Lifestyle management of hypertension : International Society of Hypertension position paper endorsed by the World Hypertension League and European Society of Hypertension
- Charchar, Fadi, Prestes, Priscilla, Mills, Charlotte, Ching, Siew, Neupane, Dinesh, Marques, Francine, Sharman, James, Vogt, Liffert, Burrell, Louise, Korostovtseva, Lyudmila, Zec, Manja, Patil, Mansi, Schultz, Martin, Wallen, Matthew, Renna, Nicolás, Islam, Sheikh, Hiremath, Swapnil, Gyeltshen, Tshewang, Chia, Yook-Chin, Gupta, Abhinav, Schutte, Aletta, Klein, Britt, Borghi, Claudio, Browning, Colette, Czesnikiewicz-Guzik, Marta, Lee, Hae-Young, Itoh, Hiroshi, Miura, Katsuyuki, Akinnibosun, Olutope, Shane Thomas
- Authors: Charchar, Fadi , Prestes, Priscilla , Mills, Charlotte , Ching, Siew , Neupane, Dinesh , Marques, Francine , Sharman, James , Vogt, Liffert , Burrell, Louise , Korostovtseva, Lyudmila , Zec, Manja , Patil, Mansi , Schultz, Martin , Wallen, Matthew , Renna, Nicolás , Islam, Sheikh , Hiremath, Swapnil , Gyeltshen, Tshewang , Chia, Yook-Chin , Gupta, Abhinav , Schutte, Aletta , Klein, Britt , Borghi, Claudio , Browning, Colette , Czesnikiewicz-Guzik, Marta , Lee, Hae-Young , Itoh, Hiroshi , Miura, Katsuyuki , Akinnibosun, Olutope , Shane Thomas
- Date: 2024
- Type: Text , Journal article
- Relation: Journal of hypertension Vol. 42, no. 1 (2024), p. 23-49
- Full Text:
- Reviewed:
- Description: Hypertension, defined as persistently elevated systolic blood pressure (SBP) >140 mmHg and/or diastolic blood pressure (DBP) at least 90 mmHg (International Society of Hypertension guidelines), affects over 1.5 billion people worldwide. Hypertension is associated with increased risk of cardiovascular disease (CVD) events (e.g. coronary heart disease, heart failure and stroke) and death. An international panel of experts convened by the International Society of Hypertension College of Experts compiled lifestyle management recommendations as first-line strategy to prevent and control hypertension in adulthood. We also recommend that lifestyle changes be continued even when blood pressure-lowering medications are prescribed. Specific recommendations based on literature evidence are summarized with advice to start these measures early in life, including maintaining a healthy body weight, increased levels of different types of physical activity, healthy eating and drinking, avoidance and cessation of smoking and alcohol use, management of stress and sleep levels. We also discuss the relevance of specific approaches including consumption of sodium, potassium, sugar, fibre, coffee, tea, intermittent fasting as well as integrated strategies to implement these recommendations using, for example, behaviour change-related technologies and digital tools. **Please note that there are multiple authors for this article therefore only the name of the first 30 including Federation University Australia affiliates “Fadi Charchar, Priscilla Prestes, Britt Klein, Colette Browning, Olutope Akinnibosun and Shane Thomas” are provided in this record**
- Description: Hypertension, defined as persistently elevated systolic blood pressure (SBP) >140 mmHg and/or diastolic blood pressure (DBP) at least 90 mmHg (International Society of Hypertension guidelines), affects over 1.5 billion people worldwide. Hypertension is associated with increased risk of cardiovascular disease (CVD) events (e.g. coronary heart disease, heart failure and stroke) and death. An international panel of experts convened by the International Society of Hypertension College of Experts compiled lifestyle management recommendations as first-line strategy to prevent and control hypertension in adulthood. We also recommend that lifestyle changes be continued even when blood pressure-lowering medications are prescribed. Specific recommendations based on literature evidence are summarized with advice to start these measures early in life, including maintaining a healthy body weight, increased levels of different types of physical activity, healthy eating and drinking, avoidance and cessation of smoking and alcohol use, management of stress and sleep levels. We also discuss the relevance of specific approaches including consumption of sodium, potassium, sugar, fibre, coffee, tea, intermittent fasting as well as integrated strategies to implement these recommendations using, for example, behaviour change-related technologies and digital tools. **Please note that there are multiple authors for this article therefore only the name of the first 30 including Federation University Australia affiliates “Fadi Charchar, Priscilla Prestes, Britt Klein, Colette Browning, Olutope Akinnibossun and Shane Thomas” are provided in this record**
- Authors: Charchar, Fadi , Prestes, Priscilla , Mills, Charlotte , Ching, Siew , Neupane, Dinesh , Marques, Francine , Sharman, James , Vogt, Liffert , Burrell, Louise , Korostovtseva, Lyudmila , Zec, Manja , Patil, Mansi , Schultz, Martin , Wallen, Matthew , Renna, Nicolás , Islam, Sheikh , Hiremath, Swapnil , Gyeltshen, Tshewang , Chia, Yook-Chin , Gupta, Abhinav , Schutte, Aletta , Klein, Britt , Borghi, Claudio , Browning, Colette , Czesnikiewicz-Guzik, Marta , Lee, Hae-Young , Itoh, Hiroshi , Miura, Katsuyuki , Akinnibosun, Olutope , Shane Thomas
- Date: 2024
- Type: Text , Journal article
- Relation: Journal of hypertension Vol. 42, no. 1 (2024), p. 23-49
- Full Text:
- Reviewed:
- Description: Hypertension, defined as persistently elevated systolic blood pressure (SBP) >140 mmHg and/or diastolic blood pressure (DBP) at least 90 mmHg (International Society of Hypertension guidelines), affects over 1.5 billion people worldwide. Hypertension is associated with increased risk of cardiovascular disease (CVD) events (e.g. coronary heart disease, heart failure and stroke) and death. An international panel of experts convened by the International Society of Hypertension College of Experts compiled lifestyle management recommendations as first-line strategy to prevent and control hypertension in adulthood. We also recommend that lifestyle changes be continued even when blood pressure-lowering medications are prescribed. Specific recommendations based on literature evidence are summarized with advice to start these measures early in life, including maintaining a healthy body weight, increased levels of different types of physical activity, healthy eating and drinking, avoidance and cessation of smoking and alcohol use, management of stress and sleep levels. We also discuss the relevance of specific approaches including consumption of sodium, potassium, sugar, fibre, coffee, tea, intermittent fasting as well as integrated strategies to implement these recommendations using, for example, behaviour change-related technologies and digital tools. **Please note that there are multiple authors for this article therefore only the name of the first 30 including Federation University Australia affiliates “Fadi Charchar, Priscilla Prestes, Britt Klein, Colette Browning, Olutope Akinnibosun and Shane Thomas” are provided in this record**
- Description: Hypertension, defined as persistently elevated systolic blood pressure (SBP) >140 mmHg and/or diastolic blood pressure (DBP) at least 90 mmHg (International Society of Hypertension guidelines), affects over 1.5 billion people worldwide. Hypertension is associated with increased risk of cardiovascular disease (CVD) events (e.g. coronary heart disease, heart failure and stroke) and death. An international panel of experts convened by the International Society of Hypertension College of Experts compiled lifestyle management recommendations as first-line strategy to prevent and control hypertension in adulthood. We also recommend that lifestyle changes be continued even when blood pressure-lowering medications are prescribed. Specific recommendations based on literature evidence are summarized with advice to start these measures early in life, including maintaining a healthy body weight, increased levels of different types of physical activity, healthy eating and drinking, avoidance and cessation of smoking and alcohol use, management of stress and sleep levels. We also discuss the relevance of specific approaches including consumption of sodium, potassium, sugar, fibre, coffee, tea, intermittent fasting as well as integrated strategies to implement these recommendations using, for example, behaviour change-related technologies and digital tools. **Please note that there are multiple authors for this article therefore only the name of the first 30 including Federation University Australia affiliates “Fadi Charchar, Priscilla Prestes, Britt Klein, Colette Browning, Olutope Akinnibossun and Shane Thomas” are provided in this record**
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
- Klein, Britt, Nguyen, Huy, McLaren, Suzanne, Andrews, Brooke, Shandley, Kerrie
- Authors: Klein, Britt , Nguyen, Huy , McLaren, Suzanne , Andrews, Brooke , Shandley, Kerrie
- Date: 2023
- Type: Text , Journal article
- Relation: JMIR Formative Research Vol. 7, no. (2023), p.
