The high global prevalence of depression, together with the recent acceleration of remote care owing to the COVID-19 pandemic, has prompted increased interest in the efficacy of digital interventions ...for the treatment of depression. We provide a summary of the latest evidence base for digital interventions in the treatment of depression based on the largest study sample to date. A systematic literature search identified 83 studies (N = 15,530) that randomly allocated participants to a digital intervention for depression versus an active or inactive control condition. Overall heterogeneity was very high (I2 = 84%). Using a random-effects multilevel metaregression model, we found a significant medium overall effect size of digital interventions compared with all control conditions (g = .52). Subgroup analyses revealed significant differences between interventions and different control conditions (WLC: g = .70; attention: g = .36; TAU: g = .31), significantly higher effect sizes in interventions that involved human therapeutic guidance (g = .63) compared with self-help interventions (g = .34), and significantly lower effect sizes for effectiveness trials (g = .30) compared with efficacy trials (g = .59). We found no significant difference in outcomes between smartphone-based apps and computer- and Internet-based interventions and no significant difference between human-guided digital interventions and face-to-face psychotherapy for depression, although the number of studies in both comparisons was low. Findings from the current meta-analysis provide evidence for the efficacy and effectiveness of digital interventions for the treatment of depression for a variety of populations. However, reported effect sizes may be exaggerated because of publication bias, and compliance with digital interventions outside of highly controlled settings remains a significant challenge.
Public Significance StatementThis meta-analysis demonstrates the efficacy of digital interventions in the treatment of depression for a variety of populations. Additionally, it highlights that digital interventions may have a valuable role to play in routine care, most notably when accompanied by human guidance. However, compliance with digital interventions remains a major challenge, with little more than 50% of participants completing the full intervention on average.
The majority of mental health disorders remain untreated.
Many limitations of traditional psychological interventions such as limited
availability of evidence-based interventions and clinicians could ...potentially be
overcome by providing Internet- and mobile-based psychological interventions
(IMIs). This paper is a report of the Taskforce E-Health of the European
Federation of Psychologists' Association and will provide an introduction
to the subject, discusses areas of application, and reviews the current evidence
regarding the efficacy of IMIs for the prevention and treatment of mental
disorders. Meta-analyses based on randomized trials clearly indicate that
therapist-guided stand-alone IMIs can result in meaningful benefits for a range
of indications including, for example, depression, anxiety, insomnia, or
posttraumatic stress disorders. The clinical significance of results of purely
self-guided interventions is for many disorders less clear, especially with
regard to effects under routine care conditions. Studies on the prevention of
mental health disorders (MHD) are promising. Blended concepts, combining
traditional face-to-face approaches with Internet- and mobile-based elements
might have the potential of increasing the effects of psychological
interventions on the one hand or to reduce costs of mental health treatments on
the other hand. We also discuss mechanisms of change and the role of the
therapist in such approaches, contraindications, potential limitations, and risk
involved with IMIs, briefly review the status of the implementation into routine
health care across Europe, and discuss confidentiality as well as ethical
aspects that need to be taken into account, when implementing IMIs. Internet-
and mobile-based psychological interventions have high potential for improving
mental health and should be implemented more widely in routine care.
Human Thriving Brown, Daniel J; Arnold, Rachel; Fletcher, David ...
European psychologist,
07/2017, Letnik:
22, Številka:
3
Journal Article
Recenzirano
Odprti dostop
Human beings have an inherent drive for self-improvement
and growth (Maslow, 1965;
Ryan & Deci, 2002).
In a quest to understand how human beings achieve fulfillment, researchers have
sought to ...explain why some individuals thrive in certain situations, whereas
others merely survive or succumb. The topic of thriving has become popular with
scholars, resulting in a divergent body of literature and a lack of consensus on
the key processes that underpin the construct. In view of such differences, the
purpose of this paper is threefold: (i) to review a number of existing
theoretical and conceptual debates, and to propose a conceptualization of
thriving applicable across different populations and domains; (ii) to
consolidate pertinent bodies of extant thriving research and identify key
personal and contextual enablers to inform applied practice; and (iii) to
identify noteworthy gaps within existing literature so as to make
recommendations for future research and, ultimately, support the development of
effective psychosocial interventions for thriving.
