Psychological Treatments For Depression Research Articles

Identifying relapse prevention elements during psychological treatment of depression: Development of an observer-based rating instrument

BackgroundAlthough observer-rated instruments assessing therapist's adherence to relapse-preventive treatments are available, they do not adequately cover specific relapse-preventive elements that focus on implementation of strategies after terminating treatment. This study describes the development of the KERI-D (Kodierbogen zur Erfassung Rückfallprophylaktischer Interventionen bei Depression/Coding System to Assess Interventions of Relapse Prevention in Depression). The KERI-D is a new observer-based rating tool for acute or continuation/maintenance-phase sessions and assesses relapse-prevention elements including implementation into patient's daily routines. MethodsThe development of the KERI-D included iterative steps referring to theoretical, clinical and empirical sources. It consists of 19 content items within four categories (self-care, early warning signs, triggering events/situations, termination of therapy) and one global item. For empirical analyses, videotaped psychotherapy sessions of 36 psychotherapies were rated by three independent observers and analyzed for their psychometric properties. ResultsMost items showed moderate to good inter-rater reliability (median ICC = .80) and retest reliability (median ICC = .93). Principal-axis factor analysis revealed three subscales, and first evidence of content validity was demonstrated. No associations with clinical follow-up data were found. LimitationsAnalysis was limited to a relatively small sample of selected psychotherapy sessions. Evaluation of predictive validity is a desirable next step to further examine applicability and scope of the instrument. ConclusionsThe KERI-D is the first observer-based rating instrument measuring specific relapse-prevention strategies in psychotherapy for depression. It may help to identify elements that prove effective in reducing relapse/recurrence in the long-term and thereby help to optimize effect duration of depression treatment.

Primary Prevention of Depression in Adolescents:An Introduction to New Approaches to Promote Resilience and Personal Growth

Mental health is integral to our well-being and is as important as being physically healthy. The growing incidence of mental health issues in adolescents is a reflection of the reality that confronts us today. Primary Prevention (PP) of mental illnesses especially depression in children and adolescents has only recently taken a hold as distinct from secondary and tertiary preventions. PP for adolescent depression encompasses school based resilience building interventions and community based stigma reduction programme at large. However, the aim of this article is limited to the introduction of approaches that help gradually build and strengthen the resilience factors and promoting the well being by developing new positive behavior among normal adolescents. This new recognition was born out of the necessity as new Mental Health Care Act (MHCA, 2017) places more emphasis on prevention of mental illness and the world health day of this year was celebrated with the theme of Depression-let's Talk in terms of preventive measures. Depression is a major public health problem in children and adolescents, which makes the identification and implementation of effective interventions an increasing concern at universal or PP level. Therefore, the main aim of this article is to discuss theoretically different psychological interventions for depression in terms of primary prevention. This article presents and discusses new interventions with rationale, such as the Positive Psychology and Mindfulness based interventions for Adolescents, which suggest that the focus of interventions for depressed adolescents should integrate well-being enhancement to achieve optimal functioning as a primary prevention strategies.

Randomized controlled pilot trial of supportive text messages for patients with depression

BackgroundDepression is projected to be the primary cause of disability worldwide by 2030. In a recent survey, the most commonly cited unmet need among 42.4% of depressed Albertans was the lack of sufficient, accessible, and affordable counselling. Our aim was to test the efficacy of a supportive text messaging mobile health intervention in improving treatment outcomes in depressed patients.MethodsWe performed a single-rater-blinded randomized trial involving 73 patients with Major Depressive Disorder. Patients in the intervention group (n = 35) received twice-daily supportive text messages for 3 months while those in the control group (n = 38) received a single text message every fortnight thanking them for participating in the study. The primary outcome of this study was: “Mean changes in the BDI scores from baseline“.ResultsAfter adjusting for baseline BDI scores, a significant difference remained in the 3 month mean BDI scores between the intervention and control groups: (20.8 (SD = 11.7) vs. 24.9 (SD = 11.5), F (1, 60) = 4.83, p = 0.03, ηp2 = 0.07). The mean difference in the BDI scores change was significant with an effect size (Cohen’s d) of 0.67. Furthermore, after adjusting for baseline scores, a significant difference remained in the 3 month mean self-rated VAS scores (EQ-5D-5 L scale) between the intervention and control groups, 65.7 (SD = 15.3) vs. 57.4 (SD = 22.9), F (1, 60) =4.16, p = 0.05, ηp2 = 0.065. The mean difference in change mean self-rated VAS scores was also statistically significant with an effect size (Cohen’s d) of 0.51.ConclusionsOur findings suggest that supportive text messages are a potentially useful psychological intervention for depression, especially in underserved populations. Further studies are needed to explore the implications of our findings in larger clinical samples.Trial registrationClinicalTrials.gov NCT02327858. Registered 24 December 2014.