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- Reviewed:
- 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=
- Authors: Klein, Britt , Nguyen, Huy , McLaren, Suzanne , Andrews, Brooke , Shandley, Kerrie
- Date: 2023
- Type: Text , Journal article
- Relation: JMIR Formative Research Vol. 7, no. (2023), p.
- Full Text:
- Reviewed:
- 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
- Andrews, Brooke, Klein, Britt, Nguyen, Huy, Corboy, Denise, McLaren, Suzanne, Watson, Shaun
- Authors: Andrews, Brooke , Klein, Britt , Nguyen, Huy , Corboy, Denise , McLaren, Suzanne , Watson, Shaun
- Date: 2023
- Type: Text , Journal article
- Relation: Journal of Medical Internet Research Vol. 25, no. (2023), p.
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- Reviewed:
- Description: Background: Digital mental health (DMH) interventions incorporating elements that adapt to the evolving needs of consumers have the potential to further our understanding of the optimal intensity of therapist assistance and inform stepped-care models. Objective: The primary objective was to compare the efficacy of a transdiagnostic biopsychosocial DMH program, with or without therapist assistance for adults with subthreshold symptoms or a diagnosis of anxiety or depression. Methods: In a randomized adaptive clinical trial design, all participants had access to the DMH program, with eligibility to have their program augmented with therapist assistance determined by program engagement or symptom severity. Participants who met stepped-care criteria were randomized to have their treatment program augmented with either low-intensity (10 min/week of video chat support for 7 weeks) or high-intensity (50 min/week of video chat support for 7 weeks) therapist assistance. A total of 103 participants (mean age 34.17, SD 10.50 years) were assessed before (week 0), during (weeks 3 and 6), and after the intervention (week 9) and at the 3-month follow-up (week 21). The effects of 3 treatment conditions (DMH program only, DMH program+low-intensity therapist assistance, and DMH program+high-intensity therapist assistance) on changes in the 2 primary outcomes of anxiety (7-item Generalized Anxiety Disorder Scale [GAD-7]) and depression (9-item Patient Health Questionnaire [PHQ-9]) were assessed using the Cohen d, reliable change index, and mixed-effects linear regression analyses. Results: There were no substantial differences in the outcome measures among intervention conditions. However, there were significant time effect changes in most outcomes over time. All 3 intervention conditions demonstrated strong and significant treatment effect changes in GAD-7 and PHQ-9 scores, with absolute Cohen d values ranging from 0.82 to 1.79 (all P<.05). The mixed-effects models revealed that, in the Life Flex program–only condition at week 3, mean GAD-7 and PHQ-9 scores significantly decreased from baseline by 3.54 and 4.38 (all P<.001), respectively. At weeks 6, 9, and 21, GAD-7 and PHQ-9 scores significantly decreased from baseline by at least 6 and 7 points (all P<.001), respectively. Nonresponders at week 3 who were stepped up to therapist assistance increased program engagement and treatment response. At the postintervention time point and 3-month follow-up, 67% (44/65) and 69% (34/49) of the participants, respectively, no longer met diagnostic criteria for anxiety or depression. Conclusions: The findings highlight that early detection of low engagement and non–treatment response presents an opportunity to effectively intervene by incorporating an adaptive design. Although the study findings indicate that therapist assistance was no more effective than the DMH intervention program alone for reducing symptoms of anxiety or depression, the data highlight the potential influence of participant selection bias and participant preferences within stepped-care treatment models. ©Brooke Andrews, Britt Klein, Huy Van Nguyen, Denise Corboy, Suzanne McLaren, Shaun Watson.
- Authors: Andrews, Brooke , Klein, Britt , Nguyen, Huy , Corboy, Denise , McLaren, Suzanne , Watson, Shaun
- Date: 2023
- Type: Text , Journal article
- Relation: Journal of Medical Internet Research Vol. 25, no. (2023), p.
- Full Text:
- Reviewed:
- Description: Background: Digital mental health (DMH) interventions incorporating elements that adapt to the evolving needs of consumers have the potential to further our understanding of the optimal intensity of therapist assistance and inform stepped-care models. Objective: The primary objective was to compare the efficacy of a transdiagnostic biopsychosocial DMH program, with or without therapist assistance for adults with subthreshold symptoms or a diagnosis of anxiety or depression. Methods: In a randomized adaptive clinical trial design, all participants had access to the DMH program, with eligibility to have their program augmented with therapist assistance determined by program engagement or symptom severity. Participants who met stepped-care criteria were randomized to have their treatment program augmented with either low-intensity (10 min/week of video chat support for 7 weeks) or high-intensity (50 min/week of video chat support for 7 weeks) therapist assistance. A total of 103 participants (mean age 34.17, SD 10.50 years) were assessed before (week 0), during (weeks 3 and 6), and after the intervention (week 9) and at the 3-month follow-up (week 21). The effects of 3 treatment conditions (DMH program only, DMH program+low-intensity therapist assistance, and DMH program+high-intensity therapist assistance) on changes in the 2 primary outcomes of anxiety (7-item Generalized Anxiety Disorder Scale [GAD-7]) and depression (9-item Patient Health Questionnaire [PHQ-9]) were assessed using the Cohen d, reliable change index, and mixed-effects linear regression analyses. Results: There were no substantial differences in the outcome measures among intervention conditions. However, there were significant time effect changes in most outcomes over time. All 3 intervention conditions demonstrated strong and significant treatment effect changes in GAD-7 and PHQ-9 scores, with absolute Cohen d values ranging from 0.82 to 1.79 (all P<.05). The mixed-effects models revealed that, in the Life Flex program–only condition at week 3, mean GAD-7 and PHQ-9 scores significantly decreased from baseline by 3.54 and 4.38 (all P<.001), respectively. At weeks 6, 9, and 21, GAD-7 and PHQ-9 scores significantly decreased from baseline by at least 6 and 7 points (all P<.001), respectively. Nonresponders at week 3 who were stepped up to therapist assistance increased program engagement and treatment response. At the postintervention time point and 3-month follow-up, 67% (44/65) and 69% (34/49) of the participants, respectively, no longer met diagnostic criteria for anxiety or depression. Conclusions: The findings highlight that early detection of low engagement and non–treatment response presents an opportunity to effectively intervene by incorporating an adaptive design. Although the study findings indicate that therapist assistance was no more effective than the DMH intervention program alone for reducing symptoms of anxiety or depression, the data highlight the potential influence of participant selection bias and participant preferences within stepped-care treatment models. ©Brooke Andrews, Britt Klein, Huy Van Nguyen, Denise Corboy, Suzanne McLaren, Shaun Watson.
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
- Andrews, Brooke, Klein, Britt, McLaren, Suzanne, Watson, Shaun, Corboy, Denise
- Authors: Andrews, Brooke , Klein, Britt , McLaren, Suzanne , Watson, Shaun , Corboy, Denise
- Date: 2023
- Type: Text , Journal article
- Relation: JMIR Research Protocols Vol. 12, no. (2023), p.
