Ecological momentary interventions for depression and anxiety

Ecological momentary interventions (EMIs) are becoming more popular and more powerful resources for the treatment and prevention of depression and anxiety due to advances in technological capacity and analytic sophistication. Previous work has demonstrated that EMIs can be effective at reducing symptoms of depression and anxiety as well as related outcomes of stress and at increasing positive psychological functioning. In this review, we highlight the differences between EMIs and other forms of treatment due to the nature of EMIs to be deeply integrated into the fabric of people's day-to-day lives. EMIs require unique considerations in their design, deployment, and evaluation. Furthermore, given that EMIs have been advanced by changes in technologies and that the use of behavioral intervention technologies for mental health has been increasing, we discuss how technologies and analytics might usher in a new era of EMIs. Future EMIs might reduce user burden and increase intervention personalization and sophistication by leveraging digital sensors and advances in natural language processing and machine learning. Thus, although current EMIs are effective, the EMIs of the future might be more engaging, responsive, and adaptable to different people and different contexts.     

当代中国推广促进心理治疗的机遇与挑战(英文)

中国第一部精神卫生法于去年开始生效,将心理治疗整合到各级医疗保健之中。但实现这一目标还存在着很多障碍。新法案赋予精神科医生提供心理治疗的权力,但是由于非生物学治疗所得到的收入较低,很少有医生会有时间或愿意去做。训练有素的临床心理治疗师非常紧缺,部分原因是缺乏督导培训的机会,也与目前的医疗制度有关,新的精神卫生法未给予他们在没有医生直接监督下诊断或治疗病人的权力。为了实现新法律的崇高目标,需要大幅度修改法规;也许更重要的是大力改变人们对于心理治疗师在医疗保健服务体系中作用和地位的态度。     

Self-control training in children: A review of interventions for anxiety and depression and the role of parental involvement

Abstract

This review critically evaluates self-control skills interventions in the treatment of childhood anxiety and depression, outlining conditions under which these interventions are successful and the specific role of parents. Findings indicated that self-control skills interventions are successful with both children and adolescents, in the context of other cognitive behavioral techniques and as the primary treatment component, and with and without parental involvement. However, despite consistent evidence of success in both pre-post and waitlist control designs, self-control skills treatments have not demonstrated superior efficacy when compared to other active treatments. Continued application and evaluation of these interventions amongst children and adolescents are recommended.     

The SAINT: A Guided Self-Help Approach for People With Intellectual Disabilities

Introduction: This article introduces the SAINT (Self-Assessment and INTervention), a guided self-help intervention for the treatment of mild depression in people with intellectual disabilities. Method: The study used a single-case experimental design and adopted quality frameworks specific to the approach to describe the participants and to standardize the study. The aim was to examine the acceptability and effectiveness of the SAINT on reducing symptoms of anxiety and depression. Semi-structured interviews were conducted to record user experiences and a framework-analysis approach was used. Attendance at sessions was also monitored. Results: Nine people receiving guided self-help using SAINT demonstrated a decrease in symptoms for both intervention phases for either depression or anxiety, with four showing a decrease in mean symptom scores in both intervention phases for both depression and anxiety. Those with a history of affective disorders and those with moderate intellectual disabilities showed improved symptom scores during both intervention phases. Summary and Conclusion: The idea that the SAINT can be feasibly implemented in routine clinical practice was broadly supported, with the positive outcomes relating to symptom reduction and acceptability. From the feedback received, the SAINT is tolerated well by participants and viewed positively by those using it and those who have supported people in its use.     

Bipolar depression: An underestimated treatment challenge

We sought to determine whether depressive and mixed/cycling episodes were as responsive to standardized pharmacotherapeutic interventions as were manic episodes in bipolar 1 patients. As part of the Maintenance Therapies in Bipolar Disorder (MH29618, E. Frank, PI) study, forty-two acutely ill bipolar 1 patients who had been randomly assigned to one of two preliminary phase non-pharmacologic treatment strategies (interpersonal and social rhythm therapy [IPSRT] or a standard medication clinic approach) were treated according to a standardized pharmacotherapeutic protocol. Symptom severity was measured weekly with the Hamilton Depression Rating Scale and the Bech-Rafaelsen Mania Scale in order to assess symptomatic remission. Survival analysis with the proportional hazards model was performed on time to remission. Manic patients were significantly more likely to achieve clinical remission than the depressed patients (100 vs. 59%) and did so significantly more rapidly. The difference in proportion remitting and time to remission between the depressed and mixed/cycling groups was not statistically significant. No significant effect for non-pharmacologic treatment assignment was found. These results point to the need to develop more effective treatments for bipolar depression. They also suggest that psychotherapy has a limited impact in the acute phase treatment of bipolar episodes. Depression and Anxiety 5:73–83, 1997. © 1997 Wiley-Liss, Inc     

Interpersonal psychotherapy for depression with panic spectrum symptoms: a pilot study

Patients whose depression is complicated by a lifetime history of panic symptoms display a poorer treatment response to both psychotherapeutic and pharmacologic interventions. A newly adapted psychosocial treatment for depression with lifetime panic spectrum symptoms was evaluated in an open pilot study.     

