Journal of Behavioral and Cognitive Therapy最新文献

Introduction

Depression is a top prevalent mental illness but has low care access globally. Community-based interventions were considered to be effective for depression with scarce resources.

Purpose

This study evaluated depression after group psychotherapy in primary settings in Vietnam for up to 12 months.

Method

A quasiexperimental study including a single-arm, pre- and post intervention assessment was conducted among 359 people aged 18–65 (PHQ-9 score ≥ 10) from August 2020 to January 2022 in 10 communes of Thai Nguyen Province, Vietnam. The PHQ-9 scores were collected at baseline and after 3, 6, and 12 months. The trained nonspecialists delivered 8 sessions of group therapy under supervision.

Result

Three hundred fifty-nine eligible people participated in the intervention, and three and two people dropped out after three months and six months, respectively. The mean PHQ-9 score decreased from 13.29 preintervention to 2.83 after 12 months. The difference in depression severity between the three points of follow-up was statistically significant (p < 0.001). Ninety percent of participants achieved reliable improvement, and 96% recovered at 12 months.

Conclusion

Community-based psychotherapy can be a promising approach to depression management in limited settings in the long term, which needs further study to evaluate its acceptance and feasibility in a specific context.

Introduction

Benzodiazepines (BDZs) are often inappropriately prescribed to manage anxiety and insomnia for longer-term use, despite guidelines recommending short-term use (i.e., <4 weeks). A range of harms can occur rapidly with regular use, and dependence can make stopping BDZs challenging. Evidence shows that a combination of BDZ tapering and psychological support are effective interventions, yet are not widely accessible.

Methods

This was a one-group pilot trial of a 6-week fully automated self-help BDZ digital intervention (‘BDZ digital health’), providing guidance on how to safely taper BDZs as well as psychological support. The trial was undertaken with Australian adults considering a reduction and/or withdrawal from their BDZ (N = 43). Participants were assessed at pre-intervention (Week 0), during intervention (Week 3), post-intervention (Week 6), and at a 3- and 6-month follow-up (Week 18 and 30 respectively).

Results

Reductions in BDZ use and self-reported dependency were observed over the course of the intervention. Significant symptom reductions in anxiety, insomnia, depression, psychological distress, and emotional dysregulation, as well as improvements in mental wellbeing and quality of life were observed when looking across all timepoints. However, the specific assessment timepoint changes for depression and psychological distress did not reach significance from the pre- to post-intervention timepoint. The intervention acceptability ratings were in the moderately high to high range.

Discussion

The preliminary results of the pilot trial suggest that BDZ digital health is an acceptable and promising self-help digital intervention to assist adults reducing and withdrawing from their BDZs, and to improve their mental health and wellbeing.

Trial registration: ACTRN12617000574347 (24/04/2017).

Pre-, peri-, and post-deployment factors, including demographic factor, psychological traits, and previous trauma experience, have been hypothesized to influence severity of combat-related posttraumatic stress disorder (PTSD) and whether an individual completes a treatment trial. Here we report on the roles of these factors on pretreatment PTSD symptom severity and how these factors affected treatment drop-out in 103 participants enrolled in a previously conducted treatment trial for PTSD for these individuals. We found that comorbid depression, IQ, breadth of combat experiences, and psychosocial functioning play significant roles in accounting for PTSD severity, with those five variables accounting for ∼51% of the variance, with depressive symptoms (∼38% of the variance in CAPS total score), extent of trauma exposure (∼5%), IQ (∼3%), the index trauma being related to witnessing a threat (∼3%), and psychosocial functioning (∼2%) contributing significantly. The same factors were investigated to assess their influence on completion of treatment protocols, where higher IQs and less diversity of trauma exposures were associated with a higher completion rate. Thus, the factors contributing to PTSD symptoms and treatment completion are diverse, encompass pre-, peri-, and post-trauma conditions, and span the breadth of neurobiological, combat, and psychosocial factors.

ClinicalTrials.gov identifier: NCT01391832.

