Psychotherapy Research Articles

The modern role of paraprofessionals in delivering brief psychological interventions

AbstractThe increasing global demand for mental health services, compounded by the COVID‐19 pandemic, has spurred innovative approaches. Among these, the utilisation of paraprofessionals for delivering brief psychological interventions (BPIs) is gaining significant traction across diverse settings and populations. Paraprofessionals (individuals equipped with specialised mental health training but lacking formal qualifications) have emerged as a valuable resource. They have the potential to offer cost‐effective, culturally sensitive and readily accessible support. The integration of paraprofessionals into various healthcare settings, such as inpatient psychiatric units and primary care clinics, underscores their potential to enhance holistic well‐being and early intervention. This integration not only lightens the load on licensed therapists but also broadens access to services while reducing treatment costs. At a global scale, paraprofessionals, armed with local knowledge and community connections, play a pivotal role in improving mental health outcomes among underserved populations. Furthermore, the rise of telemental health, an increasingly crucial aspect of mental healthcare, presents new avenues for paraprofessionals to deliver psychological care. Despite their potential, paraprofessionals encounter challenges related to work‐life balance, boundary‐setting and the stigma attached to their roles. Their integration into healthcare systems requires clear roles and responsibilities, along with continuous support to ensure effective intervention and the well‐being of both providers and recipients. Further research and development are necessary to harness their full potential and meet the increasing demand for accessible mental health services.

‘Thanks, but no thanks’: The public's response to engagement with NHS Talking Therapies – a salutary tale?

AbstractObjectivesThe English NHS Talking Therapies has been hailed as a world leader in demonstrating outcomes, generating 1.76 million referrals in the year 2022–2023, with a claimed 49.9% recovery rate, but there has been a dearth of independent evaluations. Importantly, there have been no published data on those who only attended one assessment/treatment session. This also applies to public services internationally. The issue of the acceptability of psychological treatment has not been addressed.MethodThe user‐friendliness of NHS Talking Therapies was examined, drawing on unpublished data revealed following a Freedom Of Information request response to the author in June 2024. These data are set alongside the service's published data to give a more comprehensive view of real‐world outcomes and whether it should be a template for other countries to follow.ResultsAlmost half (45%) do not complete treatment, and for completers, the results are no better than for placebo. The diagnostic status of almost a third (29.1%) who attend just one session is unknown. The numbers of people who attend one assessment/ treatment session is approximately half of those who attend two or more treatment sessions, but the ratio varies by disorder.ConclusionNHS Talking Therapies' engagement difficulties casts serious doubt on the service's claim to be a ‘world beater’. There is no evidence that NICE‐compliant evidence‐based psychological treatments have been delivered. While this model has been widely adopted in the UK, this should not be transferred to other service systems without contextualisation and evidence on whether/how some of its components could be implemented in those settings.

Access to psychological therapies amongst patients with a mental health diagnosis in primary care: a data linkage study.

Significant numbers of people in England have fallen into a gap between primary care psychological therapies and specialist mental health services. We aim to examine pathways to care by looking at demographic variation in detection and referral to primary and secondary psychological services in south London. Longitudinal descriptive study using a record linkage between a primary care database (Lambeth DataNet) and a secondary care mental health database (CRIS). We extracted data on mental health diagnosis, prescriptions and episodes of care in mental health services for all patients of working age registered from 1 January 2008 to 1 March 2018 (pre-covid era). Of those with a mental disorder detected in primary care (n = 110,419; 26.8%); 33.7% (n = 37,253) received no treatment; 21.3% (n = 23,548) exclusively accessed psychological treatment within NHS Talking Therapies and 7.6% accessed secondary care psychological therapies. People from minoritised groups were more likely to be prescribed psychotropic medication as the only treatment offered compared to the White British group. Men, Black African and Asian groups were less likely to access NHS Talking Therapies. People with a personality disorder diagnosis had the highest prevalence and number of NHS Talking Therapies treatment episodes (48.0%, n = 960), a similar percentage (44.1%, n = 881) received secondary care psychology treatment. Our study highlights marked inequalities in access to psychological therapies for men and people from some minoritised ethnic groups across primary and secondary care and how individuals with personality disorders are offered multiple short-term courses in NHS Talking Therapies even where this is not recommended treatment.

