Greater Reductions In Anxiety Research Articles

A holistic intervention for alleviating anxiety, depression, and fatigue in cervical cancer

ObjectiveEvaluate how well an intervention program reduces anxiety, depression, and fatigue. MethodsThe study was carried out at the Postgraduate Institute of Medical Education in a hospital in Lebanon. A randomized controlled trial (RCT) was conducted with 30 patients undergoing radiotherapy or chemotherapy. Participants were randomized into two groups of 15 each using an approach for comprehensive enumeration sampling. The Zung Anxiety Scale, Beck Depression Inventory, and Fatigue Scale were among the research instruments. The study approach involved counseling, home care, and the Progressive Muscle Relaxation technique. ResultsBoth groups had comparable sociodemographic and clinical profiles. The study comprised 30 participants, averaging 32 years in the experimental group and 28 years in the control group. Most of the participants were married (74 % experimental, 60 % control), with a significant proportion identified as housewives (87 % control, 60 % experimental). In addition, many had limited education, with 74 % of the experimental group and 67 % of the control group below the primary level. The intervention group, which received counseling, home care and Progressive Muscle Relaxation, experienced significantly greater reductions in anxiety, depression, and fatigue, with p-values below 0.001 for all variables. Statistical analyzes, including paired and independent t-tests, confirmed these findings. ConclusionsThe therapeutic program significantly reduced anxiety, depression, and fatigue in patients undergoing cancer treatment, with p-values less than 0.001. These findings highlight the importance of tailored support, suggesting that integrating such interventions into standard care can improve patients’ mental and emotional well-being

Assessing the Impact of the Way of Saint James on Psychological Distress and Subjective Well-being: The Ultreya Study

This study aimed to examine the impact of a pilgrimage on the Way of St. James on psychological distress and subjective well-being, and to compare these outcomes with a control group on non-pilgrimage vacations. Additionally, the study explored psychological process variables that may mediate the pilgrimage's beneficial effects. A nonrandomized pretest-posttest design was used, involving 444 pilgrims and 124 controls. Participants completed baseline and post-experience self-reported measures of psychological distress, subjective well-being, and psychological processes (i.e., mindfulness, nonattachment, engaged living). A 3-month follow-up was conducted only in the pilgrim group. Mediation analyses examined psychological processes as potential mediators of pre-post change in the pilgrim group (vs. control). Within-group analyses revealed that the pilgrim group experienced improvements in psychological distress, subjective well-being, and psychological processes immediately post-experience, with most measures sustaining improvement at the 3-month follow-up. Compared to the control group, pilgrims showed significantly greater increases in positive affect, life satisfaction, and valued living, alongside greater reductions in anxiety, depression, and perceived stress. Valued living partially mediated the relationship between pilgrimage and positive affect, and fully mediated the effects on perceived stress, negative affect, life satisfaction, and subjective happiness. Pilgrimage on the Way of St. James effectively reduced psychological distress and enhanced subjective well-being, with greater benefits observed compared to a non-pilgrimage vacation control group. Consistent with the concept of pilgrimage as a transformative experience, significant improvements in valued living were noted, which mediated some of the positive outcomes post-pilgrimage. The Way of St. James may serve as a valuable complementary approach for alleviating distress and promoting well-being. Further studies exploring the effects of this pilgrimage on specific populations and using more robust study designs are warranted.Trial Registration ClinicalTrials.gov Identifier NCT04141813.

Testing the Shamiri Intervention and Its Components With Kenyan Adolescents During the COVID-19 Pandemic: Outcomes of a Universal, 5-Arm Randomized Controlled Trial

