A fully automated self-help biopsychosocial transdiagnostic digital intervention to reduce anxiety and/or depression and improve emotional regulation and well-being: pre-follow-up single-arm feasibility trial
Description:
Background: Anxiety disorders and depression are prevalent disorders with high comorbidity, leading to greater chronicity and severity of symptoms. Given the accessibility to treatment issues, more evaluation is needed to assess the potential benefits of fully automated self-help transdiagnostic digital interventions. Innovating beyond the current transdiagnostic one-size-fits-all shared mechanistic approach may also lead to further improvements. Objective: The primary objective of this study was to explore the preliminary effectiveness and acceptability of a new fully automated self-help biopsychosocial transdiagnostic digital intervention (Life Flex) aimed at treating anxiety and/or depression, as well as improving emotional regulation; emotional, social, and psychological well-being; optimism; and health-related quality of life. Methods: This was a real-world pre-during-post-follow-up feasibility trial design evaluation of Life Flex. Participants were assessed at the preintervention time point (week 0), during intervention (weeks 3 and 5), at the postintervention time point (week 8), and at 1- and 3-month follow-ups (weeks 12 and 20, respectively). Results: The results provided early support for the Life Flex program in reducing anxiety (Generalized Anxiety Disorder 7), depression (Patient Health Questionnaire 9), psychological distress (Kessler 6), and emotional dysregulation (Difficulties in Emotional Regulation 36) and increasing emotional, social, and psychological well-being (Mental Health Continuum-Short Form); optimism (Revised Life Orientation Test); and health-related quality of life (EQ-5D-3L Utility Index and Health Rating; all false discovery rate [FDR] < .001). Large within-group treatment effect sizes (range |d|=0.82 to 1.33) were found for most variables from pre- to postintervention assessments and at the 1- and 3-month follow-up. The exceptions were medium treatment effect sizes for EQ-5D-3L Utility Index (range Cohen d=
Description:
Background: Anxiety disorders and depression are prevalent disorders with high comorbidity, leading to greater chronicity and severity of symptoms. Given the accessibility to treatment issues, more evaluation is needed to assess the potential benefits of fully automated self-help transdiagnostic digital interventions. Innovating beyond the current transdiagnostic one-size-fits-all shared mechanistic approach may also lead to further improvements. Objective: The primary objective of this study was to explore the preliminary effectiveness and acceptability of a new fully automated self-help biopsychosocial transdiagnostic digital intervention (Life Flex) aimed at treating anxiety and/or depression, as well as improving emotional regulation; emotional, social, and psychological well-being; optimism; and health-related quality of life. Methods: This was a real-world pre-during-post-follow-up feasibility trial design evaluation of Life Flex. Participants were assessed at the preintervention time point (week 0), during intervention (weeks 3 and 5), at the postintervention time point (week 8), and at 1- and 3-month follow-ups (weeks 12 and 20, respectively). Results: The results provided early support for the Life Flex program in reducing anxiety (Generalized Anxiety Disorder 7), depression (Patient Health Questionnaire 9), psychological distress (Kessler 6), and emotional dysregulation (Difficulties in Emotional Regulation 36) and increasing emotional, social, and psychological well-being (Mental Health Continuum-Short Form); optimism (Revised Life Orientation Test); and health-related quality of life (EQ-5D-3L Utility Index and Health Rating; all false discovery rate [FDR] < .001). Large within-group treatment effect sizes (range |d|=0.82 to 1.33) were found for most variables from pre- to postintervention assessments and at the 1- and 3-month follow-up. The exceptions were medium treatment effect sizes for EQ-5D-3L Utility Index (range Cohen d=
Efficacy of a digital mental health biopsychosocial transdiagnostic intervention with or without therapist assistance for adults with anxiety and depression : adaptive randomized controlled trial
Evaluation of various support intensities of digital mental health treatment for reducing anxiety and depression in adults : protocol for a mixed methods, adaptive, randomized clinical trial