Objective: To provide a comprehensive meta-analysis on the efficacy of psychological and medical treatments for binge-eating disorder (BED), including those targeting weight loss. Method: Through a ...systematic search before March 2018, 81 published and unpublished randomized-controlled trials (RCTs), totaling 7,515 individuals with BED (Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition DSM-IV and Fifth Edition DSM-5), were retrieved and analyzed using random-effect modeling. Results: In RCTs with inactive control groups, psychotherapy, mostly consisting of cognitive-behavioral therapy, showed large-size effects for the reduction of binge-eating episodes and abstinence from binge eating, followed by structured self-help treatment with medium-to-large effects when compared with wait-list. Pharmacotherapy and pharmacological weight loss treatment mostly outperformed pill placebo conditions with small effects on binge-eating outcome. These results were confirmed for the most common treatments of cognitive-behavioral therapy, self-help treatment based on cognitive-behavioral therapy, and lisdexamfetamine. In RCTs with active control groups, there was limited evidence for the superiority of one treatment category or treatment. In a few studies, psychotherapy outperformed behavioral weight loss treatment in short- and long-term binge-eating outcome and led to lower longer-term abstinence than self-help treatment, while combined treatment revealed no additive effect on binge-eating outcome over time. Overall study quality was heterogeneous and the quality of evidence for binge-eating outcome was generally very low. Conclusions: This comprehensive meta-analysis demonstrated the efficacy of psychotherapy, structured self-help treatment, and pharmacotherapy for patients with BED. More high quality research on treatments for BED is warranted, with a focus on long-term maintenance of therapeutic gains, comparative efficacy, mechanisms through which treatments work, and complex models of care.
What is the public health significance of this article?
This comprehensive meta-analysis on psychological and medical treatments for binge-eating disorder demonstrates the efficacy of psychotherapy, structured self-help treatment, and pharmacotherapy. Psychotherapy may be prioritized over behavioral weight loss treatment, self-help treatment, and combined treatment. These results can be used as guidance in translating evidence-based treatments into clinical practice.
The Best Possible Self is a Positive Psychology Intervention which asks participants to write down about themselves in their best possible future. Previous studies have shown its efficacy to enhance ...wellbeing, but the mechanisms that underlie its efficacy are still unknown.
The aim of this study was to analyze the content of the essays of the BPS intervention and to examine how this content was related to the efficacy of the intervention to increase positive affect.
Participants (N = 78) were randomized to either the Best Possible Self condition, or one of two variants of the intervention: one's best self in the present, and one's best self in the past. Qualitative analyses of the texts were carried out to explore the main themes and features of the essays. Then, a mixed-methods approach with quantitative and qualitative data was followed, in order to analyze the relationship between the content of the texts and the change in positive affect produced by the interventions.
Significant differences between conditions were found in the content of the compositions. Regression analyses showed that different variables predicted the change in positive affect depending on the condition. Mediation analyses also found differences among conditions.
These findings suggest that these interventions respond to different underlying mechanisms which influence their efficacy. This study contributed to a better understanding of how Positive Psychology Interventions work, and how to increment their efficacy.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Post-traumatic Stress Disorder by Gender and Veteran Status Lehavot, Keren; Katon, Jodie G.; Chen, Jessica A. ...
American journal of preventive medicine,
January 2018, 2018-Jan, 2018-01-00, 20180101, Letnik:
54, Številka:
1
Journal Article
Recenzirano
Odprti dostop
Population-based data on the prevalence, correlates, and treatment utilization of post-traumatic stress disorder by gender and veteran status are limited. With changes in post-traumatic stress ...disorder diagnostic criteria in 2013, current information from a uniform data source is needed.
This was a secondary analysis of the 2012–2013 National Epidemiologic Survey on Alcohol and Related Conditions-III, which consisted of in-person interviews that were conducted with a representative sample of U.S. adults. The Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-5 Version was used to assess past-year and lifetime post-traumatic stress disorder among veterans (n=3,119) and civilians (n=32,982). Data were analyzed from January to March 2017.
Adjusting for age and race/ethnicity, women veterans reported the highest rates of lifetime and past-year post-traumatic stress disorder (13.4%, 95% CI=8.8%, 17.9%, and 11.7%, 95% CI=7.1%, 16.4%) compared with women civilians (8.0%, 95% CI=7.4%, 8.6%, and 6.0%, 95% CI=5.5%, 6.6%); men veterans (7.7%, 95% CI=6.5%, 8.8%, and 6.7%, 95% CI=5.7%, 7.8%); and men civilians (3.4%, 95% CI=3.0%, 3.9%, and 2.6%, 95% CI=2.2%, 2.9%). Traumatic event exposure, correlates of lifetime post-traumatic stress disorder, and treatment seeking varied across subgroups. Men and women veterans were more likely than civilians to use a variety of treatment sources, with men civilians being least likely to seek treatment and men veterans exhibiting the longest delay in seeking treatment.
Post-traumatic stress disorder is a common mental health disorder that varies by gender and veteran status. Women veterans’ high rates of post-traumatic stress disorder highlight a critical target for prevention and intervention, whereas understanding treatment barriers for men veterans and civilians is necessary.
