Steven D. Hollon’s research while affiliated with Vanderbilt University and other places

Introduction Burnout, low motivation and poor job satisfaction among community health workers (CHWs) have negative impacts on health workers and on patients. This study aimed to characterise levels of burnout, motivation and job satisfaction in CHWs in Madhya Pradesh, India and to determine the relation between these levels and participant characteristics. This study can inform efforts to promote well-being and address stress in this population. Methods In this cross-sectional study, we recruited participants via simple random sampling without replacement. We administered two validated questionnaires, the Copenhagen Burnout Inventory and a Motivation and Job Satisfaction Assessment, to CHWs who had enrolled in a training programme to deliver a brief psychological intervention for depression. We calculated mean scores for each questionnaire item, examined the reliability of the measures and analysed associations between participant demographic characteristics and questionnaire scores. Results 339 CHWs completed the questionnaires. The personal burnout domain had the highest mean burnout score (41.08, 95% CI 39.52 to 42.64, scale 0–100) and 33% of participants reported moderate or greater levels of personal burnout. Items that reflected physical exhaustion had the highest item-test correlations. The organisation commitment domain had the highest mean motivation score (mean 3.34, 95% CI 3.28 to 3.40, scale 1–4). Items describing pride in CHWs’ work had the highest item-test correlations. Several pairwise comparisons showed that higher education levels were associated with higher motivation levels (degree or higher vs eighth standard (p=0.0044) and 10th standard (p=0.048) and 12th standard versus eighth standard (p=0.012)). Cronbach’s alpha was 0.82 for the burnout questionnaire and 0.86 for the motivation and job satisfaction questionnaire. Conclusion CHWs report experiencing burnout and feeling physically tired and worn out. A sense of pride in their work appears to contribute to motivation. These findings can inform efforts to address burnout and implement effective task-sharing programmes in low-resource settings.

Interpersonal psychotherapy (IPT) and antidepressant medications are both first-line interventions for adult depression, but their relative efficacy in the long term and on outcome measures other than depressive symptomatology is unknown. Individual participant data (IPD) meta-analyses can provide more precise effect estimates than conventional meta-analyses. This IPD meta-analysis compared the efficacy of IPT and antidepressants on various outcomes at post-treatment and follow-up (PROSPERO: CRD42020219891). A systematic literature search conducted May 1st, 2023 identified randomized trials comparing IPT and antidepressants in acute-phase treatment of adults with depression. Anonymized IPD were requested and analyzed using mixed-effects models. The prespecified primary outcome was post-treatment depression symptom severity. Secondary outcomes were all post-treatment and follow-up measures assessed in at least two studies. IPD were obtained from 9 of 15 studies identified ( N = 1536/1948, 78.9%). No significant comparative treatment effects were found on post-treatment measures of depression ( d = 0.088, p = 0.103, N = 1530) and social functioning ( d = 0.026, p = 0.624, N = 1213). In smaller samples, antidepressants performed slightly better than IPT on post-treatment measures of general psychopathology ( d = 0.276, p = 0.023, N = 307) and dysfunctional attitudes ( d = 0.249, p = 0.029, N = 231), but not on any other secondary outcomes, nor at follow-up. This IPD meta-analysis is the first to examine the acute and longer-term efficacy of IPT v . antidepressants on a broad range of outcomes. Depression treatment trials should routinely include multiple outcome measures and follow-up assessments.

Depression is an eminently treatable disorder that responds to psychotherapy or medications; the efficacy of each has been established in hundreds of controlled trials. Nonetheless, the prevalence of depression has increased in recent years despite the existence of efficacious treatments—a phenomenon known as the treatment–prevalence paradox. We consider several possible explanations for this paradox, which range from a misunderstanding of the very nature of depression, inflated efficacy of the established treatments, and a lack of access to efficacious delivery of treatments. We find support for each of these possible explanations but especially the notion that large segments of the population lack access to efficacious treatments that are implemented as intended. We conclude by describing the potential of using lay therapists and digital technologies to overcome this lack of access and to reach historically underserved populations and simultaneously guarantee the quality of the interventions delivered.