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- Description: Background: Anxiety and depression are leading causes of disease worldwide, requiring timely access to evidence-based treatment. Digital mental health (dMH) interventions increase accessibility to evidence-based psychological services delivered in a variety of web-based formats (eg, self-help and therapist-assisted interventions). Robust and rigorous studies of adaptive web-based intervention designs are scarce. No identified randomized clinical trial has investigated the efficacy of a 2-stage adaptive design, whereby the program-only condition or no support dMH treatment program is augmented by either low or high therapist assistance, if a participant does not improve or engage in the program-only condition. Objective: The primary objective is to assess whether low or high therapist-assisted support delivered via video chat is more effective in reducing anxiety and depressive symptoms compared with a dMH program–only condition. The secondary objective is to evaluate the role of motivation; self-efficacy; and preferences in participant engagement, adherence, and clinical outcomes (anxiety and depression symptoms) among the 3 treatment conditions (program only, low-intensity therapist assistance, and high-intensity therapist assistance). A mixed methods analysis of factors affecting participant attrition, participant reasons for nonengagement and withdrawal, and therapist training and implementation of dMH interventions will be completed. Qualitative data regarding participant and therapist experiences and satisfaction with video chat assessment and treatment will also be analyzed. Methods: Australian adults (N=137) with symptoms or a diagnosis of anxiety or depression will be screened for eligibility and given access to the 8-module Life Flex dMH treatment program. On day 15, participants who meet the augmentation criteria will be stepped up via block randomization to receive therapist assistance delivered via video chat for either 10 minutes (low intensity) or 50 minutes (high intensity) per week. This adaptive trial will implement a mixed methods design, with outcomes assessed before the intervention (week 0), during the intervention (weeks 3 and 6), after the intervention (week 9), and at the 3-month follow-up (week 21). Results: The primary outcome measures are for anxiety (Generalized Anxiety Disorder–7) and depression severity (Patient Health Questionnaire–9). Measures of working alliance, health status, health resources, preferences, self-efficacy, and motivation will be used for secondary outcomes. Qualitative methods will be used to explore participant and therapist experiences of video chat assessment and treatment, participant reasons for withdrawal and nonengagement, and therapist training and implementation experiences. Data collection commenced in November 2020 and was completed at the end of March 2022. Conclusions: This is the first mixed methods adaptive trial to explore the comparative efficacy of different intensity levels of self-help and a therapist-assisted dMH intervention program delivered via video chat for adults with anxiety or depression. Anticipated results may have implications for the implementation of dMH interventions. © Brooke Andrews, Britt Klein, Suzanne McLaren, Shaun Watson, Denise Corboy. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 28.04.2023.
- Authors: Andrews, Brooke , Klein, Britt , McLaren, Suzanne , Watson, Shaun , Corboy, Denise
- Date: 2023
- Type: Text , Journal article
- Relation: JMIR Research Protocols Vol. 12, no. (2023), p.
- Full Text:
- Reviewed:
- Description: Background: Anxiety and depression are leading causes of disease worldwide, requiring timely access to evidence-based treatment. Digital mental health (dMH) interventions increase accessibility to evidence-based psychological services delivered in a variety of web-based formats (eg, self-help and therapist-assisted interventions). Robust and rigorous studies of adaptive web-based intervention designs are scarce. No identified randomized clinical trial has investigated the efficacy of a 2-stage adaptive design, whereby the program-only condition or no support dMH treatment program is augmented by either low or high therapist assistance, if a participant does not improve or engage in the program-only condition. Objective: The primary objective is to assess whether low or high therapist-assisted support delivered via video chat is more effective in reducing anxiety and depressive symptoms compared with a dMH program–only condition. The secondary objective is to evaluate the role of motivation; self-efficacy; and preferences in participant engagement, adherence, and clinical outcomes (anxiety and depression symptoms) among the 3 treatment conditions (program only, low-intensity therapist assistance, and high-intensity therapist assistance). A mixed methods analysis of factors affecting participant attrition, participant reasons for nonengagement and withdrawal, and therapist training and implementation of dMH interventions will be completed. Qualitative data regarding participant and therapist experiences and satisfaction with video chat assessment and treatment will also be analyzed. Methods: Australian adults (N=137) with symptoms or a diagnosis of anxiety or depression will be screened for eligibility and given access to the 8-module Life Flex dMH treatment program. On day 15, participants who meet the augmentation criteria will be stepped up via block randomization to receive therapist assistance delivered via video chat for either 10 minutes (low intensity) or 50 minutes (high intensity) per week. This adaptive trial will implement a mixed methods design, with outcomes assessed before the intervention (week 0), during the intervention (weeks 3 and 6), after the intervention (week 9), and at the 3-month follow-up (week 21). Results: The primary outcome measures are for anxiety (Generalized Anxiety Disorder–7) and depression severity (Patient Health Questionnaire–9). Measures of working alliance, health status, health resources, preferences, self-efficacy, and motivation will be used for secondary outcomes. Qualitative methods will be used to explore participant and therapist experiences of video chat assessment and treatment, participant reasons for withdrawal and nonengagement, and therapist training and implementation experiences. Data collection commenced in November 2020 and was completed at the end of March 2022. Conclusions: This is the first mixed methods adaptive trial to explore the comparative efficacy of different intensity levels of self-help and a therapist-assisted dMH intervention program delivered via video chat for adults with anxiety or depression. Anticipated results may have implications for the implementation of dMH interventions. © Brooke Andrews, Britt Klein, Suzanne McLaren, Shaun Watson, Denise Corboy. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 28.04.2023.
- Klein, Britt, Oldenhof, Erin, Nguyen, Huy, Schattner, Peter, Shandley, Kerrie
- Authors: Klein, Britt , Oldenhof, Erin , Nguyen, Huy , Schattner, Peter , Shandley, Kerrie
- Date: 2023
- Type: Text , Journal article
- Relation: Journal of Behavioral and Cognitive Therapy Vol. 33, no. 3 (2023), p. 179-193
- Full Text: false
- Reviewed:
- Description: 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). © 2023 Association Française de Therapie Comportementale et Cognitive
Suicidality among older Australian adults
- Klein, Britt, Shandley, Kerrie, McLaren, Suzanne, Clinnick, Lisa, Nguyen, Huy
- Authors: Klein, Britt , Shandley, Kerrie , McLaren, Suzanne , Clinnick, Lisa , Nguyen, Huy
- Date: 2023
- Type: Text , Journal article
- Relation: Frontiers in Public Health Vol. 10, no. (2023), p.
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- Description: Background: Vulnerability to suicidality is a concern among older adults, particularly as this proportion of the population is growing. Determining what factors contribute to suicidality will help to create a framework for understanding and assessing suicidal risk among older adults and developing effective treatments. This study examined suicidality among older Australian adults. Methods: This study forms part of a larger study to trial a survey to collect cross-sectional data on the mental and physical health of older Australian adults across time. One hundred and fourteen Australian residents aged 65 years and over completed an anonymous survey online or by returning a paper-and-pencil version of the survey by post. The survey took approximately 25 min to complete and comprised of (1) sociodemographic questions (e.g., age, gender, education), (2) validated questionnaires measuring depression, general anxiety, psychological distress, insomnia, substance dependence, problem gambling, and stress, and (3) mental and physical health and wellbeing items (e.g., religiosity, assistance with daily tasks, and mental health service usage in the last 12-months). The dependent variable, suicidality, was measured by asking participants whether they had ever seriously thought about committing suicide. Results: Associations with suicidality were analyzed using Chi-squares and independent samples t-tests. The results found suicidality to be significantly associated with lower levels of satisfaction with the frequency of seeing and/or communicating with friends, and inadequate levels of community engagement. Conclusion: The results of this survey reinforce the importance of social connectedness as a central and significant protective factor against suicidality among older adults. Copyright © 2023 Klein, Shandley, McLaren, Clinnick and Nguyen.
- Authors: Klein, Britt , Shandley, Kerrie , McLaren, Suzanne , Clinnick, Lisa , Nguyen, Huy
- Date: 2023
- Type: Text , Journal article
- Relation: Frontiers in Public Health Vol. 10, no. (2023), p.
