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6 researchers in the Department of Psychiatry are in the Highly Cited Researchers 2020 list.
Are cognitive behavioural therapy, cognitive therapy, and behavioural activation for depression effective in primary care? A systematic review and meta-analysis.
Cognitive behavioural therapy (CBT) is a recommended first-line treatment for depression. Evidence mainly derives from studies in secondary care, though most treatment occurs in primary care. This review examined efficacy of CBT, cognitive therapy (CT), or behavioural activation (BA) for depression within primary care. Databases were searched for trials up to 23rd July 2024. Risk of bias was assessed using the Cochrane risk-of-bias tool, version 2.0.44 studies were included. CBT, CT, and BA significantly reduced depression symptoms compared to inactive controls (k = 40, g = 0.44, p
Smartphone-based Monitoring and cognition Modification Against Recurrence of Depression (SMARD): An RCT of Memory Bias Modification Training vs. Cognitive Control Training vs. Attention Bias Modification Training in remitted recurrently depressed patients with 1.5 year follow-up.
BACKGROUND: Major Depressive Disorder (MDD) has a 50-80% recurrence rate highlighting the urgent need for more efficient recurrence prevention programs. Currently, recurrences are often identified too late, while existing preventive strategies may not sufficiently address ethio-patho-physiological mechanisms for recurrence. Negative memory bias (the tendency to better remember negative than positive events), negative attention bias (selective attention favoring mood-congruent information), and cognitive control deficits are important factors involved in the onset, maintenance, and recurrence of depressive episodes. METHODS: Here we describe the protocol for the Smartphone-based Monitoring and cognition Modification Against Recurrence of Depression (SMARD) study, aiming to investigate different forms of cognitive training programs administered via smartphones, in order to develop a second-generation recurrence prevention program. In addition, we will gather Experience Sampling Method (ESM) assessments during a 6-day period, and during the follow-up period we will obtain behavioral data on (social) activities with BEHAPP, a smartphone-based Mobile Passive Monitoring application for remote behavioral monitoring to identify behavioral changes indicative of an imminent depressive episode. In a randomized controlled trial, SMARD will compare the effects of a smartphone-based Memory Bias Modification Training (MBT), Cognitive Control Training (CCT), and Attention Bias Modification Training (ABT) versus cognitive domain-specific (active-) sham trainings in 120 remitted MDD-patients with recurrent-MDD. Over the course of three weeks, participants receive multiple daily training sessions. Thereafter, participants will be followed up for 1.5 years with 3-monthly interviews to assess recurrences. DISCUSSION: The SMARD study aims to 1. assess the effects of the cognitive training programs versus their training-specific (active-) sham conditions on changes in memory, cognitive control dysfunction and attention; 2. relate training effects to neural networks previously identified in (recurrence of) MDD (therefore we obtain functional Magnetic Resonance Imaging ((f)MRI) scans before and after the training in a subset of participants); 3. link baseline and change in memory, cognitive control, attention and neural functioning, and ESM data to prospective recurrences; 4. examine whether passive smartphone-use monitoring can be used for prediction of recurrences. TRIAL REGISTRATION: NL-OMON26184 and NL-OMON27513. Registered 12 August 2021-Retrospectively registered, https://onderzoekmetmensen.nl/en/trial/26184 en https://onderzoekmetmensen.nl/en/trial/27513 .
Young people's attitudes towards online self-help single-session interventions: findings from a co-produced qualitative study.
BACKGROUND: Many young people experience at least subthreshold depression symptoms which impact their functioning. Yet, access to evidence-based help is limited, with barriers such as service thresholds, stigma, and lack of knowledge about mental health and available services. One way to ensure young people have access to free, early, immediate and anonymous help is through online self-help single-session interventions. This study aimed to qualitatively explore young people's perceptions of and attitudes towards these interventions. METHODS: Twenty-four young people (UK based, age 15-18) took part in qualitative semi-structured interviews which were hosted online and co-conducted with a young research team (N = 4, age 16-18), during which we described online single-session interventions and asked participants for their perspectives. Together with our young researchers, we analyzed the data using reflexive thematic analysis. RESULTS: Three themes were generated: (1) Will it help, or won't it? Hope versus skepticism; (2) Why this approach? Benefits of single-session interventions for young people; and (3) Have you considered this? Logistics for implementation. CONCLUSIONS: The current study highlights that whilst young people perceived there to be many benefits associated with online single-session interventions, including anonymity, easy access, and lack of disclosure, they expressed doubts regarding sufficiency and ability to address severe mental health problems. Despite this, the potentially preventative effects during the early stages of help-seeking were highlighted, alongside single-session interventions acting as a gateway to further help-seeking and support. However, logistical considerations should also be reflected upon when developing online single-session interventions, including where they are advertised, age appropriateness, and how to demonstrate trustworthiness.
