Racial minorities showed more stigma than racial majorities (g = 0.20 (95% CI: 0.12 ~ 0.27) for common mental disorders. Sensitivity analyses showed robustness of these results. Multivariate meta-regression analyses pointed to the possible moderating role of the number of studies with high risk of bias on the effect size. Racial minorities have more stigma for common mental disorders when compared with majorities. Limitations included moderate to high risk of bias, high heterogeneity, few studies in most comparisons, and the use of non-standardized outcome measures. Conclusions: Mental illness stigma is higher among ethnic minorities than majorities. An important clinical implication of these findings would be to tailor anti-stigma strategies related with mental illnesses according to specific racial and/or ethnic backgrounds with the intention to improve mental health outreach.
... For example, coping, i.e., behavioral or cognitive efforts to manage stressful situations, has been consistently examined as a mediator between stressors and depression in existing literature. It was found that coping reduced depressive symptoms, promoted recovery from depression, and prevented depression recurrence (Cuijpers et al., 2009;Lam & Wong, 2005;Willner et al., 2013). ...
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Background: Coping behavior is known to moderate the effect of stressors on depressive symptoms. Increased reassessing coping, that is, waiting patiently for an appropriate opportunity to handle a stressful relationship, as coping strategy for interpersonal stressors is associated with lower depressive symptoms. Objectives: We hypothesized that higher reassessing coping would be associated with lower depressive symptoms in individuals with higher coping flexibility. Coping flexibility is the ability to discontinue a coping strategy that produces undesirable outcomes by monitoring and evaluating stressful situations and the effects of coping strategies. Methods: Two studies involving approximately 1,800 college students were conducted, one using a cross-sectional design (n = 281) and another a longitudinal design (n = 1,468). Results: In both studies, hierarchical multiple regression analyses showed that the interaction between reassessing coping and coping flexibility scores was predictive of a significant depressive symptom score. This indicates that higher levels of reassessing coping are associated with lower levels of depressive symptoms when coping flexibility is higher, whereas reassessing coping is not associated with depressive symptoms when coping flexibility is lower. Conclusions: These results were consistent with our hypothesis in both studies.
... The CWD program has been used with an array of diverse client populations and in many countries and has been tested in over 25 randomized controlled trials. It has also been shown to be an effective method to prevent depression (Cuijpers et al. 2009). ...
... The IPPI-D was designed using positive empirically validated interventions, integrating both hedonic and eudaimonic components . The CBT intervention was adapted from the 'Coping with Depression' course (Cuijpers et al., 2009). ...
Article
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Although positive psychology interventions increase well-being and reduce depression, little is known about whether they facilitate a reorganization of the connections between psychological elements. We used Network Analysis (NA) to explore the topography of changes in psychological elements after a Positive Psychology Intervention (PPI) and a Cognitive-Behavioral Therapy (CBT) program for depression. Clinically depressed women were blindly allocated to a PPI (n = 45) or CBT (n = 48) 10-week group treatment. NA showed that the PPI program was the only one that significantly changed the structure of the network for psychological elements. The results showed that hedonic and eudaimonic elements played a substantial role in the reorganization of the network, becoming key connecting elements between the group of clinical variables and the group of positive functioning variables. Our findings support, from the NA perspective, the unique contributions of positive intervention programs to change the complex patterns of relationships between symptoms and positive variables.
... As such, self-report is likely to be affected by social desirability effects 9 . The repeated application of self-report questionnaires might even exert a psychoeducational effect 10 . Other systematic biases which might impact on the validity of self-reports are known, such as memory or recency effects in depression 11,12 . ...
Article
BACKGROUND: A shift from goal-directed toward habitual control has been associated with alcohol dependence. Whether such a shift predisposes to risky drinking is not yet clear. We investigated how goal-directed and habitual control at age 18 predict alcohol use trajectories over the course of 3 years. METHODS: Goal-directed and habitual control, as informed by model-based (MB) and model-free (MF) learning, were assessed with a two-step sequential decision-making task during functional magnetic resonance imaging in 146 healthy 18-year-old men. Three-year alcohol use developmental trajectories were based on either a consumption score from the self-reported Alcohol Use Disorders Identification Test (assessed every 6 months) or an interview-based binge drinking score (grams of alcohol/occasion; assessed every year). We applied a latent growth curve model to examine how MB and MF control predicted the drinking trajectory. RESULTS: Drinking behavior was best characterized by a linear trajectory. MB behavioral control was negatively associated with the development of the binge drinking score; MF reward prediction error blood oxygen level-dependent signals in the ventromedial prefrontal cortex and the ventral striatum predicted a higher starting point and steeper increase of the Alcohol Use Disorders Identification Test consumption score over time, respectively. CONCLUSIONS: We found that MB behavioral control was associated with the binge drinking trajectory, while the MF reward prediction error signal was closely linked to the consumption score development. These findings support the idea that unbalanced MB and MF control might be an important individual vulnerability in predisposing to risky drinking behavior.