Objectives

High levels of stress are associated with suicide ideation among college students. The interpersonal theory of suicide provides a framework for conceptualizing the association between stress and suicide. This study will examine the associations between multiple types of stress (daily life hassles vs. negative life events) on suicidal ideation and the role of adaptive/maladaptive coping skills as potential moderators of the relationship between stress, thwarted belongingness, perceived burdensomeness, and suicidal ideation.

Design

The current study is a secondary analysis of data gathered from South-eastern university students in the U.S.

Method

College students (N = 218) with elevated depressive symptoms completed cross-sectional surveys. Participants were predominantly (78%) women and (72.8%) Hispanic, with a mean age of 20.81 years (SD = 3.96).

Results

Daily life hassles and negative life events were indirectly associated with suicidal ideation via perceived burdensomeness and thwarted belongingness. Only maladaptive coping behaviors significantly moderated the indirect effect of daily life hassles and negative life events on suicide ideation via perceived burdensomeness, but not thwarted belongingness. Thus, reliance on maladaptive coping behaviors increased the strength of the association between daily life hassles/negative life events and suicidal ideation.

Limitations

This study utilized cross-sectional data from a sample of college students with elevated depressive symptoms and may not generalize to other college student populations. Additionally, the use of cross-sectional data precludes causal interpretations of the findings.

Conclusion

An improved understanding of potential buffers against the effects of stress can help identify opportunities for targeted prevention efforts to reduce rates of suicide-related behaviors in college students. Findings suggest that efforts to reduce student use of maladaptive coping behaviors may help to negate the negative impacts of stress on suicidal ideation.

As college counseling centers struggle to meet the growing demands of behavioral health services, digital mental health tools like smartphone apps offer a scalable solution to increase access to care. However, clinicians report greater time demands and uncertainty over how to act upon digital data. In this paper, by using established statistical techniques, we condense complex smartphone data into results that are quickly understood and clinically meaningful. Specifically, we show how smartphone digital phenotyping data collected by college students can be used to predict an individual’s anxiety and depression level on a daily or weekly basis with an error of less than 10%. These predictions are then condensed into a 1 to 5 scale with a 1 representing patients with the lowest risk of presenting high anxiety or depression, and a 5 representing the patients with the highest risk. If used in a clinical setting, these risk scores have the potential to help college counseling centers monitor symptom severity in real-time via students’ own smartphones, allocate resources more efficiently, and ensure that students are receiving the appropriate level of treatment.

There is a lack of evidence-based models and treatment for dissociation. This article aims to fill this gap by providing a comprehensive evidence-based model for dissociation using a cognitive behavioral conceptualization. We postulate that, following an initial experience of dissociation, associative conditioning will increase the frequency and intensity of dissociative symptoms. Various mechanisms could facilitate dissociation: negative beliefs about emotion, beliefs about dissociation, emotional dysregulation, low attentional control and poor mindfulness skills. Based on this model, a range of clinical interventions can be proposed to reduce dissociation, including cognitive restructuring through reality testing, decisional balance and Socratic questioning, emotion regulation and attentional training, and mindfulness-based programs. The impact of these interventions on dissociation needs to be appraised using experimental methodologies (randomized controlled trials and intervention studies with outcome measures).

Background

Mental health problems are increasing in prevalence among college students, yet few students receive treatment due to barriers such as insufficient resources in college counseling centers. Digital mental health interventions (DMHIs) have potential to overcome barriers and offer accessible, evidence-based care to college students. However, to evaluate the true public health impact of evidence-based DMHIs, it is important to assess the reach and uptake rates of DMHIs on college campuses.

Objectives

We conducted a systematic review to examine the reach (i.e., % of invited students who express interest) and uptake (i.e., % of enrolled participants who initiate an intervention) of DMHIs based on cognitive-behavioral therapy (CBT) for college students.

Methods

Eight databases were searched. Inclusion criteria included: (1) college population; (2) experimental design; (3) CBT-based intervention; (4) intervention targeting specific mental health conditions; and (5) digital intervention. Reach and uptake rates were calculated from data reported. A systematic narrative review framework was used to synthesize results.

Results

Of 10,315 articles screened, 90 were included. Seventeen studies (19%) reported sufficient data to calculate reach; 35 studies (39%) reported uptake rates. Of studies that reported reach or uptake, most evaluated unguided (n = 20) or guided (n = 16) self-help programs. Measurement methods varied widely. Overall reach was low, whereas uptake was high among enrolled participants.