Mental health problems are prevalent among African adolescents, but professional treatment capacity is limited. Shamiri, an efficient lay provider-delivered intervention, has significantly reduced depression and anxiety symptoms in previous randomized controlled trials (RCTs). This trial investigated effects of the full Shamiri intervention and its components (growth-only, gratitude-only, and values-only) against a study skills control. In a 5-group RCT with adolescents from Kenyan high schools, anxiety, depression, and well-being were self-reported through 8-month follow-up. The RCT occurred immediately after an unanticipated government-mandated COVID-19 shutdown forced 3 years of schoolwork into 2 years, escalating academic pressures. Participants (N= 1,252; 48.72% female) were allocated to: growth (n= 249), gratitude (n= 237), values (n= 265), Shamiri (n= 250), and study skills (n= 251) conditions. Longitudinal multilevel models showed that, across all conditions, anxiety scores significantly improved at midpoint (B=-0.847), end point (B=-2.948), 1-month (B=-1.587), 3-month (B=-2.374), and 8-month (B=-1.917) follow-ups. Depression scores also improved significantly at midpoint (B=-0.796), end point (B=-3.126), 1-month (B=-2.382), 3-month (B=-2.521), and 8-month (B=-2.237) follow-ups. Well-being scores improved significantly at midpoint (B= 1.73), end point (B= 3.44), 1-month (B= 2.21), 3-month (B= 1.78), and 8-month (B= 1.59) follow-ups. Symptom reduction with Shamiri matched that of pre-COVID-19 trials, but symptom reduction with study skills far outpaced that of trials before the COVID-19-related school shutdown (31% greater anxiety reduction and 60% greater depression reduction). Thus, in contrast to previous RCTs, this COVID-19-era trial showed no significant differences between outcomes in any intervention and active control groups. Our RCT conducted during a post-COVID-19 period of heightened academic pressure produced unexpected results. Improvements in youth-reported anxiety and depression were consistent with previous trials for Shamiri, but markedly larger than in previous trials for study skills. Control interventions teaching life skills may produce mental health benefits when they convey skills of particular contextual relevance. A large five-group randomized controlled trial involved comparing the Shamiri Intervention to its component interventions (growth mindset, gratitude, and values affirmation) and a study-skills control. In contrast to previous studies of Shamiri, similar effects were observed across all groups (p<.05). This trial was conducted right after an unanticipated government-mandated COVID shutdown forced three years of schoolwork into two. Benchmarking analyses against previous trials showed approximately equal effects of Shamiri over time, but a 31% greater anxiety reduction and 60% greater depression reduction for the study-skills condition; this highlights the potential of interventions teaching highly relevant life-skills for improving mental health. Five-Arm Shamiri Trial; https://pactr.samrc.ac.za/; PACTR202104716135752.

Effectiveness of a Web-based and Mobile Therapy Chatbot on Anxiety and Depressive Symptoms in Subclinical Young Adults: Randomized Controlled Trial.

There has been an increased need to provide specialized help for people with depressive and anxiety symptoms, particularly teenagers and young adults. There is evidence from a 2-week intervention that chatbots (eg, Woebot) are effective in reducing depression and anxiety, an effect that was not detected in the control group that was provided self-help materials. Although chatbots are a promising solution, there is limited scientific evidence for the efficacy of agent-guided cognitive behavioral therapy (CBT) outside the English language, especially for highly inflected languages. This study aimed to measure the efficacy of Fido, a therapy chatbot that uses the Polish language. It targets depressive and anxiety symptoms using CBT techniques. We hypothesized that participants using Fido would show a greater reduction in anxiety and depressive symptoms than the control group. We conducted a 2-arm, open-label, randomized controlled trial with 81 participants with subclinical depression or anxiety who were recruited via social media. Participants were divided into experimental (interacted with a fully automated Fido chatbot) and control (received a self-help book) groups. Both intervention methods addressed topics such as general psychoeducation and cognitive distortion identification and modification via Socratic questioning. The chatbot also featured suicidal ideation identification and redirection to suicide hotlines. We used self-assessment scales to measure primary outcomes, including the levels of depression, anxiety, worry tendencies, satisfaction with life, and loneliness at baseline, after the 2-week intervention and at the 1-month follow-up. We also controlled for secondary outcomes, including engagement and frequency of use. There were no differences in anxiety and depressive symptoms between the groups at enrollment and baseline. After the intervention, depressive and anxiety symptoms were reduced in both groups (chatbot: n=36; control: n=38), which remained stable at the 1-month follow-up. Loneliness was not significantly different between the groups after the intervention, but an exploratory analysis showed a decline in loneliness among participants who used Fido more frequently. Both groups used their intervention technique with similar frequency; however, the control group spent more time (mean 117.57, SD 72.40 minutes) on the intervention than the Fido group (mean 79.44, SD 42.96 minutes). We did not replicate the findings from previous (eg, Woebot) studies, as both arms yielded therapeutic effects. However, such results are in line with other research of Internet interventions. Nevertheless, Fido provided sufficient help to reduce anxiety and depressive symptoms and decreased perceived loneliness among high-frequency users, which is one of the first pieces of evidence of chatbot efficacy with agents that use a highly inflected language. Further research is needed to determine the long-term, real-world effectiveness of Fido and its efficacy in a clinical sample. ClinicalTrials.gov NCT05762939; https://clinicaltrials.gov/study/NCT05762939; Open Science Foundation Registry 2cqt3; https://osf.io/2cqt3.

The influence of interactions with pet dogs on psychological distress.

