Journal of Behavioral and Cognitive Therapy最新文献

Purpose

Digital mental health interventions (DMHI) may enhance equity in college student mental health, but engagement with them is poor. Little is known about barriers and strategies to enhance DMHI uptake among college students of color. The goal of this study was to attain expert consensus on important barriers to DMHI uptake and important and feasible engagement strategies to enhance DMHI uptake among college students of color.

Methods

The study utilized a modified, three-round Delphi survey. Researcher and industry stakeholders with relevant expertise participated (n = 35). Across rounds, experts generated and rated the importance and feasibility of barriers and strategies to promote DMHI uptake for students of color. Experts viewed group consensus and importance ratings between rounds and were provided the opportunity to re-rate items. Barriers and strategies were coded into frameworks using rapid qualitative analysis and grounded theory techniques.

Results

A total of n = 63 barriers and n = 64 strategies were derived, and consensus on level of importance was met for 98% of barriers and strategies. Key barriers included mistrust of mental health services and lack of culturally responsive care. Strategies spanned levels of implementation and emphasized codesign, diverse representation, reducing user burden, addressing privacy issues, and embedding DMHI within existing infrastructure.

Conclusions

This study identified barriers and strategies for improving DMHI uptake for college students of color. The subset of highly feasible and important engagement strategies derived in this study provides direction for the design of scalable engagement interventions with the potential to improve DMHI implementation and reduce disparities in care receipt.

Young people often experience difficulties accessing mental health support. In moments of crisis, many young people search for mental health-related information or support on social media platforms. When users search or post crisis-related content (e.g., “suicide”) on these platforms, many are programmed to automatically provide the user with crisis hotlines. Little research has examined whether young people use crisis hotlines when they are automatically shared, or whether other resource-provision strategies may better support hope and help-seeking.

Methods

Users flagged as being potentially in-crisis by social media platforms were referred to Koko—a nonprofit that partners with online platforms to provide crisis support. Users were randomized to receive either a typical crisis response (988 crisis hotline provision) or a one-minute, enhanced crisis response Single-Session Intervention (SSI).

Results

Users who received the enhanced crisis response SSI reported greater decreases in hopelessness ten minutes later, compared to users who received the typical crisis response (t(153) = -2.16, p = 0.03, d = -0.35; 95 % CI, −0.67, −0.03). Users who received the SSI were more than twice as likely to report using the resources provided to them, compared to users who received the typical crisis response (78.02 % vs 38.64 %; χ2(1) = 27.02, p < 0.001, V = 0.28).

Conclusion

An enhanced crisis response SSI embedded within social media platforms can reduce users’ hopelessness and dramatically increase young people’s odds of accessing mental health resources in moments of crisis.

The purpose of this study was to investigate preliminary outcomes associated with an undergraduate course titled, “Wellness and Resilience for College and Beyond” (WRC), which teaches students evidence-based skills for emotional health. Three campuses in Southwestern Pennsylvania with no previous experience delivering this course implemented the one-semester WRC during the Fall 2019 semester; 24 students completed a baseline survey and at least 1 follow-up survey. Participants completed electronic surveys at baseline, post-semester, and 3-month follow-up. Paired t-tests were used to compare baseline scores to scores at post-semester and 3-month follow-up. At post-semester, students reported significant improvements in psychological inflexibility, resilience, mindfulness, emotion dysregulation, distress tolerance, life satisfaction, dysfunctional coping, and adaptive skills use. With the exceptions of life satisfaction and emotion dysregulation, significant gains were maintained at 3-month follow-up. Notably, the follow-up assessment occurred at the beginning of the COVID-19 lockdown in the U.S. (March 2020), which may have affected life satisfaction and emotion dysregulation for participants. There was a nonsignificant decline in anxiety at post-semester which became statistically significant at 3-month follow-up. These preliminary data show proof of concept that WRC can be implemented successfully on new campuses with no previous expertise in this course and can achieve meaningful improvements on several emotional health outcomes with high relevance to collegiate mental health. In addition to these data, barriers to implementation and scale-up are discussed at length with “lessons learned” that may have broad relevance to the implementation of emotional wellbeing coursework in higher education and support such efforts to address student mental health at the population level.