Predicting dropout and non-response to psychotherapy for personality disorders: A study protocol focusing on therapist, patient, and the therapeutic relationship

BackgroundThe abandonment of psychotherapeutic treatments is influenced by various factors, including patient characteristics, therapist traits, and the therapeutic relationship. Despite the well-documented importance of these factors, limited empirical research has focused on the role of the therapeutic relationship and the characteristics of therapist-patient dyads in predicting treatment dropout. This study protocol outlines a longitudinal research project aimed at predicting dropout and non-response in psychotherapy for individuals with personality disorders. The research seeks to identify predictive factors related to psychotherapy outcomes, focusing on patient, therapist, and dyadic elements. Specifically, the study will examine the influence of therapist characteristics (e.g., personality traits, countertransference, responsiveness) on treatment outcomes, explore the impact of relational factors (e.g., treatment expectations, epistemic trust, therapeutic alliance) on therapy effectiveness, and assess how the therapeutic alliance within therapist-patient dyads affects the likelihood of dropout and non-response.MethodsThe longitudinal study will include 100 therapist-patient dyads (200 participants) recruited from various Mental Health Services in Milan, Italy. Validated instruments will be administered to both patients and therapists at four-time points: T0 (baseline), T1 (3 months), T2 (6 months), and T3 (1 year). Data will be collected at baseline and at the one-year mark to evaluate the relationships between therapist, patient, and dyadic factors and treatment outcomes.DiscussionIdentifying predictive variables associated with high dropout rates can help preempt treatment discontinuation, reducing the financial and operational burdens on mental health services. Understanding these factors will enable the development of targeted interventions to improve treatment engagement and reduce attrition. This approach could enhance outcomes for individuals with personality disorders and lead to more efficient resource allocation and sustainable delivery of mental health care.

Walking and talking for well‐being: Exploring the effectiveness of walk and talk therapy

AbstractDespite the rising trend of integrating nature and movement into talking therapy, the extent of empirical support remains limited. This study explored the effects of a walk and talk intervention on adult mood and well‐being using a multiple baseline design with pre, post and follow‐up assessments. Five adults (3 males and 2 females) from a technology company took part in a walk and talk intervention lasting approximately 6–8 sessions. They completed self‐report measures at baseline, post‐intervention and follow‐up, with semi‐structured interviews conducted at follow‐up. Results showed a reduction in psychological distress and an increase in well‐being for all participants from baseline to follow‐up. Qualitative data from a thematic analysis supported these findings: participants found the natural, calming effect of the outdoors, combined with the movement of walking, facilitated a sense of freedom to express themselves and, in doing so, maximise the benefits of the therapeutic space. These included gaining a broader perspective, heightened self‐awareness and greater acceptance of oneself, others and life's challenges. This study offers real‐world evidence supporting walk and talk therapy as an effective intervention for adult well‐being and mood.

Virtual connection and real community: the qualitative experience of participating in a videoconferencing-based psychotherapy group for postpartum depression and anxiety