Mapping the Dynamics of Generalized Anxiety Symptoms and Actionable Transdiagnostic Mechanisms: A Panel Study
Background: The long‐term dynamic interaction between symptoms of generalized anxiety disorder (GAD) and their theorized mechanistic processes derived from three treatment models of GAD—the emotion dysregulation model, the model underlying metacognitive therapy (MCT), and the intolerance of uncertainty model—was investigated.Methods: Four data waves 2 months apart were delivered by a representative population sample of 4361 participants during the COVID‐19 pandemic in Norway. Networks were estimated using the newly developed panel graphical vector autoregression (panel‐GVAR) methods.Results: In the temporal network, and consistent with processes stipulated in the metacognitive model, the experience that worry is uncontrollable predicted the GAD symptom fear of awful events, which in turn predicted a range of other GAD symptoms, that is, anxiety, restlessness, and irritability. Fear of awful events had high outstrength, that is, predicted other variables to a large degree. Inconsistent with the metacognitive model, the coping strategy thought suppression negatively predicted restlessness. Consistent with the emotion dysregulation model, emotion dysregulation predicted avoidance. No relationships proposed by the intolerance of uncertainty model of GAD were identified in the temporal network. The contemporaneous network was dense with nodes clustering according to the constructs they belonged to.Conclusions: The findings indicate the importance of the theory‐derived variables, the experience and belief that worry is uncontrollable and emotion dysregulation, as potential targets for intervention to alleviate GAD symptoms. The findings also indicate that uncontrollability of worry and fear of awful events should be considered central symptoms of GAD in a within‐individual diagnostics supplementary to current diagnostic manuals, such as the Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM‐5).
The compulsive eating paradigm: can psychedelics help in treating obesity?
Obesity is a multifactorial disorder involving a behavioural aetiology in subsets of patients that traditional therapeutic approaches have failed to address. Drawing parallels with addiction, the rewarding aspects of a chronic energy-dense diet can compromise dopaminergic reward circuits, eventually causing individuals to become habitually responsive to food-related stimuli despite adverse health consequences. The maladaptive prediction of reward and motivational salience that becomes associated with food-related stimuli can exert top-down influence on perception and attention, promoting compulsive eating behaviour. Emerging research suggests that psychedelics, e.g., psilocybin and LSD, induce non-ordinary mental states where the influence of such behaviours could potentially be reduced and modified. Based on current evidence, mechanisms have been proposed which suggest that psychedelics might relax the top-down influence of high-level predictions encoded within neuronal hierarchies and sensitise them to bottom-up information flow. Additionally, psychedelics are thought to open a window of psychological flexibility, allowing people to potentially become open to new cognitive and behavioural strategies that can be offered via assisted psychotherapy. Therefore, psychedelics-assisted psychotherapy may encourage beneficial changes to eating behaviour, in those with maladaptive eating habits. While promising in theory, new research is needed to assess the potential efficacy of psychedelics-assisted psychotherapy in treating compulsive eating behaviour.
Radiomic Analysis of Striatal [18F]FDOPA PET Imaging in Patients with Psychosis for the Identification of Antipsychotic Response
Purpose: Schizophrenia (SCZ) is a severe psychiatric disorder marked by abnormal dopamine synthesis, measurable through [18F]FDOPA PET imaging. This imaging technique has been proposed as a biomarker for treatment stratification in SCZ, where one-third of patients respond poorly to standard antipsychotics. This study explores the use of radiomics on [18F]FDOPA PET data to examine dopamine synthesis in SCZ and predict antipsychotic response. Methods: We analysed 273 [18F]FDOPA PET scans from healthy controls (n = 138) and SCZ patients (n = 135) from multiple cohorts, including first-episode psychosis cases. Radiomic features from striatal regions were extracted using the MIRP Python package. Reproducibility was assessed with test–retest scans, selecting features with an intraclass correlation coefficient (ICC) > 0.80. These features were grouped via hierarchical clustering based on Spearman correlation. Regression analysis evaluated sex and age effects on radiomic features. Predictive power for treatment response was tested and compared to standard imaging analysis obtained from the Standardised Uptake Value ratio (SUVr) of striatal over cerebellar tracer activity. Results: Out of 177 features, 15 met the ICC criteria (ICC: 0.81–0.99). Age and sex influenced features in patients but not in controls. The best performance were was by the GLCM joint maximum feature, which effectively differentiated responders from non-responders (AUC: 0.66–0.87), but did not reach statistical significance in classification over SUVr. Conclusion: Radiomic analysis of [18F]FDOPA PET supports its use as a biomarker for assessing antipsychotic efficacy in schizophrenia, highlighting differential striatal tracer uptake based on patient response. While it provides modest classification improvements over standard imaging, further validation in larger datasets and integration with multivariate classification algorithms are needed.
