An evaluation of low and high intensity digital mental health treatment models for anxiety and depression : an adaptive treatment randomized clinical trial
- Authors: Andrews, Brooke
- Date: 2023
- Type: Text , Thesis , PhD
- Full Text:
- Description: Doctor of Philsophy
- Authors: Andrews, Brooke
- Date: 2023
- Type: Text , Thesis , PhD
- Full Text:
- Description: Doctor of Philsophy
An examination of physical exercise as an adjunct treatment for depressive symptoms in adults aged 65 years and older
- Authors: Miller, Kyle
- Date: 2020
- Type: Text , Thesis , PhD
- Full Text:
- Description: In light of impending demographic shifts and projected strain on healthcare systems, this thesis set out to progress our putative understanding of the benefits of physical exercise on mental health in older adults aged 65 years and over. Herein, four studies of divergent research design interrogated the current knowledge base relating to the potential benefits of exercise in older adults with depressive symptomology. Study 1 set out to establish preliminary experimental evidence that four years of unsupervised aerobic exercise can improve cardiorespiratory function (determined by VO2max) and health-related quality of life (HRQL) in lifelong sedentary ageing men compared with lifelong exercising athletes. Results demonstrated preliminary proof of concept for exercise-induced benefits on cardiorespiratory function and HRQL in ageing men. Study 2 surveyed community-dwelling older adults (n = 586) to establish a hierarchy of exercise-associated factors to predict depressive symptomology. Contrary to expectation, exercise behaviour did not confer additional antidepressant effect, but was substantially predicted by exercise-induced mood, exercise self-efficacy, and social support (f2 = 0.993). Study 3 pooled evidence from randomised controlled trials (RCTs) to quantitatively compare the treatment effectiveness from aerobic, resistance and mind-body exercise training in older adults with pre-existing clinical depression, whereas Study 4 followed the same methodology in apparently health older adults without pre-existing clinical depression. Using network meta-analytical techniques, both clinical depressed (g = -0.41 to -1.38) and apparently healthy (g = -0.27 to -0.51) older adults demonstrated equivalent effectiveness for aerobic, resistance, and mind-body exercise interventions, with encouraging levels of study compliance. Taken together, these findings encourage personal exercise preference when prescribing either aerobic, resistance, or mind-body exercise as a treatment adjunct for clinical depression and older adults with symptoms thereof. The sum of works herein provide new knowledge to guide exercise prescription for stakeholders in mental health and older adults over 65 years.
- Description: Doctor of Philosophy
- Authors: Miller, Kyle
- Date: 2020
- Type: Text , Thesis , PhD
- Full Text:
- Description: In light of impending demographic shifts and projected strain on healthcare systems, this thesis set out to progress our putative understanding of the benefits of physical exercise on mental health in older adults aged 65 years and over. Herein, four studies of divergent research design interrogated the current knowledge base relating to the potential benefits of exercise in older adults with depressive symptomology. Study 1 set out to establish preliminary experimental evidence that four years of unsupervised aerobic exercise can improve cardiorespiratory function (determined by VO2max) and health-related quality of life (HRQL) in lifelong sedentary ageing men compared with lifelong exercising athletes. Results demonstrated preliminary proof of concept for exercise-induced benefits on cardiorespiratory function and HRQL in ageing men. Study 2 surveyed community-dwelling older adults (n = 586) to establish a hierarchy of exercise-associated factors to predict depressive symptomology. Contrary to expectation, exercise behaviour did not confer additional antidepressant effect, but was substantially predicted by exercise-induced mood, exercise self-efficacy, and social support (f2 = 0.993). Study 3 pooled evidence from randomised controlled trials (RCTs) to quantitatively compare the treatment effectiveness from aerobic, resistance and mind-body exercise training in older adults with pre-existing clinical depression, whereas Study 4 followed the same methodology in apparently health older adults without pre-existing clinical depression. Using network meta-analytical techniques, both clinical depressed (g = -0.41 to -1.38) and apparently healthy (g = -0.27 to -0.51) older adults demonstrated equivalent effectiveness for aerobic, resistance, and mind-body exercise interventions, with encouraging levels of study compliance. Taken together, these findings encourage personal exercise preference when prescribing either aerobic, resistance, or mind-body exercise as a treatment adjunct for clinical depression and older adults with symptoms thereof. The sum of works herein provide new knowledge to guide exercise prescription for stakeholders in mental health and older adults over 65 years.
