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Recent research: 3 studies on internet-delivered therapy, 2 on speed of antidepressant response, and 1 on therapy effectiveness

Here are three studies (for all abstracts & links see below) highlighting the increasingly encouraging results being reported for internet-delivered psychological interventions.  Van't Hof, Cuijpers et al report on " ... a systematic review of meta-analyses on the efficacy of self-help interventions, including internet-guided therapy, for depression and anxiety disorders". They conclude that the 13 meta-analyses indicate "self-help methods are effective in a range of different disorders, including depression and anxiety disorders. Most meta-analyses found relatively large effect sizes for self-help treatments, independent of the type of self-help, and comparable to effect sizes for face-to-face treatments" (see below for abstracts and links to the six research papers mentioned).  Riper, Kramer et al describe how an experimental internet-delivered self-help alcohol reduction intervention transferred well to being made more generally available.  The authors conclude that " ...

The Ben Lui group (second post): how to know when to change direction on a walk or in treatment for psychological difficulties!

A couple of lines from the Bruce Springsteen song "Hungry heart" kept going through my head - "Like a river that don't know where it's flowing, I took a wrong turn and I just kept going."  Something was wrong.  I couldn't work out where I'd got to on my map.  The line of pylons shouldn't have been where they were - and certainly not where they were in relation to the stream and rough track I could see across the valley. 

I'd started walking fine in the morning.  I left Edinburgh early and before 9.00am was heading out from Dalrigh on the long walk up the valley to Ben Lui.  Two hours walking saw me at the bottom of the hill.  Then a steady tramp up and into the low lying cloud. 

Walking up into the mist on Ben Lui

Recent research: six papers relevant to psychotherapy

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.

Recent research: six papers on helping children & adolescents

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.

Self disclosure by health professionals

Blogging about my mum's illness and my reactions to it led me to think again about self disclosure by health professionals.  Our job is to be helpful for our clients - it's what we're about.  Self disclosure by health professionals is a mixed bag.  It can sometimes be helpful and sometimes damaging.  Different schools of therapy and different styles of doctor have strong opinions about what's right and wrong in this area.  Strong opinions without research back-up tend to generate more heat than light.  As has been so delightfully stated "The plural of anecdote is not data".  This post is not at all intended to be exhaustive about research on health professional self disclosure.  It is intended to shine a light on some interesting facts and to raise some questions.

Recent research: six studies on depression – bereavement, pregnancy, bipolar disorder, suicide, & stress in hospital staff

Five of these six studies are from last month's American Journal of Psychiatry.  Kendler et al discuss the many similarities and only occasional differences between bereavement-related and other life event-related depression - an issue explored further in Maj's editorial.  Li et al show that depression in pregnancy (exacerbated further by stressful life events and obesity) increases the risk of preterm delivery.  Miklowitz reviews research on the value of adjunctive psychotherapy for bipolar disorder sufferers (already taking medication) and discusses the various ways it can be helpful.  Oquendo et al (in a freely viewable editorial) argue that suicidal behaviour should be placed on a "separate axis" in the next version of the DSM diagnostic system.  Finally Vertanen et al, in an interesting study, demonstrate that increased hospital overcrowding - measured by bed occupancy rates - is associated with increased use of antidepressants by hospital staff.

Kendler, K. S., J. Myers, et al. (2008). "Does Bereavement-Related Major Depression Differ From Major Depression Associated With Other Stressful Life Events?" Am J Psychiatry 165(11): 1449-1455.  [Abstract/Full Text]  

Draft SIGN non-pharmacological depression treatments guideline, 8th post: therapeutic alliance in the treatment of depression

There was some discussion at the SIGN "Non-pharmacological management of depression" seminar about the possible importance of the therapeutic alliance in depression treatment.  Profe

Draft SIGN non-pharmacological depression treatments guideline, 7th post: effectiveness of psychological therapies 2

This is the 7th blog post in a series reviewing the recent Scottish Intercollegiate Guideline Network's (SIGN) draft guideline for "Non-pharmacological management of depression".  I gave more background details in the first post of the series.  This post covers the third session of the guideline presentation seminar.  The session was entitled "Effectiveness of psychological therapies in depression 2" and there were three speakers.  Professor Kevin Power, Area Head of Psychological Therapies, NHS Tayside, talked about "Counselling, marital, family and reminiscence therapy".  Kevin said there were comparatively few good randomized controlled trials on counselling interventions specifically for patients diagnosed with major depressive disorder.  SIGN gave a Grade

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