Many people, including nearly half of American households, own a pet dog. Previous work has found that therapy dog interactions reduce distress, but little work to date has empirically established the mood-enhancing effects of interaction with one's own pet dog. In this study, dog owners (N = 73; 86.3% female, 13.7% male; age 25-77 years) underwent a stress-inducing task followed by random assignment to either (a) interacting with their dog (n = 24), (b) an expectancy control (n = 25; "stress-reducing" coloring books), or (c) a waiting control (n = 24). We compared the effects of each condition on affect and state anxiety. Participants assigned to the dog interaction showed greater increases in positive affect, as well as greater reductions in anxiety compared to both expectancy and waiting controls (ds > 0.72, ps < .018). No significant reductions in negative affect were detected. Second, we found that self-reported experiences with animals, attitudes toward animals, or bondedness with their dog did not differentially predict the condition's impact on the owner's mood. Finally, we coded participants' degree of engagement (e.g., time spent playing) with the dog and found that higher engagement predicted reduced negative affect. Overall, interacting with one's own pet dog reduced owners' distress. Such interactions, which occur commonly in daily life, may have the potential to alleviate distress at a large scale. Precisely how this works and for whom it is especially well suited remain intriguing open questions. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Effects of music intervention combined with progressive muscle relaxation on anxiety, depression, stress and quality of life among women with cancer receiving chemotherapy: A pilot randomized controlled trial.

The study was carried out from March to May 2022 in an oncology hospital in Vietnam. A single-blinded randomized controlled trial was conducted among 24 women with breast and gynaecological cancer undergoing chemotherapy. The intervention group (n = 12) received a face-to-face training program about music listening and progressive muscle relaxation skills. They then performed the self-practice daily at home for three weeks. The control group (n = 12) received standard care, including health assessment, regular health advice and nutrition consultation. Ten participants in the intervention group were interviewed with open-ended questions to explore the acceptability of the intervention. Anxiety, depression and stress were measured using the Depression Anxiety Stress Scale, while The Functional Assessment of Cancer Therapy-General was used to evaluate the quality of life. The outcome measurements were collected at baseline (T0), post-intervention (3rd week, T1) and follow-up (6th week, T2). Appropriate descriptive statistics were used to depict the outcome measures across study time points. A total of 24 patients were eligible to join, and 20 of them completed the study. Greater reductions in anxiety, depression and stress were observed in the intervention group than in the control group at T1 and T2. Greater improvements on quality of life were found in the intervention group than control group at T1 and T2 with respect to T0. The content analysis supported the acceptable intervention of participants through two themes, perceived beneficial effects on psychological and physical health and willingness to keep practising in the future. Implementing music intervention combined with progressive muscle relaxation is feasible and had a trend in reducing anxiety, depression and stress levels. A larger scale randomized controlled trial is needed to confirm the effect of the intervention on outcomes. This trial was registered on ClinicalTrials.gov with ID: NCT05262621.

The Effectiveness of Low-Intensity Psychological Interventions for Comorbid Depression and Anxiety in Patients with Long-Term Conditions: A Real-World Naturalistic Observational Study in IAPT Integrated Care

BackgroundLow-intensity psychological interventions may be a cost-effective, accessible solution for treating depression and anxiety in patients with long-term conditions, but evidence from real-world service settings is lacking. This study examined the effectiveness of low-intensity psychological interventions provided in the Improving Access to Psychological Therapies programme in England for patients with and without long-term conditions.MethodsA retrospective analysis was conducted on patients (total N = 21,051, long-term conditions n = 4024) enrolled in three low-intensity psychological interventions, i.e. Internet-delivered cognitive behavioural therapy (iCBT), guided self-help (GSH), and psychoeducational group therapy (PGT) within a Talking Therapies service from 2016 to 2020. Primary outcomes included pre–post-treatment changes in depression (Patient Health Questionnaire-9) and anxiety (Generalised Anxiety Disorder-7).ResultsOverall, both cohorts significantly improved on all outcomes post-treatment, with large effect sizes. Patients with long-term conditions experienced a greater reduction in depression while those without experienced a greater reduction in anxiety, but these differences were marginal (< 1 score difference on both measures). No difference between the cohorts was shown when comparing the differential effectiveness across interventions, but those engaging in iCBT showed greater reduction in depression and anxiety than those in GSH and PGT, while those in GSH improved more than PGT.ConclusionsLow-intensity psychological interventions, particularly iCBT, were effective in treating depression and anxiety in patients with long-term conditions in a real-world service setting. Our large-scale study supports the continued and increased implementation of low-intensity psychological interventions for this subpopulation via integrated care.