BackgroundGroup psychotherapy, an effective treatment for common postpartum mental disorders (e.g. depression, anxiety), has increasingly been delivered virtually since the pandemic. This study aims to understand experiential aspects of participating in videoconferencing-based group psychotherapy in the postpartum period.MethodsOur urban academic ambulatory hospital has delivered group psychotherapy for women (cis and trans) and non-binary individuals of female sex with postpartum depressive and anxiety symptomatology via videoconferencing since 2020. One therapist-facilitator conducts weekly 60-min group therapy sessions with 5-6 participants for eight weeks. Group participants were invited to complete a semi-structured qualitative interview on their experience. Using an interpretive description approach, we conducted reflexive thematic analysis to code anonymized transcripts and construct themes. Facilitator interviews were used for triangulation and additional context.ResultsOf 134 patients in video psychotherapy groups over 11 months, 14 completed an interview, as did all group facilitators (n = 3). Overall, participants felt the experience with videoconferencing group therapy was beneficial for their mental health. Three themes were constructed: (1) “Moving Towards a New Normal”: The group helped participants normalize feelings and experiences around transition to parenthood, and accessing health care virtually was now considered to be normal practice, although some wanted an element of choice. (2) “Virtual Connection, Real Community”: Connections were made virtually, yet participants felt a real sense of community. Facilitators played an important role fostering an environment in which participants could create lasting bonds. Participants noted challenges with feeling comfortable virtually and provided pragmatic and structural suggestions for enhancing the creation of community. (3) “Trade-offs to Virtual Engagement”: Participants made positive and negative trade-offs (e.g. no informal interactions, travel, isolation at home, childcare challenges) to maximize their experience and were able to be more authentic in their self-presentation to the group.ConclusionsPeople with postpartum depression and anxiety who participated in videoconferencing-based group psychotherapy appreciated the sense of community within their groups to normalize their experience transitioning to parenthood. Participants had to make trade-offs to access virtual groups, but felt the experience was worthwhile and helped improve their mental health. Findings will help inform continued delivery of virtual group mental health services.

Client characteristics and early working alliance development: A person-centered research approach

Objective Certain client characteristics are associated with early working alliance difficulties in psychotherapy. However, there is limited quantitative evidence on whether combinations of these characteristics (e.g., intersectional identities, prior treatment experiences) are related to alliance development. The present study leveraged a person-centered research approach to examine profiles of early alliance development and differences in the latent class structure of client characteristics among alliance development profiles. Method Individual psychotherapy clients (N = 2,579) rated the working alliance for their first four sessions and self-reported demographics, treatment history, and psychological distress. Therapists provided their assessment of clients’ primary presenting concerns at baseline. Results Latent profile analysis revealed three profiles of working alliance development: high and stable, moderate and increasing, and low and stable. Follow-up person-centered analyses (multigroup confirmatory latent class analysis) indicated that clients in the alliance profiles differed in their combinations of clinical and demographic characteristics. For example, women of color with high baseline distress and a history of prior psychotherapy were over-represented in the low and stable alliance profile. Conclusion These results are consistent with recommendations to holistically consider how clients’ characteristics and experiences shape psychotherapy processes. Results also highlight the utility of person-centered quantitative methods in psychotherapy research.

Real-world effectiveness of primary care psychological therapy for depression and anxiety in patients with coronary heart disease