Therapist training in video chat technology for use in an adaptive digital mental health intervention: Challenges, facilitators and implications for training models
Description:
The purpose of this article is to qualitatively explore participant and therapist experiences of the therapeutic alliance, perceived benefits, challenges, and areas for improvement when using video chat as a mode of therapist assistance within an adaptive digital mental health intervention. In total, 74 semistructured interviews were completed with participants and therapists who participated in an adaptive clinical trial. The participant interviews explored experiences of attending a clinical assessment via video chat and experiences of receiving low- or high-intensity therapist assistance via video chat. Interviews completed with therapists explored their experience of administrating a clinical assessment tool and delivering therapist assistance, both via video chat. Reflexive thematic analysis identified four themes: using video chat, characteristics of therapeutic relationships, task-specific experiences, and utility and adoption of video chat. Both participants and therapists were able to adapt to the modality of video chat and develop positive therapeutic alliances. They reported satisfaction with video chat for conducting clinical assessments and delivering therapist assistance. Concerns were identified by both participants and therapists with low-intensity therapist assistance. This study identified elements of task-specific experiences and human characteristics as more influential in participant and therapist experience than the modality of video chat technology. Implications for assessing suitability for the modality of video chat and low- and high-intensity models of therapist assistance are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved) (Source: journal abstract)
Description:
Trans and gender diverse adults are at increased suicide risk. Optimism protects against suicide across multiple populations. Applying the Interpersonal-Psychological Theory of Suicide (IPTS), we examined both factors among 237 adults recruited via social media and online platforms, 79.3% of whom reported serious suicide ideation. Dispositional optimism predicted suicidal ideation and behaviors (SIB), but did not moderate the relationship between the IPTS components and SIB. After controlling for depressive symptoms, hormone therapy and gender-affirming surgery did not predict SIB. Promoting dispositional optimism within a therapeutic framework may reduce SIB in this vulnerable population.
Description:
Trans and gender diverse adults are at increased suicide risk. Optimism protects against suicide across multiple populations. Applying the Interpersonal-Psychological Theory of Suicide (IPTS), we examined both factors among 237 adults recruited via social media and online platforms, 79.3% of whom reported serious suicide ideation. Dispositional optimism predicted suicidal ideation and behaviors (SIB), but did not moderate the relationship between the IPTS components and SIB. After controlling for depressive symptoms, hormone therapy and gender-affirming surgery did not predict SIB. Promoting dispositional optimism within a therapeutic framework may reduce SIB in this vulnerable population.
Description:
Objectives: Living alone is a risk factor for depressive symptoms among older men, and is likely to occur due to belongingness needs being unmet. It is proposed the living alone-sense of belonging and living alone-depressive symptoms relations are stronger for gay men than heterosexual men, due to different family circumstances. This research tested a moderated mediation model, specifically whether the relationship between living alone and depressive symptoms is mediated by sense of belonging, and whether the living alone-sense of belonging and living alone-depressive symptoms relationships are moderated by sexual orientation. Method: A community sample of 169 Australian gay men aged 65 to 93 years and 187 Australian heterosexual men aged 65 to 94 years completed the Psychological subscale of the Sense of Belonging Instrument and the Center for Epidemiologic Studies Depression Scale. Results: Results supported the simple mediation model, with living alone being associated directly and indirectly with depressive symptoms via sense of belonging. The conditional indirect effect of living alone on depressive symptoms via sense of belonging was not significant, and therefore the moderated mediation model was not supported. Conclusion: Results imply that older men who live alone are at increased risk of depressive symptoms directly and indirectly via lower levels of sense of belonging.
