A broad array of transdiagnostic psychological treatments for depressive and anxiety disorders have been evaluated, but existing reviews of this literature are restricted to face-to-face cognitive ...behavioural therapy (CBT) protocols. The current meta-analysis focused on studies evaluating clinician-guided internet/computerised or face-to-face manualised transdiagnostic treatments, to examine their effects on anxiety, depression and quality of life (QOL). Results from 50 studies showed that transdiagnostic treatments are efficacious, with large overall mean uncontrolled effects (pre- to post-treatment) for anxiety and depression (gs=.85 and .91 respectively), and medium for QOL (g=.69). Uncontrolled effect sizes were stable at follow-up. Results from 24 RCTs that met inclusion criteria showed that transdiagnostic treatments outperformed control conditions on all outcome measures (controlled ESs: gs=.65, .80, and .46 for anxiety, depression and QOL respectively), with the smallest differences found compared to treatment-as-usual (TAU) control conditions. RCT quality was generally poor, and heterogeneity was high. Examination of the high heterogeneity revealed that CBT protocols were more effective than mindfulness/acceptance protocols for anxiety (uncontrolled ESs: gs=.88 and .61 respectively), but not depression. Treatment delivery format influenced outcomes for anxiety (uncontrolled ESs: group: g=.70, individual: g=.97, computer/internet: g=.96) and depression (uncontrolled ESs: group: g=.89, individual: g=.86, computer/internet: g=.96). Preliminary evidence from 4 comparisons with disorder-specific treatments suggests that transdiagnostic treatments are as effective for reducing anxiety, and may be superior for reducing depression. These findings show that transdiagnostic psychological treatments are efficacious, but higher quality research studies are needed to explore the sources of heterogeneity amongst treatment effects.
•Transdiagnostic (TD) treatments have large effects on anxiety and depression.•TD-CBT has been most widely evaluated, followed by mindfulness-based treatments.•Medium to large comparative group differences between TD treatments and control conditions•Type of treatment, delivery format, and type of control condition influenced outcomes.•More comparisons are needed with TAU controls, and across treatment types.
Depression and anxiety often emerge for the first time during youth. The school environment provides an ideal context to deliver prevention programs, with potential to offset the trajectory towards ...disorder. The aim of this review was to provide a comprehensive evaluation of randomised-controlled trials of psychological programs, designed to prevent depression and/or anxiety in children and adolescents delivered in school settings. Medline, PsycINFO and the Cochrane Library were systematically searched for articles published until February 2015. Eighty-one unique studies comprising 31,794 school students met inclusion criteria. Small effect sizes for both depression (g=0.23) and anxiety (g=0.20) prevention programs immediately post-intervention were detected. Small effects were evident after 12-month follow-up for both depression (g=0.11) and anxiety (g=0.13). Overall, the quality of the included studies was poor, and heterogeneity was moderate. Subgroup analyses suggested that universal depression prevention programs had smaller effect sizes at post-test relative to targeted programs. For anxiety, effect sizes were comparable for universal and targeted programs. There was some evidence that externally-delivered interventions were superior to those delivered by school staff for depression, but not anxiety. Meta-regression confirmed that targeted programs predicted larger effect sizes for the prevention of depression. These results suggest that the refinement of school-based prevention programs have the potential to reduce mental health burden and advance public health outcomes.
•School-based prevention programs have small effects on depression and anxiety.•Significant prevention effects were detected at 6 and 12month follow-up.•Prevention type and personnel delivering the prevention program influenced outcomes.•For depression, targeted prevention was more effective than universal prevention.•School-based prevention programs have potential to reduce mental health burden.
Health anxiety is associated with high distress, disability and increased health service utilisation. However, there are relatively few epidemiological studies examining the extent of health anxiety ...or the associated sociodemographic and health risk factors in the general population.
To provide epidemiological data on health anxiety in the Australian population.
Lifetime and current prevalence estimates, associations between comorbid disorders, psychological distress, impairment, disability and mental health service utilisation were generated using the Australian 2007 National Survey of Mental Health and Wellbeing.
Health anxiety affects approximately 5.7% of the Australian population across the lifespan and 3.4% met criteria for health anxiety at the time of the interview. Age, employment status, smoking status and comorbid physical conditions were significantly related to health anxiety symptoms. Health anxiety was associated with significantly more distress, impairment, disability and health service utilisation than that found in respondents without health anxiety.
