Psychological treatment of postpartum depression: a meta-analysis

Postpartum depression is a widespread and disruptive depressive disorder seriously affecting the lives of new mothers and their families. We conducted a meta-analysis of controlled and comparative studies of psychological treatments of postpartum depression. Seventeen studies were included. The mean standardized effect size of all psychological treatments compared to control conditions was 0.61 (95% CI: 0.37 approximately 0.85). Several subgroup analyses were conducted. Studies with waiting list control groups had a larger mean effect size (0.96; 95% CI: 0.63 approximately 1.29) than studies with a care-as-usual control group (0.41; 95% CI: 0.25 approximately 0.58). No definite conclusions can be drawn about the longer term effects. Too few studies were available to draw conclusions about the relative effects of psychological treatments compared to pharmacological and other treatments.     

Psychological treatment of depression in inpatients: a systematic review and meta-analysis

Research on psychological treatment of depression in inpatients is not conclusive, with some studies finding clear positive effects and other studies finding no significant benefit compared to usual care or structured pharmacotherapy. The results of a meta-analysis investigating how effective psychological treatment is for depressed inpatients are presented. A systematic search in bibliographical databases resulted in 12 studies with a total of 570 respondents. This set of studies had sufficient statistical power to detect small effect sizes. Psychological treatments had a small (g = 0.29), but statistically significant additional effect on depression compared to usual care and structured pharmacological treatments only. This corresponded with a numbers-needed-to-be-treated of 6.17. Heterogeneity was zero in most analyses, and not significant in all analyses. There was no indication for significant publication bias. Effects were not associated with characteristics of the population, the interventions and the design of the studies. Although the number of studies was small, and the quality of many studies was not optimal, it seems safe to conclude that psychological treatments have a small but robust effect on depression in depressed inpatients. More high-quality research is needed to verify these results.     

认知行为治疗对改善乳腺癌患者术后抑郁以及生活质量的Meta分析

目的:通过Meta分析的方法评价认知行为治疗(cognitive behavioral therapy,CBT)对改善乳腺癌患者术后抑郁以及生活质量的效果.方法:手动检索Cochrane Library,EMBASE,PubMed,Web of Science英文数据库以及中国生物医学文摘数据库(CBM)、维普数据库(VIP)、万方数据库及中国知网数据库(CNKI),纳入认知行为疗法改善术后抑郁以及生活质量的随机对照研究,评价结果包括焦虑自评量表(Self-Rating Anxiety Scale,SAS)评分,抑郁自评量表(Self-Rating Depression Scale,SDS)评分、生活质量核心问卷(Quality of Life-Core 30 Questionnaire,QLQ-C30)总分以及各个项目的评分进行Meta分析.结果:共纳入17篇文献,纳入患者1645例,认知行为护理组832例,对照组813例.与对照组比较,行为认知疗法可以改善乳腺癌患者术后抑郁以及焦虑情绪评分,差异有统计学意义(P<0.05).同时行为认知疗法可以降低患者术后QLQ-C30各个项目评分,差异有统计学意义(P<0.05).结论:认知行为疗法可以改善乳腺癌患者术后抑郁以及焦虑情绪,改善患者生活质量.     

Behavioral Activation Treatments for Depression in Adults: A Meta-analysis and Review

Behavioral activation (BA) treatments for depression require patients to increase overt behavior to bring them in contact with reinforcing environmental contingencies. This meta-analysis sought to identify all randomized controlled studies of BA, determine the effect of this approach, and examine the differential effectiveness of variants. Thirty-four studies with 2,055 participants reporting symptoms of depression were included. The pooled effect size indicating the difference between BA and control conditions at posttest was 0.78. For participants who satisfied the criteria for major depressive disorder, the overall effect size of 0.74 remained large and significant. No differences in effectiveness between BA and cognitive therapy were found. BA may be considered a well-established and advantageous alternative to other treatments of depression.     

正念疗法对产后抑郁患者干预效果的meta分析

目的:探讨正念疗法对产后抑郁患者的干预效果。方法:检索PubMed、Cochrane Library、EMbase、Web of Science、CNKI、万方数据库,检索正念疗法对产后抑郁患者疗效的相关文献,纳入随机对照试验,由2名研究人员根据纳入/排除标准提取数据,并根据Cochrane Handbook5.1.0手册进行文献质量评价。结果:共纳入6篇随机对照试验(RCT)和2篇自身对照研究的文献,合计404名患者。Meta分析结果显示,与常规护理方法相比,正念疗法能有效缓解产妇的抑郁和焦虑情绪。接受正念疗法的产后抑郁患者抑郁水平明显低于常规护理组[MD=3.01,95%CI(2.29,3.72),P<0.05]。结论:正念疗法能改善产后抑郁患者的焦虑、抑郁情绪。     

Couple therapy for depression

Relationship problems and depression often influence one another in a bidirectional, recursive fashion. Results from several clinical trials have demonstrated that couple therapy is effective in improving depression and reducing relationship problems. In this article, we describe an approach to working with depression in partnered individuals who are also unhappy in their relationship. This cognitive-behavior approach strives to (a) eliminate major stressors and reestablish positive activities in the relationship, (b) improve communication and problem solving in the relationship, and (c) solidify gains made in therapy and prevent relapse. The typical course of therapy is described and demonstrated in a case illustration. Couple therapy is a promising treatment for depressed individuals in distressed relationships.     

