Evidence for the efficacy of computer-based psychological interventions is growing. A number of such interventions have been found to be effective, especially for mild to moderate cases. They largely ...rely on psychoeducation and 'homework tasks', and are specific to certain diagnoses (e.g. depression).
This paper presents the results of a web-based randomized controlled trial of Manage Your Life Online (MYLO), a program that uses artificial intelligence to engage the participant in a conversation across any problem topic.
Healthy volunteers (n = 213) completed a baseline questionnaire and were randomized to the MYLO program or to an active control condition where they used the program ELIZA, which emulates a Rogerian psychotherapist. Participants completed a single session before completing post-study and 2-week follow-up measures.
Analyses were per protocol with intent to follow-up. Both programs were associated with improvements in problem distress, anxiety and depression post-intervention, and again 2 weeks later, but MYLO was not found to be more effective than ELIZA. MYLO was rated as significantly more helpful than ELIZA, but there was no main effect of intervention on problem resolution.
Findings are consistent with those of a previous smaller, laboratory-based trial and provide support for the acceptability and effectiveness of MYLO delivered over the internet for a non-clinical sample. The lack of a no-treatment control condition means that the effect of spontaneous recovery cannot be ruled out.
Objectives
Distressing and pleasant/positive voices (auditory verbal hallucinations) are common in both clinical and non‐clinical voice‐hearers. Identifying factors that contribute to emotional ...reactions to voices is essential for developing effective psychological interventions. Several theories propose that facilitation and interference with personal goals are important predictors of distress and well‐being. This study examined whether voice‐related distress is related to the degree to which voices interfere with personal goals, and whether pleasantness of voices is influenced by the extent to which they facilitate goals.
Design
Cross‐sectional with clinical and non‐clinical voice‐hearers.
Method
Twenty‐two clinical and 18 non‐clinical voice‐hearers completed interviews and self‐report measures assessing (1) personal goals, (2) content, characteristics, and affective reactions to voices, and (3) ratings of the extent to which voices facilitated and/or interfered with achievement of important personal goals.
Results
Affective reactions were strongly correlated with measures of goal interference and goal facilitation. Regression analyses revealed that these associations remained significant when controlling for important covariates (e.g., participant grouping; content, frequency and duration of voices). Goal interference was specifically associated with distress, whereas goal facilitation specifically predicted perceived pleasantness of voices.
Conclusions
This study provides a novel perspective on the factors that might contribute to distress in people who hear voices. The findings suggest that perceived impact of voices on valued personal goals may be an important contributor of voice‐related distress. We propose that clinical assessments, formulations, and interventions could benefit from the careful analysis of the perceived impact of voices on goals.
Practitioner points
These findings suggest that variability in voice‐related distress is closely linked to the perceived impact of voices on personal goals.
These strong effects observed highlight the importance of considering the role of personal goals in future research on the psychological mechanisms leading to distress associated with voice hearing.
Psychological assessments may benefit from the careful exploration of the impact of voice hearing on valued goals, and interventions promoting control over personal goals may be explored as treatment options for clients with distressing voices.
The Method of Levels (MOL) is a transdiagnostic cognitive therapy that promotes contentment, wellbeing, and goal achievement through the resolution of internal conflicts underlying psychological ...distress. MOL, based on Perceptual Control Theory (PCT), was developed in routine clinical practice and has been used effectively across different health services by different practitioners. Access to MOL-style questions through a smartphone app could, potentially, help both the general public maintain robust mental health, and also be a useful adjunct to therapy for clinical populations. The app is called MindSurf because of its focus on helping people explore their thinking. Prior to developing the app and using it with different populations it was necessary to determine whether such an idea would be usable for and acceptable to potential app users. Therefore, a pilot study was conducted with a non-clinical sample to assess the usability and acceptability of the app including monitoring whether the questions delivered in this way were associated with any adverse events.
A pilot study using quantitative as well as qualitative methods and incorporating a repeated measures, A-B design was conducted.