Health anxiety is non-trivial; it affects a significant proportion of the population and further research and clinical investigation of health anxiety is required.
There has been significant disruption to the lives and mental health of adolescents during the COVID-19 pandemic. The purpose of this study was to assess the psychological and lifestyle impact of the ...pandemic on Australian adolescents, using an online survey, administered during the outbreak. Self-report surveys were administered online to a sample of 760 Australian adolescents aged 12–18 years assessing impact on a range of domains including behaviour, education, relationships, lifestyle factors (exercise, technology use, and sleep), and mental health outcomes (psychological distress, loneliness, health anxiety and well-being). Results showed that three quarters of the sample experienced a worsening in mental health, since the pandemic began, with negative impacts reported on learning, friendships and family relationships. There were also high higher levels of sleep disturbance, psychological distress and health anxiety, relative to normative samples. Effects on mental health were worse among those who reported a previous diagnosis of depression and/or anxiety relative to those without no such history. Adolescents are already vulnerable to the onset of mental illness at this developmental stage, and the current research underscores the need to find rapid and accessible ways to support adolescent mental health during times of crisis.
Abstract People with PTSD experience high levels of cardiovascular disease and comorbid mental health problems. Physical activity (PA) is an effective intervention in the general population. We ...conducted the first systematic review and meta-analysis to determine the effect of PA on PTSD. We searched major electronic databases from inception till 03/2015 for RCTs of PA interventions among people with PTSD. A random effects meta-analysis calculating hedges g was conducted. From a potential of 812 hits, four unique RCTs met the inclusion criteria ( n =200, mean age of participants 34–52 years). The methodological quality of included trials was satisfactory, and no major adverse events were reported. PA was significantly more effective compared to control conditions at decreasing PTSD and depressive symptoms among people with PTSD. There was insufficient data to investigate the effect on anthropometric or cardiometabolic outcomes. Results suggest that PA may be a useful adjunct to usual care to improve the health of people with PTSD. Although there is a relative paucity of data, there is reason to be optimistic for including PA as an intervention for people with PTSD, particularly given the overwhelming evidence of the benefits of PA in the general population. Robust effectiveness and implementation studies are required.
•Cyberchondria is associated with health anxiety.•Examined whether internet CBT (iCBT) for health anxiety improves cyberchondria.•Large differences between iCBT and control group on health ...anxiety.•iCBT outperformed control in improving cyberchondria severity.•Improvements in cyberchondria mediated improvements in health anxiety.
Cyberchondria refers to an emotional-behavioural pattern whereby excessive online searches lead to increased anxiety about one’s own health status. It has been shown to be associated with health anxiety, however it is unknown whether existing cognitive behavioural therapy (CBT) interventions targeting health anxiety also improve cyberchondria. This study aimed to determine whether internet-delivered cognitive behavioural therapy (iCBT) for severe health anxiety led to improvements in self-reported cyberchondria and whether improvements in cyberchondria were associated with improvements in health anxiety observed during treatment. Methods: We analysed secondary data from a randomised controlled trial (RCT) comparing an iCBT group (n = 41) to an active control group who underwent psychoeducation, monitoring and clinical support (n = 41) in health anxious patients with a DSM-5 diagnosis of Illness Anxiety Disorder and/or Somatic Symptom Disorder. The iCBT group showed a significantly greater reduction in cyberchondria compared to the control group, with large differences at post-treatment on the Cyberchondria Severity Scale Total scale (CSS; Hedges g = 1.09), and the Compulsion, Distress, Excessiveness subscales of the CSS (g’s: 0.8–1.13). Mediation analyses showed improvements in health anxiety in the iCBT group were mediated by improvements in all of the CSS subscales, except for the Mistrust subscale. Conclusions: Internet CBT for health anxiety improves cyberchondria.
•Uptake of online CBT for anxiety and depression increased >500% during COVID-19.•The course was associated with large effect size reductions in symptom severity.•Most users undertook the self-guided ...online course.•Results highlight the utility and scalability of digital mental health services.