- Description: Doctor of Philosophy
Time experience and judgement in depression : A theory of isomorphic general relativity (TIGR)
- Authors: Kent, Lachlan
- Date: 2019
- Type: Text , Thesis , PhD
- Full Text:
- Description: This thesis presents studies assessing aspects of time experience and judgement in depression. It focuses on a phenomenon called time dilation, which is the perception of slow temporal flow in conscious experience. This thesis by publication explains a novel theory of time dilation in depression, called the Theory of Isomorphic General Relativity (TIGR), and elaborates this theory to propose a general framework for consciousness and cognition according to timescale. The final outcome is a dual-pronged theory of time consciousness and the experience of time dilation in depression that has the same form as Einstein’s (1920) general theory of relativity. The thesis begins with a published paper called “Duration perception versus perception duration: A proposed model for the consciously experienced moment” (Kent, 2019). This paper defines temporal flow in conscious experience in terms of an interval of time perception known as the ‘experienced moment’ (Wittmann, 2011). In this paper, I reviewed evidence for a view of time dilation in depression that is distinct from either immediate sensory integration or working memory (WM) activity. The thesis continues with a second published paper called “Time dilation and acceleration in depression” (Kent, Van Doorn, & Klein, 2019) that reviews the literature specific to time perception in depression, and meta-analytically tests the preceding definition of time dilation within the experienced moment. This paper also details the experimental methodology used and proposes the TIGR as a descriptive and explanatory theory of time perception. xx The third published paper, “Bayes, time perception, and relativity: The central role of hopelessness” (Kent, Van Doorn, Hohwy, & Klein, 2019), formulates and tests the TIGR in a time perception experiment using the methodology outlined in the second paper. The time judgement and experience data of 64 participants, with and without sub-clinical symptoms of depression, were analysed using a statistical version of a Bayesian prediction error minimisation framework called ‘distrusting the present’ (Hohwy, Paton, & Palmer, 2016). The results showed that hopelessness was associated with slower time experience, while arousal was associated with faster time experience. The paper also supported the use of a relative difference equation to model these effects. This relative difference equation has the same general form as a basic general relativity equation used to calculate time dilation due to gravity, called the Schwarzschild metric (Schwarzschild, 1916). The fourth paper, “Time perception in depression: A perceived delay cues feelings of hopelessness” (Kent, Van Doorn, Hohwy, & Klein, under review), is under review by the journal Acta Psychologica. It looks more closely at the experimental effect reported in the third paper to explore the clinical implications of an increase in hopelessness caused by a brief time production task. The analysis showed that a particular sub-factor of the Beck Hopelessness Scale (BHS) called ‘feelings of hopelessness’ was more affected than other facets of hopelessness (Beck, Weissman, Lester, & Trexler, 1974). The fifth paper, “Systema temporis: A time-based dimensional framework for consciousness and cognition” (Kent, Van Doorn, & Klein, under review), is currently under review by the journal Consciousness and Cognition. In this paper, we extend elements of the TIGR related to consciousness in the first four papers xxi to argue that time consciousness can be used to systematise aspects of consciousness and cognition. The paper proposes a hierarchical framework that reflects the commonly-conceived structure of memory, intelligence, and emotional intelligence. This framework integrates aspects of consciousness including experience, wakefulness, and self-consciousness. The final paper, submitted to the journal Personality and Social Psychology Review and entitled “Systema psyches: A time-based framework for consciousness, cognition and related psychological and social theories” (Kent, Van Doorn, & Klein, submitted) extends the ‘Systema Temporis’ paper to incorporate extended timeframes and theories of social cognition including personality, cognitive and moral development, and personal values. The analysis suggests that time consciousness is also a facet of collective experience and so, in framing the closing discussion around time dilation in depression, the thesis concludes that the TIGR extends beyond the narrow domain of individual psychopathology to incorporate timescales of collective memory and human evolution.