Cognitive-behavioral therapy (CBT-E) is the most widely researched and effective treatment for bulimia nervosa (BN). CBT-E for BN emphasizes the importance of therapeutic skills utilization as consistent skill utilization is proposed to drive treatment outcomes. Despite its theoretical importance, there is limited research on skill use during BN treatment and its impact on BN symptoms. The current study was an exploratory analysis of whether skills utilization during CBT for BN were associated with improvements in BN at post-treatment. Participants (N = 54) with BN-spectrum eating disorders received 16 weekly sessions of individual CBT-E, in which they were taught six core skills designed to reduce BN symptoms. After each session, clinicians rated the degree of skills utilization by participants during the past week. Linear regressions were used to examine whether within-person averages of utilization of each of the six skills were related to treatment outcomes (measured as reduction in binge eating and EDE global scores assessed via the Eating Disorders Examination Global Scale) at post treatment and follow up. Higher average use of all six skills during treatment predicted improvements in global eating pathology at post treatment and follow up. There was no relationship found between skill use and improvements in binge eating at post treatment, however, all six skills except regular eating skill predicted improvements in binge eating at follow up. These findings suggest that greater utilization of skills is crucial in maximizing treatment gains for BN patients. Future studies should explore ways to increase the acceptability and utilization of these skills.

University students experience a high prevalence of mental health and substance use concerns; however, few students access support for these challenges. Although digital mental health interventions have been promoted as a means of addressing this need, engagement with these tools is often poor. A lack of user-centric design is frequently cited as a reason for low engagement. The goal of this study is to describe the co-development processes and associated feedback used to develop the Minder app, a tool designed to support a non-clinical population of university students to maintain mental wellbeing and manage substance use. This process can be organized into three main phases: conceptualization and initial app design, iterative user testing, and final app design. As a result of meaningful engagement with end-users throughout the design and testing process, key changes were made to the design (e.g., graphical interface), content (e.g., language used, addition of components related to general wellbeing), and support (e.g., peer coaching) provided within the app. In addition to describing these changes, we also discuss considerations related to the broader implementation and scale-up of the Minder app within existing university systems.

The evidence base for psychological interventions for suicidal individuals is limited and the delivery of longer-term therapy within mental health crisis services is confronted by several barriers. For these reasons, identifying briefer techniques that can be delivered to at-risk groups is pertinent. This study provides a preliminary evaluation of the Broad Minded Affective Coping (BMAC) technique, a brief positive mental imagery intervention, for suicidal adults. Of 32 individuals referred by mental health crisis services, 14 adults with experience of suicidal ideation in the past three months took part. All participants received a one-session BMAC brief intervention, and invited to practice the BMAC independently for the next seven days and provide logbook ratings of pre-post BMAC mood states. Suicidal ideation and depression were assessed at baseline and at the end of the week of imagery practice. Nine participants (64%) completed the study by providing baseline and follow-up assessments of depression and suicidal ideation, completing a logbook and participating in a feedback interview. The BMAC appeared acceptable to participants and showed promise in improving mood and suicidal thoughts. We discuss the implications of these findings for future investigations of a one-session BMAC brief intervention.

Despite robust empirical support, exposure therapy is severely underutilized in routine clinical care. Clinicians’ perception of exposure therapy as too difficult is a key but largely unaddressed barrier to implementation. This pilot study sought to evaluate the acceptability and feasibility of a novel clinical web-tool—Exposurepedia—designed to support the implementation of exposure therapy for anxiety-related disorders by alleviating its perceived difficulty. Clinicians in an anxiety specialty clinic were given access to Exposurepedia. Of 20 eligible clinicians, 16 (80%) voluntarily registered for the website. Of those who registered, 13 (81%) used the website at least once and 10 (77% of users) became repeat users. Over the 6-week pilot, Exposurepedia was accessed 46 times (M = 7.7 times per week; SD = 2.8). Clinicians reported in majority that Exposurepedia made exposure therapy easier, saved them time, was easy to use, and increased their confidence in doing exposures. Clinicians are interested in using Exposurepedia and found the tool to be both acceptable and feasible in alleviating the intellectual, logistical, and emotional demands of exposure therapy. This pilot provides the basis for future research seeking to further develop and evaluate this novel digital implementation support tool.