Abstract Background Depression and anxiety are often inadequately treated in patients with coronary heart disease (CHD), despite mental health issues being associated with poorer quality of life, higher cardiovascular morbidity, and higher mortality. Talking therapies, such as cognitive behavioural therapy, are the recommended first-line treatment for depression and anxiety symptoms in CHD patients. However, the evidence for their effectiveness was considered low in a recent Cochrane review, and trial participants may not represent patients treated in routine clinical settings. Purpose To assess the effectiveness of routinely-delivered talking therapies in patients with CHD from nationwide primary care talking therapy services in England, and to compare their treatment outcomes to patients without a CHD diagnosis. Methods Healthcare records from 1.9 million patients who completed a course of treatment (≥2 treatment sessions) via NHS Talking Therapies for anxiety and depression (NHS TTad) between 2012-2019 were linked to Hospital Episode Statistics, the Mental Health Services Data Set, and death records. Standard NHS TTad outcome indicators (recovery, reliable improvement, and reliable deterioration) were examined in three groups, with (1) any CHD (n=41,317; ICD-10=I20-I25), (2) acute coronary syndromes (ACS, n=29,991; I21, I22, I20.0), and (3) chronic CHD (n=40,524; I20.1-I20.9, I23-I25) at baseline. Effect sizes for pre-post treatment changes in depression and anxiety symptom measures (PHQ-9 and GAD-7) were calculated using the adapted Cohen’s d for within-subjects design (dav). Outcomes were also compared to those of propensity-score matched control groups without the relevant diagnoses, using logistic regression. Results After completing a course of talking therapy, 49.8% (95%CI=49.3;50.3) of patients with CHD recovered from depression or anxiety, 69.4% (95%CI=69.0;69.9) saw reliable improvement in symptoms, and 7.3% (95%CI=7.0;7.5) experienced reliable deterioration in symptoms. There were large reductions in both depression (dav=-1.02) and anxiety symptoms (dav=-1.03) on average. Compared to a control sample of patients with no diagnosis of CHD, those with a CHD diagnosis were less likely to recover (OR=0.87[95%CI=0.84;0.89]) or reliably improve (OR=0.84[95%CI=0.81;0.87]) and more likely to reliably deteriorate (OR=1.28[95%CI=1.21;1.36]), when matched on age, sex, ethnicity, deprivation, baseline depression and anxiety symptom scores, self-reported long-term health condition, and waiting times between referral, assessment, and treatment. The findings were consistent for patients with ACS and those with chronic CHD. Conclusions Nearly half of CHD patients who received primary care talking therapy recovered, in line with the UK Government target of 50% recovery for the services. Nevertheless, compared to otherwise similar patients without CHD, those with CHD at baseline had worse psychological treatment outcomes.

Assessing the implementation of suicide-focused treatments delivered in hybrid telemental health format in a real-world setting

Objective The purpose of this study was to assess the implementation of suicide-focused treatments delivered via a hybrid telemental health (TMH) and in-person format. Method This study was conducted at four university counseling centers (UCCs) across the United States. Treatment-seeking clients were recruited from their local UCCs and participated in adaptive treatment strategies (ATSs) involving Treatment as Usual (TAU), Collaborative Assessment and Management of Suicidality (CAMS), and Dialectical Behavior Therapy (DBT). Implementation outcomes, including appropriateness, acceptability, feasibility, fidelity, safety, and client satisfaction, were assessed. UCC clinicians participated in qualitative interviews focused on implementation of TMH for clients presenting with suicidal ideation (SI). Results Overall, treatments delivered via hybrid format were reported to be appropriate, acceptable, feasible, and satisfactory by clinicians and clients. Implementation of TMH was reported to be equivalent to in-person treatment across multiple measurement methods. Conclusion Results from this study demonstrate that TMH is an implementable treatment modality for addressing suicidality, particularly for college students presenting to UCCs with SI. This study has implications for real-world clinical settings planning to offer hybrid treatment modalities to address SI. Trial registration: ClinicalTrials.gov identifier: NCT04728815.

Comparative Study of Two Semi-Occluded Vocal Tract Protocols: A Randomized Clinical Trial.

