So we're past yesterday's workshops and into the first day of the conference proper.  Two and a half days now involving about 51 symposia, 5 panel debates, 8 open paper sessions, 2 poster sessions, and 17 keynote addresses.  I really like this Exeter campus with it's trees and little paths.  Easy to get lost, but lovely.  I also really like the many casual conversations - in coffee queues, at breakfast, with whoever's sitting beside you in a lecture.  Lots of interactions.  The conference attenders are almost universally friendly and easy to strike up chats with.  We all have the shared interest of psychotherapy, so it's very straightforward to hit the ground running when talking to complete strangers.  At the same time, I sometimes find these conferences quite lonely - great for social integration, not so great for social intima

Here are six recently published research papers.  Barnhofer and colleagues report on encouraging results using mindfulness-based cognitive therapy (MBCT) for sufferers from chronic-recurrent depression while they are still depressed.  The three major studies published already have used MBCT for recurrent depression while the sufferers are reasonably well.  The next step will clearly be a fuller randomized controlled trial.  Heeren and colleagues report on the how MBCT acts to reduce overgeneral autobiographical memoriy in formerly depressed patients. 

Archer and colleagues describe the successful development and assessment of a group-based cognitive behavioural intervention for sleep problems.  Participants' satisfaction ratings with the training were very high and there were very encouraging reductions in their sleep problems and depressive symptoms.  Morin and coworkers also report on CBT for sleep problems, this time singly or combined with sleep medication.  They concluded that "In patients with persistent insomnia, the addition of medication to CBT produced added benefits during acute therapy, but long-term outcome was optimized when medication is discontinued during maintenance CBT."

I read a lot of research.  When I find an article of particular interest I download it to my bibliographic database - EndNote - which currently contains over 13,000 abstracts. 

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. 

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.

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." 

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.

Here are five papers on difficulties experienced by adolescents.  A couple of the papers are follow-up studies.  Colman et al looked at the multiple negative personal & relationship outcomes in a UK national cohort of adolescents with conduct problems followed over 40 years.  Wentz et al studied the somewhat more encouraging 18 year outcomes of a group of adolescents suffering from anorexia. 

A couple of the papers are about depression.  Kennard and colleagues report again on the well-known Treatment for Adolescents with Depression Study (TADS) comparing antidepressants, cognitive-behavioural therapy and combined treatment.  By about six months there was little difference between the three forms of treatment.  At nine months the remission rate for intent-to-treat cases was 60% overall.  Primack et al investigated the association between electronic media use in adolescence and subsequent depression in young adulthood.  They reported "Controlling for all covariates including baseline Center for Epidemiologic Studies-Depression Scale score, those reporting more television use had significantly greater odds of developing depression."

Here are a few handouts that I've put together over the years to provide background information about depression.  The development & maintenance diagram is probably the handout here that I use most - both to explain issues about depression and also for many other psychological disorders as well. 

Development & maintenance of distressed states - I use this Powerpoint diagram a lot when discussing with people why they are in a distressed state.  The diagram applies to depression but it also applies to nearly all other distressed psychological states as well.  It can be helpful in highlighting the importance of maintaining, precipitating and vulnerability factors.  I also point out that therapeutic gains can be made working with all three of these general sets of factors - for example, emotional processing work for past experience (both precipitating and vulnerability factors) and more standard cognitive-behavioural approaches for maintaining factors. 

Here are two papers on mindfulness and four on sleep.  The Kuyken et al paper is important.  It compares mindfulness-based cognitive therapy (MBCT) with continuation antidepressants in the prevention of relapse in recurrent depression.  The results are great - "Relapse/recurrence rates over 15-month follow-ups in MBCT were 47%, compared with 60% in the m-ADM (maintenance antidepressant) group (hazard ratio = 0.63; 95% confidence interval: 0.39 to 1.04).  MBCT was more effective than m-ADM in reducing residual depressive symptoms and psychiatric comorbidity and in improving quality of life in the physical and psychological domains."  I have been cautious in my enthusiasm for MBCT (see previous post) but this is exactly the kind of research that we need to help clarify MBCT's potential further.  The second paper on mindfulness is lower key.  It is a mention of its potential in enhancing sexuality.  It makes sense - see last month's posts on the effects of meditation training on experiencing positive emotions - but the relevant research is still in its early stages.