The mental health impacts of COVID-19 have been considerable with many individuals experiencing significant anxiety and depression. Online cognitive behavioural therapy (iCBT) programs provide scalable access to psychological interventions, however the effectiveness of these programs during the pandemic has not been investigated. This study examined the uptake and effectiveness of iCBT for symptoms of anxiety and depression during the first eight months of the pandemic in Australia (March- October 2020) and compared outcomes to the 12 months prior to COVID-19.
6,132 adults commenced iCBT (5,074 during the pandemic and 1,058 in the year before) and completed measures of anxiety and depression symptom severity, and psychological distress pre- and post-treatment.
In the COVID-19 period, we observed a 504% increase in the number of monthly course registrations compared to the year prior (with a peak increase of 1,138% between April and June 2020). Baseline anxiety and depression symptom severity were similar for the COVID and pre-COVID groups. Prior to and during the pandemic, the iCBT course was associated with large effect size reductions in anxiety (g = 0.94–1.18) and depression (g = 0.92–1.12) symptom severity, as well as psychological distress (g = 1.08–1.35).
lack of control group and long-term follow-up, as well as lack of detailed information about course users (e.g., health status and life context).
Results indicate the considerable increase in demand for psychological support during the COVID-19 pandemic in Australia and demonstrate the effectiveness and scalability of iCBT for symptoms of anxiety and depression.
Depression and anxiety are often first experienced during childhood and adolescence, and interest in the prevention of these disorders is growing. The focus of this review was to assess the ...effectiveness of psychological prevention programs delivered in schools, and to provide an update to our previous review from five years ago (Werner-Seidler, Perry, Calear, Newby, & Christensen, 2017). Three electronic databases were systematically searched for published articles of randomised controlled trials (RCTs) evaluating the efficacy of school-based prevention programs until October 2020. There were 130 articles that met inclusion criteria, representing 118 unique trials and 45,924 participants. Small between-group effect sizes for depression (g = 0.21) and anxiety (g = 0.18) were detected immediately post-intervention. Subgroup analyses suggested that targeted prevention programs (for young people with risk factors or symptoms) were associated with significantly greater effect sizes relative to universal programs for depression, which was confirmed by meta-regression. There was also some evidence that external providers conferred some benefit over school-staff delivered programs. Overall, study quality was moderate and no association between risk of bias and effect size was detected. School-delivered psychological prevention programs have small effects in reducing symptoms of depression and anxiety. Refinement of these programs, and knowledge about how they can be sustainably delivered in schools beyond the trial period is now needed for population-level preventive effects.
Systematic Review Registration Number: PROPSERO - CRD42020188323
•This meta-analysis evaluated the effectiveness of school-based psychological prevention on depression and anxiety.•118 RCTs were identified involving >45,000 participants.•These interventions had a small effect on depression and anxiety symptoms.•Targeted programs may be more effective than universal programs.•Schools are a suitable environment to deliver prevention programs.
Highlights • Compared effectiveness of three ICBT programs in primary care. • Transdiagnostic (TD-ICBT), disorder-specific ICBT for depression and GAD. • Patients in the TD-ICBT group had higher ...baseline comorbidity and severity. • Completion rates were modest (TD-ICBT: 44.9%, Depression: 51.6%; GAD: 49.2%). • Effect sizes were comparable across programs, and moderate to large.
Abstract Objectives There were three aims of this study, the first was to examine the efficacy of CBT versus treatment-as-usual (TAU) in the treatment of anxiety and depressive disorders, the second ...was to examine how TAU is defined in TAU control groups for those disorders, and the third was to explore whether the type of TAU condition influences the estimate of effects of CBT. Method A systematic search of Cochrane Central Register of Controlled Trials, PsycINFO, and CINAHL was conducted. Results 48 studies of CBT for depressive or anxiety disorders ( n =6926) that specified that their control group received TAU were identified. Most ( n =45/48) provided an explanation of the TAU group however there was significant heterogeneity amongst TAU conditions. The meta-analysis showed medium effects favoring CBT over TAU for both anxiety ( g =0.69, 95% CI 0.47–0.92, p <0.001, n =1318) and depressio n ( g =0.70, 95% CI 0.49–0.90, p <0.001, n =5054), with differential effects observed across TAU conditions. Conclusions CBT is superior to TAU and the size of the effect of CBT compared to TAU depends on the nature of the TAU condition. The term TAU is used in different ways and should be more precisely described. The four key details to be reported can be thought of as “who, what, how many, and any additional treatments?”
PDF