... En otro estudio clásico, el análisis de componentes de la terapia cognitiva realizado por el tratamiento con activación conductual tuvo una duración promedio de 20 sesiones. En esta misma línea, diversos meta análisis de ECAs para la depresión mayor refieren duraciones promedio de entre 12 y 20 sesiones para la intervención cognitivo -conductual (Hollon et al., 1991); entre 4 y 20 sesiones para la intervención psicológica, sin distinción por tipo de tratamiento (Cuijpers et al., 2014); y 6 a 16 sesiones para la intervención conductual (Cuijpers, Muñoz, Clarke, y Lewinsohn, 2009a;Hans y Hiller, 2013;Minami et al., 2009). Por su parte, en un meta análisis sobre tratamiento de la depresión crónica y la distimia , se encontró que la duración media de las terapias cognitivas y cognitivo -conductuales aplicadas en los ECAs era de unas 22 sesiones de promedio (rango 6-47), siendo necesarias unas 18 sesiones para obtener resultados. ...
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Objectives: the present work aims at analysing the reality of the assistance offered to patients with depressive disorders through an observational study with descriptive and comparative strategies. More specifically, the objectives of this study are: to assess the characteristics of evidence based treatments in healthcare settings; it’s effectivity at reducing depressive symptoms and other related variables; and it’s efficiency. Method: this work constitutes a retrospective and archival study that collects the results of psychological treatments that took place in a natural setting, which were followed up in a longitudinal fashion. An intentional sample of 89 cases diagnosed with either Major Depressive Disorder (80,9%) or Dysthymia (19,1%) at the “Clínica Universitaria de Psicología” [University Psychology Clinic] of the UCM was gathered. 78,7% of all cases were women, and 48,3% were undergoing pharmacological treatment; average length of current episode was 30,9 months, and average score on the BDI-II was 33 points. Several demographic, clinical and treatment variables were recorded to address the objectives of the study. Results: patients received individualized, self-corrective treatments based upon psychoeducation, cognitive restructuring, behavioural activation, relaxation techniques, problem solving and social skills training, among other techniques up to a mean number of seven techniques, during 18 weekly sessions on average. A 35,96% of all patients terminated the intervention prematurely, with adherence to sessions and techniques and the global severity index of the SCL-90-R significantly associated to dropout. Treatments that ended prematurely were shorter and comprised fewer techniques in a significant way. Of the total sample, 80,3% patients reached a clinically significant change in depressive symptoms measured with the BDI-II, 86,2% with the BAI. The amount of reduction on BDI-II scores was related to the use of social skills training; moreover, more severely disturbed patients and those diagnosed through BDI-II and clinical judgement had a better improvement. Younger patients, those with lower pre-treatment scores on the BAI and the global severity index of the SCL-90-R, and those with better functioning, assessed through the GAF, reached remission with a significantly higher chance. Treatment was cost-effective related to pharmacological treatment delivered at Primary Care; specifically, direct average costs of increasing in 1% the amount of the treated sample that reached remission in Primary Care was 34,9% (considering just treatment) or 11,0% (considering assessment and treatment) higher than that of the evidence based psychological treatment. Discussion: it is confirmed in the present study that treatments delivered at a healthcare setting with an evidence based clinical practice approach are equivalent in length, techniques and “dosage” to the empirically supported treatments, specially Beck’s cognitive therapy, although additional components are included on the basis of clinical judgement; in the case of relaxation techniques and problem solving training, they don’t seem to increase improvement in a significant manner. It’s not possible to reliably assess the effect of cognitive restructuring and behavioural activation; therefore, there is room for treatment reduction and cost- effectiveness improvement. Treatment’s effectivity, based upon the contrast with effect sizes and improvement ratios, was as good as or better than other treatments in healthcare or research settings, with a high dropout rate, but consistent with that found at other university settings. Theses results were not affected by potentially confounding variables as the payment of a reduced fee for the members of the university community, the use of adjunctive pharmacological treatment, or the diagnosis of Dysthymia versus Major Depressive Disorder. On the other hand, the diagnostic procedure, whether it was SCID or clinical judgement, did produce differences. The lack of a significant effect of treatment duration, and the evidence that patients that prematurely terminated interventions did nonetheless benefit from them is consistent with a “good enough level” (GEL) model, which states that patients undergo treatment until they decide that they have improved enough related to objective and subjective costs of treatment. Generalizability of the results of this study is high according to standardized criteria. Among the limitations of this study are the lack of long term follow up for many cases, the high amount of missing values among post treatment measures – which is nonetheless common in healthcare clinical practice; and the archival nature of the study, which precludes the use of adequate experimental controls and hence might hamper it’s internal validity. Conclusions: this study supports the empirical evidence on the effectivity of evidence – based treatment of depressive disorders in healthcare settings. Patients’ change pattern seems consistent with the seeking of a good enough level. Additionally, evidence-based psychological intervention was more expensive, but also more cost-effective, regarding direct healthcare costs, than treatment delivered in Primary Care settings. Moreover, there is room for further increase of its efficiency, positioning evidence based psychological treatment as a highly competitive treatment option. From these results, the prolongation of psychological treatments until improvement is reached, while the objective and subjective costs of the intervention are considered, it’s recommended, as is the use of clinical case formulation as a way of reducing treatment’s length, getting rid of superfluous elements and emphasizing instead the interpersonal themes of depression. Regarding future studies, the development of measure tools that promote adherence to its use and longitudinal follow up, and the use of multivariate methods to identify dropout and improvement predictors, are encouraged. Keywords: depression: evidence based practice; effectivity; cost-effectiveness; moderating variables.