The 23 participants were healthy adult volunteers who were all either undergraduate students, postgraduate students, or staff of the University of Manchester. They received MOL-style questions on their mobile phones over a 1-week period. Qualitative results were encouraging and indicated that the format and style of questioning were acceptable to participants and did not lead to increased worry or concern. A one-way, repeated measures ANOVA indicated that there was a nonsignificant decrease in scores on the 21-item Depression, Anxiety, and Stress Scale (DASS21) over a 2 week period.
The results of the pilot study justified development of MindSurf and further testing once it is available for use. A power analysis indicated that the pilot study was underpowered to detect significant effects but provided important information regarding the appropriate sample size for future research. The pilot study also indicated that future research should investigate the effects of receiving more than three questions per day.
Results of the pilot study indicate that MindSurf will be a usable and acceptable app. Its benefits should be further explored through longer studies with larger sample of both the general population as well as clinical populations.
Immunoglobulin G4-related disease (IgG4-RD) was not recognised as a systemic condition until 2003, when extra pancreatic manifestations were identified in patients with autoimmune pancreatitis. Since ...then, IgG4-RD has been described to involve virtually every organ system. It is highly responsive to immunosuppressants but can have detrimental effects if left untreated. Early recognition of the disease is, therefore, critical. The diagnosis of IgG4-RD is frequently challenging owing to its non-specific clinical manifestations, indolent nature and broad differential diagnoses. Although histopathological examination remains the cornerstone of diagnosis, imaging plays an important role in establishing extent of disease and identifying areas suitable for biopsy.
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F-Fluorodeoxyglucose (
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F-FDG) positron emission tomography/computed tomography (PET/CT) has been demonstrated to be useful in assessing organ involvement, guiding biopsy and monitoring disease response. The
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F-FDG PET/CT scan is highly sensitive and able to evaluate multiorgan involvement in a single examination, a key advantage over conventional imaging modalities. A potential pitfall is its low specificity. As such, detailed knowledge of the imaging findings in IgG4-related disease is required to avoid misdiagnosis. This pictorial review aims to depict the diverse spectrum of imaging findings of IgG4-RD and the key imaging features to distinguish it from other important differential diagnoses.
Objective
We aimed to determine the feasibility and acceptability of Method of Levels (MOL) for people experiencing first‐episode psychosis (FEP) to inform decision making about the therapy's ...suitability for further testing in a larger clinical trial.
Method
A parallel group randomized controlled trial design was used. Participants (N = 36) were allocated to receive either treatment as usual (TAU) or TAU plus MOL. Recruitment and retention in the trial and the acceptability of the MOL intervention were the primary outcomes.
Results
The recruitment target was met within the planned time frame. Retention in the trial at final follow‐up was 97%, substantially higher than the 80% threshold prespecified as a successful feasibility outcome. Participant feedback provided initial evidence of the acceptability of the study design and intervention for this population.
Conclusion
Results support progressing to a larger trial of MOL for FEP. Recommendations for the design of future trials are provided.
Purpose
To conduct a thematic synthesis to evaluate qualitative studies exploring individuals’ experiences of psychological‐based interventions for bipolar disorder (BD).
Method
A systematic search ...of relevant databases (Web of Science, PsycINFO, MEDLINE, CINAHL) was conducted using predefined search terms related to ‘Bipolar’ ‘Qualitative method’, ‘Psychological‐based interventions’ and ‘Adults’. Studies meeting the inclusion criteria were selected and were then evaluated using established quality appraisal criteria. A thematic synthesis was used to synthesize the findings.
Results
From the thematic synthesis, nine analytical themes were derived from the 10 identified research studies. These were helpful and unhelpful aspects of the intervention, increased knowledge of BD, mood recognition, control of moods, change of perspective, mood stability, empowerment, improved relationships and lifestyle changes.
Conclusions
Findings from the review suggest there were characteristics of psychological‐based interventions that individuals with BD valued and which helped facilitate areas of positive change, such as feeling empowered and in control of their moods and other aspects of their lives. However, there were also elements that individuals did not find as helpful and therefore reflects the challenge of a one‐size‐fits‐all model or plan of interventions, compared to a wider recognition of the individuals as being the agent of their recovery. Future qualitative research is needed to explore individual experiences across a range of psychological interventions, in order to further understand the therapeutic processes, which may facilitate recovery.