Do ultra-short screening instruments accurately detect depression in primary care?: A pooled analysis and meta-analysis of 22 studies

BACKGROUND: Guidance from the National Institute for Health and Clinical Excellence recommends one or two questions as a possible screening method for depression. Ultra-short (one-, two-, three- or four-item) tests have appeal due to their simple administration but their accuracy has not been established. AIM: To determine whether ultra-short screening instruments accurately detect depression in primary care. DESIGN OF STUDY: Pooled analysis and meta analysis. METHOD: A literature search revealed 75 possible studies and from these, 22 STARD-compliant studies (Standards for Reporting of Diagnostic Accuracy) involving ultra-short tests were entered in the analysis. RESULTS: Meta-analysis revealed a performance accuracy better than chance (P<0.001). More usefully for clinicians, pooled analysis of single-question tests revealed an overall sensitivity of 32.0% and specificity of 97.0% (positive predictive value [PPV] was 55.6% and negative predictive value [NPV] was 92.3%). For two- and three-item tests, overall sensitivity on pooled analysis was 73.7% and specificity was 74.7% with a PPV of only 38.3% but a pooled NPV of 93.0%. The Youden index for single-item and multiple item tests was 0.289 and 0.47 respectively, suggesting superiority of multiple item tests. Re-analysis examining only 'either or' strategies improved the 'rule in' ability of two- and three-question tests (sensitivity 79.4% and NPV 94.7%) but at the expense of being able to rule out a possible diagnosis if the result was negative. CONCLUSION: A one-question test identifies only three out of every 10 patients with depression in primary care, thus unacceptable if relied on alone. Ultra-short two- or three-question tests perform better, identifying eight out of 10 cases. This is at the expense of a high false-positive rate (only four out of 10 cases with a positive score are actually depressed). Ultra-short tests appear to be, at best, a method for ruling out a diagnosis and should only be used when there are sufficient resources for second-stage assessment of those who screen positive.     

The relationship between the therapeutic alliance and clinical outcomes in cognitive behaviour therapy for adults with depression: A meta‐analytic review

Research consistently provides evidence for the relationship between the therapeutic alliance (TA) and outcome across various therapies and presenting problems. Depression is considered the leading cause of disability worldwide, and there is substantial evidence for the efficacy for Cognitive Behaviour Therapy (CBT) in its treatment. At present, there is lack of clarity specifically about the relationship between the TA and outcome in CBT for depression. The present review is the first meta‐analytic review to explore this relationship and also considering moderators. Within a random‐effects model, an overall mean effect size of r = 0.26 (95% CI [.19–.32]) was found, indicating that the TA was moderately related to outcome in CBT for depression. The mean TA–outcome correlation is consistent with existing meta‐analysis that looked across a broad range of presenting problems and psychological therapies. A secondary exploratory analysis of moderators suggested the TA–outcome relationship varied according to the TA rater, where the relationship was weaker for therapist raters compared with clients and observer raters. Additionally, the results indicated that the TA–outcome relationship marginally increased over the course of CBT treatment. The results of the meta‐analysis are discussed in reference to the wider body of research, methodological limitations, clinical implications, and future directions for research.     

Complex depression: The treatment of major depression and severe personality pathology

The intensive treatment of a patient presenting with major depression, chronic suicidal ideation, and a borderline personality disorder with narcissistic features is described as it developed over an 18-month treatment. The treatment approach is a transdiagnostic one with an emphasis on change in the patient's representation of self and others, identity and interpersonal functioning. The intended change is not only in the reduction of depression and suicidal ideation but also an improvement in interactions with others at work and intimate relations. The combination of rich clinical information from the therapist and independent research ratings of patient progress provide a complex picture of the treatment.     

The efficacy of internet-based cognitive behavioural therapy for social anxiety disorder: A systematic review and meta-analysis

Social anxiety disorder (SAD) is one of the most common lifelong anxiety disorders. Although cognitive behavioural therapy (CBT) has proven to be effective in treating people with SAD, it may not be available for a considerable proportion of patients. Internet-based CBT (ICBT) is more accessible than face-to-face treatment. This meta-analysis evaluated the efficacy of ICBT in patients with SAD. We searched five databases, PubMed, Cochrane Central Register of Controlled Trials, Health Management Information Consortium, Ovid MEDLINE and EMBASE, and identified 20 eligible randomized controlled trials published from inception to 25 July 2020, with the outcome data from 1,743 participants. The results indicated that ICBT had a significant positive effect on patients with SAD compared with the control groups (g = −0.55). A subgroup analysis revealed that ICBT and CBT had an equal effect on treating patients with SAD (g = −0.18). There was also no difference between ICBT and ICBT plus other therapies in the treatment of patients with SAD (g = −0.07). The effect size of ICBT on patients with SAD was maintained at the 6-month follow-up (g = −0.08) and at the 12-month follow-up (g = −0.17). The findings of this review demonstrated that ICBT can significantly reduce SAD symptoms and that ICBT and face-to-face CBT produce equivalent effects. The results of this meta-analysis contributed to the literature on ICBT for the treatment of patients with SAD, although numerous aspects of ICBT were identified for future investigations.     