Article
Background and objectives Psychological and psychosocial interventions proved to be effective in treatment of depression. The main objective of this study is to examine the effects of psychosocial day care program on the quality of life and clinical symptoms of persons with depression. Methods In a controlled trial, 114 participants aged 20 or older with ICD-10 major depression were recruited after they being discharged from in-patient treatment. The intervention group (n = 59) received a 4-month group psychosocial program consisting of psychoeducation, social skills training and therapeutic community, and the control group (n = 55) received the usual care. Participants were assessed three times: at baseline, at the end-of-treatment and at 6-months follow-up. The outcome measures were the Montgomery-Åsberg Depression Rating Scale and Manchester Short Assessment of Quality of Life. Results The intervention group had significantly larger symptom reduction compared to control group (F (1,98) = 15.11, p < 0.01), at both second assessment (−8.31 ± 0.78, p < 0.01) and third assessment (−10.7 ± 0.69, p < 0.01). Both groups showed significant reduction in depressive symptoms over study time (F (1.53, 150.28) = 228.01, p < 0.01). The psychosocial intervention program had no statistically significant effect on subjective quality of life. Conclusion The psychosocial intervention program led to significant reduction of depressive symptoms but had no effect on patients’ subjective quality of life.
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In caring for persons with diabetes (PWD), healthcare professionals (HCP) have an important role to play when it comes to offering psychosocial support as integral part of ongoing diabetes care. Inquiring about and discussing emotional health with PWD is appreciated by them and can help to identify problem areas that require further assessment. For this purpose practical, validated self-report measures of well-being and diabetes distress are available for use in routine care. Based on a needs assessment, PWD may be offered psychosocial support by one of the team members (physician, nurse educator, dietitian) or a referral to a specialized mental health professional, preferably as part of team care. There is convincing evidence that cognitive behavioral therapy (CBT) is effective in reducing emotional distress and enhancing coping skills in PWD, with subsequent improvements of self-care and glycemic control, at least on the short term. Next to diabetes distress and depression, chronic fatigue has shown to be prevalent among PWD. Here too, CBT has been shown to be effective. Internet-based CBT is increasingly used, which allows for economic and patient-friendly delivery of psychotherapy while reaching a large audience. Further research is warranted to develop effective strategies for successful implementation of integral psychological support for PWD with psychological comorbidity, addressing the medical and the psychological needs of PWD.
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Background Psychoeducation has emerged as an intervention for women with breast cancer (BC). This meta-analysis evaluated the effectiveness of psychoeducation on adherence to diagnostic procedures and medical treatment, anxiety, depression, quality of life (QoL), and BC knowledge among patients with BC symptoms or diagnosis and BC survivors. Methods A systematic literature search (in PubMed, Embase, PsycINFO and Cochrane) for randomised controlled trials (RCTs) comparing the effects of psychoeducation to control among patients with BC symptoms or diagnosis and BC survivors. Effects were expressed as relative risks (RRs) and standardized mean differences (SMDs) with their 95% confidence intervals. Results Twenty-seven RCTs (7742 participants; 3880 psychoeducation and 3862 controls) were included. Compared with controls, psychoeducation had no significant effect on adherence to diagnostic procedures and medical treatment (RR 1.553; 95% CI 0.733 to 3.290, p = .16), but it significantly decreased anxiety (SMD -0.710, 95% CI -1.395 to −0.027, p = .04) and improved QoL with (SMD 0.509; 95% CI 0.096 to 0.923, p < .01). No effects were found for psychoeducation on depression (SMD -0.243, 95% CI -0.580 to 0.091, p = .14), or BC knowledge (SMD 0.718, 95% CI -0.800 to 2.236, p = .23). Conclusion We demonstrated that psychoeducation did not improve adherence to diagnostic procedures and treatment, depression and BC knowledge but was valuable for reducing anxiety and improving QoL. Future studies may explore the effectiveness of psychoeducation in promoting adherence across various types of cancer.