- Description: Doctor of Philosophy
- Authors: Kent, Lachlan
- Date: 2019
- Type: Text , Thesis , PhD
- Full Text:
- Description: This thesis presents studies assessing aspects of time experience and judgement in depression. It focuses on a phenomenon called time dilation, which is the perception of slow temporal flow in conscious experience. This thesis by publication explains a novel theory of time dilation in depression, called the Theory of Isomorphic General Relativity (TIGR), and elaborates this theory to propose a general framework for consciousness and cognition according to timescale. The final outcome is a dual-pronged theory of time consciousness and the experience of time dilation in depression that has the same form as Einstein’s (1920) general theory of relativity. The thesis begins with a published paper called “Duration perception versus perception duration: A proposed model for the consciously experienced moment” (Kent, 2019). This paper defines temporal flow in conscious experience in terms of an interval of time perception known as the ‘experienced moment’ (Wittmann, 2011). In this paper, I reviewed evidence for a view of time dilation in depression that is distinct from either immediate sensory integration or working memory (WM) activity. The thesis continues with a second published paper called “Time dilation and acceleration in depression” (Kent, Van Doorn, & Klein, 2019) that reviews the literature specific to time perception in depression, and meta-analytically tests the preceding definition of time dilation within the experienced moment. This paper also details the experimental methodology used and proposes the TIGR as a descriptive and explanatory theory of time perception. xx The third published paper, “Bayes, time perception, and relativity: The central role of hopelessness” (Kent, Van Doorn, Hohwy, & Klein, 2019), formulates and tests the TIGR in a time perception experiment using the methodology outlined in the second paper. The time judgement and experience data of 64 participants, with and without sub-clinical symptoms of depression, were analysed using a statistical version of a Bayesian prediction error minimisation framework called ‘distrusting the present’ (Hohwy, Paton, & Palmer, 2016). The results showed that hopelessness was associated with slower time experience, while arousal was associated with faster time experience. The paper also supported the use of a relative difference equation to model these effects. This relative difference equation has the same general form as a basic general relativity equation used to calculate time dilation due to gravity, called the Schwarzschild metric (Schwarzschild, 1916). The fourth paper, “Time perception in depression: A perceived delay cues feelings of hopelessness” (Kent, Van Doorn, Hohwy, & Klein, under review), is under review by the journal Acta Psychologica. It looks more closely at the experimental effect reported in the third paper to explore the clinical implications of an increase in hopelessness caused by a brief time production task. The analysis showed that a particular sub-factor of the Beck Hopelessness Scale (BHS) called ‘feelings of hopelessness’ was more affected than other facets of hopelessness (Beck, Weissman, Lester, & Trexler, 1974). The fifth paper, “Systema temporis: A time-based dimensional framework for consciousness and cognition” (Kent, Van Doorn, & Klein, under review), is currently under review by the journal Consciousness and Cognition. In this paper, we extend elements of the TIGR related to consciousness in the first four papers xxi to argue that time consciousness can be used to systematise aspects of consciousness and cognition. The paper proposes a hierarchical framework that reflects the commonly-conceived structure of memory, intelligence, and emotional intelligence. This framework integrates aspects of consciousness including experience, wakefulness, and self-consciousness. The final paper, submitted to the journal Personality and Social Psychology Review and entitled “Systema psyches: A time-based framework for consciousness, cognition and related psychological and social theories” (Kent, Van Doorn, & Klein, submitted) extends the ‘Systema Temporis’ paper to incorporate extended timeframes and theories of social cognition including personality, cognitive and moral development, and personal values. The analysis suggests that time consciousness is also a facet of collective experience and so, in framing the closing discussion around time dilation in depression, the thesis concludes that the TIGR extends beyond the narrow domain of individual psychopathology to incorporate timescales of collective memory and human evolution.