Semi-occluded vocal tract exercises (SOVTEs) are widely used as a therapeutic tool to create flow resistance in the upper airway. The current study was a randomized controlled clinical trial to establish the efficacy of two SOVTE protocols, flow-resistant tube (FRT) and Lessac-Madsen Resonant Voice Therapy (LMRVT). Exploratory investigations included a noninferiority analysis of FRT to the widely adopted therapy protocol (LMRVT), as well as examining the dosing required to improve acoustic measures and subjective ratings. Sixty-seven participants with voice disorder were randomized into one of five groups: 4-week FRT (n = 14), 8-week FRT (n = 19), 4-week LMRVT (n = 15), 8-week LMRVT (n = 5), and control (n = 14). Voice Handicap Index (VHI) and Vocal Fatigue Index scores were collected pre- and posttreatment. Acoustic analysis using the Acoustic Voice Quality Index was completed. We compared VHI between controls and 8-week FRT and LMRVT, adjusting for pre-VHI using linear regression. We examined the efficacy of 4-week protocols relative to controls and conducted a noninferiority comparison of FRT (4 and 8 weeks) to LMRVT (4 and 8 weeks) using 5- and 10-point margins. Finally, we compared the 4- versus 8-week sessions for both therapies. A statistically significant reduction of VHI in both 8-week FRT relative to controls (-10.60, 95% CI [-19.80, -1.40], p = .025) and 8-week LMRVT (-15.74, 95% CI [-29.40, -2.08], p = .025) was found. We also found an improvement in 4-week FRT relative to controls (-10.11, 95% CI [-20.03, -0.20], p = .046), but the 4-week LMRVT result was not statistically significant (p = .057). FRT was found to be noninferior to LMRVT in terms of VHI using a 10-point margin (FRT - LMRVT: 0.69, 95% CI [-5.76, 7.15], p = .01), but not using a 5-point margin (p = .054). There were no statistically significant differences in VHI scores between 4- and 8-week sessions for either therapy. Both FRT and LMRVT improved VHI scores relative to controls. FRT was noninferior to LMRVT in terms of VHI scores. There were no statistically significant differences in VHI scores between 4- and 8-week therapy sessions.

Fostering trust - a qualitative outcome study of psychodynamic group and individual psychotherapy for refugees with PTSD.

Background: Refugees and asylum-seekers have an elevated risk of mental health issues, such as depression and posttraumatic stress. Qualitative outcome studies can contribute by offering insight into patients' experiences of what they find beneficial and how they undergo the process of recovery. This study aligns with the small body of qualitative research focusing on refugees' perspectives of psychotherapeutic treatment for PTSD.Objective: This study investigates and compares the treatment experiences of refugees with posttraumatic stress disorder (PTSD) in psychoanalytic group therapy (PAGT) and individual psychodynamic therapy (PDT) within an outpatient context in Sweden.Method: 10 former patients were interviewed using a semi-structured interview schedule. Data were analysed and interpreted according to the principles of grounded theory.Results: The findings reveal distinct categories for each treatment modality, being reborn for PDT and building a home for PAGT. Being reborn involved persistent intrapersonal change and lasting improvement in posttraumatic symptoms. Building a home involved a sense of belonging, support and temporary relief from posttraumatic symptoms. Participants from both treatment modalities underscored the significance of cultivating trust in therapeutic relationships.Conclusions: The study emphasises the necessity for tailored therapeutic approaches, contributing valuable insights to the limited research on effective mental health interventions for this population.

Ten Years of Bipolar Telehealth: Program Evaluation of a Team-Based Telemental Health Clinic.

Objectives: Telemental health via videoconferencing (TMH-V) can overcome many of the barriers to accessing quality mental health care. Toward this end, in 2011, the U.S. Department of Veterans Affairs (VA) established the National Bipolar Disorders TeleHealth (BDTH) Program to provide expert mental health consultation and treatment to Veterans with bipolar spectrum disorders. Methods: Initial analyses of BDTH services suggested that participants had positive changes in quality-of-care indices and clinical outcomes; however, that evaluation was based on a limited sample of both participants and VA medical centers. We were able to confirm and expand upon those early results by using nearly eight times the number of participants and more than twice as many medical centers. Results: For the 2,456 Veterans who completed the intake to our program, there were significant improvements in some of the quality metrics (e.g., lithium use) and a 54% reduction in positive suicide screens (p < 0.05). The Veterans who completed the initial and postprogram assessments (n = 815) reported a 16.6% reduction in manic symptoms (p < 0.001), a 29.3% reduction in depressive symptoms (p < 0.001), and a 21.2% reduction in mood episodes (p < 0.001). Additionally, these Veterans demonstrated significant improvements (p < 0.001) in mental health-related quality of life between the two assessments. Conclusions: These analyses provide further support for the general effectiveness and safety of telemental health via videoconferencing. Future research should examine the generalizability of these findings across various subgroups (e.g., minority patients, patients in rural areas), populations, and health care systems.