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Introduction Depression is now the most common illness worldwide affecting more than 300 million people. Studies modelling the impact of depression interventions have shown that the burden of depression cannot be minimised by more than 35% with existing treatments. There is a need to develop better preventative interventions. The overall aim of this programme of work is to develop interventions to reduce depression symptom scores and prevent development of depression in people with subthreshold depression. The objectives are to adapt a low intensity community-based depression prevention intervention, establish the acceptability and uptake of this model and conduct a parallel randomised controlled feasibility trial to inform a full-scale trial. Methods and analysis Focus groups will be run with members of the public, voluntary sector providers and researchers to inform the adaptation of an existing depression prevention course. Sixty-four people with subthreshold depression, as represented by a score of between 5 and 9 on the Patient Health Questionnaire-9 depression measure, will be recruited to take part in the feasibility trial. Participants will be randomised equally to the intervention or usual care control groups. Participants in the intervention group will receive the new revised manual and attend a 1-day workshop delivered by voluntary sector service providers. Outcome measures will be completed 3 months after baseline. Quantitative data on recruitment, randomisation, attendance, retention, questionnaire completion rates will be collected. Primary analyses will be descriptive and a process evaluation will be conducted to assess the processes involved in implementing the intervention. Interviews will be conducted to explore acceptability and framework analysis will be used to analyse the data. Ethics and dissemination The study has been reviewed and approved by NHS Research and Ethics Committee: NW-Greater Manchester East. The results will be actively disseminated through peer-reviewed journals, conference presentations, social media, the internet and community engagement activities. Trial registration number ISRCTN23278208 ;Pre-results.
Chapter
Several factors limit the capacity for primary care providers to deliver behavioral health-focused preventive care. Novel systems of care are needed to integrate prevention into a healthcare system primarily designed for treatment. The integration of behavioral health providers into wellness visits could address this need. Integrating behavioral health providers into the annual wellness visit could facilitate the routine delivery of behavioral health-focused preventive care into real-world settings. This chapter reviews the annual wellness visit as it pertains to the prevention of physical disease and considers the potential for this model to apply to the prevention of behavioral health disorders. This chapter describes existing research on behavioral health integration into the annual wellness visit and outlines a principle-based stepped care approach for the implementation of this model. Behavioral health integration into the wellness visit could include screening, brief intervention, and recommendations for low-intensity stepped care approaches to the prevention of behavioral health disorders. Advantages and challenges to this format for preventive care service delivery are discussed.
Article
Background : The aim of this study was to investigate the effectiveness of a Computer-based Cognitive Behavioral Therapy (CCBT) and identify the characteristics of depressed adolescents that participated in the CCBT program. Methods : Screening tests for depression and help-seeking variables were conducted in school-aged Korean adolescents (n= 376, mean age=15.71 years, 53.7% female). The number of adolescents that scored above the threshold for mild depression (PHQ-9, CES-D) was 139. Fifty adolescents agreed to participate in the randomized clinical trial (RCT) of CCBT program. Twenty-five adolescents were randomly assigned to the treatment group, and the other 25 to the waitlist control group. The treatment group engaged in CCBT with therapeutic support. To identify variables affecting the outcomes, the quality of their homework compliance also was assessed. Results : Participants (n=50) who agreed to participate in the CCBT program demonstrated different help-seeking attitudes - a greater recognition of the need for help and lower interpersonal openness - compared to the adolescents (n=87) who did not participate (t = -2.93, p < .01; t = 3.50, p < .001). The treatment group showed significant improvements in depression, self-esteem, and quality of life compared to the waitlist group. Adolescents with high homework compliance showed a significant decrease in the depression scores compared to adolescents with low homework compliance. Limitations : Small sample size, no follow-up assessments. Conclusion : CCBT could be an effective alternative for depressed adolescents, especially those who tend to have low interpersonal openness. To improve the effects of CCBT, therapeutic support needs to be provided.
Article
Background Cognitive–behavioural therapy aims to increase quality of life by changing cognitive and behavioural factors that maintain problematic symptoms. A previous overview of cognitive–behavioural therapy systematic reviews suggested that cognitive–behavioural therapy was effective for many conditions. However, few of the included reviews synthesised randomised controlled trials. Objectives This project was undertaken to map the quality and gaps in the cognitive–behavioural therapy systematic review of randomised controlled trial evidence base. Panoramic meta-analyses were also conducted to identify any across-condition general effects of cognitive–behavioural therapy. Data sources The overview was designed with cognitive–behavioural therapy patients, clinicians and researchers. The Cochrane Library, MEDLINE, EMBASE, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Child Development & Adolescent Studies, Database of Abstracts of Reviews of Effects and OpenGrey databases were searched from 1992 to January 2019. Review methods Study inclusion criteria were as follows: (1) fulfil the Centre for Reviews and Dissemination criteria; (2) intervention reported as cognitive–behavioural therapy or including one cognitive and one behavioural element; (3) include a synthesis of cognitive–behavioural therapy trials; (4) include either health-related quality of life, depression, anxiety or pain outcome; and (5) available in English. Review quality was assessed with A MeaSurement Tool to Assess systematic Reviews (AMSTAR)-2. Reviews were quality assessed and data were extracted in duplicate by two independent researchers, and then mapped according to condition, population, context and quality. The effects from high-quality reviews