- Description: Doctor of Philosophy
Cognitive behaviour therapy for insomnia and depression among older adults : A mixed methods randomised controlled clinical trial
- Authors: Sadler, Paul
- Date: 2018
- Type: Text , Thesis , PhD
- Full Text:
- Description: Background A strong relationship exists between insomnia and depression, particularly among older adults (aged 65 years and older). Recently experts in the field of behavioural sleep medicine established cognitive behaviour therapy (CBT) was an effective treatment for comorbid insomnia, however, it was unknown whether cognitive behaviour therapy for insomnia (CBT-I) benefitted older adults with co-occurring depression (literature review published in Cognitive Behaviour Therapy). A mixed-methods randomised controlled clinical trial (RCT) was warranted within a community mental health setting to investigate the efficacy of CBT-I for older adults with comorbid insomnia and depression. Furthermore, no study had tested whether an advanced form of CBT-I that included additional positive mood-enhancing strategies produced better outcomes compared to a standard form of CBT-I that only targeted insomnia. It was anticipated that the results from such a trial could influence the evolution of treatment for older adults with these highly prevalent comorbid conditions. Methodology An RCT was conducted between 2014 and 2016 across Victoria, Australia, through Latrobe Regional Hospital‟s and Peninsula Health‟s Community Mental Health Services (protocol published in Trials). Seventy-two older adults with diagnosed comorbid insomnia and depression were randomly assigned to one of three group therapy conditions: cognitive behaviour therapy for insomnia (CBT-I, standard), cognitive behaviour 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). Participants who completed the experiential conditions were invited to provide feedback in the form of semi- xvii structured focus groups following the final session of treatment. Thirty-one participants from six groups reflected on their experiences of participating in CBT-I and CBT-I+. Results Quantitative analyses demonstrated the experiential CBT conditions both generated significantly greater reductions in insomnia and depression severity compared to PCG from pre to post, which were maintained at follow-up. The standard and advanced conditions showed similar reductions on insomnia and depression severity at post and follow up. These results were also consistent for the secondary measures across conditions. Both active treatments demonstrated large effect sizes, high retention, and strong remission rates for older adults with insomnia and depression (published in journal SLEEP). A qualitative analysis was also conducted to explore the participants‟ experiences of treatment. Interview data from the reflective focus groups was transcribed into 424 sentences and 60 codes were extracted. Thirty-four initial themes emerged, which were finally transformed into 3 themes and 10 subthemes. The three 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 (manuscript under review in Aging and Mental Health). Conclusion This is the first RCT to demonstrate that specifically treating comorbid insomnia with CBT has an additional positive effect of improving depression for older adults with multiple comorbidities. Both CBT programs were effective at reducing insomnia and depression severity for older adults with comorbidity. Replication of this study is necessary with a larger sample size to conclusively establish whether the two interventions have different or equivalent effects. It was suggested mental health services that deliver treatment for comorbid insomnia with CBT may improve recovery outcomes for older adults with 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).
- Description: Doctor of Philosophy
- Authors: Sadler, Paul
- Date: 2018
- Type: Text , Thesis , PhD
- Full Text:
- Description: Background A strong relationship exists between insomnia and depression, particularly among older adults (aged 65 years and older). Recently experts in the field of behavioural sleep medicine established cognitive behaviour therapy (CBT) was an effective treatment for comorbid insomnia, however, it was unknown whether cognitive behaviour therapy for insomnia (CBT-I) benefitted older adults with co-occurring depression (literature review published in Cognitive Behaviour Therapy). A mixed-methods randomised controlled clinical trial (RCT) was warranted within a community mental health setting to investigate the efficacy of CBT-I for older adults with comorbid insomnia and depression. Furthermore, no study had tested whether an advanced form of CBT-I that included additional positive mood-enhancing strategies produced better outcomes compared to a standard form of CBT-I that only targeted insomnia. It was anticipated that the results from such a trial could influence the evolution of treatment for older adults with these highly prevalent comorbid conditions. Methodology An RCT was conducted between 2014 and 2016 across Victoria, Australia, through Latrobe Regional Hospital‟s and Peninsula Health‟s Community Mental Health Services (protocol published in Trials). Seventy-two older adults with diagnosed comorbid insomnia and depression were randomly assigned to one of three group therapy conditions: cognitive behaviour therapy for insomnia (CBT-I, standard), cognitive behaviour 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). Participants who completed the experiential conditions were invited to provide feedback in the form of semi- xvii structured focus groups following the final session of treatment. Thirty-one participants from six groups reflected on their experiences of participating in CBT-I and CBT-I+. Results Quantitative analyses demonstrated the experiential CBT conditions both generated significantly greater reductions in insomnia and depression severity compared to PCG from pre to post, which were maintained at follow-up. The standard and advanced conditions showed similar reductions on insomnia and depression severity at post and follow up. These results were also consistent for the secondary measures across conditions. Both active treatments demonstrated large effect sizes, high retention, and strong remission rates for older adults with insomnia and depression (published in journal SLEEP). A qualitative analysis was also conducted to explore the participants‟ experiences of treatment. Interview data from the reflective focus groups was transcribed into 424 sentences and 60 codes were extracted. Thirty-four initial themes emerged, which were finally transformed into 3 themes and 10 subthemes. The three 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 (manuscript under review in Aging and Mental Health). Conclusion This is the first RCT to demonstrate that specifically treating comorbid insomnia with CBT has an additional positive effect of improving depression for older adults with multiple comorbidities. Both CBT programs were effective at reducing insomnia and depression severity for older adults with comorbidity. Replication of this study is necessary with a larger sample size to conclusively establish whether the two interventions have different or equivalent effects. It was suggested mental health services that deliver treatment for comorbid insomnia with CBT may improve recovery outcomes for older adults with 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).