The Depression Conundrum and the Advantages of Uncertainty.

According to the WHO (2012), the prevalence of unipolar depressive disorders is rising, even in those places where mental health treatments are widely available. The WHO predicts that these disorders will be the leading contributor to the global burden of disease by 2030. This sobering projection fits poorly with how psychological treatments for depression are presented in the mainstream scientific literature: as highly effective therapies, based upon a sound understanding of the causes of distress. There is a clear discrepancy between the rising prevalence figures on the one hand, and the confident claims of this effectiveness research on the other. This discrepancy prompts a set of complex interlinked questions, which we have called ‘The Depression Conundrum.’ In search of a partial answer, the aim of our study was to critically analyze five meta-analytic studies investigating the effectiveness of psychological EBTs for depression, all of which had been published in high impact factor journals. Our examination established a number of methodological and statistical shortcomings in every study. Furthermore, we argue that the meta-analytic technique is founded upon problematic assumptions. The implications of our analysis are clear: decades of quantitative research might not allow us to conclude that psychological EBTs for depression are effective. The uncertainty and questions raised by our findings might act as a catalyst to broaden the way in which depression and associated therapies are researched. In addition, it might contribute toward a more vigorous and interdisciplinary debate about how to tackle this soon-to-be global public health priority number one.

Psychological treatment of depression and anxiety in patients with co-morbid personality disorder: A scoping study of trial evidence.

It is unclear what the best psychological treatment is for depression and anxiety in people with co-morbid personality disorder. Trials of different psychological treatment options for this patient group have been conducted, but this evidence has not previously been systematically reviewed or critically appraised. We set out to conduct a scoping review in order to describe which psychological therapies appear most effective in treating depression and/or anxiety in patients with co-morbid personality disorder. PsycINFO, Cochrane library trials, Medline and Embase databases were searched for studies involving randomized, controlled, experimental, parallel-arm comparisons, examining any well-defined, psychotherapeutic intervention for adults, in an outpatient setting, with a clearly defined diagnosis of depression and/or anxiety, and co-morbid personality disorder. A total of 1662 papers were identified. Fifteen met criteria for inclusion and were reviewed. There was weak evidence to support the use of cognitive behavioural therapy as a psychological treatment for depression in patients with co-morbid personality disorder. However, the literature is characterized by considerable methodological heterogeneity, and further research is needed before there is sufficient evidence to indicate which psychological treatment would be most effective in treating anxiety and/or depression in this patient group. Copyright © 2017 John Wiley & Sons, Ltd.

Supportive text messages for patients with depression – A randomized controlled trial

BackgroundDepression is projected to be the primary cause of disability worldwide by 2030. Our aim was to test the feasibility of a supportive text messaging mobile health intervention in improving treatment outcomes in depressed patients.MethodsWe performed a single-rater-blinded randomised trial involving 73 patients with Major Depressive Disorder. Patients in the intervention group (n = 35) received twice-daily supportive text messages for 3 months while those in the control group (n = 38) received a single text message every fortnight thanking them for participating in the study.ResultsAfter adjusting for baseline BDI scores, a significant difference remained in the three month mean BDI scores between the intervention and control groups: (20.8 (SD = 11.7) vs. 24.9 (SD = 11.5), F (1, 60) = 4.83, P = 0.03, ηp2 = 0.07). The mean difference in the BDI scores change was significant with an effect size (Cohen's d) of 0.67. Furthermore, after adjusting for baseline scores, a significant difference remained in the three month mean self-rated VAS scores (EQ-5D-5L scale) between the intervention and control groups, 65.7 (SD = 15.3) vs. 57.4 (SD = 22.9), F (1, 60) = 4.16, P = 0.05, ηp2 = 0.065. The mean difference in change mean self-rated VAS scores was also statistically significant with an effect size (Cohen's d) of 0.51.ConclusionsOur findings suggest that supportive text messages are a potentially useful psychological intervention for depression, especially in underserved populations. Further studies are needed to explore the implications of our findings in larger clinical samples.