were pooled within condition groups, using a random-effect panoramic meta-analysis. If the across-condition heterogeneity was I ² < 75%, we pooled across conditions. Subgroup analyses were conducted for age, delivery format, comparator type and length of follow-up, and a sensitivity analysis was performed for quality. Results A total of 494 reviews were mapped, representing 68% (27/40) of the categories of the International Classification of Diseases, Eleventh Revision, Mortality and Morbidity Statistics. Most reviews (71%, 351/494) were of lower quality. Research on older adults, using cognitive–behavioural therapy preventatively, ethnic minorities and people living outside Europe, North America or Australasia was limited. Out of 494 reviews, 71 were included in the primary panoramic meta-analyses. A modest effect was found in favour of cognitive–behavioural therapy for health-related quality of life (standardised mean difference 0.23, 95% confidence interval 0.05 to 0.41, prediction interval –0.05 to 0.50, I ² = 32%), anxiety (standardised mean difference 0.30, 95% confidence interval 0.18 to 0.43, prediction interval –0.28 to 0.88, I ² = 62%) and pain (standardised mean difference 0.23, 95% confidence interval 0.05 to 0.41, prediction interval –0.28 to 0.74, I ² = 64%) outcomes. All condition, subgroup and sensitivity effect estimates remained consistent with the general effect. A statistically significant interaction effect was evident between the active and non-active comparator groups for the health-related quality-of-life outcome. A general effect for depression outcomes was not produced as a result of considerable heterogeneity across reviews and conditions. Limitations Data extraction and analysis were conducted at the review level, rather than returning to the individual trial data. This meant that the risk of bias of the individual trials could not be accounted for, but only the quality of the systematic reviews that synthesised them. Conclusion Owing to the consistency and homogeneity of the highest-quality evidence, it is proposed that cognitive–behavioural therapy can produce a modest general, across-condition benefit in health-related quality-of-life, anxiety and pain outcomes. Future work Future research should focus on how the modest effect sizes seen with cognitive–behavioural therapy can be increased, for example identifying alternative delivery formats to increase adherence and reduce dropout, and pursuing novel methods to assess intervention fidelity and quality. Study registration This study is registered as PROSPERO CRD42017078690. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment ; Vol. 25, No. 9. See the NIHR Journals Library website for further project information.
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Background: Primary prevention has the potential to modify the course of depression, but the consistency and magnitude of this effect are currently undetermined. Methods: PRISMA and RIGHT compliant (PROSPERO:CRD42020179659) systematic meta-review, PubMed/Web of Science, up to June 2020. Meta-analyses of controlled interventions for the primary prevention of depressive symptoms [effect measures: standardized mean difference (SMD)] or depressive disorders [effect measure: relative risk (RR)] were carried out. Results were stratified by: (i) age range; (ii) target population (general and/or at-risk); (iii) intervention type. Quality (assessed with AMSTAR/AMSTAR-PLUS content) and credibility (graded as high/moderate/low) were assessed. USPSTF grading system was used for recommendations. Results: Forty-six meta-analyses (k=928 individual studies, n=286,429 individuals, mean age=22.4 years, 81.1% female) were included. Effect sizes were: SMD=0.08-0.53; for depressive symptoms; RR=0.90-0.28 for depressive disorders. Sensitivity analyses including only RCTs did not impact the findings. AMSTAR median=9 (IQR=8-9); AMSTAR-PLUS content median=4.25 (IQR=4-5). Credibility of the evidence was insufficient/low in 43 (93.5%) meta-analyses, moderate in two (4.3%), and high in one (2.2%): reduction of depressive symptoms using psychosocial interventions for young adults only, and a combination of psychological and educational interventions in primary care had moderate credibility; preventive administration of selective serotonin reuptake inhibitors (SSRIs) for depressive disorders in individuals with a stroke had high credibility. Limitations: Intervention heterogeneity and lack of long-term efficacy evaluation. Conclusions: Primary preventive interventions for depression might be effective. Among them, clinicians may offer SSRIs post-stroke to prevent depressive disorders, and psychosocial interventions for children/adolescents/young adults with risk factors or during the prenatal/perinatal period.
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Background Quality improvement (QI) programs for depressed primary care patients can improve health outcomes for 6 to 28 months; effects for longer than 28 months are unknown. Objective To assess how QI for depression affects health outcomes, quality of care, and health outcome disparities at 57-month follow-up. Design A group-level randomized controlled trial. Setting Forty-six primary care practices in 6 managed care organizations. Patients Of 1356 primary care patients who screened positive for depression and enrolled in the trial, 991 (73%, including 451 Latinos and African Americans) completed 57-month telephone follow-up. Interventions Clinics were randomly assigned to usual care or to 1 of 2 QI programs supporting QI teams, provider training, nurse assessment, and patient education, plus resources to support medication management (QI-meds) or psychotherapy (QI-therapy) for 6 to 12 months. Main Outcome Measures Probable depressive disorder in the previous 6 months, mental health–related quality of life in the previous 30 days, primary care or mental health specialty visits, counseling or antidepressant medications in the previous 6 months, and unmet need, defined as depressed but not receiving appropriate care. Results Combined QI-meds and QI-therapy, relative to usual care, reduced the percentage of participants with probable disorder at 5 years by 6.6 percentage points (P = .04). QI-therapy improved health outcomes and reduced unmet need for appropriate care among Latinos and African Americans combined but provided few long-term benefits among whites, reducing outcome disparities related to usual care (P = .04 for QI-ethnicity interaction for probable depressive disorder). Conclusions Programs for QI for depressed primary care patients implemented by managed care practices can improve health outcomes 5 years after implementation and reduce health outcome disparities by markedly improving health outcomes and unmet need for appropriate care among Latinos and African Americans relative to whites; thus, equity was improved in the long run.