- Full Text:
- Reviewed:
- Description: Background: Vulnerability to suicidality is a concern among older adults, particularly as this proportion of the population is growing. Determining what factors contribute to suicidality will help to create a framework for understanding and assessing suicidal risk among older adults and developing effective treatments. This study examined suicidality among older Australian adults. Methods: This study forms part of a larger study to trial a survey to collect cross-sectional data on the mental and physical health of older Australian adults across time. One hundred and fourteen Australian residents aged 65 years and over completed an anonymous survey online or by returning a paper-and-pencil version of the survey by post. The survey took approximately 25 min to complete and comprised of (1) sociodemographic questions (e.g., age, gender, education), (2) validated questionnaires measuring depression, general anxiety, psychological distress, insomnia, substance dependence, problem gambling, and stress, and (3) mental and physical health and wellbeing items (e.g., religiosity, assistance with daily tasks, and mental health service usage in the last 12-months). The dependent variable, suicidality, was measured by asking participants whether they had ever seriously thought about committing suicide. Results: Associations with suicidality were analyzed using Chi-squares and independent samples t-tests. The results found suicidality to be significantly associated with lower levels of satisfaction with the frequency of seeing and/or communicating with friends, and inadequate levels of community engagement. Conclusion: The results of this survey reinforce the importance of social connectedness as a central and significant protective factor against suicidality among older adults. Copyright © 2023 Klein, Shandley, McLaren, Clinnick and Nguyen.
Therapist training in video chat technology for use in an adaptive digital mental health intervention: Challenges, facilitators and implications for training models
- Andrews, Brooke, Klein, Britt, Corboy, Denise, McLaren, Suzanne, Watson, Shaun
- Authors: Andrews, Brooke , Klein, Britt , Corboy, Denise , McLaren, Suzanne , Watson, Shaun
- Date: 2023
- Type: Text , Journal article
- Relation: Counselling and Psychotherapy Research Vol. 23, no. 3 (2023), p. 818-829
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- Description: Objective: This qualitative study investigated therapist training experiences, elements of skill acquisition, and barriers and facilitators associated with conducting assessments, and the delivery of low- and high-intensity therapist assistance delivered via video chat technology, adjunctive to a transdiagnostic digital mental health intervention programme for anxiety and depression. Methodology: In total, 34 semistructured interviews were conducted with 20 therapists. Twenty interviews explored experiences of training to administer a clinical assessment tool, and 14 additional interviews explored training experiences of delivering low- and high-intensity therapist assistance via video chat technology. Results: Reflexive thematic analysis identified three themes: video chat skill acquisition, competencies transferrable to video chat and video chat service quality. Training and supervision were identified as important to scaffold skill development, and therapists described surprise that their skill set was transferrable to video chat. The most cited barrier to the adoption of video chat was the management of risk and distress, along with environmental suitability. Frequently cited facilitators to the adoption of video chat included stable Internet connection, protocols and resources. Conclusion: The benefits of video chat technology and digital mental health interventions can be maximised through the expansion and integration of training into existing teaching curricula. If therapists are familiarised and competent to deliver mental health services via the Internet, as well as in person, the future adoption of blended and stepped-care models is likely to be increased. © 2023 The Authors. Counselling and Psychotherapy Research published by John Wiley & Sons Ltd on behalf of British Association for Counselling and Psychotherapy.
- Authors: Andrews, Brooke , Klein, Britt , Corboy, Denise , McLaren, Suzanne , Watson, Shaun
- Date: 2023
- Type: Text , Journal article
- Relation: Counselling and Psychotherapy Research Vol. 23, no. 3 (2023), p. 818-829
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- Description: Objective: This qualitative study investigated therapist training experiences, elements of skill acquisition, and barriers and facilitators associated with conducting assessments, and the delivery of low- and high-intensity therapist assistance delivered via video chat technology, adjunctive to a transdiagnostic digital mental health intervention programme for anxiety and depression. Methodology: In total, 34 semistructured interviews were conducted with 20 therapists. Twenty interviews explored experiences of training to administer a clinical assessment tool, and 14 additional interviews explored training experiences of delivering low- and high-intensity therapist assistance via video chat technology. Results: Reflexive thematic analysis identified three themes: video chat skill acquisition, competencies transferrable to video chat and video chat service quality. Training and supervision were identified as important to scaffold skill development, and therapists described surprise that their skill set was transferrable to video chat. The most cited barrier to the adoption of video chat was the management of risk and distress, along with environmental suitability. Frequently cited facilitators to the adoption of video chat included stable Internet connection, protocols and resources. Conclusion: The benefits of video chat technology and digital mental health interventions can be maximised through the expansion and integration of training into existing teaching curricula. If therapists are familiarised and competent to deliver mental health services via the Internet, as well as in person, the future adoption of blended and stepped-care models is likely to be increased. © 2023 The Authors. Counselling and Psychotherapy Research published by John Wiley & Sons Ltd on behalf of British Association for Counselling and Psychotherapy.
Transforming global approaches to chronic disease prevention and management across the lifespan : integrating genomics, behavior change, and digital health solutions
- Thomas, Shane, Browning, Collette, Charchar, Fadi, Klein, Britt, Ory, Marcia, Bowden-Jones, Henrietta, Chamberlain, Samuel
- Authors: Thomas, Shane , Browning, Collette , Charchar, Fadi , Klein, Britt , Ory, Marcia , Bowden-Jones, Henrietta , Chamberlain, Samuel
- Date: 2023
- Type: Text , Journal article
- Relation: Frontiers in Public Health Vol. 11, no. (2023), p.
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- Description: Chronic illnesses are a major threat to global population health through the lifespan into older age. Despite world-wide public health goals, there has been a steady increase in chronic and non-communicable diseases (e.g., cancer, cardiovascular and metabolic disorders) and strong growth in mental health disorders. In 2010, 67% of deaths worldwide were due to chronic diseases and this increased to 74% in 2019, with accelerated growth in the COVID-19 era and its aftermath. Aging and wellbeing across the lifespan are positively impacted by the presence of effective prevention and management of chronic illness that can enhance population health. This paper provides a short overview of the journey to this current situation followed by discussion of how we may better address what the World Health Organization has termed the “tsunami of chronic diseases.” In this paper we advocate for the development, validation, and subsequent deployment of integrated: 1. Polygenic and multifactorial risk prediction tools to screen for those at future risk of chronic disease and those with undiagnosed chronic disease. 2. Advanced preventive, behavior change and chronic disease management to maximize population health and wellbeing. 3. Digital health systems to support greater efficiencies in population-scale health prevention and intervention programs. It is argued that each of these actions individually has an emerging evidence base. However, there has been limited research to date concerning the combined population-level health effects of their integration. We outline the conceptual framework within which we are planning and currently conducting studies to investigate the effects of their integration. Copyright © 2023 Thomas, Browning, Charchar, Klein, Ory, Bowden-Jones and Chamberlain.
- Authors: Thomas, Shane , Browning, Collette , Charchar, Fadi , Klein, Britt , Ory, Marcia , Bowden-Jones, Henrietta , Chamberlain, Samuel
- Date: 2023
- Type: Text , Journal article
- Relation: Frontiers in Public Health Vol. 11, no. (2023), p.
- Full Text:
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- Description: Chronic illnesses are a major threat to global population health through the lifespan into older age. Despite world-wide public health goals, there has been a steady increase in chronic and non-communicable diseases (e.g., cancer, cardiovascular and metabolic disorders) and strong growth in mental health disorders. In 2010, 67% of deaths worldwide were due to chronic diseases and this increased to 74% in 2019, with accelerated growth in the COVID-19 era and its aftermath. Aging and wellbeing across the lifespan are positively impacted by the presence of effective prevention and management of chronic illness that can enhance population health. This paper provides a short overview of the journey to this current situation followed by discussion of how we may better address what the World Health Organization has termed the “tsunami of chronic diseases.” In this paper we advocate for the development, validation, and subsequent deployment of integrated: 1. Polygenic and multifactorial risk prediction tools to screen for those at future risk of chronic disease and those with undiagnosed chronic disease. 2. Advanced preventive, behavior change and chronic disease management to maximize population health and wellbeing. 3. Digital health systems to support greater efficiencies in population-scale health prevention and intervention programs. It is argued that each of these actions individually has an emerging evidence base. However, there has been limited research to date concerning the combined population-level health effects of their integration. We outline the conceptual framework within which we are planning and currently conducting studies to investigate the effects of their integration. Copyright © 2023 Thomas, Browning, Charchar, Klein, Ory, Bowden-Jones and Chamberlain.