Description:
Background: Depression is a chronic condition that affects up to 15% of older adults. The healthogenic effects of regular exercise are well established, but it is still unclear which exercise-related variables characterise the antidepressant effects of exercise. Thus, the purpose of this study was to examine the extent to which exercise-related variables (exercise behaviour, exercise-induced mood, exercise self-efficacy, and social support) can predict depressive symptoms in a cohort of community-dwelling older adults. Methods: This study employed a cross-sectional analysis of questionnaire data from a sample of 586 community-dwelling older Australians aged 65 to 96 years old. Participants completed the Center for Epidemiologic Studies Depression Scale, modified CHAMPS Physical Activity Questionnaire for Older Adults, Four-Dimension Mood Scale, Self-Efficacy for Exercise Scale, and Social Provisions Scale - Short Form. Bivariate correlations were performed, and hierarchical multiple regression was subsequently used to test the regression model. Results: Exercise behaviour, exercise-induced mood, exercise self-efficacy, and social support were all negatively associated with depressive symptoms (r = -0.20 to -0.56). When the variables were entered as predictors into the hierarchical multiple regression model, social support was the strongest predictor of depressive symptoms (beta = -0.42), followed by exercise-induced mood (beta = -0.23), and exercise self-efficacy (beta = -0.07). Exercise behaviour did not explain any additional variance in depressive symptoms. A modest interaction effect was also observed between exercise-induced mood and social support. Conclusion: These findings indicate that social support is the strongest predictor of depressive symptomology in community-dwelling older adults, particularly when combined with positive exercise-induced mood states. When addressing the needs of older adults at risk of depression, healthcare professionals should consider the implementation of exercise programmes that are likely to benefit older adults by improving mood, enhancing self-efficacy, and building social support.
Description:
Background: Depression is a chronic condition that affects up to 15% of older adults. The healthogenic effects of regular exercise are well established, but it is still unclear which exercise-related variables characterise the antidepressant effects of exercise. Thus, the purpose of this study was to examine the extent to which exercise-related variables (exercise behaviour, exercise-induced mood, exercise self-efficacy, and social support) can predict depressive symptoms in a cohort of community-dwelling older adults. Methods: This study employed a cross-sectional analysis of questionnaire data from a sample of 586 community-dwelling older Australians aged 65 to 96 years old. Participants completed the Center for Epidemiologic Studies Depression Scale, modified CHAMPS Physical Activity Questionnaire for Older Adults, Four-Dimension Mood Scale, Self-Efficacy for Exercise Scale, and Social Provisions Scale - Short Form. Bivariate correlations were performed, and hierarchical multiple regression was subsequently used to test the regression model. Results: Exercise behaviour, exercise-induced mood, exercise self-efficacy, and social support were all negatively associated with depressive symptoms (r = -0.20 to -0.56). When the variables were entered as predictors into the hierarchical multiple regression model, social support was the strongest predictor of depressive symptoms (beta = -0.42), followed by exercise-induced mood (beta = -0.23), and exercise self-efficacy (beta = -0.07). Exercise behaviour did not explain any additional variance in depressive symptoms. A modest interaction effect was also observed between exercise-induced mood and social support. Conclusion: These findings indicate that social support is the strongest predictor of depressive symptomology in community-dwelling older adults, particularly when combined with positive exercise-induced mood states. When addressing the needs of older adults at risk of depression, healthcare professionals should consider the implementation of exercise programmes that are likely to benefit older adults by improving mood, enhancing self-efficacy, and building social support.
Description:
ObjectiveLevels of suicidal behavior among gay men are a significant concern. The Interpersonal Theory of Suicide proposes that being unpartnered is a risk factor for suicidal behavior due to thwarted belongingness; however, this has yet to be tested empirically. Recent studies also indicate that the two components of hope, agency and pathways, may be protective against suicidal behavior. The first aim of the current study was to investigate whether thwarted belongingness mediates the relationship between relationship status and suicidal behavior in gay men. The study also examined whether agency and pathways weaken the association between relationship status and thwarted belongingness, and whether agency weakens the relation between thwarted belongingness and suicidal behavior. MethodA sample of 370 self-identified gay men aged from 18 to 66 years old (M = 26.13, SD = 8.02) completed the Suicidal Behaviors Questionnaire-Revised, the Interpersonal Needs Questionnaire-Revised, and the Adult Dispositional Hope Scale. ResultsResults showed that thwarted belongingness mediated the relationship between relationship status and suicidal behavior. The hypothesized moderated-mediation models were not supported. ConclusionsThese findings have implications for the development of interventions that aim to reduce suicidal behaviors in gay men.