- Description: Doctor of Philosophy
The relationship between internalised homophobia, sense of belonging to specific communities and depressive symptoms among self-identified gay men
- Authors: Davidson, Kenneth
- Date: 2011
- Type: Text , Thesis , PhD
- Full Text:
- Description: This study explored depressive symptoms among gay men. Gay men who internalised anti-gay attitudes experienced more depressive symptoms, where as gay men who reported a sense of belonging to gay friends and the general community reported fewer depressive symptoms.
- Description: Doctor of Psychology (Clinical)
- Authors: Davidson, Kenneth
- Date: 2011
- Type: Text , Thesis , PhD
- Full Text:
- Description: This study explored depressive symptoms among gay men. Gay men who internalised anti-gay attitudes experienced more depressive symptoms, where as gay men who reported a sense of belonging to gay friends and the general community reported fewer depressive symptoms.
- Description: Doctor of Psychology (Clinical)
Mental health of older adults : the development and testing of a model
- Authors: Turner, Jayne
- Date: 2006
- Type: Text , Thesis , PhD
- Full Text:
- Description: The high rates of depression and suicide among older adults have given rise to research which aims to identify factors that protect older people from mental illness. Recently, Bailey and McLaren (2005) developed and tested a model which investigated the relationships between engagement in various leisure activities performed alone or with others, sense of belonging, depression, and suicidal ideation. The present study examined an extended version of the mental health model, incorporating the additional variables of perceived freedom in leisure and physical health status. A sample of Australian males and females (N = 379) aged 65 years and over (M age = 77.23, SD = 7.48) completed the Perceived Freedom in Leisure Questionnaire, the Yale Physical Activity Survey,the Duke Health Profile, the Sense of Belonging Instrument, the Centre for Epidemiological Studies-Depressive Scale, and the Suicide Subscale of the General Health Questionnaire. Results indicated that the model was invariant for gender, and accounted for 56% of the variance in suicidal ideation. The model indicated that physical health had direct relationships with each variable in the model. Perceived freedom in leisure predicted engagement in physical activity, sense of belonging-antecedent, and depression, whereas sense of belonging psychological state predicted depression and suicidal ideation. Results suggest that interventions aimed at improving older adults’ perceptions of freedom and personal choice with regard to their leisure experiences, maintaining optimal health, and increasing opportunities to foster feelings of belonging and relatedness with others, should protect against the development of mental ill health.
- Description: Doctor of Psychology (Clinical)
- Authors: Turner, Jayne
- Date: 2006
- Type: Text , Thesis , PhD
- Full Text:
- Description: The high rates of depression and suicide among older adults have given rise to research which aims to identify factors that protect older people from mental illness. Recently, Bailey and McLaren (2005) developed and tested a model which investigated the relationships between engagement in various leisure activities performed alone or with others, sense of belonging, depression, and suicidal ideation. The present study examined an extended version of the mental health model, incorporating the additional variables of perceived freedom in leisure and physical health status. A sample of Australian males and females (N = 379) aged 65 years and over (M age = 77.23, SD = 7.48) completed the Perceived Freedom in Leisure Questionnaire, the Yale Physical Activity Survey,the Duke Health Profile, the Sense of Belonging Instrument, the Centre for Epidemiological Studies-Depressive Scale, and the Suicide Subscale of the General Health Questionnaire. Results indicated that the model was invariant for gender, and accounted for 56% of the variance in suicidal ideation. The model indicated that physical health had direct relationships with each variable in the model. Perceived freedom in leisure predicted engagement in physical activity, sense of belonging-antecedent, and depression, whereas sense of belonging psychological state predicted depression and suicidal ideation. Results suggest that interventions aimed at improving older adults’ perceptions of freedom and personal choice with regard to their leisure experiences, maintaining optimal health, and increasing opportunities to foster feelings of belonging and relatedness with others, should protect against the development of mental ill health.
- Description: Doctor of Psychology (Clinical)
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