- Andrews, Brooke, Klein, Britt, Corboy, Denise, McLaren, Suzanne, Watson, Shaun
- Authors: Andrews, Brooke , Klein, Britt , Corboy, Denise , McLaren, Suzanne , Watson, Shaun
- Date: 2023
- Type: Text , Journal article
- Relation: Professional psychology, research and practice Vol. 54, no. 6 (2023), p. 418-429
- Full Text: false
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- 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)
Community expectations and anticipated outcomes for crisis support services—Lifeline Australia
- Ma, Jennifer, Batterham, Philip, Kõlves, Kairi, Woodward, Alan, Bradford, Sally, Klein, Britt, Titov, Nickolai, Mazzer, Kelly, O’Riordan, Megan, Rickwood, Debra
- Authors: Ma, Jennifer , Batterham, Philip , Kõlves, Kairi , Woodward, Alan , Bradford, Sally , Klein, Britt , Titov, Nickolai , Mazzer, Kelly , O’Riordan, Megan , Rickwood, Debra
- Date: 2022
- Type: Text , Journal article
- Relation: Health and Social Care in the Community Vol. 30, no. 5 (2022), p. 1775-1788
- Full Text: false
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- Description: Crisis lines provide a critical first line of mental wellbeing support for community members in distress. Given the increasing referral to such services, there is a need to understand what the expectations of the community are around the role of such services in our public health responses. A computer assisted telephone interview was undertaken between 28th October and 30th November 2019. The aim was to explore expectations and anticipated outcomes of Lifeline Australia's crisis support services from a nationally representative community sample (N = 1,300). Analysis was undertaken to determine if demographic variables (age, gender, indigenous status, country of birth, culturally and linguistically diverse (CALD) status, sexual orientation, household composition, region and State/territory) and past service use affected community expectations. Results showed that a majority of respondents expected Lifeline to listen and provide support, recommend other services, and provide information. Help-seekers were expected to feel heard and listened to, receive safety advice or support to stay safe, and feel more hopeful. Lifeline was expected to prioritise people feeling suicidal, in immediate personal crisis, and experiencing domestic violence. Findings reveal that community members hold expectations for Lifeline Australia to serve as a suicide prevention and general crisis support service, which are congruent with the service's aims. There was little variation in community expectations of crisis support services based on demographic factors and past service use. The results show that the community has extensive and diverse expectations for this national crisis service to meet both short and longer-term needs for all vulnerable members of the community—entailing a very substantial public health service responsibility. © 2021 John Wiley & Sons Ltd.
Consumer perspectives on the use of artificial intelligence technology and automation in crisis support services : mixed methods study
- Ma, Jennifer, O’Riordan, Megan, Mazzer, Kelly, Batterham, Philip, Bradford, Sally, Kõlves, Kairi, Titov, Nickolai, Klein, Britt, Rickwood, Debra
- Authors: Ma, Jennifer , O’Riordan, Megan , Mazzer, Kelly , Batterham, Philip , Bradford, Sally , Kõlves, Kairi , Titov, Nickolai , Klein, Britt , Rickwood, Debra
- Date: 2022
- Type: Text , Journal article
- Relation: JMIR Human Factors Vol. 9, no. 3 (2022), p.
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- Description: Background: Emerging technologies, such as artificial intelligence (AI), have the potential to enhance service responsiveness and quality, improve reach to underserved groups, and help address the lack of workforce capacity in health and mental health care. However, little research has been conducted on the acceptability of AI, particularly in mental health and crisis support, and how this may inform the development of responsible and responsive innovation in the area. Objective: This study aims to explore the level of support for the use of technology and automation, such as AI, in Lifeline’s crisis support services in Australia; the likelihood of service use if technology and automation were implemented; the impact of demographic characteristics on the level of support and likelihood of service use; and reasons for not using Lifeline’s crisis support services if technology and automation were implemented in the future. Methods: A mixed methods study involving a computer-assisted telephone interview and a web-based survey was undertaken from 2019 to 2020 to explore expectations and anticipated outcomes of Lifeline’s crisis support services in a nationally representative community sample (n=1300) and a Lifeline help-seeker sample (n=553). Participants were aged between 18 and 93 years. Quantitative descriptive analysis, binary logistic regression models, and qualitative thematic analysis were conducted to address the research objectives. Results: One-third of the community and help-seeker participants did not support the collection of information about service users through technology and automation (ie, via AI), and approximately half of the participants reported that they would be less likely to use the service if automation was introduced. Significant demographic differences were observed between the community and help-seeker samples. Of the demographics, only older age predicted being less likely to endorse technology and automation to tailor Lifeline’s crisis support service and use such services (odds ratio 1.48-1.66, 99% CI 1.03-2.38; P<.001 to P=.005). The most common reason for reluctance, reported by both samples, was that respondents wanted to speak to a real person, assuming that human counselors would be replaced by automated robots or machine services. Conclusions: Although Lifeline plans to always have a real person providing crisis support, help-seekers automatically fear this will not be the case if new technology and automation such as AI are introduced. Consequently, incorporating innovative use of technology to improve help-seeker outcomes in such services will require careful messaging and assurance that the human connection will continue. © Jennifer S Ma, Megan O’Riordan, Kelly Mazzer, Philip J Batterham, Sally Bradford, Kairi Kõlves, Nickolai Titov, Britt Klein, Debra J Rickwood.
- Authors: Ma, Jennifer , O’Riordan, Megan , Mazzer, Kelly , Batterham, Philip , Bradford, Sally , Kõlves, Kairi , Titov, Nickolai , Klein, Britt , Rickwood, Debra
- Date: 2022
- Type: Text , Journal article
- Relation: JMIR Human Factors Vol. 9, no. 3 (2022), p.
- Full Text:
- Reviewed:
- Description: Background: Emerging technologies, such as artificial intelligence (AI), have the potential to enhance service responsiveness and quality, improve reach to underserved groups, and help address the lack of workforce capacity in health and mental health care. However, little research has been conducted on the acceptability of AI, particularly in mental health and crisis support, and how this may inform the development of responsible and responsive innovation in the area. Objective: This study aims to explore the level of support for the use of technology and automation, such as AI, in Lifeline’s crisis support services in Australia; the likelihood of service use if technology and automation were implemented; the impact of demographic characteristics on the level of support and likelihood of service use; and reasons for not using Lifeline’s crisis support services if technology and automation were implemented in the future. Methods: A mixed methods study involving a computer-assisted telephone interview and a web-based survey was undertaken from 2019 to 2020 to explore expectations and anticipated outcomes of Lifeline’s crisis support services in a nationally representative community sample (n=1300) and a Lifeline help-seeker sample (n=553). Participants were aged between 18 and 93 years. Quantitative descriptive analysis, binary logistic regression models, and qualitative thematic analysis were conducted to address the research objectives. Results: One-third of the community and help-seeker participants did not support the collection of information about service users through technology and automation (ie, via AI), and approximately half of the participants reported that they would be less likely to use the service if automation was introduced. Significant demographic differences were observed between the community and help-seeker samples. Of the demographics, only older age predicted being less likely to endorse technology and automation to tailor Lifeline’s crisis support service and use such services (odds ratio 1.48-1.66, 99% CI 1.03-2.38; P<.001 to P=.005). The most common reason for reluctance, reported by both samples, was that respondents wanted to speak to a real person, assuming that human counselors would be replaced by automated robots or machine services. Conclusions: Although Lifeline plans to always have a real person providing crisis support, help-seekers automatically fear this will not be the case if new technology and automation such as AI are introduced. Consequently, incorporating innovative use of technology to improve help-seeker outcomes in such services will require careful messaging and assurance that the human connection will continue. © Jennifer S Ma, Megan O’Riordan, Kelly Mazzer, Philip J Batterham, Sally Bradford, Kairi Kõlves, Nickolai Titov, Britt Klein, Debra J Rickwood.