Consenting for themselves: a qualitative study exploring a Gillick Competence assessment to enable adolescents to self-consent to low-risk online research.
BACKGROUND: Providing digital mental health interventions online could expand access to help for young people, but requiring parental consent may be a barrier to participation. We therefore need a method that enables young people <16 years old (ie, presumed competent in the UK) to demonstrate Gillick Competence (understanding of purpose, process, potential benefits and potential harms) to self-consent to online, anonymous, low-risk studies. AIM: To explore whether a new method for assessing Gillick Competence to participate in low-risk, anonymous online studies is acceptable to both young people and parents. METHODS: We interviewed 15 young people aged 13-5 years and 12 parents of this age group in the UK. Using a qualitative approach, we explored the acceptability of a series of multiple-choice questions (MCQs) designed to assess understanding of a specific online self-help research study testing a self-kindness intervention. RESULTS: The MCQ answers that participants gave mostly corresponded with their narrative explanations of their understanding during interviews. Young people and parents thought that the process was empowering and could increase access to research while also promoting independence. However, they emphasised the importance of individual differences and different research contexts and highlighted the need for safeguards to be in place. CONCLUSIONS: The MCQs were acceptable to both young people and parents, providing preliminary evidence for the potential of this process for allowing <16s to self-consent to online, anonymous, low-risk mental health research. Further research is needed to validate the effectiveness of this process among a diverse range of populations and research contexts.
Investigating the Efficacy of the Web-Based Common Elements Toolbox (COMET) Single-Session Interventions in Improving UK University Student Well-Being: Randomized Controlled Trial.
BACKGROUND: Mental health problems in university students are associated with many negative outcomes, yet there is a gap between need and timely access to help. Single-session interventions (SSIs) are designed to be scalable and accessible, delivering core evidence-based intervention components within a one-off encounter. OBJECTIVE: COMET (Common Elements Toolbox) is an online self-help SSI that includes behavioral activation, cognitive restructuring, gratitude, and self-compassion. COMET has previously been evaluated in India, Kenya, and the United States with promising results. This study tests the acceptability, appropriateness, perceived utility, and efficacy of COMET among UK university students during the peripandemic period. METHODS: We conducted a randomized controlled trial evaluating the efficacy of COMET compared with a control group, with 2- and 4-week follow-ups. Outcome variables were subjective well-being, depression severity, anxiety severity, positive affect, negative affect, and perceived stress. We also measured intervention satisfaction immediately after completion of COMET. All UK university students with access to the internet were eligible to participate and were informed of the study online. The data were analyzed using linear mixed models and reported in accordance with the CONSORT-EHEALTH (Consolidated Standards of Reporting Trials of Electronic and Mobile Health Applications and Online Telehealth) checklist. RESULTS: Of the 831 people screened, 468 participants were randomized to a condition, 407 completed the postintervention survey, 147 returned the 2-week follow-up survey, 118 returned the 4-week follow-up survey, and 89 returned both. Of the 239 randomized, 212 completed COMET. Significant between-group differences in favor of the COMET intervention were observed at 2-week follow-ups for subjective well-being (Warwick-Edinburgh Mental Well-Being Scale; mean difference [MD] 1.39, 95% CI 0.19-2.61; P=.03), depression severity (9-item Patient Health Questionnaire; MD -1.31, 95% CI -2.51 to -0.12; P=.03), and perceived stress (4-item Perceived Stress Scale; MD -1.33, 95% CI -2.10 to -0.57; P
"Are we genuinely going to have our voices heard?" The experience of co-producing a blended intervention to prevent relapse in obsessive-compulsive disorder: a qualitative study on the perspectives of experts by lived experience.