“互联网+”医院-社区-家庭三元联动管理模式在围产期抑郁中的应用

背景围产期抑郁严重影响孕产妇身心健康,如影响其角色转换及认同感、家庭关系等,严重者甚至引起自杀行为,给孕产妇及家庭造成沉重的负担。以孕产妇为中心,家庭、社区、医院共同参与的分级管理模式,有助于对存在围产期抑郁者进行全程、动态管理。目的 评价“互联网+”医院-社区-家庭三元联动管理模式在孕产妇围产期抑郁中的应用效果,以期为孕产妇围产期抑郁的临床干预提供参考。方法 选取2022年1月—12月在绵阳市第三人民医院妇产科门诊建档、且爱丁堡产后抑郁量表（EPDS）评分>9分的80例孕妇为研究对象,采用随机数字表法分为研究组和对照组各40例,两组分娩前在妇产科门诊孕妇学校、入院待产后在妇产科住院部学习室接受常规护理干预,研究组在此基础上接受“互联网+”医院-社区-家庭三元联动管理。于干预前和干预后（产后42天）采用EPDS、匹兹堡睡眠质量指数量表（PSQI）、生活质量综合评定问卷（GQOLI-74）及自编护理满意度问卷进行评定。结果 干预后,研究组EPDS评分和PSQI评分均低于对照组（F=42.823、60.453,P均<0.05）,GQOLI-74评分和护理满意度均高于对照组（F=...     

Treating depression with the evidence-based psychotherapies: a critique of the evidence

OBJECTIVE: While Cognitive Behaviour Therapy (CBT) and Interpersonal Therapy (IPT) have been positioned as first-line evidence-based treatments for depression, we suggest that limitations to the 'evidence' deserve wider appreciation. METHOD: A systematic literature search was undertaken, and limitations to the evidence base discussed. RESULTS: The review suggests that the specificity of CBT and IPT treatments for depression has yet to be demonstrated and details likely reasons. CONCLUSION: The superiority of CBT and IPT may well be able to be demonstrated across defined rather than universal circumstances. To achieve this aim, outcome research should move away from testing treatments as if they have universal application for heterogeneous disorder categories. Findings have distinct implications for the clinical management of depressive disorders, and particularly in relation to the utility of psychotherapy.     

Predicting dropout in adolescents receiving therapy for depression

Objective: Therapy dropout is a common occurrence, especially in adolescence. This study investigated whether dropout could be predicted from a range of child, family, and treatment factors in a sample of adolescents receiving therapy for depression. Method: This study draws on data from 406 participants of the IMPACT study, a randomized controlled trial, investigating three types of therapy in the treatment of adolescent depression. Logistic regression was used to estimate the effects of predictors on the odds of dropout. Results: Few pre-treatment predictors of dropout were found, with the only significant predictors being older age, antisocial behaviour, and lower scores of verbal intelligence. Missed sessions and poorer therapeutic alliance early in treatment also predicted dropout. Most child and family factors investigated were not significantly associated with dropout. Conclusions: There may be little about depressed adolescents’ presentation prior to therapy starting that indicates their risk of dropout. However, within-treatment factors indicated that warning signs of dropout may be identifiable during the initial phase of therapy. Identifying and targeting early treatment indicators of dropout may provide possibilities for improving engagement.

Clinical and methodological significance of this article: In the literature, a great deal of attention has been paid to child and family factors that predict therapy dropout, yet in this study, few pre-treatment characteristics were predictive of dropout. However, findings revealed possible warning signs of dropout in the early part of treatment, as poor therapeutic alliance and missed sessions were both found to be predictive of dropout. These findings call for therapists to be aware of such warning signs and clinical guidelines for managing cases at risk of dropout are warranted.     

Cognitive therapy for depression in the elderly

The applicability for older patients of cognitive (CT) and cognitive-behavioural (CBT) therapies for depression, now well established for clinical populations aged less than 65 years, was reviewed. Eighteen English language articles published to the end of 1994 were located using Medline, Psychlit and key reference searches. Outcome data from seven studies indicate that CT is clearly more effective than no therapy or placebo, through prediction of success remains uncertain. Several variables may influence outcome. Outcome in younger and older depressives with CT was comparable. Adaptation of cognitive-behavioural techniques for older depressives is described. While these may enhance CT’s efficacy with older people, they as yet lack empirical evidence. The review, though limited, concludes that CT is an effective intervention for depression in older people and recommends strategies for further research to enable more accurate targeting of therapy.     