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Doel. Een overzicht geven van de meta-analysen naar de effectiviteit van psychologische behandelingen van patiënten met een depressieve stoornis. Opzet. Systematische review. Methode. Gezocht werd in Pubmed, Psycinfo en DARE, in eerdere reviews en in referentielijsten van geïncludeerde studies. Inclusiecriteria waren: statistische meta-analyse van gerandomiseerde studies die in de jaren 2000-2004 waren gepubliceerd in een Engelstalig tijdschrift. Er werden 3 typen uitkomstmaten onderscheiden: effecten op herstel, effecten op de mate van depressieve symptomen, en uitval. Resultaten. Er werden 10 meta-analysen geïncludeerd met in totaal 132 primaire studies, waarvan 25 (19) in meer dan 1 meta-analyse voorkwamen. Psychologische interventies hadden een groot effect op herstel (oddsratio: 3,01) en op vermindering van klachten (gestandaardiseerde effectgrootte: –0,90). Met name cognitieve gedragstherapie was goed onderzocht; er was geen bewijs dat deze effectiever was dan andere psychologische behandelingen. Ook minimale psychologische interventies hadden grote effecten. Psychologische behandeling was ook effectief bij kinderen en adolescenten. Behandeling met antidepressiva alleen was minder effectief dan gecombineerde behandeling met antidepressiva en een psychologische interventie. Er waren geen aanwijzingen dat de uitval bij psychologische behandeling anders was dan in controlegroepen. Conclusie. Er was ruime ondersteuning voor de effectiviteit van psychologische behandeling van patiënten met een depressieve stoornis.
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Activity scheduling is a behavioral treatment of depression in which patients learn to monitor their mood and daily activities, and how to increase the number of pleasant activities and to increase positive interactions with their environment. We conducted a meta-analysis of randomized effect studies of activity scheduling. Sixteen studies with 780 subjects were included. The pooled effect size indicating the difference between intervention and control conditions at post-test was 0.87 (95% CI: 0.60~1.15). This is a large effect. Heterogeneity was low in all analyses. The comparisons with other psychological treatments at post-test resulted in a non-significant pooled effect size of 0.13 in favor of activity scheduling. In ten studies activity scheduling was compared to cognitive therapy, and the pooled effect size indicating the difference between these two types of treatment was 0.02. The changes from post-test to follow-up for activity scheduling were non-significant, indicating that the benefits of the treatments were retained at follow-up. The differences between activity scheduling and cognitive therapy at follow-up were also non-significant. Activity scheduling is an attractive treatment for depression, not only because it is relatively uncomplicated, time-efficient and does not require complex skills from patients or therapist, but also because this meta-analysis found clear indications that it is effective. Keywords: Activity scheduling; Depression; Meta-analysis; Cognitive behavior therapy
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This chapter offers clinical guidelines for the treatment of Puerto Rican adolescents with depression through the presentation of work aimed at adapting and testing two promising treatments. The adaptations of cognitive-behavioral therapy (CBT) and interpersonal psychotherapy treatment (IPT) for depression followed ecological validity and culturally sensitive criteria. The authors present a brief description of the problem of depression in Puerto Rico, followed by the guidelines and process used in the adaptation of the two treatments. Next, they present the basic steps employed in both CBT and IPT. Finally, the chapter closes with a description of our research findings about the efficacy of the two treatment interventions. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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Measurement of health-related quality of life (HRQoL) with generic preference-based instruments enables comparisons of severity across different conditions and treatments. This is necessary for rational public health policy. To measure HRQoL decrement and loss of quality-adjusted life-years (QALYs) associated with pure and comorbid forms of depressive and anxiety disorders and alcohol dependence. A general population survey was conducted of Finns aged 30 years and over. Psychiatric disorders were diagnosed with the Composite International Diagnostic Interview and HRQoL was measured with the 15D and EQ-5D questionnaires. Dysthymia, generalised anxiety disorder and social phobia were associated with the largest loss of HRQoL on the individual level before and after adjusting for somatic and psychiatric comorbidity. On the population level, depressive disorders accounted for 55%, anxiety disorders 30%, and alcohol dependence for 15% of QALY loss identified in this study. Chronic anxiety disorders and dysthymia are associated with poorer HRQoL than previously thought.