A cognitive behavioral digital therapeutic for anxiety and depression in patients with cancer: A decentralized randomized controlled trial.

1507 Background: Patients with cancer often experience clinically elevated levels of distress, including anxiety and depression. Psychological interventions, such as Cognitive Behavioral Stress Management (CBSM), have evidenced benefits on distress, quality of life, and long-term health outcomes, however, they are not widely available or easily accessible. Digitizing these interventions may be a means of democratizing access to cancer-focused and empirically-supported mental health care. Methods: This double-blind randomized controlled trial (RCT) compared the impact of a 10-module digitized CBSM app [attune] vs. a health education control app [cerena] on anxiety and depression symptoms in patients with cancer (n=449). Patients with non-metastatic (stage I-III) and hematological cancers who were receiving or recently (≤6 months) completed systemic treatment and reported a PROMIS-A T-Score &gt;60 were recruited to participate in this decentralized clinical trial through a nationwide online advertising campaign. The pre-specified primary outcome was change in anxiety symptoms (PROMIS-A) across conditions over time (week 0, 4, 8, and 12) in the intention-to-treat population analyzed using a linear mixed effects model with repeated measures. Secondary outcomes included change in depression symptoms (PROMIS-D) and global impression of change in anxiety and depression (PGI-C). Results: Patients in the study were 80.6% female, 76.5% white, and the mean (SD; range) age was 52.44 (11.46; 25-80) years. Compared to the control, attune participants showed significantly greater reductions in anxiety (β=-0.03; p=0.019) and depression (β=-0.02; p=0.042) symptoms over 12-weeks, and at end-of-study (week 12) there was a greater proportion of attune participants in the PROMIS-A (χ2=7.13; p=0.004) and PROMIS-D (χ2=3.53; p=0.035) mild-none symptom severity category. There were also significant group differences in PGI-C, with attune participants more likely to report ‘much’ or ‘very much’ improvement in their anxiety (χ2=31.76; p&lt;0.001) and depression symptoms (χ2=19.70; p&lt;0.001). Conclusions: Digital therapeutics have the potential to improve access to empirically supported psychological treatments for symptoms of anxiety and depression in patients with cancer. In this decentralized, double-blind RCT, we show that compared with a visually and functionally similar sham app, patients who used attune had significantly greater reductions in anxiety and depression symptoms over time. Moreover, at the end of the study, participants who used attune were significantly more likely to report their anxiety and depression symptoms were ‘much’ or ‘very much’ improved, indicating clinically meaningful change. Future work aims to explore implementation strategies to maximize benefit and accessibility of this cancer-specific digital therapeutic. Clinical trial information: NCT05227898 .

Effect of the Memory Training for Recovery–Adolescent Intervention vs Treatment as Usual on Psychiatric Symptoms Among Adolescent Girls in Afghanistan

Adolescents who experience conflict in humanitarian contexts often have high levels of psychiatric distress but rarely have access to evidence-based interventions. To investigate the efficacy of Memory Training for Recovery-Adolescent (METRA) intervention in improving psychiatric symptoms among adolescent girls in Afghanistan. This randomized clinical trial included girls and young women aged 11 to 19 years with heightened psychiatric distress living in Kabul, Afghanistan, and was conducted as a parallel-group trial comparing METRA with treatment as usual (TAU), with a 3-month follow-up. Participants were randomized 2:1 to receive either METRA or TAU. The study occurred between November 2021 and March 2022 in Kabul. An intention-to-treat approach was used. Participants assigned to METRA received a 10-session group-intervention comprised of 2 modules (module 1: memory specificity; module 2: trauma writing). The TAU group received 10 group adolescent health sessions. Interventions were delivered over 2 weeks. Primary outcome measures were self-reported posttraumatic stress disorder (PTSD) and depression symptoms after the intervention. Secondary outcomes were self-reported measures of anxiety, Afghan-cultural distress symptoms, and psychiatric difficulties. Assessments occurred at baseline, after modules 1 and 2, and at 3 months after treatment. The 125 participants had a mean (SD) age of 15.96 (1.97) years. Overall sample size for primary analyses included 80 adolescents in the METRA group and 45 adolescents in TAU. Following the intention-to-treat principle, generalized estimating equations found that the METRA group had a 17.64-point decrease (95% CI, -20.38 to -14.91 points) in PTSD symptoms and a 6.73-point decrease (95% CI, -8.50 to -4.95 points) in depression symptoms, while the TAU group had a 3.34-point decrease (95% CI, -6.05 to -0.62 points) in PTSD symptoms and a 0.66-point increase (95% CI, -0.70 to 2.01 points) in depression symptoms, with the group × time interactions being significant (all P < .001). METRA participants had significantly greater reductions in anxiety, Afghan-cultural distress symptoms, and psychiatric difficulties than TAU participants. All improvements were maintained at 3-month follow-up. Dropout in the METRA group was 22.5% (18 participants) vs 8.9% for TAU (4 participants). In this randomized clinical trial, those in the METRA group had significantly greater improvements in psychiatric symptoms relative to those in the TAU group. METRA appeared to be a feasible and effective intervention for adolescents in humanitarian contexts. anzctr.org.au Identifier: ACTRN12621001160820.