RETRACTED: The effectiveness of group-based behavioral activation in the treatment of depression: An updated meta-analysis of randomized controlled trial

Depression is a common mental health problem associated with significant morbidity and mortality. Amongst various psychological treatments for depression, individual behavioral activation (BA) has been shown to be effective and relatively simple in its delivery by health care providers although its effectiveness as a group based intervention requires further evidence. The objective of this study is to evaluate and update on the effectiveness of group-based BA to relieve symptoms of depression. A meta-analysis was performed and prospective randomized trials were systematically searched from the OVID databases. The trials comparing group-based BA intervention versus usual care or waitlist controls were included. Depressive symptom measured by various validated scales was the primary outcome. As the interventions can be heterogeneous across the included studies, all analyses were performed by random-effects model. Seven randomized control trials were identified from the United States, United Kingdom, Sweden and Iran from 2003 to 2013. A total of 240 subjects were randomly assigned to group-based BA, and all participants included met the criteria for moderate to severe depression at baseline with the majority of participants being females. Participants who joined the group-based BA showed lower depressive symptoms (MD of BDI-II: -6.06 (95% CI: -8.28 to -3.85 and MD of HRSD: -2.82 (95% CI: -4.62 to -1.02)) than participants randomized to the control group with usual treatment. The group-based BA also showed significant reduction in anxiety level (MD of BAI: -3.66 (95% CI: -6.11 to -1.22)) but not quality of life according to two studies. Risk of bias was evident amongst the studies as blinding of health providers and patients were not feasible in psychological studies. Group-based behavioral activation remains promising in relieving depressive symptoms for people with moderate to severe depression from this meta-analysis. Future studies should be higher quality research with larger sample size, longer follow-up periods, and synchronized clinical outcome measures. Patient feedback for group-based behavioral activation can also be further evaluated in order to ensure long term satisfaction and usage in health services.

Psychological Treatments for Depression and Anxiety in Dementia and Mild Cognitive Impairment

The Mission of the Cochrane Nursing Care Field (CNCF) is to improve health outcomes through increasing the use of the Cochrane Library and supporting Cochrane's role by providing an evidence base for nurses and related healthcare professionals involved in delivering, leading, or researching nursing care. The CNCF produces “Cochrane Corner” columns (summaries of recent nursing-care-relevant Cochrane Reviews) that are regularly published in collaborating nursing-care-related journals. Information on the processes this Field has developed can be accessed at: http://cncf.cochrane.org/evidence-transfer-program-review-summaries

Psychological interventions for depression in people with multiple sclerosis

A systematic review was conducted to investigate the effectiveness of published trials that used psychological interventions to decrease depression in people with multiple sclerosis.

Brief cognitive behavioural intervention for depression and anxiety symptoms improves quality of life in chronic haemodialysis patients.

Psychological treatment of depression in end-stage renal disease (ESRD) has focused on severely depressed patients. We designed and tested a brief (5weeks) cognitive behavioural intervention (CBI) to reduce mild and moderate depression and anxiety symptoms in patients with ESRD. For the purpose of this study, a single-blind, randomized controlled design was used to compare patients with ESRD under haemodialysis treatment with and without the CBI. Depression and anxiety symptoms were screened in 152 subjects (18-60years old, 84 male). Sixty participants (age 41.8±14.7, 29 males) with mild or moderate scores of depression (Beck Depression Inventory) and anxiety (Beck Anxiety Inventory) were randomly assigned to CBI or the control group. CBI techniques consisted of positive self-reinforcement, deep breathing, muscle relaxation, and cognitive restructuring. Depression, anxiety, quality of life (QoL), and cognitive distortion scores were evaluated at baseline, after 5weeks (end of treatment) and after 4-week follow-up. All scores were compared by ANOVA for repeated measures with post-hoc tests adjusted by Bonferroni's method (p<.05 was considered significant). At follow-up, depression, anxiety, and cognitive distortions had decreased, and QoL had increased in the intervention group, and there were no changes in the control group. Clinical utility was 33% for depression and 43% for anxiety. A brief CBI of 5weeks is effective for decreasing mild or moderate depression and anxiety symptoms and improving QoL in ESRD haemodialysis patients. A brief, systematic and structured cognitive behavioural intervention (CBI) decreases anxiety and depression symptoms and improves quality of life in patients with end-stage renal disease (ESRD) who are being treated with haemodialysis. These benefits are not achieved when anxiety and depression symptoms are identified but not treated psychologically. This CBI consisted of cognitive restructuring of the distorted thoughts (perfectionism, catastrophic thinking, negative self-labelling, and dichotomous thinking) that are correlated with depression and anxiety symptoms and that can be assessed by a validated questionnaire designed for patients with ESRD. The handbooks that were developed for this study are structured and systematic. They could be valuable in supporting the efforts and participation of non-specialized health professionals in CBI such as nurses, physicians, social workers, and psychologists, raising the possibility of further application in a variety of clinical populations. Both the therapy and the client workbooks are available in Spanish upon request.

