Last updated on 14th December 2016
Here are six studies relevant to improving psychotherapy outcomes. Brewin et al report on using imagery-based interventions to help people with depressioin. Lydiard et al highlight the importance of sleep-related disturbances as a treatment target in PTSD. McCrady and colleagues show that working with couples rather than just individuals seems more effective when using behavioural therapy to help women with alcohol use disorders. Geerts et al describe rather amazing research investigating "The role of parental bonding and nonverbal communication in the short-term treatment response was investigated in 104 depressed outpatients. At baseline patients completed the Parental Bonding Instrument. We registered the nonverbal involvement behaviour of patients and interviewers from video recordings of baseline clinical interviews and calculated the convergence between patient-interviewer behaviour over the interview ... As hypothesized, low maternal care and high paternal overprotection predicted a poor response to an 8-week treatment. Maternal care was positively correlated with nonverbal convergence. Moreover, convergence moderated the relationship between maternal care and the response to treatment: Lack of convergence between patients and interviewers turned out to annul the positive effects of maternal care on the treatment response.
Here are half a dozen papers on helping kids and adolescents. The Fuligni et al paper found that adolescents experiencing frequent interpersonal stresses tended to have increased levels of C-reactive protein, " ... an inflammatory marker that is a key indicator of cardiovascular risk ... ". Jackson et al showed that in preschool kids each extra hour of regular TV viewing is associated with an extra 1 kg of body fat. This appeared to be due to increases in calorie intake rather than reduction in physical activity. Decreased family accommodation is associated with improved outcome in paediatric OCD, Merlo et al found. Naylor et al found that a six lesson teaching block on mental health benefitted young teenagers. Proctor et al provide a free full text overview of teenage life satisfaction assessment measures, while Wilkinson and colleagues report on 28 week follow-up in a treatment trial for depressed adolescents. The authors found "Depression at 28 weeks was predicted by the additive effects of severity, obsessive-compulsive disorder and suicidal ideation at entry together with presence of at least one disappointing life event over the follow-up period.
"There's nothing so practical as a good theory". Kurt Lewin
Looking back over relevant research papers that caught my attention last month, some stand out for me more than the others. Here are three on depression that stood out and got me thinking. The Fergusson et al paper looks at links between alcohol abuse and major depression. There has been debate for years on whether alcohol dependence leads to depression or depression leads to alcohol dependence. In this kind of debate, it's usually a good bet that both pathways contain some truth. What this study adds is that often it is the alcohol dependence that is primary. As the authors state " ... the associations between AAD (alcohol abuse or dependence) and MD (major depression) were best explained by a causal model in which problems with alcohol led to increased risk of MD as opposed to a self-medication model in which MD led to increased risk of AAD."
This set of five papers documents, in part, our mixed viewpoints on depression. Worryingly, Mehta & colleagues show deteriorating public attitudes towards mental illness in England (and to a lesser extent Scotland) between 1994 and 2003. Meanwhile Blumner et al demonstrate a shift towards a more biological view on causes and treatment of depression in the US between 1996 and 2006.
In contrast, Miranda et al's editorial (and Grote et al's research) highlight the growing evidence showing psychotherapies for depression can be "very effective for low-income and minority populations in the United States and abroad" - extending their validity well beyond more privileged groups in developed countries. Andersson too discusses a further way to make psychotherapies more widely available and helpful - in this case, the increasing literature documenting the widespread value of delivering cognitive behavioural therapy via the internet.
This is the eleventh and final post about the Moroccan trip - a reflection once I was back in Scotland.
So it's before breakfast on Tuesday morning in Edinburgh. We got back about 36 hours ago. I'm now mostly into the swing of "normal, everyday life" again. 150 plus emails, piles of post, phone messages - the usual "welcome back" after being away. I said at the end of the first post about this trip (just 12 days ago) " ... it feels a fun, slightly crazy thing to attempt - to try to combine/construct something that's a mix of adventure, holiday, time with good friends, and also a meditation retreat. Like trying to play some strange mix of musical styles." We achieved this well. Good. And now what's been brought back with us?
Cipriani and colleagues published a major multiple-treatments meta-analysis of new generation antidepressants last week - see abstract below. As Parikh wrote in his linked editorial (see below) "Andrea Cipriani and colleagues provide the field with a major answer. Free of any potential funding bias (and including an analysis of studies based on pharmaceutical-company sponsorship), these researchers used a newer methodology, multiple treatments meta-analysis, to examine 117 head-to-head randomised trials in almost 26 000 patients ... Of 12 newer antidepressants, four emerged as superior in efficacy: escitalopram, mirtazapine, sertraline, and venlafaxine ... In terms of acceptability, four agents were better tolerated: bupropion, citalopram, escitalopram, and sertraline. Balancing efficacy and acceptability and lower drug costs, the researchers concluded that sertraline might be particularly appropriate as a first-choice treatment ... " This is superbly useful information. Parikh's editorial goes on to raise helpful queries about next step questions, however Cipriani et al have done antidepressant prescribers and users a major service with this very important paper.