Evaluating In-home Assistive Technology for Dementia Caregivers

ABSTRACT Objectives Dementia caregivers (CGs) are at heightened risk for developing problems with anxiety and depression. Much attention has been directed toward developing and deploying interventions designed to protect CG health, but few have been supported by rigorous empirical evidence. Technology-based interventions that are effective, scalable, and do not add greatly to the CG burden are of particular interest. Methods We conducted a nine-month randomized controlled trial in 63 homes evaluating People Power Caregiver (PPCg), a system of sensors in the home connected to cloud-based software that alerts CGs about worrisome deviations from normal patterns (e.g., falls, wandering). Results CGs in the active condition had significantly less anxiety than those in the control condition at the six-month assessment. Greater anxiety reduction in the active condition at the six-month assessment was associated with greater interaction with PPCg via SMS text messages. There were no differences in anxiety at the three-month or nine-month assessments or in depression at any assessment. Conclusions PPCg shows promise for reducing anxiety associated with caring for a =person with dementia. Clinical implications Technology-based interventions can help reduce CG anxiety, a major adverse consequence of caregiving that may be difficult to treat due to other demands on caregiver time and energy.

Effects of a Virtual Reality-Based Meditation Intervention on Anxiety and Depression Among Patients With Acute Leukemia During Induction Chemotherapy: A Randomized Controlled Trial.

Emerging evidence supports that virtual reality (VR)-based meditation interventions may improve anxiety and depression among patients with cancer. However, empirical studies involving patients with acute leukemia during induction chemotherapy are limited. This study aimed to examine the effects of VR-based meditation intervention on alleviating anxiety and depression and improving the quality of life among patients with acute leukemia during induction chemotherapy. This randomized controlled trial recruited 63 patients newly diagnosed with acute leukemia. Participants were randomly assigned to an intervention group (received VR-based meditation for 20 min daily for 14 days) and a control group. Anxiety, depression, and quality of life were measured using the State Anxiety Inventory, the Center for Epidemiological Studies Depression Scale, and the Functional Assessment of Cancer Therapy-Leukemia Questionnaire, respectively. All outcomes were measured at baseline and post-intervention. Compared with patients in the control group, those in the intervention group demonstrated a significantly greater reduction in anxiety (P = .04) and improvement in quality of life (P = .04). However, no significant difference was noted in depression levels between groups (P = .09), although a decreasing trend was observed in the intervention group. Virtual reality-based meditation intervention effectively alleviated anxiety and improved the quality of life among acute leukemia patients during induction chemotherapy. Future randomized controlled trials with larger sample sizes and longer follow-up periods are warranted. Virtual reality-based meditation can be applied in clinical practice virtually anytime and anywhere to provide a convenient intervention for anxiety reduction for acute leukemia patients during induction chemotherapy.

Choosing ACT or CBT: A preliminary test of incorporating client preferences for depression treatment with college students

BackgroundDepression is a significant concern among college students, who suffer at higher rates and with greater severity than the general population. Online self-help could reduce the burden currently placed on college counseling centers, and programs based in cognitive behavioral therapies (CBTs) have a strong evidence base. However, online CBTs for depression often suffer from low adherence rates. An understudied method for improving adherence in this population is offering students a choice between various CBTs. MethodsWe conducted a randomized trial with 142 students with high levels of depression, with a subset of participants randomly receiving either traditional cognitive behavioral therapy (tCBT) or acceptance and commitment therapy (ACT) and an additional arm who could choose between the two. ResultsBoth treatments effectively reduced depression over 10 weeks, with ACT showing a slight advantage over tCBT. Surprisingly, students who were randomized to their treatment saw greater reductions in anxiety, and higher adherence to the program, than those who chose between the two. LimitationsOur study suffered from a notable amount of dropout and our results should be considered preliminary. Our sample size was relatively small at posttreatment, limiting our ability to make strong conclusions about group differences. Additionally, further steps could have been taken to minimize the risk of bias when presenting treatment options to the choice group. ConclusionsOur preliminary results suggest that simply providing students with an evidence-based resource may be more important than providing options and raise additional questions about the function of client preference in self-help dissemination.