Suicide prevention strategies revisited: 10-year systematic review

Many countries are developing suicide prevention strategies for which up-to-date, high-quality evidence is required. We present updated evidence for the effectiveness of suicide prevention interventions since 2005. We searched PubMed and the Cochrane Library using multiple terms related to suicide prevention for studies published between Jan 1, 2005, and Dec 31, 2014. We assessed seven interventions: public and physician education, media strategies, screening, restricting access to suicide means, treatments, and internet or hotline support. Data were extracted on primary outcomes of interest, namely suicidal behaviour (suicide, attempt, or ideation), and intermediate or secondary outcomes (treatment-seeking, identification of at-risk individuals, antidepressant prescription or use rates, or referrals). 18 suicide prevention experts from 13 European countries reviewed all articles and rated the strength of evidence using the Oxford criteria. Because the heterogeneity of populations and methodology did not permit formal meta-analysis, we present a narrative analysis. We identified 1797 studies, including 23 systematic reviews, 12 meta-analyses, 40 randomised controlled trials (RCTs), 67 cohort trials, and 22 ecological or population-based investigations. Evidence for restricting access to lethal means in prevention of suicide has strengthened since 2005, especially with regard to control of analgesics (overall decrease of 43% since 2005) and hot-spots for suicide by jumping (reduction of 86% since 2005, 79% to 91%). School-based awareness programmes have been shown to reduce suicide attempts (odds ratio [OR] 0·45, 95% CI 0·24-0·85; p=0·014) and suicidal ideation (0·5, 0·27-0·92; p=0·025). The anti-suicidal effects of clozapine and lithium have been substantiated, but might be less specific than previously thought. Effective pharmacological and psychological treatments of depression are important in prevention. Insufficient evidence exists to assess the possible benefits for suicide prevention of screening in primary care, in general public education and media guidelines. Other approaches that need further investigation include gatekeeper training, education of physicians, and internet and helpline support. The paucity of RCTs is a major limitation in the evaluation of preventive interventions. In the quest for effective suicide prevention initiatives, no single strategy clearly stands above the others. Combinations of evidence-based strategies at the individual level and the population level should be assessed with robust research designs. The Expert Platform on Mental Health, Focus on Depression, and the European College of Neuropsychopharmacology.

The Effects of Mindfulness‐Based Cognitive Therapy and Cognitive Behavioral Analysis System of Psychotherapy added to Treatment as Usual on suicidal ideation in chronic depression: Results of a randomized-clinical trial

BackgroundSuicidal ideation (SI) is common in chronic depression, but only limited evidence exists for the assumption that psychological treatments for depression are effective for reducing SI. MethodsIn the present study, the effects of Mindfulness-based Cognitive Therapy (MBCT; group version) plus treatment-as-usual (TAU: individual treatment by either a psychiatrist or a licensed psychotherapist, including medication when indicated) and Cognitive Behavioral Analysis System of Psychotherapy (CBASP; group version) plus TAU on SI was compared to TAU alone in a prospective, bi-center, randomized controlled trial. The sample consisted of 106 outpatients with chronic depression. ResultsMultivariate regression analyses revealed different results, depending on whether SI was assessed via self-report (Beck Depression Inventory suicide item) or via clinician rating (Hamilton Depression Rating Scale suicide item). Whereas significant reduction of SI emerged when assessed via clinician rating in the MBCT and CBASP group, but not in the TAU group while controlling for changes in depression, there was no significant effect of treatment on SI when assessed via self-report. LimitationsSI was measured with only two single items. ConclusionsBecause all effects were of small to medium size and were independent of effects from other depression symptoms, the present results warrant the application of such psychotherapeutical treatment strategies like MBCT and CBASP for SI in patients with chronic depression.