Help-seeker expectations and outcomes of a crisis support service : comparison of suicide-related and non-suicide-related contacts to lifeline Australia
- O'Riordan, Megan, Ma, Jennifer, Mazzer, Kelly, Batterham, Philip, Kõlves, Kairi, Woodward, Alan, Klein, Britt, Larsen, Mark, Goecke, Roland, Gould, Madelyn, Rickwood, Debra
- Authors: O'Riordan, Megan , Ma, Jennifer , Mazzer, Kelly , Batterham, Philip , Kõlves, Kairi , Woodward, Alan , Klein, Britt , Larsen, Mark , Goecke, Roland , Gould, Madelyn , Rickwood, Debra
- Date: 2022
- Type: Text , Journal article
- Relation: Health and Social Care in the Community Vol. 30, no. 6 (2022), p. e4535-e4544
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- Description: Lifeline Australia aims to prevent suicide and support community members in personal crisis via the provision of free anonymous telephone, online chat and text message services. This study aimed to identify the expectations and outcomes of Lifeline help-seekers, including whether there are differences between suicide-related and non-suicide-related contacts. Help-seekers (N = 553) who had previously contacted Lifeline via telephone, online chat, or text message crisis services were recruited via social media and a link provided after Lifeline service use, who completed an online survey about their awareness, expectations and outcomes of Lifeline's services. The responses from help-seekers who self-reported suicide-related and non-suicide-related reasons for contact were compared. Participants were highly aware of Lifeline's services, particularly the phone service. The main expectations of all help-seekers were to feel heard and listened to, feel less upset and feel understood. There were 59.5% of the sample that reported suicidality as a reason for contact. Suicide-related contacts endorsed more reasons for contact than non-suicide-related contacts. Expectations of suicide-related help-seekers were greater, but they were less likely to report that their expectations were met. The high expectations and complexity of suicide-related contacts reveal the challenges in meeting the needs of this high-priority group, particularly within the context of the multiple demands on crisis support services. © 2022 The Authors. Health and Social Care in the Community published by John Wiley & Sons Ltd.
- Authors: O'Riordan, Megan , Ma, Jennifer , Mazzer, Kelly , Batterham, Philip , Kõlves, Kairi , Woodward, Alan , Klein, Britt , Larsen, Mark , Goecke, Roland , Gould, Madelyn , Rickwood, Debra
- Date: 2022
- Type: Text , Journal article
- Relation: Health and Social Care in the Community Vol. 30, no. 6 (2022), p. e4535-e4544
- Full Text:
- Reviewed:
- Description: Lifeline Australia aims to prevent suicide and support community members in personal crisis via the provision of free anonymous telephone, online chat and text message services. This study aimed to identify the expectations and outcomes of Lifeline help-seekers, including whether there are differences between suicide-related and non-suicide-related contacts. Help-seekers (N = 553) who had previously contacted Lifeline via telephone, online chat, or text message crisis services were recruited via social media and a link provided after Lifeline service use, who completed an online survey about their awareness, expectations and outcomes of Lifeline's services. The responses from help-seekers who self-reported suicide-related and non-suicide-related reasons for contact were compared. Participants were highly aware of Lifeline's services, particularly the phone service. The main expectations of all help-seekers were to feel heard and listened to, feel less upset and feel understood. There were 59.5% of the sample that reported suicidality as a reason for contact. Suicide-related contacts endorsed more reasons for contact than non-suicide-related contacts. Expectations of suicide-related help-seekers were greater, but they were less likely to report that their expectations were met. The high expectations and complexity of suicide-related contacts reveal the challenges in meeting the needs of this high-priority group, particularly within the context of the multiple demands on crisis support services. © 2022 The Authors. Health and Social Care in the Community published by John Wiley & Sons Ltd.
The impact of a novel mimicry task for increasing emotion recognition in adults with autism spectrum disorder and alexithymia : protocol for a randomized controlled trial
- Caine, Joshua, Klein, Britt, Edwards, Stephen
- Authors: Caine, Joshua , Klein, Britt , Edwards, Stephen
- Date: 2021
- Type: Text , Journal article
- Relation: JMIR Research Protocols Vol. 10, no. 6 (2021), p.
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- Description: Background: Impaired facial emotion expression recognition (FEER) has typically been considered a correlate of autism spectrum disorder (ASD). Now, the alexithymia hypothesis is suggesting that this emotion processing problem is instead related to alexithymia, which frequently co-occurs with ASD. By combining predictive coding theories of ASD and simulation theories of emotion recognition, it is suggested that facial mimicry may improve the training of FEER in ASD and alexithymia. Objective: This study aims to evaluate a novel mimicry task to improve FEER in adults with and without ASD and alexithymia. Additionally, this study will aim to determine the contributions of alexithymia and ASD to FEER ability and assess which of these 2 populations benefit from this training task. Methods: Recruitment will primarily take place through an ASD community group with emphasis put on snowball recruiting. Included will be 64 consenting adults equally divided between participants without an ASD and participants with an ASD. Participants will be screened online using the Kessler Psychological Distress Scale (K-10; cut-off score of 22), Autism Spectrum Quotient (AQ-10), and Toronto Alexithymia Scale (TAS-20) followed by a clinical interview with a provisional psychologist at the Federation University psychology clinic. The clinical interview will include assessment of ability, anxiety, and depression as well as discussion of past ASD diagnosis and confirmatory administration of the Autism Mental Status Exam (AMSE). Following the clinical interview, the participant will complete the Bermond-Vorst Alexithymia Questionnaire (BVAQ) and then undertake a baseline assessment of FEER. Consenting participants will then be assigned using a permuted blocked randomization method into either the control task condition or the mimicry task condition. A brief measure of satisfaction of the task and a debriefing session will conclude the study. Results: The study has Federation University Human Research Ethics Committee approval and is registered with the Australian New Zealand Clinical Trials. Participant recruitment is predicted to begin in the third quarter of 2021. Conclusions: This study will be the first to evaluate the use of a novel facial mimicry task condition to increase FEER in adults with ASD and alexithymia. If efficacious, this task could prove useful as a cost-effective adjunct intervention that could be used at home and thus remove barriers to entry. This study will also explore the unique effectiveness of this task in people without an ASD, with an ASD, and with alexithymia. © 2021 JMIR Research Protocols.
- Authors: Caine, Joshua , Klein, Britt , Edwards, Stephen
- Date: 2021
- Type: Text , Journal article
- Relation: JMIR Research Protocols Vol. 10, no. 6 (2021), p.
- Full Text:
- Reviewed:
- Description: Background: Impaired facial emotion expression recognition (FEER) has typically been considered a correlate of autism spectrum disorder (ASD). Now, the alexithymia hypothesis is suggesting that this emotion processing problem is instead related to alexithymia, which frequently co-occurs with ASD. By combining predictive coding theories of ASD and simulation theories of emotion recognition, it is suggested that facial mimicry may improve the training of FEER in ASD and alexithymia. Objective: This study aims to evaluate a novel mimicry task to improve FEER in adults with and without ASD and alexithymia. Additionally, this study will aim to determine the contributions of alexithymia and ASD to FEER ability and assess which of these 2 populations benefit from this training task. Methods: Recruitment will primarily take place through an ASD community group with emphasis put on snowball recruiting. Included will be 64 consenting adults equally divided between participants without an ASD and participants with an ASD. Participants will be screened online using the Kessler Psychological Distress Scale (K-10; cut-off score of 22), Autism Spectrum Quotient (AQ-10), and Toronto Alexithymia Scale (TAS-20) followed by a clinical interview with a provisional psychologist at the Federation University psychology clinic. The clinical interview will include assessment of ability, anxiety, and depression as well as discussion of past ASD diagnosis and confirmatory administration of the Autism Mental Status Exam (AMSE). Following the clinical interview, the participant will complete the Bermond-Vorst Alexithymia Questionnaire (BVAQ) and then undertake a baseline assessment of FEER. Consenting participants will then be assigned using a permuted blocked randomization method into either the control task condition or the mimicry task condition. A brief measure of satisfaction of the task and a debriefing session will conclude the study. Results: The study has Federation University Human Research Ethics Committee approval and is registered with the Australian New Zealand Clinical Trials. Participant recruitment is predicted to begin in the third quarter of 2021. Conclusions: This study will be the first to evaluate the use of a novel facial mimicry task condition to increase FEER in adults with ASD and alexithymia. If efficacious, this task could prove useful as a cost-effective adjunct intervention that could be used at home and thus remove barriers to entry. This study will also explore the unique effectiveness of this task in people without an ASD, with an ASD, and with alexithymia. © 2021 JMIR Research Protocols.