Multidisciplinary Home-Based Rehabilitation Program for Individuals With Disabilities: Longitudinal Observational Study.

Disability affects a significant portion of the global population nowadays, necessitating innovative approaches to access rehabilitation processes. Home-based rehabilitation has emerged as a beneficial approach, offering comfort and context-specific therapy. This study aims to evaluate the impact of a multidisciplinary home-based rehabilitation program for individuals with moderate neuromusculoskeletal disabilities in terms of motor function and mood. A total of 270 participants with median age of 66 (IQR 20-98) years were recruited from the National Disability Registry of Chile. The intervention involved a multidisciplinary team composed of 49 health care professionals providing personalized treatment plans over 4 months (32 sessions for physical therapy, 8 sessions for occupational therapy, 4 sessions for nutrition, 8 sessions for psychology, and 4 sessions for nursing and podiatry). This program also included 2 medical evaluations (at the beginning and the end) to monitor clinical progress in terms of motor function and mental health, using the Berg Balance Scale and Beck Depression Inventory, respectively. The home-based rehabilitation program showed significant improvements (P<.001) in motor function and balance with a reduction in fall risk. Specifically, the Berg Balance Scale score decreased close to 15% after the home-based rehabilitation program for all enrolled participants. On the other hand, depression levels showed no significant changes (P=.27), with percentages of variation less than 8% between the 2 assessed conditions. In this sense, participants remained with the same mild depression level (14 of 63) concerning the Beck Depression Inventory score. This study concludes that personalized home-based rehabilitation programs are effective in enhancing motor function and balance, particularly in individuals with neurological conditions. On the other hand, the findings in terms of mood advocate for further exploration of psychological support within such programs to enhance overall patient well-being. ClinicalTrials.gov NCT06537791; https://clinicaltrials.gov/study/NCT06537791.

Effectiveness of group analytic and psychodynamic psychotherapy in routine secondary-care practice

Group psychotherapy has been shown to be effective across a diverse range of participants and settings. However, few quantitative studies have examined outcomes of Group Analytic Psychotherapy (GAP) specifically, or compared this with alternative treatments. In the present study we compare outcomes of weekly group analytic psychotherapy (GAP) and individual psychodynamic psychotherapy (PPT) at a psychotherapy service within the UK’s National Health Service. The service collected Clinical Outcomes in Routine Evaluation (CORE) outcome measures between 2010 and 2020 as part of routine clinical practice, furnishing a large observational dataset (N=600 clients). We found that clients showed clinically significant improvement following either GAP (Cohen’s d=0.77) or PPT (d=0.68), and the rate of change during therapy exceeded that during a pre-treatment waiting period. There were no clinically significant differences in effectiveness between GAP and PPT, of either short-term (&lt;1 year) or long-term (&gt; 1 year) duration. These results support a conclusion that both GAP and PPT are effective in routine clinical practice. We consider the advantages and limitations of quantitative outcome measurement from a group analytic perspective and highlight the possible pitfalls of attempting to optimise therapy based on overly narrow criteria.

Integration Telemental Health to Reach Out Patients at Community Mental Health Services: A Systematic Review

Low- and middle-income countries (LMICs) need to digitize mental health services to address disparities and improve access to healthcare. This study systematically reviewed the digitalization of integration mental health services that can reach interactions between service providers and recipients with media such as telemental health and mobile health. A literature search was conducted in March 2023. Randomized controlled trial (RCT) data were used from available studies. RCT data sources were obtained from internationally reputable journal articles with the theme of telehealth. The literature used was obtained from the databases Scopus, Web of Science, and PubMed. Integration digitalized mental healthcare system under the auspices of the Ministry of Health that reach-nationally, official psychiatrists and other professional mental healthcare that provides mental healthcare support to areas lacking specialists consisting crisis and emergency, stable conditions, as well as the process of counseling and follow-up therapy with telemental health and mobile health media. Telemental health plays a major role in mental health services and modality therapy that can be accessed effectively and efficiently, especially for mental patients in remote areas who experience barriers to attending in person.