Does cognitive flexibility predict treatment gains in Internet-delivered psychological treatment of social anxiety disorder, depression, or tinnitus?

Little is known about the individual factors that predict outcomes in Internet-administered psychological treatments. We hypothesized that greater cognitive flexibility (i.e. the ability to simultaneously consider several concepts and tasks and switch effortlessly between them in response to changes in environmental contingencies) would provide a better foundation for learning and employing the cognitive restructuring techniques taught and exercised in therapy, leading to greater treatment gains. Participants in three trials featuring Internet-administered psychological treatments for depression (n = 36), social anxiety disorder (n = 115) and tinnitus (n = 53) completed the 64-card Wisconsin Card Sorting Test (WCST) prior to treatment. We found no significant associations between perseverative errors on the WCST and treatment gains in any group. We also found low accuracy in the classification of treatment responders. We conclude that lower cognitive flexibility, as captured by perseverative errors on the WCST, should not impede successful outcomes in Internet-delivered psychological treatments.

Management by geographical area or management specialised by disorder? A mixed-methods evaluation of the effects of an organisational intervention on secondary mental health care for common mental disorder

BackgroundIn 2010, South London and Maudsley NHS Foundation Trust (SLaM) established a programme replacing the borough directorates responsible for adult mental health services with three Clinical Academic Groups (CAGs), each of which took on a subset of adult services straddling all four boroughs. Care pathways were also introduced. We studied the Mood Anxiety and Personality CAG, which took on assessment and treatment teams and psychotherapy services.ObjectivesWe aimed (1) to understand the CAG programme using realistic evaluation and (2) to assess whether or not it led to changes in activity and health-care quality.MethodsQualitative analysis was based on interviews and project documents. Quantitative analyses were based on electronic patient records and compared care in community mental health teams (CMHTs) and psychotherapy teams before and after CAG implementation. Analyses of activity covered caseload, counts of new episodes, episode length and number of contacts per episode. We also looked at CMHT costs. Analyses of effectiveness covered processes (pharmacological and psychological treatment of depression in CMHTs) and outcomes (effect on the Health of the Nation Outcome Scales total score or the Clinical Outcomes in Routine Evaluation 10-item version total score). Analyses of safety examined the rates of self-harm among current or recent CMHT patients. Patient centredness was represented by waiting time.ResultsThe first core component of SLaM’s CAG programme was the CAG restructuring itself. The second was the promotion of care pathways; interpreted as ‘high level pathways’, these schematised processes of referral, assessment, treatment, reassessment and discharge, but abstracted from the details of treatment. The three mechanisms of the CAG restructuring were increasing oversight, making teams fit the template of team types defined for each CAG (‘CAG compliance’) and changing financial accounts by grouping services in new ways; these mechanisms resulted in further reconfigurations. The use of high-level pathways supported service redesign and performance management. In CMHTs and psychotherapy teams activity tended to decrease, but this was probably not because of the CAG programme. CMHT costs were largely unchanged. There was no evidence that the CAG programme altered effectiveness or safety. Effects on waiting times varied but these were reduced in some cases. Overall, therefore, the CAG programme appeared to have had few effects on quality. We attributed this to the limited effect of the programme on individual treatment.ConclusionsSLaM’s CAG programme had clear effects on service reconfiguration at team level, with high-level pathways changing the ways that managers conceptualised their work. However, our quantitative work indicated no clear effects on quality. Thinking about how to use care pathways in ways that complement ‘high-level’ pathways by supporting the delivery of evidence-based treatments is a strategy that could help SLaM and other providers. Future research should look at the genesis of organisational change and how this is altered through implementation; it should also look at the effectiveness of care pathways in mental health services.FundingThe research was supported by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and was performed using infrastructure provided by the NIHR South London and Maudsley and Institute of Psychiatry Biomedical Research Centre.