Facing uncertainty: A comparison of hierarchical and variable exposure interventions for contamination fear

Consistent with the inhibitory retrieval approach, one proposed modification to improve the effectiveness of exposure-based interventions is to maximize variability by not proceeding linearly up an exposure hierarchy. Accordingly, the present study compares hierarchical and variable exposure interventions for contamination-fearful individuals and examines the role of uncertainty to predict intervention outcomes. Participants (N = 73) were randomly assigned to complete a single-session exposure intervention using a standard hierarchy or a variable exposure intervention in which hierarchy items were randomly presented. Participants completed a behavioral approach task (BAT) at baseline and two follow-up visits over a two-week period. Both interventions resulted in a significant decrease in anxiety and disgust as well as more BAT steps completed but did not differ from one another. However, individuals in the variable exposure condition reported less variability in uncertainty during exposure compared to those in the standard condition, d = .78. Furthermore, lower levels of variability in uncertainty predicted greater reductions in anxiety and disgust post-intervention. Consistent with previous studies, variable exposure did not convey additional benefit over standard, hierarchical exposure. The experience of uncertainty during exposure is an important yet understudied process that warrants additional investigation.

Can Internet-Delivered Pain Management Programs Reduce Psychological Distress in Chronic Pain? Exploring Relationships Between Anxiety and Depression, Pain Intensity, and Disability.

Adults with chronic pain who also report high pain intensity and disability are more likely to experience depression and anxiety symptoms. The present study examined changes in anxiety and depression symptoms after an Internet-delivered pain management program based on baseline pain intensity and disability severity categories. We conducted a secondary analysis of data from four randomized controlled trials (N = 1,333). Greater pain intensity and disability were associated with increased odds of elevated anxiety or depression symptoms at baseline. Treatment led to greater reductions in anxiety and depression symptoms compared with a waitlist control, and these improvements occurred irrespective of baseline pain intensity or disability severity. Those individuals who reported ≥30% improvements in pain intensity or disability after treatment were more likely to also report ≥30% improvements in psychological symptoms. Importantly, most participants who achieved ≥30% improvements in depression and anxiety had not experienced such improvements in pain intensity or disability. These findings suggest that emerging Internet-delivered pain management programs can lead to reductions in psychological distress even when pain intensity and disability are severe or do not improve with treatment. This indicates the value of such treatments in treating distress and improving mental health in people with chronic pain.

Moderators Of A Multi-Component Physical Activity Behavior Change Intervention Effects On Fatigue, Depression, And Anxiety

BACKGROUND: Fatigue, depression, and anxiety significantly reduce quality of life in breast cancer survivors (BCS). Identifying factors that predict symptom response to physical activity (PA) behavior change interventions may allow for more targeted interventions. PURPOSE: To determine demographic and medical factors that moderate the effects of a multi-component PA behavior change intervention (i.e., BEAT Cancer) on fatigue, depressive symptomatology, and anxiety in BCS. METHODS: In this multi-center randomized controlled trial, post-primary treatment BCS (N=222; Stage 0-III) were assigned to BEAT Cancer PA intervention or usual care (i.e., PA-related written materials) Fatigue Symptom Inventory (11-point, Likert scale (0=best; 10=worst) and Hospital Anxiety and Depression Scale were assessed at baseline, 3 months (immediately post-intervention) and 6 months. Moderators (baseline value of each outcome, age, income, marital status, cancer stage, months since diagnosis, cancer treatment, body mass index [BMI], and comorbidities) were assessed at baseline (BMI measured on-site; remaining factors self-reported). This study is a post-hoc exploratory analysis using linear regression to test hypothesized moderators. RESULTS: Participants with baseline fatigue interference ≥3 experienced greater improvements in fatigue interference (p = .020; -1.35 vs. -.42 for interference <3). Those with a history of radiation experienced greater reductions in depressive symptomatology (p = .013; -1.53 vs. 0.08 if no history of radiation). Finally, participants with <2 comorbidities or BMI <30 experienced greater reductions in anxiety (p = .010; -1.97 vs. -.26 for ≥ 2 comorbidities and p = .033; -1.66 vs. -.33 for BMI ≥ 30, respectively). No statistically significant moderators of the intervention effects on fatigue intensity were found. CONCLUSIONS: Findings indicate that BCS with higher baseline fatigue interference, history of radiation, <2 comorbidities, and BMI <30 may have a more favorable symptom response with a PA behavior change intervention. Future research is needed to identify etiologic mechanisms for lack of response (e.g., radiation therapy) and unmet needs of less responsive subgroups (e.g., multiple comorbidities, obesity).