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Although many meta-analyses have shown that psychological therapies are effective in the treatment of depression, no comprehensive metaregression analysis has been conducted to examine which characteristics of the intervention, target population, and study design are related to the effects. The authors conducted such a metaregression analysis with 83 studies (135 comparisons) in which a psychological treatment was compared with a control condition. The mean effect size of all comparisons was 0.69 (95% confidence interval = 0.60-0.79). In multivariate analyses, several variables were significant: Studies using problem-solving interventions and those aimed at women with postpartum depression or specific populations had higher effect sizes, whereas studies with students as therapists, those in which participants were recruited from clinical populations and through systematic screening, and those using care-as-usual or placebo control groups had lower effect sizes.
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A growing number of studies have tested the efficacy of preventive interventions in reducing the incidence of depressive disorders. Until now, no meta-analysis has integrated the results of these studies. The authors conducted a meta-analysis. After a comprehensive literature search, 19 studies were identified that met inclusion criteria. The studies had to be randomized controlled studies in which the incidence of depressive disorders (based on diagnostic criteria) in an experimental group could be compared with that of a control group. The mean incidence rate ratio was 0.78, indicating a reduction of the incidence of depressive disorders by 22% in experimental compared with control groups. Heterogeneity was low to moderate (I(2)=33%). The number needed to treat to prevent one case of depressive disorder was 22. Moderator analyses revealed no systematic differences between target populations or types of prevention (universal, selective, or indicated). The data included indications that prevention based on interpersonal psychotherapy may be more effective than prevention based on cognitive-behavioral therapy. Prevention of new cases of depressive disorders does seem to be possible. Prevention may become an important way, in addition to treatment, to reduce the enormous public health burden of depression in the coming years.
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The prevention of major depression is an important research goal which deserves increased attention. Depressive symptoms and disorders are particularly common in primary care patients and have a negative impact on functioning and well-being comparable with other major chronic medical conditions. The San Francisco Depression Prevention Research project conducted a randomized, controlled, prevention trial to demonstrate the feasibility of implementing such research in a public sector setting serving low-income, predominantly minority individuals: 150 primary care patients free from depression or other major mental disorders were randomized to an experimental cognitive-behavioral intervention or to a control condition. The experimental intervention group reported a significantly greater reduction in depressive levels. Decline in depressive levels was significantly mediated by decline in the frequency of negative conditions. Group differences in the number of new episodes (incidence) of major depression did not reach significance during the 1-year trial. We conclude that depression prevention trials in public sector primary care settings are feasible, and that depressive symptoms can be reduced even in low-income, minority populations. To conduct randomized prevention trials that can test effects on incidence with sufficient statistical power, subgroups at greater imminent risk have to be identified.
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The purpose of this study was to provide an experimental test of the theory of change put forth by A. T. Beck, A. J. Rush, B. F. Shaw, and G. Emery (1979) to explain the efficacy of cognitive-behavioral therapy (CT) for depression. The comparison involved randomly assigning 150 outpatients with major depression to a treatment focused exclusively on the behavioral activation (BA) component of CT, a treatment that included both BA and the teaching of skills to modify automatic thoughts (AT), but excluding the components of CT focused on core schema, or the full CT treatment. Four experienced cognitive therapists conducted all treatments. Despite excellent adherence to treatment protocols by the therapists, a clear bias favoring CT, and the competent performance of CT, there was no evidence that the complete treatment produced better outcomes, at either the termination of acute treatment or the 6-month follow-up, than either component treatment. Furthermore, both BA and AT treatments were just as effective as CT at altering negative thinking as well as dysfunctional attributional styles. Finally, attributional style was highly predictive of both short- and long-term outcomes in the BA condition, but not in the CT condition.
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Alcoholics with depressive symptoms score > or = 10 on the Beck Depression Inventory (A.T. Beck, C. H. Ward, M. Mendelson, J. Mock, & J. Erbaugh, 1961) received 8 individual sessions of cognitive-behavioral treatment for depression (CBT-D, n = 19) or a relaxation training control (RTC; n = 16) plus standard alcohol treatment. CBT-D patients had greater reductions in somatic depressive symptoms and depressed and anxious mood than RTC patients during treatment. Patients receiving CBT-D had a greater percentage of days abstinent but not greater overall abstinence or fewer drinks per day during the first 3-month follow-up. However, between the 3- and 6-month follow-ups, CBT-D patients had significantly better alcohol use outcomes on total abstinence (47% vs. 13%), percent days abstinent (90.5% vs. 68.3%), and drinks per day (0.46 vs. 5.71). Theoretical and clinical implications of using CBT-D in alcohol treatment are discussed.