Clinical characteristics of patients assessed within an Improving Access to Psychological Therapies (IAPT) service: results from a naturalistic cohort study (Predicting Outcome Following Psychological Therapy; PROMPT).

BackgroundA substantial number of patients do not benefit from first line psychological therapies for the treatment of depression and anxiety. Currently, there are no clear predictors of treatment outcomes for these patients. The PROMPT project aims to establish an infrastructure platform for the identification of factors that predict outcomes following psychological treatment for depression and anxiety. Here we report on the first year of recruitment and describe the characteristics of our sample to date.MethodsOne hundred and forty-seven patients awaiting treatment within an Improving Access to Psychological Therapies (IAPT) service were recruited between February 2014 and February 2015 (representing 48 % of those eligible). Baseline assessments were conducted to collect information on a variety of clinical, psychological and social variables including a diagnostic interview using the Mini International Neuropsychiatric Interview (MINI).ResultsOur initial findings showed that over a third of our sample were not presenting to IAPT services for the first time, and 63 % had been allocated to receive higher intensity IAPT treatments. Approximately half (46 %) were taking prescribed psychotropic medication (most frequently antidepressants). Co-morbidity was common: 72 % of the sample met criteria for 2 or more current MINI diagnoses. Our initial data also indicated that 16 % met criteria for borderline personality disorder and 69 % were at high risk of personality disorder. Sixty-one percent scored above the screening threshold for bipolarity. Over half of participants (55 %) reported experiencing at least one stressful life event in the previous 12 months, whilst 67 % reported experiencing at least one form of childhood trauma.ConclusionsOur results to date highlight the complex nature of patients seen within an urban IAPT service, with high rates of psychiatric comorbidity, personality disorder, bipolarity and childhood trauma. Whilst there are significant challenges associated with researching IAPT populations, we have also confirmed the feasibility of undertaking such research.

Integrating Cognitive Processing, Brain Activity, Molecules and Genes to Advance Evidence-Based Psychological Treatment for Depression and Anxiety: From Cognitive Neurogenetics to CBT-Based Neurogenetics

In order to promote the improvement of evidence-based psychological treatments (EBPT) and/or the integration of EBPT and bio-medical treatments, we propose a change in direction in cognitive neurogenetics (CNG)—from cognitive neurogenic to cognitive behavioral-based neurogenetics—starting from a top-down analysis: from symptoms and clinical-relevant cognitions to their implementation (brain, protein, genes). To illustrate our proposal, we specifically focus trans-diagnostically on symptoms of depression and anxiety, and consider the next underlying/interrelated mechanisms: (1) specific cognitions related to EBPT clinical theory/practice (cognitions/cognitive biases); (2) involved brain areas; (3) variability in protein expression; and (4) genetic polymorphisms. The proposed CBT-based neurogenetics framework rectifies the limitations of the classical CNG paradigm, and guides a more ecological and integrative approach in CNG. We argue that using large datasets, comparative methods of data analysis, and complex modelling techniques the CNG paradigm can be transcended. Our approach offers the framework for targeting key questions that have been previously disregarded, but which could revolutionize our understanding of the human mind and mental disorders: (Q1) do biological and psychological variables reflect different things in different “realities” or in the same reality?; (Q2) are biological and psychological variables different descriptions, at the same or at a different level of the same thing?; (Q3) if they are different descriptions at different levels of the same thing, are they reducible to each other or are there some emergent properties at more abstract levels?; (Q4) if they are different descriptions at the same level of the same thing, does it make sense to use both of them? Based on the innovative multi-/inter-/trans-disciplinary paradigm we propose, we should answer these questions.

Supervision for treatment of depression: An experimental study of the role of therapist gender and anxiety

Psychological treatments for depression are not always delivered effectively or consistently. Clinical supervision of therapists is often assumed to keep therapy on track, ensuring positive patient outcomes. However, there is a lack of empirical evidence supporting this assumption. This experimental study explored the focus of supervision of depression cases, comparing guidance given to supervisees of different genders and anxiety levels. Participants were clinical supervisors who supervised therapists working with patients with depression. Supervisors indicated their supervision focus for three supervision case vignettes. Supervisee anxiety and gender was varied across vignettes. Supervisors focused calm female supervisees more on therapeutic techniques than state anxious female supervisees. Males were supervised in the same way, regardless of their anxiety. Both male and female supervisors had this pattern of focus. Findings indicate that supervision is influenced by supervisors' own biases towards their supervisees. These factors may cause supervisors to drift from prompting their supervisees to deliver best practice. Suggestions are made for ways to improve the effectiveness of clinical supervision and how these results may inform future research practice.