INTRODUCTION: Co-production involves researchers, practitioners and people with lived experience working in a collaborative manner, with shared power. The potential benefits of co-production are well documented. However, there is little research describing the experience of having been involved in co-production from the perspective of Experts By Lived Experience (EBLE). The aim of the present study is to explore the experiences of EBLE of obsessive-compulsive disorder (OCD) on their involvement in co-producing a blended intervention to prevent relapse for OCD. METHODS: Five EBLE took part in semi-structured interviews enquiring about their experiences of co-producing a relapse prevention intervention. Reflexive thematic analysis was used to analyse the data. RESULTS: Four themes were developed: (1) Welcome but unexpected therapeutic benefits; (2) The parameters of a safe space; (3) Genuine co-production brings meaningful change; and (4) Navigating the challenging terrain of co-production. CONCLUSIONS: Overall, EBLE reported their involvement in the co-production process to have had positive impacts on both the development of the intervention and their own personal recovery journey. EBLE valued the safety created within the group, and the importance this had for allowing them to speak open and honestly about their experiences and the difficulties that can arise with the nature of the work.
What do they look for and what do they find? A coproduced qualitative study on young people's experiences of searching for mental health information online.
BACKGROUND: Many young people (YP) struggle with their mental health and look online for help. To capitalise on their digital presence, we need to better understand how and where they seek information online and what they think of what they find. METHOD: We recruited 24 YP (aged 13-18 years). Online interviews were co-conducted by research team members and trained young researchers. We presented a persona with depression symptoms and asked about potential sources of information/support they might seek. They were also asked to think aloud while searching online and reviewing mental health resources (NHS, Young Minds). We used reflexive thematic analysis. RESULTS: Analysis generated four themes: (1) the online help-seeking process, showcasing where YP look for information and why; (2) the mismatch between the information YP expected to find and the reality; (3) the strategies YP employed to determine a source's trust and credibility and (4) individual differences that can influence help-seeking. CONCLUSION: Participants initiated their online search by Googling symptoms. They trusted NHS websites for basic medical information, while charities provided detailed content. Despite scepticism about content, social media offered validation. Online resources should prioritise visual appeal, user-friendliness, age-appropriate and personalised content and peer insights. Codesign is imperative to ensure high-quality, impactful research.
A systematic review and narrative synthesis of the use and effectiveness of extended reality technology in the assessment, treatment and study of obsessive compulsive disorder
Extended reality (XR) technologies including virtual and augmented reality are seeing increasing research interest in the field of mental health. Obsessive compulsive disorder (OCD) is a condition that remains difficult to assess and treat despite the availability of effective therapies. This systematic review synthesises the current knowledge regarding the use and effectiveness of XR in the assessment, treatment, and study of OCD. The protocol for this review was registered on PROSPERO (ID: CRD42021248021). Searches of six databases were conducted. The xReality framework was used to define which technologies would be included as XR. Studies that recruited analogue samples as well as clinical OCD populations were included. A narrative synthesis of the findings was planned. There was consistent evidence for the use of virtual reality as a tool for symptom provocation in people with contamination-related OCD, as part of exposure and response prevention. Significant heterogeneity exists between study designs found in both symptom provocation and treatment outcome studies. This review has important implications about the narrow focus of research in this area thus far, highlighting the need for further study of different uses of XR in providing positive treatment outcomes across a broader range of OCD symptoms.
Reflection over compliance: Critiquing mandatory data sharing policies for qualitative research.
Many journals are moving towards a 'Mandatory Inclusion of Raw Data' (MIRD) model of data sharing, where it is expected that raw data be publicly accessible at article submission. While open data sharing is beneficial for some research topics and methodologies within health psychology, in other cases it may be ethically and epistemologically questionable. Here, we outline several questions that qualitative researchers might consider surrounding the ethics of open data sharing. Overall, we argue that universal open raw data mandates cannot adequately represent the diversity of qualitative research, and that MIRD may harm rigorous and ethical research practice within health psychology and beyond. Researchers should instead find ways to demonstrate rigour thorough engagement with questions surrounding data sharing. We propose that all researchers utilise the increasingly common 'data availability statement' to demonstrate reflexive engagement with issues of ethics, epistemology and participant protection when considering whether to open data.