The fundamental requirement for the autonomous capsule-based self-healing process to work is that cracks need to reach the capsules and break them such that the healing agent can be released. ...Ignoring all other aspects, the amount of healing agents released into the crack is essential to obtain a good healing. Meanwhile, from the perspective of the capsule shapes, spherical or elongated capsules (hollow tubes/fibres) are the main morphologies used in capsule-based self-healing materials. The focus of this contribution is the description of the effects of capsule shape on the efficiency of healing agent released in capsule-based self-healing material within the framework of the theory of geometrical probability and integral geometry. Analytical models are developed to characterize the amount of healing agent released per crack area from capsules for an arbitrary crack intersecting with capsules of various shapes in a virtual capsule-based self-healing material. The average crack opening distance is chosen to be a key parameter in defining the healing potential of individual cracks in the models. Furthermore, the accuracy of the developed models was verified by comparison to the data from a published numerical simulation study.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Background: Adolescent depression and anxiety symptoms are prevalent in sub-Saharan African countries, yet treatment options are scarce, and stigma limits help-seeking. Brief, computerized ...single-session interventions (SSIs) that contain empirically supported stigma-reducing elements may help expand access to treatment. We developed and evaluated such an intervention for Kenyan adolescents. Method: High school students (N = 103, age 13-18) were randomized to a digital SSI Shamiri-Digital (Shamiri means "thrive" in Kiswahili) or a study-skills control intervention. Shamiri-Digital consisted of reading and writing activities about 3 concepts: growth mindset, gratitude, and value affirmation. Both Shamiri-Digital and the study-skills control condition were delivered electronically in schools. Results: Compared to the control, Shamiri-Digital produced a greater reduction in adolescent depressive symptoms in both the full sample (p = .028, d = 0.50) and a subsample of youths with moderate to severe depression symptoms (p = .010, d = 0.83) from baseline to 2-week follow-up. The effects exceed the mean effects reported in meta-analyses of full-length, face-to-face psychotherapy for youth depression. There were no significant effects on anxiety symptoms, well-being, or happiness. Conclusion: This is the first report that a brief, computerized SSI may reduce depressive symptoms in adolescents in sub-Saharan Africa. Replication trials with extended follow-ups will help gauge the strength and durability of these effects.
What is the public health significance of this article?
This study provides evidence that a brief, single-session positive-psychology intervention may help reduce the depressive symptoms of adolescents living in sub-Saharan Africa, where there are few mental health professionals and stigma limits help-seeking.
Mental health apps are viewed as a promising modality to extend the reach of mental health care beyond the clinic. They do so by providing a means of assessment, tracking, and treatment through a ...smartphone. Given that nearly 2/3 of the American population owns a smartphone, mental health apps offer the possibility of overcoming treatment barriers such as geographic location or financial barriers. Unfortunately, the excitement surrounding mental health apps may be premature as the current supporting literature regarding their efficacy is limited. The app marketplace is littered with apps claiming to treat or assess symptoms, but even those created by reputable organizations or those incorporating components of evidence‐based treatments have not yet been validated in terms of their efficacy. This review aims to provide a comprehensive review of the current state of the mental health app literature by examining published reports of apps designed for DSM‐5 anxiety and mood disorders, OCD, and PTSD. The breadth of apps reviewed includes those oriented around assessment, symptom tracking, and treatment as well as “multipurpose” apps, which incorporate several of these components. This review will also present some of the most popular mental health apps which may have clinical utility and could be prescribed to clients. While we discuss many potential benefits of mental health apps, we focus on a number of issues that the current state of the app literature presents. Overall there is a significant disconnect between app developers, the scientific community and health care, leaving the utility of existing apps questionable.
Post-traumatic stress disorder (PTSD) is a potentially chronic and disabling disorder affecting a significant minority of people exposed to trauma. Various psychological treatments have been shown to ...be effective, but their relative effects are not well established.
We undertook a systematic review and network meta-analyses of psychological interventions for adults with PTSD. Outcomes included PTSD symptom change scores post-treatment and at 1-4-month follow-up, and remission post-treatment.
We included 90 trials, 6560 individuals and 22 interventions. Evidence was of moderate-to-low quality. Eye movement desensitisation and reprocessing (EMDR) standardised mean difference (SMD) -2.07; 95% credible interval (CrI) -2.70 to -1.44, combined somatic/cognitive therapies (SMD -1.69; 95% CrI -2.66 to -0.73), trauma-focused cognitive behavioural therapy (TF-CBT) (SMD -1.46; 95% CrI -1.87 to -1.05) and self-help with support (SMD -1.46; 95% CrI -2.33 to -0.59) appeared to be most effective at reducing PTSD symptoms post-treatment v. waitlist, followed by non-TF-CBT, TF-CBT combined with a selective serotonin reuptake inhibitor (SSRI), SSRIs, self-help without support and counselling. EMDR and TF-CBT showed sustained effects at 1-4-month follow-up. EMDR, TF-CBT, self-help with support and counselling improved remission rates post-treatment. Results for other interventions were either inconclusive or based on limited evidence.
EMDR and TF-CBT appear to be most effective at reducing symptoms and improving remission rates in adults with PTSD. They are also effective at sustaining symptom improvements beyond treatment endpoint. Further research needs to explore the long-term comparative effectiveness of psychological therapies for adults with PTSD and also the impact of severity and complexity of PTSD on treatment outcomes.
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