Feasibility trial of a telehealth support group intervention to reduce anxiety in multiple sclerosis

Objective Anxiety is common among persons with MS (PwMS), but widely accepted treatments are lacking. Group-based interventions delivered via telehealth are an accessible treatment option requiring clinical trial evidence to support feasibility and initial efficacy. We conducted a pilot feasibility trial of an online support group intervention to reduce anxiety in PwMS. Methods A non-randomized, parallel arm clinical trial was conducted. A total of 31 PwMS were enrolled: 20 completed a 12-week telehealth-delivered support group intervention and 11 were assigned to a survey-only control group. Primary feasibility outcomes were adherence and completion rates. Primary efficacy outcome was anxiety, secondary outcomes were depression, loneliness, distress, self-efficacy, stress, and quality of life. Results Twenty-six participants completed the study. Intervention group adherence (75%) and completion (85%) rates were acceptable. Results indicated a medium size between-group effect, suggesting a greater reduction in anxiety in the intervention group compared to the control group [U = 39.50, p = 0.045, r = 0.39]. No group differences in other outcomes were observed. Conclusion A telehealth-delivered support group intervention appears feasible for further study and shows initial efficacy for the reduction of anxiety in PwMS.

0472 Dynamic Features of the Treatment Process Predict Different Outcomes for Patients Undergoing Cognitive Behavioral Therapy for Insomnia

Abstract Introduction Individuals who undergo Cognitive Behavioral Therapy for Insomnia (CBT-I) show different trajectories during treatment and different outcomes after treatment. However, the factors contributing to this interindividual variability have not been adequately identified. Daily sleep logs might help us understand some of these factors. Methods Patients with insomnia (N=34), as confirmed by clinical evaluation and Insomnia Severity Index score &amp;gt;10, completed 4 weeks of group CBT-I conducted in Mandarin via telehealth. Participants completed daily sleep logs and self-reported sleep quality, sleep effort and anxiety before and after treatment. Predictor variables included daily sleep efficiency and daily sleep anxiety. Response variables included pre-post changes in sleep quality, sleep effort and anxiety. Multilevel structural equation modeling was performed to examine the relationship between trajectories of change in predictors and response variables. Results Dynamic features of sleep log data significantly predicted individual differences in response variables. The growth rate of daily sleep efficiency during treatment significantly predicted reduced sleep effort (p=.012), decreased anxiety (p=.046), and improved sleep quality (p&amp;lt;.01) after treatment. Conversely, the growth rate of daily sleep anxiety during treatment significantly predicted increases in sleep effort (p&amp;lt;.01). In addition, daily sleep anxiety had a significant negative effect on daily sleep efficiency (p&amp;lt;.001), and the weaker this negative effect, the greater the reduction in sleep effort (p&amp;lt;.001) and anxiety (p&amp;lt;.01) after treatment. Conclusion Individuals exhibit different trajectories during treatment, which are related to different outcomes after treatment. Those who experience less wakefulness at night across treatment become less anxious about sleep and exert less effort to manage sleep, leading to better sleep quality. However, those who experience increasing anxiety across treatment exert more effort to control sleep. Finally, individuals whose anxiety is not as closely associated with sleep efficiency show greater reductions in anxiety and sleep effort post-treatment. Thus, different trajectories and treatment outcomes appear to distinguish between those individuals who are less anxious about sleep during CBT-I, and thus more willing to implement recommendations, which leads to better outcomes, and those individuals who are more anxious about sleep during treatment, and thus less willing to implement recommendations, which leads to worse outcomes. Support (If Any)

People with the least positive attitudes to green exercise derive most anxiolytic benefit from walking in green space

Green exercise elicits greater psychological benefits than urban exercise. We assessed the role of expectations, attitudes to green exercise, and trait anxiety on the anxiolytic effect of green exercise. Participants were randomly assigned to one of two groups to reduce order effects. One group completed a bout of green exercise followed by a bout of urban exercise and the second group vice-versa. Participants ( N = 22) completed 30-minutes of walking in both green and urban environments, with state anxiety assessed pre-, during- and post-activity. Measures of expectations, attitudes to green exercise, and trait anxiety were recorded at baseline. The findings suggest that green exercise does not elicit greater reductions in anxiety than urban exercise. However, a 30-minute walk in green space elicited greater improvements in state anxiety for participants with a lower positive attitude to green exercise(b = 5.14, 95% CI 0.48–9.80, p = 0.032). Attitudes to green exercise play a role in the anxiolytic effects of green exercise and should be considered when delivering green exercise interventions for mental health outcomes.