E-CBT (myCompass), Antidepressant Medication, and Face-to-Face Psychological Treatment for Depression in Australia: A Cost-Effectiveness Comparison.

BackgroundThe economic cost of depression is becoming an ever more important determinant for health policy and decision makers. Internet-based interventions with and without therapist support have been found to be effective options for the treatment of mild to moderate depression. With increasing demands on health resources and shortages of mental health care professionals, the integration of cost-effective treatment options such as Internet-based programs into primary health care could increase efficiency in terms of resource use and costs.ObjectiveOur aim was to evaluate the cost-effectiveness of an Internet-based intervention (myCompass) for the treatment of mild-to-moderate depression compared to treatment as usual and cognitive behavior therapy in a stepped care model.MethodsA decision model was constructed using a cost utility framework to show both costs and health outcomes. In accordance with current treatment guidelines, a stepped care model included myCompass as the first low-intervention step in care for a proportion of the model cohort, with participants beginning from a low-intensity intervention to increasing levels of treatment. Model parameters were based on data from the recent randomized controlled trial of myCompass, which showed that the intervention reduced symptoms of depression, anxiety, and stress and improved work and social functioning for people with symptoms in the mild-to-moderate range.ResultsThe average net monetary benefit (NMB) was calculated, identifying myCompass as the strategy with the highest net benefit. The mean incremental NMB per individual for the myCompass group was AUD 1165.88 compared to treatment as usual and AUD 522.58 for the cognitive behavioral therapy model.ConclusionsInternet-based interventions can provide cost-effective access to treatment when provided as part of a stepped care model. Widespread dissemination of Internet-based programs can potentially reduce demands on primary and tertiary services and reduce unmet need.

Psychological treatments for depression and anxiety in dementia and mild cognitive impairment: systematic review and meta-analysis.

BackgroundAnxiety and depression are common in people with dementia and mild cognitive impairment (MCI), but there is uncertainty about the effectiveness of both pharmacological and psychological therapies.AimsTo evaluate the evidence of effectiveness of psychological treatments in treating depression and anxiety in people with dementia and MCI.MethodWe carried out a systematic review and meta-analysis of randomised controlled trials (RCTs) of psychological treatment versus usual care in people with dementia and MCI. Primary outcomes were symptoms of anxiety and depression. Secondary outcomes were quality of life, ability to perform daily activities, neuropsychiatric symptoms, cognition and caregivers' self-rated depressive symptoms.ResultsWe included six RCTs, involving 439 participants with dementia, which used cognitive–behavioural therapy, interpersonal therapy, counselling or multimodal interventions including a specific psychological therapy. We found beneficial effects for both depression and anxiety. Overall, the quality of the evidence was moderate for depression and low for anxiety, due to the methodological limitations of the studies we identified and the limited number of trials.ConclusionsThe evidence from six RCTs suggests that psychological treatments are effective in reducing symptoms of depression and anxiety for people with dementia. There is a need for high-quality, multicentre trials including standardised, well-defined interventions.

Interventions for youth depression: from symptom reduction to well-being and optimal functioning

Depression is a major public health problem in children and adolescents, which makes the identification and implementation of effective interventions an increasing concern. Therefore, the main aim of this article is to discuss theoretically different psychological interventions for depression. In particular, those focused on psychopathology and depressive symptom reduction and the new interventions based on the positive psychology approach, which focus on optimal functioning and wellbeing. Empirically supported interventions for children and adolescents, such as cognitive-behavioral therapy (CBT) and interpersonal therapy (IPT), have focus on symptom reduction, which represents an incomplete vision of youth functioning. In contrast, interventions based on positive psychology promote a more balanced approach that takes into consideration the negative and positive aspects of experience and aims to enhance well-being. We present and discuss new interventions, such as the Optimal Functioning Therapy for Adolescents, which suggest that the focus of interventions for depressed adolescents should integrate symptom reduction and well-being enhancement to achieve optimal functioning. Helping young people be happier and more engaged in their lives is part of a new perspective for clinical psychology practice.