成人注意缺陷多动障碍的心理治疗(综述)

成人注意缺陷多动障碍(ADHD)对患者的社会功能存在持续不良影响,需要在药物治疗基础上进行包括心理治疗在内的综合性治疗.本文总结了针对成人ADHD不同种类的心理治疗方法,包括认知行为治疗、辩证行为治疗、正念冥想、训练治疗、婚姻家庭治疗,并对不同的治疗方法进行了研究、比较和总结.目前,中枢兴奋剂联合针对症状的心理治疗是多部治疗指南推荐的成人ADHD治疗方法,而在多种心理治疗方法中,认知行为治疗被证明对ADHD核心症状及与焦虑、抑郁相关的合并症状最为有效.最后本文分析了目前研究存在的问题和未来可能的研究方向,希望有助于成人ADHD的相关研究和临床治疗.     

Psychological Assessment and Psychotherapy in Long-Term Care

The continued growth of the older adult population, combined with the inclusion of psychologists in Medicare, is leading to psychological services increasingly being delivered in long-term care settings. This article reviews some basic concepts in psychological assessment and psychotherapy with older adults in long-term care settings. A guide is provided for the assessment of dementia, delirium, and depression. The use of validated empirical instruments, the collection of multiple sources of historical data, and the incorporation of assessment results in treatment planning are emphasized. Psychotherapy with persons having a dementia, and psychotherapy with persons having a personality disorder are the focus of the treatment section of this article. We argue that these have been neglected areas of practice, and yet treatment can produce significant benefits to these patients.     

Exploring patients' reasons for declining contact in a cognitive behavioural therapy randomised controlled trial in primary care

Background

The difficulties of recruiting individuals into mental health trials are well documented. Few studies have collected information from those declining to take part in research, in order to understand the reasons behind this decision.

Aim

To explore patients'' reasons for declining to be contacted about a study of the effectiveness of cognitive behavioural therapy as a treatment for depression.

Design and setting

Questionnaire and telephone interview in general practices in England and Scotland.

Method

Patients completed a short questionnaire about their reasons for not taking part in research. Semi-structured telephone interviews were conducted with a purposive sample to further explore reasons for declining.

Results

Of 4552 patients responding to an initial invitation to participate in research involving a talking therapy, 1642 (36%) declined contact. The most commonly selected reasons for declining were that patients did not want to take part in a research study (n = 951) and/or did not want to have a talking therapy (n = 688) (more than one response was possible). Of the decliners, 451 patients agreed to an interview about why they declined. Telephone interviews were completed with 25 patients. Qualitative analysis of the interview data indicated four main themes regarding reasons for non-participation: previous counselling experiences, negative feelings about the therapeutic encounter, perceived ineligibility, and misunderstandings about the research.

Conclusion

Collecting information about those who decline to take part in research provides information on the acceptability of the treatment being studied. It can also highlight concerns and misconceptions about the intervention and research, which can be addressed by researchers or recruiting GPs. This may improve recruitment to studies and thus ultimately increase the evidence base.     

Live psychotherapy by video versus in-person: A meta-analysis of efficacy and its relationship to types and targets of treatment

In-person psychotherapy (IPP) has a long and storied past, but technology advances have ushered in a new era of video-delivered psychotherapy (VDP). In this meta-analysis, pre-post changes within VDP were evaluated as were outcome differences between VDP versus IPP or other comparison groups. A literature search identified k = 56 within-group studies (N = 1681 participants) and 47 between-group studies (N = 3564). The pre-post effect size of VDP was large and highly significant, g = +0.99 95% CI [0.67–0.31]. VDP was significantly better in outcome than wait list controls (g = 0.77) but negligible in difference from IPP. Within-groups heterogeneity of effect sizes was reduced after subgrouping studies by treatment target, of which anxiety, depression, and posttraumatic stress disorder (PTSD) (each with k > 5) had effect sizes nearing 1.00. Disaggregating within-groups studies by therapy type, the effect size was 1.34 for CBT and 0.66 for non-CBT. Adjusted for possible publication bias, the overall effect size of VDP within groups was g = 0.54. In conclusion, substantial and significant improvement occurs from pre- to post-phases of VDP, this in turn differing negligibly from IPP treatment outcome. The VDP improvement is most pronounced when CBT is used, and when anxiety, depression, or PTSD are targeted, and it remains strong though attenuated by publication bias. Clinically, therapy is no less efficacious when delivered via videoconferencing than in-person, with efficacy being most pronounced in CBT for affective disorders. Live psychotherapy by video emerges not only as a popular and convenient choice but also one that is now upheld by meta-analytic evidence.