The current study estimated effects of intervention dose (attendance) of a cognitive behavioral prevention (CBP) program on depression-free days (DFDs) in adolescent offspring of parents with a history of depression. As part of secondary analyses of a multisite randomized controlled trial, we analyzed the complete intention-to-treat sample of 316 at-risk adolescents ages 13 to 17 years. Youth were randomly assigned to the CBP program plus usual care (n = 159) or to usual care alone (n = 157). The CBP program involved 8 weekly acute sessions and 6 monthly continuation sessions. Results showed that higher CBP program dose predicted more DFDs, with a key threshold of approximately 75% of a full dose in analyses employing instrumental variable methodology to control multiple channels of bias. Specifically, attending at more than 75% of acute phase sessions led to 45.3 more DFDs over the 9-month period after randomization, which accounted for over 12% of the total follow-up days. Instrument sets were informed by study variables and external data, including weather and travel burden. In contrast, conventional analysis methods failed to find a significant dose-outcome relation. Application of the instrumental variable approach, which better controls the influence of confounding, demonstrated that higher CBP program dose resulted in more DFDs. This article is part of a Special Collection on Mental Health.

Research investigating whether depression is an adaptation or a disorder has been hindered by the lack of an experimental paradigm that can test causal relationships. Moreover, studies attempting to induce the syndrome often fail to capture the suite of feelings, thoughts, and behaviors that characterize depression. An experimental paradigm for triggering depressive symptoms can improve our etiological understanding of the syndrome. The present study attempts to induce core symptoms of depression, particularly those related to rumination, in a healthy, nonclinical sample through a controlled social experiment. These symptoms are sad or depressed mood, anhedonia, feelings of worthlessness or guilt, and difficulty concentrating. One hundred and thirty-four undergraduate students were randomly assigned to either an exclusion (E) or control (C) group. Participants in the exclusion group were exposed to a modified Cyberball paradigm, designed to make them feel socially excluded, followed by a dual-interference task to assess whether their exclusion interfered with their working memory. Excluded participants: (a) self-reported a significant increase in sadness and decrease in happiness, but not anxiety or calmness; (b) scored significantly higher in four of five variables related to depressive rumination; and (c) performed significantly worse on a dual-interference task, suggesting an impaired ability to concentrate.

The most important lesson that I have learned in my half century as a therapist (and therapy researcher) is that principles matter more than processes. I had the great good fortune to arrive in Philadelphia at a time when Beck and colleagues were just beginning to test the efficacy of cognitive therapy for depression and what I learned was that helping clients (and myself) get the better of depression involved two main principles: (1) when in doubt do whatever you would have done if you were not depressed (behavioral); and (2) do not believe everything you think - check it out (cognitive). A third major principle is that the most powerful way to test an existing belief is to use one’s own behaviors to test its accuracy, which usually means doing whatever you least want to do in that situation (opposite action). I find that focusing on these principles is wholly liberating in the therapy process; I am free to be myself, to follow any line of inquiry, to respond to any request and to comport myself much as I would with any friend outside of therapy. This focus on principles has been good for my clients and even better for me.

Eye Movement Desensitization and Reprocessing (EMDR), while recognized as evidence-based, continues to be viewed as a novel and controversial treatment. At the same time, numerous alternative eye movement therapies have been introduced, each of which requires its own set of randomized controlled trials (RCTs) to assess remarkable claims of cure. The present situation is untenable in our opinion because any clever entrepreneur can claim a new method and trademark a new acronym. Recommendations are made for more stringent criteria to establish science-based methods that guide clinical practice.

A science-based approach to understanding health and disease emerged gradually over the past two centuries, while the modern evidence-based approach to health care emerged only about a half-century ago. The evidence-based approach to practice in health service psychology (HSP) gained significant traction after the American Psychological Association (APA) adopted it as policy in 2005, and in 2021, APA approved the first comprehensive set of guidelines for practicing HSP in an evidence-based manner. Several authors of this 2021 set of guidelines along with an additional subject matter expert wrote the current article. This article outlines the development of evidence-based practice in psychology, discusses the strengths and weaknesses of each of the three components of evidence-based practice (i.e., best available research, clinical expertise, and patient characteristics, culture, and preferences), and highlights the complexity involved in integrating related considerations during clinical decision making. The article then discusses strategies for the systematic application of this approach in HSP to improve the effectiveness of behavioral health care and strengthen population health.