- Sadler, Paul, McLaren, Suzanne, Klein, Britt, Jenkins, Megan
- Authors: Sadler, Paul , McLaren, Suzanne , Klein, Britt , Jenkins, Megan
- Date: 2020
- Type: Text , Journal article
- Relation: Aging and Mental Health Vol. 24, no. 6 (2020), p. 932-938
- Full Text: false
- Reviewed:
- Description: Objectives: To explore the experiences of older adults who participated in a randomised controlled trial (RCT) that tested cognitive behaviour therapy for insomnia and depression. Methods: Focus groups were conducted post treatment for older adults (M age = 75 years; 61% female) who participated in a RCT that tested two experiential interventions targeting comorbid insomnia and depression (cognitive behaviour therapy for insomnia, CBT-I; cognitive behaviour therapy for insomnia plus positive mood strategies, CBT-I+). Six semi-structured focus group interviews (N = 31) were analysed using a qualitative thematic analysis. Results: Interview data were transcribed into 424 sentences and 60 codes were extracted. Thirty-four initial themes emerged, which were transformed into 3 themes and 10 subthemes. The three primary themes were (1) positive experiences, (2) negative experiences, and (3) suggested modifications. The positive subthemes were (1a) therapists, (1b) togetherness, (1c) use of strategies reduced symptoms, and (1d) acceptance. The negative subthemes were (2a) persistent symptoms, (2b) program too condensed, and (2c) attendance obstacles. The suggested modifications were (3a) lengthen program, (3b) multi-dimensional learning, and (3c) multi-modal delivery options. Conclusion: The experiences and suggestions identified in this study strengthen the foundation to advance therapeutic program development for older adults with comorbid insomnia and depression. Future CBT-I programs for older adults may be improved by increasing the length of therapy (e.g. 8 sessions to 12 sessions), adding multi-dimensional learning opportunities (e.g. visual/audio/mentorship), and offering various modes of treatment delivery (e.g. group, individual, internet, telephone). © 2019, © 2019 Informa UK Limited, trading as Taylor & Francis Group.
- Description: Federation University Australia and the Australian Government Research Training Program Scholarship
Bayes, time perception, and relativity : The central role of hopelessness
- Kent, Lachlan, Van Doorn, George, Hohwy, Jakob, Klein, Britt
- Authors: Kent, Lachlan , Van Doorn, George , Hohwy, Jakob , Klein, Britt
- Date: 2019
- Type: Text , Journal article
- Relation: Consciousness and Cognition Vol. 69, no. (2019), p. 70-80
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- Description: Time judgement and time experience are distinct elements of time perception. It is known that time experience tends to be slow, or dilated, when depressed, but there is less certainty or clarity concerning how depression affects time judgement. Here, we use a Bayesian Prediction Error Minimisation (PEM) framework called 'distrusting the present' as an explanatory and predictive model of both aspects of time perception. An interval production task was designed to probe and modulate the relationship between time perception and depression. Results showed that hopelessness, a symptom of severe depression, was associated with the ordering of interval lengths, reduced overall error, and dilated time experience. We propose that 'distrusting the future' is accompanied by 'trusting the present', leading to the experiences of time dilation when depressed or hopeless. Evidence was also found to support a relative difference model of how hopelessness dilates, and arousal accelerates, the rate of experienced time.
- Authors: Kent, Lachlan , Van Doorn, George , Hohwy, Jakob , Klein, Britt
- Date: 2019
- Type: Text , Journal article
- Relation: Consciousness and Cognition Vol. 69, no. (2019), p. 70-80
- Full Text:
- Reviewed:
- Description: Time judgement and time experience are distinct elements of time perception. It is known that time experience tends to be slow, or dilated, when depressed, but there is less certainty or clarity concerning how depression affects time judgement. Here, we use a Bayesian Prediction Error Minimisation (PEM) framework called 'distrusting the present' as an explanatory and predictive model of both aspects of time perception. An interval production task was designed to probe and modulate the relationship between time perception and depression. Results showed that hopelessness, a symptom of severe depression, was associated with the ordering of interval lengths, reduced overall error, and dilated time experience. We propose that 'distrusting the future' is accompanied by 'trusting the present', leading to the experiences of time dilation when depressed or hopeless. Evidence was also found to support a relative difference model of how hopelessness dilates, and arousal accelerates, the rate of experienced time.
- Smith, Allan., Bamgboje-Ayodele, Adeola, Butow, Phyllis, Klein, Britt, Turner, Jane, Sharpe, Louise, Fardell, Joanna, Beatty, Lisa, Pearce, Alison, Thewes, Belinda, Beith, Jane, Girgis, Afaf, iConquerFear Community Advisory, Group
- Authors: Smith, Allan. , Bamgboje-Ayodele, Adeola , Butow, Phyllis , Klein, Britt , Turner, Jane , Sharpe, Louise , Fardell, Joanna , Beatty, Lisa , Pearce, Alison , Thewes, Belinda , Beith, Jane , Girgis, Afaf , iConquerFear Community Advisory, Group
- Date: 2019
- Type: Text , Journal article
- Relation: Psycho-Oncology Vol. , no. (2019), p.
- Full Text: false
- Reviewed:
- Description: Objective: To develop and evaluate the usability of iConquerFear, an online self-management adaptation of an efficacious face-to-face therapist-delivered treatment for fear of cancer recurrence (FCR). Methods: iConquerFear development was theory based and person based. Development was guided by Ritterband et al's behaviour change model for internet interventions. iConquerFear end users (cancer survivors) provided iterative feedback in accordance with Yardley et al's person-based approach to maximise engagement and usability. Online focus groups and cognitive interviews were conducted to evaluate the usability of iConquerFear. Discussions were recorded, transcribed verbatim, and thematically analysed. Results: Five online FCR modules were developed. Twenty-three cancer survivors (47% of those eligible) participated; 11/23 (58%) were breast cancer survivors, and average age was 53 years (SD = 10.8). Thematic saturation was reached after six focus groups (n = 16) and seven individual think-aloud interviews. Thematic analysis produced five overarching themes: easy navigation essential; satisfaction and engagement with content; flexible access is key; normalising and empowering; and a useful first step. Conclusions: Online self-management interventions like iConquerFear have the potential to address the unmet supportive care needs reported by burgeoning numbers of cancer survivors. However, that potential may not be realised unless interventions are rigorously developed and user tested, as benefits are constrained by limited engagement. Themes from the usability testing of iConquerFear highlight the importance of developing flexible, tailored, interactive, and contextual online self-management interventions for people with cancer. © 2019 John Wiley & Sons, Ltd.