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Cognitive therapy (CT) has been studied in 78 controlled clinical trials from 1977 to 1996. The meta-analysis used Hedges and Olkin d+ and included 48 high-quality controlled trials. The 2765 patients presented non-psychotic and non-bipolar major depression, or dysthymia of mild to moderate severity. At post-test CT appeared significantly better than waiting-list, antidepressants (P < 0.0001) and a group of miscellaneous therapies (P < 0.01). But, CT was equal to behaviour therapy. As between-trial homogeneity was not met, the comparisons of CT with waiting-list or placebo, and other therapies should be taken cautiously. In contrast, between-trial homogeneity was high for the comparisons of CT with behaviour therapy and antidepressants. A review of eight follow-up studies comparing CT with antidepressants suggested that CT may prevent relapses in the long-term, while relapse rate is high with antidepressants in naturalistic studies. CT is effective in patients with mild or moderate depression.
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Background Depression is one of the most ancient and common diseases of the human race and its burden on society is really impressive. This stems both from the epidemiological spread (lifetime prevalence rate, up to 30 years of age, was estimated as greater than 14.4% by Angst et al.) and from the economic burden on healthcare systems and society, but also as it pertains to patient well‐being. Aims of the study The scope of this review was to examine studies published in the international literature to describe and compare the social costs of depression in various countries.Methods: A bibliographic search was performed on international medical literature databases (Medline, Embase), where all studies published after 1970 were selected. Studies were carefully evaluated and only those that provided cost data were included in the comparative analysis; this latter phase was conducted using a newly developed evaluation chart. Results 10 abstracts were firstly selected; 46 of them underwent a subsequent full paper reading, thus providing seven papers, which were the subject of the in‐depth comparative analysis: three studies investigated the cost of depression in the USA, three studies in the UK and one study was related to Italy. All the studies examined highlight the relevant economic burden of depression; in 1990, including both direct and indirect costs, it accounted for US$ 43.7 billion in the US (US$ 65 billion, at 1998 prices) according to Greenberg and colleagues, whilst direct costs accounted for £417 million in the UK (or US$ 962.5 million, at 1998 prices), according to Kind and Sorensen. Within direct costs, the major cost driver was indeed hospitalization, which represented something in between 43 and 75% of the average per patient cost; conversely, drug cost accounted for only 2% to 11% in five out of seven studies. Discussion Indeed, our review suggests that at the direct cost level, in both the United States and the United Kingdom, the burden of depression is remarkable, and this is confirmed by a recent report issued by the Pharmaceutical Research and Manufacturers Association (PhRMA) where prevalence and cost of disease were compared for several major chronic diseases, including Alzheimer, asthma, cancer, depression, osteoporosis, hypertension, schizophrenia and others: in this comparison, depression is one of the most significant diseases, ranked third by prevalence and sixth in terms of economic burden. Moreover, in terms of the average cost per patient, depression imposes a societal burden that is larger than other chronic conditions such as hypertension, rheumatoid arthritis, asthma and osteoporosis. The application of economic methods to the epidemiological and clinical field is a relatively recent development, as evidenced by the finding that, out of the seven studies examined, three refer to the US environment, three to the UK and one to Italy, while nothing was available about the cost of depression for large countries such as France, Germany, Spain, Japan and others. Implication for health care provision and use The high incidence of hospitalization, and the finding that drug cost represents only a minor component of the total direct cost of the disease, suggests that room is still available for disease management strategies that, while effectively managing the patient's clinical profile, could also improve health economic efficiency. Implication for health policies Disease management strategies, with particular emphasis on education, should be targeted not only at patients and medical professionals but also at health decision makers in order ‘to encourage effective prevention and treatment of depressive illness’. Implications for further research Cost of illness studies are a very useful tool allowing cost data comparisons across countries and diseases: for this reason, we suggest that further research is needed especially in some western European countries to assess the true economic burden of depression on societies. Copyright © 2000 John Wiley & Sons, Ltd.
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Developed and tested a mood management intervention to assess its feasibility and effect on mood, drug use, and high-risk behaviors related to HIV in Spanish-speaking injection drug users. Ss were 35 Latino patients at a San Francisco methadone maintenance clinic, 11 of whom agreed to participate. From pretest and posttest interview data, difference scores were computed and analyzed between the participating and nonparticipating comparison groups. The study demonstrated the feasibility of short-term cognitive-behavioral interventions with this Spanish-speaking sample. Results suggest that the intervention moderated the depressive symptoms of the participants, including the HIV positive individuals. No significant changes were found in drug use and HIV-related high-risk behaviors.
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Cigarette smokers with past major depressive disorder (MDD) received 8 group sessions of standard, cognitive-behavioral smoking cessation treatment (ST; n = 93) or standard, cognitive-behavioral smoking cessation treatment plus cognitive-behavioral treatment for depression (CBT-D; n = 86). Although abstinence rates were high in both conditions (ST, 24.7%; CBT-D, 32.5%, at 1 year) for these nonpharmacological treatments, no main effect of treatment was found. However, secondary analyses revealed significant interactions between treatment condition and both recurrent depression history and heavy smoking (greater than or equal to 25 cigarettes a day) at baseline. Smokers with recurrent MDD and heavy smokers who received CBT-D were significantly more likely to be abstinent than those receiving ST (odds ratios = 2.3 and 2.6, respectively). Results suggest that CBT-D provides specific benefits for some, but not all, smokers with a history of MDD.