A Suicide Attempt Multicomponent Intervention Treatment (SAMIT Program): study protocol for a multicentric randomised controlled trial.

Suicide has become a first-order public health concern, especially following the negative impact of COVID-19 on the mental health of the general population. Few studies have analysed the effects of early psychotherapeutic interventions on subjects who have attempted suicide, and even fewer have focused on those hospitalized in non-psychiatric units after a Medically Serious Suicide Attempt (MSSA). The main aim of this study is to describe the protocol designed to evaluate the effectiveness of individual psychological treatment for patients hospitalized after an MSSA. The secondary objectives of the study are: (1) to evaluate the impact on quality of life and other psychosocial variables of patients with a recent MSSA who receive early psychological intervention; (2) to analyse the biological, psychological, and clinical impact of early psychotherapeutic treatment on subjects hospitalized after an MSSA. A longitudinal randomised controlled trial will be conducted with patients over 16 years of age admitted to two general hospitals. The case intervention group will enrol for 8-sessions of individual psychotherapy, Suicide Attempts Multi-component Intervention Treatment (SAMIT), combining Dialectical Behaviour Therapy (DBT), Mentalization-Based Therapy (MBT), and Narrative approaches, while the control group will receive a treatment-as-usual intervention (TAU). Longitudinal assessment will be conducted at baseline (before treatment), post-treatment, and 3, 6, and 12 months after. The main outcome variable will be re-attempting suicide during follow-up. Some psychotherapeutic interventions, usually implemented in outpatient, have proven to be effective in preventing suicidal behaviours. The combination of some of these may be a powerful treatment for preventing future SA in patients hospitalised after an MSSA, which is the most severely suicidal subgroup. Moreover, assessment of the biological, clinical and psychometric impact of this new intervention on patients during the first year after the attempt may help understand some of the multi-level factors associated with the effectiveness of psychotherapeutic interventions in MSSAs. The prevalence of high suicide rates requires the design of effective psychological interventions for their prevention, and also in order to design new pharmacological and psychological treatments. ClinicalTrials.gov ID: NCT06238414. Date of registration: 1st February 2024, final update is protocol version 3.0, 19th March 2024.

Could intranasal oxytocin enhance the effects of psychotherapy in individuals with mental disorders? A systematic review and meta-analysis

Interest in the therapeutic potential of oxytocin for the treatment of mental health disorders, especially those involving social dysfunction, has increased considerably in recent years. To date, most studies have only evaluated oxytocin as monotherapy, with highly inconsistent results. A new line of research is exploring the effects of combining oxytocin with psychotherapy. The aim of the present review was to evaluate the therapeutic effects of intranasal oxytocin combined with psychotherapy in individuals with psychiatric disorders. Only randomized clinical trial design was eligible for inclusion. A search of relevant databases yielded 2480 articles published through April 30, 2024. Of these, 13 trials (518 participants) were included in this review and 4 of them in a meta-analysis. The trials evaluated a range of different psychotherapeutic interventions, oxytocin doses, and mental disorders. Overall, the trials suggested that combined treatment reduced negative mental representations, decreased stress, and increased therapeutic alliance. Meta-analysis showed that combined treatment significantly reduced depressive symptoms (d= −1.58, 95 % CI: −3.15 to −0.01). However, the treatment with oxytocin had no significant effects on psychiatric symptoms (d= 0.00, 95 % CI: −0.56–0.57) or social functioning (d = 0.21, 95 % CI: −0.07–0.49). Limitations included the heterogeneity and limited sample sizes of the trials. The findings suggest that the combination of intranasal oxytocin and psychotherapy may be an effective therapeutic approach to reduce depressive symptoms in individuals with mental disorders and may improve retention and therapeutic alliance.