Discussion

Despite evidence that improving reach and uptake can increase the public health impact of DMHIs, most studies did not report on either outcome. Suggested practices to improve these outcomes, and their reporting, are discussed.

This study examined descriptions of suicidal thoughts and behavior (STB) to identify risk and protective factors that may present in clinical settings among university students from Latin America. Our focus was on answering the following key questions: How are suicidal thoughts and behavior described? What are reasons for wanting to die and for living? What impact do STBs have on motivations to seek or avoid psychological treatment? To this end, 55 qualitative interviews were completed with university students from Colombia and Mexico who recently endorsed emotional difficulties in the World Mental Health International College Student (WMH-ICS) surveys. Interviews were coded to identify themes specific to STBs. Findings revealed insight on symptom presentations and consequences of STBs. Participants described uncontrollable somatic symptoms during periods of high suicide risk, which serves as a relevant clinical marker for health providers. An important reason for living was to avoid suffering for family, which was protective against suicide and motivates familial involvement in treatment planning. Participants sought solutions to emotional problems after experiencing STBs, including psychological treatment. Cultural stigma of mental illness induced feelings of shame and burden, which led to avolition, avoidance, and nondisclosure of symptom severity. This study provides insight into the utility of evaluating cultural context in (a) detecting antecedents to STBs frequently reported as somatic symptoms, (b) identifying protective factors against suicide, and (c) recognizing how stigma of mental illness and suicide, shame avoidance, and familism might influence personal motivations to seek or avoid help for emotional distress.

BACKGROUND: Online surveys are routinely used in mental health screening and treatment follow-up assessment, though they can yield low response rates. We tested the effects of social psychology-informed influence strategies for increasing rates of participation in an online mental health screening survey (Experiment 1) and a treatment follow-up survey (Experiment 2). METHODS and RESULTS: In Experiment 1 (N = 45,569), embedding one or any combination of three motivational appeals (personal gain, community gain, and inclusivity) in screening survey invitation and reminder emails unexpectedly led to lower rates of survey participation compared to when the appeals were not included (overall participation rate = 12.02%, ORs = 0.75 to 0.97, ps < .001). In Experiment 2 (N = 873), a video of a TikTok influencer encouraging survey participation embedded in treatment follow-up survey invitation and reminder emails did not significantly affect survey completion compared to a humorous gif unrelated to survey participation (overall participation rate = 47.88%, OR = 1.18, p = .200). Moderator analyses revealed that the video led to higher rates of participation than the gif among White participants (OR = 1.39, p = .031) and non-Hispanic participants (OR = 1.35, p = .029) only, whereas the video led to lower rates of participation than the gif among students who did not disclose their race (OR = 0.31, p = .010). CONCLUSIONS: Efforts to improve online survey participation should be balanced with possible downsides (e.g., added email length) and should be evaluated for differential performance among population subgroups prior to widespread implementation.

Despite the effectiveness and safety of telehealth, many clinicians are hesitant to deliver Dialectical Behavior Therapy (DBT) remotely to high-risk clients. However, the COVID-19 pandemic resulted in a rapid shift to telehealth services, pushing patients and providers to adapt to therapy in an online format. Only a few studies have assessed providers’ attitudes about the transition of DBT to telemedicine during COVID-19, identifying both challenges and advantages. Using an online self-report survey, the current study assessed DBT therapists’ experiences with telehealth use for DBT implementation, with an emphasis on clinicians’ fear of treating suicidal patients (N = 99). Despite endorsing some challenges with telehealth, almost all therapists reported they will continue implementing some DBT via telehealth post-COVID, highlighting both clinicians’ perceived benefits and challenges of telehealth. Fear of treating suicidal patients was associated with higher perceived telehealth challenges and higher reported future telehealth use. Several other descriptive patterns are discussed. This study provides important preliminary findings about DBT therapists’ telehealth practices and experiences, suggesting future directions for research and practice. The transition to telehealth offers a long-term opportunity for clinicians to leverage technology in the delivery of DBT to increase access and improve mental health.