Description:
A common form of treatment for Australian men with prostate cancer is a radical prostatectomy (RP). Although sociodemographic and medical factors have been found to be predictive of psychological distress following RP, the traditional masculine norms of self-reliance and stoicism are also implicated in poor psychological outcomes. The strength of the relationship between these masculine norms and distress may vary according to place of residence-specifically, living in regional/remote versus urban areas. The aim of the current study was to investigate these masculine norms as predictors of psychological distress among a sample of men who had received the same treatment for prostate cancer, in the context of place of residence. Participants were 447 men, aged between 42 and 77 years (M = 63.1, SD = 6.4), all of whom had undergone a RP within the previous 6 months. Participants completed self-report measures of psychological distress, physical functioning, self-reliance, and stoicism. As hypothesized, self-reliance and stoicism were independent and unique predictors of psychological distress, after controlling for sociodemographic and medical factors. Place of residence moderated the relationship between stoicism and distress, whereby the relationship was only significant for urban men. The relationship between self-reliance and distress was significant for all men regardless of place of residence. The current study takes an important step toward identifying potentially modifiable and context-specific factors that can impact the experience of psychological distress among men following RP.
Description:
Study Objectives: To investigate whether cognitive behavior therapy was effective for older adults with comorbid insomnia and depression in a community mental health setting, and explore whether an advanced form of cognitive behavior therapy for insomnia produced better outcomes compared to a standard form of cognitive behavior therapy for insomnia. Methods: An 8-week randomized controlled clinical trial was conducted within community mental health services, Victoria, Australia. Seventy-two older adults (56% female, M age 75 ± 7 years) with diagnosed comorbid insomnia and depression participated. Three conditions were tested using a group therapy format: cognitive behavior therapy for insomnia (CBT-I, standard), cognitive behavior therapy for insomnia plus positive mood strategies (CBT-I+, advanced), psychoeducation control group (PCG, control). The primary outcomes were insomnia severity (Insomnia Severity Index) and depression severity (Geriatric Depression Scale). Primary and secondary measures were collected at pre (week 0), post (week 8), and follow-up (week 20). Results: CBT-I and CBT-I+ both generated significantly greater reductions in insomnia and depression severity compared to PCG from pre to post (p < .001), which were maintained at follow-up. Although the differences between outcomes of the two treatment conditions were not statistically significant, the study was not sufficiently powered to detect either superiority of one treatment or equivalence of the two treatment conditions. Conclusion: CBT-I and CBT-I+ were both effective at reducing insomnia and depression severity for older adults. Mental health services that deliver treatment for comorbid insomnia with cognitive behavior therapy may improve recovery outcomes for older adults with depression. Trial Registration: Australian and New Zealand Clinical Trials Registry (ANZCTR); URL: https://www.anzctr.org.au; Trial ID: ACTRN12615000067572; Date Registered: December 12, 2014.
Description:
Objectives: Depression is a significant mental health issue among older Australian adults. Research has indicated that insomnia is a key risk factor for the development of depressive symptoms in older adults, and that dispositional hope may be protective against the development of depressive symptoms in this population. This study examined whether dispositional hope and its dimensions, agency and pathways, moderated the relationship between insomnia symptoms and depressive symptoms among older Australian adults. Method: A community sample of 88 men (Mage = 71.11, SDage = 5.54) and 111 women (Mage = 70.25, SDage = 4.64), aged 65–94 years, completed the Insomnia Severity Index, Adult Dispositional Hope Scale, and Centre of Epidemiologic Studies Depression Scale. Results: After controlling for gender, age, relationship status, education level, method of participation, and perceived physical health, results supported the moderation models. The insomnia–depressive symptoms relation was significant for older adults with low and average (but not high) levels of dispositional hope, agency, and pathways. The Johnson–Neyman analyses indicated that the insomnia–depressive symptoms relation was significant for older adults who scored below 27.10 on dispositional hope, below 13.73 on agency, and below 13.49 and above 15.64 on pathways. Conclusion: The results of this study imply that interventions aimed at increasing dispositional hope, agency, and pathways among older adults who experience symptoms of insomnia may reduce their depressive symptoms. A cautionary note, however, is that very high scores on pathways among older adults who experience insomnia symptoms may be detrimental to their mental health.