Practitioner points
Psychological‐based interventions for BD need to consider facilitating and measuring empowerment in individuals, rather than focusing just on mood stability.
Clinicians with expertise and knowledge in BD should provide timely information to individuals and their families to help increase their understanding of the diagnosis.
Objective
To understand the therapeutic processes associated with the helpfulness of an online relational agent intervention, Manage Your Life Online (MYLO).
Methods
Fifteen participants experiencing ...a mental health related problem used Manage Your Life Online for 2 weeks. At follow-up, the participants each identified two helpful and two unhelpful questions posed by Manage Your Life Online within a single intervention session. Qualitative interviews were conducted and analyzed using thematic and content analysis to gain insight into the process of therapy with Manage Your Life Online.
Results
MYLO appeared acceptable to participants with a range of presenting problems. Questions enabling free expression, increased awareness, and new insights were key to a helpful intervention. The findings were consistent with the core processes of therapeutic change, according to Perceptual Control Theory, a unifying theory of psychological distress. Questions that elicited intense emotions, were repetitive, confusing, or inappropriate were identified as unhelpful and were associated with disengagement or loss of faith in Manage Your Life Online.
Conclusions
The findings provide insight into the likely core therapy processes experienced as helpful or hindering and outlines further ways to optimize acceptability of Manage Your Life Online.
Sonidegib (LDE225) is a potent, selective hedgehog (Hh) inhibitor of Smoothened. This study explored the safety and pharmacokinetics of sonidegib in children with relapsed/recurrent tumors followed ...by a phase II trial in pediatric and adult patients with relapsed medulloblastoma (MB) to assess tumor response.
Pediatric patients aged ≥1 to <18 years were included according to a Bayesian design starting at 372 mg/m2 of continuous once daily oral sonidegib. Tumor samples were analyzed for Hh pathway activation using a validated 5-gene Hh signature assay. In phase II, pediatric patients were treated at the recommended phase II dose (RP2D) while adults received 800 mg daily.
Sixteen adult (16 MB) and 60 pediatric (39 MB, 21 other) patients with an age range of 2-17 years were enrolled. The RP2D of sonidegib in pediatric patients was established at 680 mg/m2 once daily. The phase II study was closed prematurely. The 5-gene Hh signature assay showed that the 4 complete responders (2 pediatric and 2 adult) and 1 partial responder (adult) all had Hh-activated tumors, while 5 patients with activated Hh had either stable disease (n = 3) or progressive disease (n = 2). No patient with an Hh-negative signature (n = 50) responded. The safety profile for pediatric patients was generally consistent with the one established for adult patients; however, growth plate changes were observed in prepubertal pediatric patients.
Sonidegib was well tolerated and the RP2D in pediatric patients was 680 mg/m2 once daily. Five of the 10 MB patients with activated Hh pathway demonstrated complete or partial responses.
The purpose of this study was to test the feasibility and acceptability of a novel psychological therapy (Method of Levels) amongst adolescents experiencing psychological distress. An initial ...estimated effect size and a clinical significance analysis were undertaken which will help inform future studies. A case-series of 16 participants utilised the YP-CORE as a primary outcome measure. Data was collected at baseline, on completion of therapy (six months) and two and four months after completion of the therapy. Young people used a self-booking system to access sessions. Additionally, young people had full control over the content and length of the sessions. A total of 14 participants reported that the therapy was acceptable to them and 12 participants were retained for the entire course of the study. The self-booking system was successfully used with young people attending on average 6-8 sessions. Analysis of clinically significant change for the YP-CORE at therapy completion indicated that five students recovered and seven experienced no change; this was largely maintained at follow up. Effect size estimations were medium-to-large. Initial findings suggest that Method of Levels is a feasible and acceptable form of counselling for young people within the school setting. Moreover, positive preliminary effectiveness outcomes suggest that a randomised control study should be considered.
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