Predicting symptoms in major depression after inpatient treatment: the role of alexithymia

Alexithymia has been considered to have a negative influence on the course of symptoms in various psychiatric disorders. Only a few studies of depressed patients have examined whether alexithymia predicts the outcome of therapeutic interventions or the course of symptoms in naturalistic settings. This prospective study investigated whether alexithymia is associated with depressive symptoms after a multimodal inpatient treatment. Forty-five inpatients suffering from acute major depression were examined in the initial phase of treatment and then again after seven weeks. Patients took part in a multimodal treatment programme comprising psychodynamic-interactional oriented individual and group therapy. The majority of patients were taking antidepressants during study participation. To assess alexithymia and depressive symptoms, the 20-item Toronto Alexithymia Scale (TAS-20), the Beck Depression Inventory II (BDI-II) and the Hamilton Depression Scale (HAMD) were administered at baseline and follow-up. When controlling for baseline depressive symptoms along with trait anxiety, high scores in the externally oriented thinking (EOT) facet of alexithymia at baseline predicted high severity of depressive symptoms at follow-up (for self-reported as well as interviewer-based scores). Inpatients suffering from major depression with a more pronounced external cognitive style might benefit less from a routine multimodal treatment approach (including psychodynamic interactional therapy, antidepressant medication, and complementary therapies). Intervention programmes might modify or account for alexithymic characteristics to improve the course of depressive symptoms in these patients.     

抗抑郁药联合用药以及其他干预策略治疗难治性抑郁症的评价(英文)

有关难治性抑郁症(treatment-resistant depression,TRD)的定义及其亚类一直有争议,从而难以评估治疗这种慢性致残性病症的不同方案的疗效。根据TRD的症状严重程度等临床特征以及人口学特征方面进行分类可能有助于对同一亚类TRD的识别,并有助于制定针对特定亚类的干预措施。     

A systematic review of perinatal depression interventions for adolescent mothers

Poor, adolescent, racial/ethnic minority women are at great risk for developing perinatal depression. However, little research has been conducted evaluating interventions for this population. We conducted a systematic review of preventive and treatment interventions for perinatal depression tested with adolescents, with a focus on low income, minority populations. Nine research-based articles (including one that reported on two studies) were reviewed systematically, and quality ratings were assigned based on a validated measure assessing randomization, double-blinding, and reporting of participant withdrawals. Two treatment studies were identified, both of which were successful in reducing depression. Eight prevention studies were located, of which four were more efficacious than control conditions in preventing depression. Studies sampled mostly minority, low socioeconomic status adolescents. No consistent characteristics across efficacious interventions could be identified. This review underscores the need for researchers to further investigate and build an evidence base.     

Online single-session interventions for Kenyan adolescents: study protocol for a comparative effectiveness randomised controlled trial

BackgroundMental health problems are the leading cause of disability among adolescents worldwide, yet access to treatment is limited. Brief digital interventions have been shown to improve youth mental health, but little is known about which digital interventions are most effective.AimsTo evaluate the effectiveness of two digital single-session interventions (Shamiri-Digital and Digital-CBT (cognitive-behavioural therapy)) among Kenyan adolescents.MethodsWe will perform a school-based comparative effectiveness randomised controlled trial. Approximately 926 Kenyan adolescents will be randomly assigned to one of three conditions: Shamiri-Digital (focused on gratitude, growth mindsets and values), Digital-CBT (focused on behavioural activation, cognitive restructuring and problem solving) or a study-skills control condition (focused on note-taking and essay writing skills). The primary outcomes include depressive symptoms (measured by the Patient Health Questionnaire-8), anxiety symptoms (Generalized Anxiety Disorder Screener-7) and subjective well-being (Short Warwick-Edinburgh Mental Well-being Scale). The secondary outcomes include acceptability, appropriateness, primary control and secondary control. Acceptability and appropriateness will be measured immediately post-intervention; other outcomes will be measured 2 weeks, 4 weeks and 12 weeks post-intervention.ResultsWe hypothesise that adolescents assigned to Shamiri-Digital and adolescents assigned to Digital-CBT will experience greater improvements (assessed via hierarchical linear models) than those assigned to the control group. We will also compare Shamiri-Digital with Digital-CBT, although we do not have a preplanned hypothesis.ConclusionsOur findings will help us evaluate two digital single-session interventions with different theoretical foundations. If effective, such interventions could be disseminated to reduce the public health burden of common mental health problems.Trial registration numberPACTR202011691886690.     

Psychometric properties of the Helping Alliance Questionnaire-I in psychodynamic psychotherapy for major depression

Abstract

The psychometric properties of the Helping Alliance Questionnaire-I were analyzed at two times in short-term psychoanalytic supportive psychotherapy for outpatient depression. Exploratory factor analysis conducted in 142 patients generated a model that was confirmed in a different validation sample (n=106) using confirmatory factor analysis. Two factors were found to have satisfactory psychometric properties and a consistent structure over time: relationship and internal change. The authors conclude that reporting on the HAQ-I with separate scores for these individual aspects of alliance offers a more precise assessment and is preferable to using a single general alliance score.