Obsessive-compulsive disorder (OCD) is associated with “emotional disconnections” (e.g., difficulty understanding your emotions), but very limited work has examined these links prospectively or in the context of OCD treatment. This study tested the hypotheses that emotional clarity and emotional awareness would predict improvement in OCD symptoms during Exposure and Response Prevention (ExRP) in a naturalistic treatment sample, based on the putative impact of these factors on emotional processing. We tested the effect of baseline levels of emotional clarity and awareness (measured using the Difficulties in Emotion Regulation Scale) on OCD symptoms at baseline, mid- and post-treatment (Obsessive-Compulsive Inventory, Revised) in a study of adults diagnosed with OCD and receiving ExRP in an open treatment clinic (N = 131) using multilevel modeling. Both lack of emotional clarity and lack of emotional awareness predicted OCD symptom severity at post-treatment. Lack of awareness also predicted greater improvement in OCD symptoms during treatment, while clarity did not. Consistent with previous research, individuals who reported being less clear about their emotions had more severe OCD symptoms at post-treatment. Extending previous findings, those who reported being more aware of their emotions before treatment showed less symptom improvement during treatment. Clinical and theoretical implications of these findings are discussed.

This meta-analysis examines the effects of mindfulness-informed and mindfulness-based interventions including acceptance and commitment therapy (ACT), mindfulness-based stress reduction (MBSR), and mindfulness-based cognitive therapy (MBCT) on depressive and anxiety symptoms among college students. Three electronic databases (PubMed, PsycINFO, and Cochrane Central) were utilized and systematically searched. Effect estimates were reported as standardized mean differences (SMDs) and data were pooled using random-effects models. Twenty-two comparisons derived from 19 studies (2716 participants) were included in the meta-analysis. For studies employing passive control conditions (n = 17), post-intervention effect sizes were significant for depressive (0.47 [95% CI: 0. 32–0.63]) and anxiety symptoms (0.58 [95% CI: 0.34–0.82]). Effect sizes were significant at post-intervention among MBCT (0.76 [95% CI: 0.48–1.03] for depressive symptoms and 1.37 [95% CI: 0.70–2.04] for anxiety symptoms) and MBSR (0.58 [95% CI: 0.31–0.86] for depressive symptoms and 0.49 [95% CI: 0.24–0.73] for anxiety symptoms). The effect size of ACT for depressive symptoms at post-intervention was significant (0.28 [95% CI: 0.09–0.48]), but the post-intervention effect size of ACT for anxiety symptoms was not significant (0.23 [95% CI: −0.01 −0.47]). Our analyses showed no superiority for ACT, MBSR, and MBCT to active control conditions, either when they were combined or considered separately. This meta-analysis provides empirical evidence in support of ACT, MBSR, and MBCT for reducing depressive and anxiety symptoms among college students.

Despite established efficacy, there is low engagement in prolonged exposure (PE) therapy for PTSD among combat veterans. In preparation for a full-scale randomized trial, we sought to evaluate the feasibility, safety, and preliminary efficacy of quetiapine to enhance patient engagement in PE therapy. Open-label, randomized pilot trial of quetiapine monotherapy vs. Treatment as Usual (TAU) medications in 20 military veterans with combat related PTSD who were seeking care from the San Antonio Polytrauma Rehabilitation Center at the South Texas Veterans Healthcare System (STVHCS). Participants were randomized to receive either Quetiapine (n = 10) monotherapy or pharmacological TAU (n = 10) in patients who were receiving PE as a standard of care therapy. We collected information on (1) the number of potentially eligible veterans approached, the number screened, and the number randomized, (2) adverse events reported, (3) number of participants continuing PE treatment at least until session #4 (i.e., after first exposure session) and the total number of sessions of PE completed by the participants, and (4) change in PTSD severity and sleep quality measured by the PTSD Checklist for DSM-5 (PCL-5) and Pittsburgh Sleep Quality Index (PSQI). Data were analyzed for 18 intent-to-treat participants with mean (SD) age, 53.5 (13.4) years; and baseline PCL-5 score, 57.6 (7.6). More veterans in the quetiapine group (n = 9; 100%) received at least the first exposure session of PE therapy compared to TAU ((n = 3; (37.5%), p = .006] and completed PE therapy (n = 8; (88.9%) vs (n = 3; (37.5%), p = .03). Both PCL-5 (p = .03) and PSQI (p = .02) scores decreased significantly more for participants in the quetiapine than the TAU group. Preliminary findings support the feasibility, safety, and possible efficacy of quetiapine as an adjunct to enhancing engagement in PE therapy. A full-scale randomized trial is required to determine the true efficacy of quetiapine to enhance engagement in PE treatment.