Resistance training for Black men with depressive symptoms: a pilot randomized controlled trial to assess acceptability, feasibility, and preliminary efficacy

BackgroundDepression is under-recognized in Black men, who are less likely to seek or have access to psychiatric treatment. Resistance training (RT; i.e., weight lifting) can improve depressive symptoms and may be more acceptable to Black men, but its effects have not been examined for Black men with depressive symptoms.MethodsFifty Black men with depressive symptoms were randomized to either (a) 12 weeks of RT (coupled with Behavioral Activation techniques to promote adherence) or (b) an attention-control group (Health, Wellness, and Education; HWE). Both groups met twice/week for 12 weeks, and follow-up assessments were done at end-of-treatment (EOT) and 6 months after enrollment. Changes in physical activity and muscular strength were collected as a manipulation check. The primary outcome was interviewer assessed symptoms of depression using the Quick Inventory of Depression Symptomology (QIDS). Secondary outcomes included self-reported depressive symptoms, anxiety, and stress. The association between change in QIDS from baseline to EOT and concurrent changes in physical activity and muscular strength in the RT group were explored as an initial assessment of mechanism. Longitudinal mixed effects regression models with subject-specific intercepts were used to examine intervention effects.ResultsA sample with high rates of medical comorbidities (e.g., 44% HIV positive), substance use (e.g., 34% smoking), and negative social determinates of health (e.g., 50% unemployed) was enrolled. Recruitment, engagement, and retention data indicate that the intervention and design were feasible. The RT group showed greater gains in self-reported exercise (b = 270.94, SE = 105.69, p = .01) and muscular strength (b = 11.71, SE = 4.23, p = .01 for upper body and b = 4.24, SE = 2.02, p = .04 for lower body) than the HWE group. The RT group had greater reductions in QIDS scores at both EOT (b = -3.00, SE = 1.34, p = .01) and 6 months (b = -2.63, SE = 1.81, p = .04). The RT group showed a greater reduction in anxiety at EOT (b = -2.67, SE = 1.06, p = .02). Findings regarding self-reported depressive symptoms and stress were non-significant, but in the expected direction with effect sizes in the small to medium range. In the RT group, improvement on the QIDS between baseline and EOT was associated with concurrent improvements in physical activity (b = 21.03, SE = 11.16, p = .02) and muscular strength (b = 1.27, SE = .44, p = .03 for upper body and b = .75, SE = .14, p = .03 for lower body). ConclusionsResults suggest that RT is feasible and may be efficacious for reducing depressive symptoms among underserved urban Black men.Trial RegistrationClinicalTrial.gov #: NCT03107039 (Registered 11/04/2017).

Dialectical behavior therapy skills training for individuals with multiple sclerosis and their support partners: A pilot randomized controlled trial

BackgroundSymptoms of anxiety, depression, and emotion dysregulation are common among individuals with MS and their support partners. Dialectical behavior therapy (DBT) – a type of cognitive behavioral intervention – may be a promising treatment for individuals affected by MS. This pilot randomized controlled trial (RCT) assessed the effects and feasibility of remotely delivered DBT skills on anxiety and depression symptoms and emotion dysregulation in individuals with MS and their support partners. MethodsThis study featured a single-masked, two-arm, parallel group design. Twenty pairs of individuals with MS and their support partners (n = 40) were randomized to 12 weeks of DBT or facilitated peer support (FPS). Masked assessments were completed at weeks 0 (baseline), 13 (post-intervention), and 26 (follow-up). ResultsAt post-intervention (primary endpoint), participants randomized to DBT exhibited significantly greater reductions in anxiety and depression symptoms compared to FPS (B = 4.45, p = .04, Cohen's d = 0.57). Secondary outcomes of emotion dysregulation and well-being favored the DBT group but did not reach statistical significance (ds = 0.51, ps = 0.07). Effects were not maintained at follow-up. Most (86%) individuals screened were eligible for the trial, and retention (70%) did not differ between study arms. ConclusionsThis pilot RCT provides encouraging evidence that DBT skills is feasible and may improve depression, anxiety, and emotion dysregulation for individuals with MS and their support partners. Future research is needed to optimize maintenance of DBT skills, investigate mechanisms for these improvements, and replicate these promising effects in a fully powered trial.