- Meaklim, Hailey, Abbott, Jo-Anne, Kennedy, Gerard, Murray, Greg, Klein, Britt, Rehm, Imogen
- Authors: Meaklim, Hailey , Abbott, Jo-Anne , Kennedy, Gerard , Murray, Greg , Klein, Britt , Rehm, Imogen
- Date: 2019
- Type: Text , Journal article
- Relation: Australian Psychologist Vol. 54, no. 3 (2019), p. 225-234
- Full Text: false
- Reviewed:
- Description: Objectives: This study examined the feasibility of delivering an online cognitive behavioural therapy for insomnia intervention (Sleep-e) within an Australian public hospital outpatient insomnia clinic. Method: This study was conducted as an open trial pilot study. Fifty-two patients waiting for clinic treatment were invited to participate, with ten commencing and six completing the 7-week internet intervention. Participants completed a battery of questionnaires regarding their demographic information, sleep and insomnia symptoms, and provided feedback about the program. Exclusion criteria were minimal, and the study allowed for participants to have other health, psychiatric, and sleep disorder co-morbidities. Results: Post-program satisfaction results suggested that Sleep-e was easy to use; participants were satisfied with it; and found it beneficial in improving sleep. Paired samples t tests for the intention-to-treat sample indicated reductions in participants' insomnia severity (p = 0.02) and sleep onset latency (p = 0.04) from pre- to post-program. However, a larger sample is needed to generalise the results to the wider population. Conclusion: The findings support Sleep-e as a helpful treatment for insomnia in a public hospital outpatient population for at least a subgroup of patients. However, significant lessons were learned regarding the importance of educating health care providers and patients about novel models of internet service delivery. Potential models of adaptive or blended stepped-care are discussed to facilitate program implementation. Future research should identify how to implement internet interventions more effectively in public health settings to take advantage of their potential to improve clinical efficiency.
Systema Temporis : a time-based dimensional framework for consciousness and cognition
- Kent, Lachlan, Van Doorn, George, Klein, Britt
- Authors: Kent, Lachlan , Van Doorn, George , Klein, Britt
- Date: 2019
- Type: Text , Journal article , Review
- Relation: Consciousness and Cognition Vol. 73, no. (2019), p. 1-12
- Full Text:
- Reviewed:
- Description: This study uses a combined categorical-dimensional approach to depict a hierarchical framework for consciousness similar to, and contiguous with, factorial models of cognition (cf., intelligence). On the basis of the longstanding definition of time consciousness, the analysis employs a dimension of temporal extension, in the same manner that psychology has temporally organised memory (i.e., short-term, long-term, and long-lasting memories). By defining temporal extension in terms of the structure of time perception at short timescales (<100 s), memory and time consciousness are proposed to fit along the same logarithmic dimension. This suggests that different forms of time consciousness (e.g., experience, wakefulness, and self-consciousness) are embedded within, or supported by, the ascending timescales of different modes of memory (i.e., short-term, long-term, etc.). A secondary dimension is also proposed to integrate higher-order forms of consciousness/emotion and memory/cognition. The resulting two-dimensional structure accords with existing theories of cognitive and emotional intelligence.
- Authors: Kent, Lachlan , Van Doorn, George , Klein, Britt
- Date: 2019
- Type: Text , Journal article , Review
- Relation: Consciousness and Cognition Vol. 73, no. (2019), p. 1-12
- Full Text:
- Reviewed:
- Description: This study uses a combined categorical-dimensional approach to depict a hierarchical framework for consciousness similar to, and contiguous with, factorial models of cognition (cf., intelligence). On the basis of the longstanding definition of time consciousness, the analysis employs a dimension of temporal extension, in the same manner that psychology has temporally organised memory (i.e., short-term, long-term, and long-lasting memories). By defining temporal extension in terms of the structure of time perception at short timescales (<100 s), memory and time consciousness are proposed to fit along the same logarithmic dimension. This suggests that different forms of time consciousness (e.g., experience, wakefulness, and self-consciousness) are embedded within, or supported by, the ascending timescales of different modes of memory (i.e., short-term, long-term, etc.). A secondary dimension is also proposed to integrate higher-order forms of consciousness/emotion and memory/cognition. The resulting two-dimensional structure accords with existing theories of cognitive and emotional intelligence.
Time dilation and acceleration in depression
- Kent, Lachlan, Van Doorn, George, Klein, Britt
- Authors: Kent, Lachlan , Van Doorn, George , Klein, Britt
- Date: 2019
- Type: Text , Journal article , Review
- Relation: Acta Psychologica Vol. 194, no. (2019), p. 77-86
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- Description: Background: A recent meta-analysis left open a significant question regarding altered time perception in depression: Why do depressed people overproduce short durations and under-produce longer durations if their present experience is that time flows slowly? Experience and judgement of time do not seem to accord with one another. Analysis: By excluding two of the six studies on methodological grounds from a previous meta-analysis of medium-length interval productions, and re-analysing the remaining four studies, the present paper finds that subjective time accelerates from initial dilation within present experience (approximately 1 s duration) to subsequent acceleration within working memory (approximately 30 s duration) when depressed. Proposals: It is proposed that depressive time dilation and acceleration refer to the default mode and central executive networks, respectively. The acceleration effect is suggested to occur due to mood congruency between long intervals, boredom, and depression. This mood congruency leads to the automatic recall of intrusive, negative, and non-specific autobiographical long-term memories used to judge intervals from previous experience. Acceleration in working memory then occurs according to the contextual change model of duration estimation. Limitations: The meta-analysis is limited to four studies only, but provides a potential link between time experience and judgement within the same explanatory model. Conclusions: Similarities between psychological time dilation/acceleration and physical time dilation/acceleration are discussed.
Towards machine learning approach for digital-health intervention program
- Santhanagopalan, Meena, Chetty, Madhu, Foale, Cameron, Klein, Britt
- Authors: Santhanagopalan, Meena , Chetty, Madhu , Foale, Cameron , Klein, Britt
- Date: 2019
- Type: Text , Journal article
- Relation: Australian Journal of Intelligent Information Processing System Vol. 15, no. 4 (2019), p. 16-24
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- Description: Digital-Health intervention (DHI) are used by health care providers to promote engagement within community. Effective assignment of participants into DHI programs helps increasing benefits from the most suitable intervention. A major challenge with the roll-out and implementation of DHI, is in assigning participants into different interventions. The use of biopsychosocial model [18] for this purpose is not wide spread, due to limited personalized interventions formed on evidence-based data-driven models. Machine learning has changed the way data extraction and interpretation works by involving automatic sets of generic methods that have replaced the traditional statistical techniques. In this paper, we propose to investigate relevance of machine learning for this purpose and is carried out by studying different non-linear classifiers and compare their prediction accuracy to evaluate their suitability. Further, as a novel contribution, real-life biopsychosocial features are used as input in this study. The results help in developing an appropriate predictive classication model to assign participants into the most suitable DHI. We analyze biopsychosocial data generated from a DHI program and study their feature characteristics using scatter plots. While scatter plots are unable to reveal the linear relationships in the data-set, the use of classifiers can successfully identify which features are suitable predictors of mental ill health.
- Authors: Santhanagopalan, Meena , Chetty, Madhu , Foale, Cameron , Klein, Britt
- Date: 2019
- Type: Text , Journal article
- Relation: Australian Journal of Intelligent Information Processing System Vol. 15, no. 4 (2019), p. 16-24
- Full Text:
- Reviewed:
- Description: Digital-Health intervention (DHI) are used by health care providers to promote engagement within community. Effective assignment of participants into DHI programs helps increasing benefits from the most suitable intervention. A major challenge with the roll-out and implementation of DHI, is in assigning participants into different interventions. The use of biopsychosocial model [18] for this purpose is not wide spread, due to limited personalized interventions formed on evidence-based data-driven models. Machine learning has changed the way data extraction and interpretation works by involving automatic sets of generic methods that have replaced the traditional statistical techniques. In this paper, we propose to investigate relevance of machine learning for this purpose and is carried out by studying different non-linear classifiers and compare their prediction accuracy to evaluate their suitability. Further, as a novel contribution, real-life biopsychosocial features are used as input in this study. The results help in developing an appropriate predictive classication model to assign participants into the most suitable DHI. We analyze biopsychosocial data generated from a DHI program and study their feature characteristics using scatter plots. While scatter plots are unable to reveal the linear relationships in the data-set, the use of classifiers can successfully identify which features are suitable predictors of mental ill health.