Ultrasound stimulation of the vagus nerve as a treatment modality for anxiety.

Anxiety is an increasingly prevalent mental disorder, causing widespread hardship and interfering with society's economic progression. Standard treatments include various talk therapies with poor prognoses or drug interventions with complex side effects, both introducing unnecessary burdens to patients. To remedy this, non-invasive ultrasound stimulation to the vagus nerve is a novel, low-cost treatment that is showing promise. Although vagus nerve stimulation is already approved for epilepsy and other conditions, it requires regular maintenance. In contrast, studies using non-invasive ultrasound stimulation have shown preliminary positive results in affecting vagal activity with minimal drawbacks. This review covers a variety of studies investigating the effects of ultrasound stimulation on the vagus nerve. With rising levels of anxiety with each generation, there is a pressing need for more innovative and diverse treatments with fewer costs and more benefits.

Clinician- vs non-clinician-supported eTherapy for anxiety and depression

Purpose The efficacy of supported computerised therapy (eTherapy) for anxiety and depression is established; however, questions remain regarding supporter type. This paper aims to examine differences in client outcomes between clinician- (Psychological Wellbeing Practitioner) and non-clinician-supported, low intensity eTherapy. Standardised outcome measures were collected and analysed pre- and post-intervention in two eTherapy services as part of National Health Service (NHS) commissioned, Improving Access to Psychological Therapy provision – now known as NHS Talking Therapies for anxiety and depression (TT). Design/methodology/approach This study is a routine service evaluation comparing two eTherapy services. In total, 494 clients (including 455 clients meeting caseness) accessed the service over a year as part of routine care for anxiety and depression. The Patient Health Questionnaire and Generalised Anxiety Disorder Questionnaire scales were administered pre- and post-treatment as part of the TT data set (NHS England, 2024). Findings Following adjustment for demographics, baseline assessment scores and clinical variables, the authors found no evidence to support differences in the likelihood of recovery between clients in the non-clinician-supported site and clients referred to the clinician-supported site: OR = 1.24 [95%CI: 0.71 to 2.17] for TT recovery, OR = 0.83 [95%CI: 0.47 to 1.49] for TT reliable improvement and OR = 1.11 [95%CI: 0.65 to 1.92] for TT reliable recovery. Originality/value Non-clinician-supported eTherapy is as effective as clinician-supported eTherapy. This finding supports the case for expansion of non-clinician-supported eTherapy services in TT services.

Augmented Depression Therapy for young adults: A mixed methods randomised multiple baseline case series evaluation

Augmented Depression Therapy (ADepT) is an individual psychotherapy for depression, which has been shown to be effective in the general adult population. A randomised multiple baseline case series evaluated the feasibility, acceptability, and effectiveness of ADepT in young adults (aged 20-24). Eleven depressed young adults were recruited from a UK university wellbeing service to receive ADepT during the COVID-19 pandemic, with outcomes evaluated relative to pre-specified continuation targets. All participants received a minimum adequate treatment dose (>60% target); 89% judged ADepT as acceptable and satisfactory and would recommend it to others (>60% target); only 9% showed reliable deterioration for depression or wellbeing (meeting <30% target); and there were no trial- or treatment- related serious adverse events. Qualitative interviews revealed most participants were satisfied with and experienced benefits from ADepT. At post-treatment, reliable improvement was shown by 33% of participants for depression and 67% of participants for wellbeing (not meeting target of both >60%), with medium effect size improvements for depression (g=.78) and large effect size improvement for wellbeing (g=.93; not meeting target of both >.80). ADepT is feasible, acceptable, and safe in young adults but may require modification to maximise effectiveness. Further research outside of the COVID-19 pandemic is warranted.