"I'm always going to be tired": a qualitative exploration of adolescents' experiences of fatigue in depression.
Adolescent depression is a prevalent and disabling condition, but current psychological treatments are only moderately effective. One way to enhance outcomes is to further our understanding of adolescent depression and improve our capacity to target the most frequently reported and problematic symptoms. A common but often neglected symptom of depression is fatigue, which is associated with considerable impairment and has the potential to interfere with adolescents' engagement in psychological therapies. Despite this, the experience of fatigue in adolescent depression and how we target it in treatment is currently poorly understood. Therefore, we aimed to explore adolescents' experiences and understandings of fatigue in depression, recruiting from clinical and community settings. Semi-structured interviews were conducted with 19 UK-based adolescents aged 14-18 years old with elevated symptoms of depression. Using reflexive thematic analysis, three themes were generated. Fatigue is a complex concept explored adolescents' understanding of fatigue as a dynamic, multifaceted symptom which had mental and physical components. Trapped in a cycle of fatigue considered the complex and reciprocal relationship between fatigue and other depressive symptoms, and the subsequent impact of limited energy on engagement with everyday activities. Finally, stigma as a barrier to help-seeking highlighted how adolescents were reluctant to seek help due to experienced stigma and the perception that fatigue was not a serious enough symptom. Findings from this study suggest that fatigue should be viewed as a psychological as well as somatic symptom of depression, with implications regarding the identification and treatment of fatigue in depression in routine clinical practice.
A qualitative evaluation of mentors’ experiences of a Black, Asian and Minority Ethnic mentor scheme for clinical psychologists
Objectives: Inequalities in the clinical psychology profession extend to the uptake and recruitment of clinical psychologists from Black, Asian, and Minority Ethnic (BAME) backgrounds. Mentoring schemes can help facilitate mentee’s personal and professional development. The aim of this study was to explore the experiences of mentors who participated in the BAME mentor scheme at University of Bath. Methods: Qualitative interviews were conducted with N = 29 mentors (both trainee and qualified clinical psychologists), who predominately identified as female and White British. The reflexive thematic analysis six-step process was employed to analyse the data. Results: Four major themes were generated; (1) Mentoring as a learning curve; (2) Mentoring in the context of BAME; (3) Why we mentor: The impact; and (4) Moving the scheme forward: What next? Conclusions: Overall, mentoring was a rewarding experience for mentors, and given the right support, could help strengthen the mentoring experience and aims of the scheme for the future. These findings offer insight and guidance for future mentoring programmes considering diversifying the clinical psychology profession.
Nonpharmacological interventions for treating fatigue in adolescents: A systematic review and narrative synthesis of randomised controlled trials.
OBJECTIVE: Fatigue is common in adolescence and can be highly disabling if experienced persistently, with adverse psychosocial outcomes. There is a need to better understand what nonpharmacological treatments are available for adolescents suffering with persistent fatigue. The current review systematically identified, synthesised, and evaluated the evidence regarding nonpharmacological interventions for fatigue in adolescents, focusing on evaluating effectiveness, describing intervention components, and mapping interventions onto the behaviour change technique taxonomy (BCTT). METHODS: CENTRAL, EMBASE, PsycINFO, PubMed, and Web of Science were systematically searched for articles including (1) adolescents aged 10-19 years old, (2) fatigue as a primary or secondary outcome, (3) nonpharmacological interventions, and (4) randomised controlled trials. Study screening, data extraction, quality assessment, and BCTT mapping were performed independently by two reviewers. Findings were presented as a narrative synthesis, with interventions ranked by promise. RESULTS: 5626 papers were identified and double-screened, resulting in the inclusion of 21 articles reporting 16 trials. Five interventions were classified as likely promising. Interventions often involved psychoeducation, cognitive behavioural therapy, and/or physical activity, incorporating various BCTT domains, most commonly shaping knowledge, repetition and substitution, and goals and planning. However, there did not seem to be any observable differences between fatigue-targeted and non-fatigue-targeted interventions. Overall study quality was mixed, particularly in relation to power and outcome measures. CONCLUSION: There are several promising nonpharmacological interventions for adolescent fatigue, although further work is needed to determine effectiveness. Future trials need to ensure design rigour, focusing on adequate powering, validated outcome measures, and adhering to best practice reporting guidelines.