Cognitive Behavioural Therapy for schizophrenia - outcomes for functioning, distress and quality of life : A meta-analysis

Background: The effect of cognitive behavioural therapy for psychosis (CBTp) on the core symptoms of schizophrenia has proven contentious, with current meta-analyses finding at most only small effects. However, it has been suggested that the effects of CBTp in areas other than psychotic symptoms are at least as important and potentially benefit from the intervention. Method: We meta-analysed RCTs investigating the effectiveness of CBTp for functioning, distress and quality of life in individuals diagnosed with schizophrenia and related disorders. Data from 36 randomised controlled trials (RCTs) met our inclusion criteria- 27 assessing functioning (1579 participants); 8 for distress (465 participants); and 10 for quality of life (592 participants). Results: The pooled effect size for functioning was small but significant for the end-of-trial (0.25: 95% CI: 0.14 to 0.33); however, this became non-significant at follow-up (0.10 [95%CI -0.07 to 0.26]). Although a small benefit of CBT was evident for reducing distress (0.37: 95%CI 0.05 to 0.69), this became nonsignificant when adjusted for possible publication bias (0.18: 95%CI -0.12 to 0.48). Finally, CBTp showed no benefit for improving quality of life (0.04: 95% CI: -0.12 to 0.19). Conclusions: CBTp has a small therapeutic effect on functioning at end-of-trial, although this benefit is not evident at follow-up. Although CBTp produced a small benefit on distress, this was subject to possible publication bias and became nonsignificant when adjusted. We found no evidence that CBTp increases quality of life post-intervention.Peer reviewedFinal Published versio

The Sleep Or Mood Novel Adjunctive therapy (SOMNA) trial: a study protocol for a randomised controlled trial evaluating an internet-delivered cognitive behavioural therapy program for insomnia on outcomes of standard treatment for depression in men

BACKGROUND: Insomnia is a significant risk factor for depression onset, can result in more disabling depressive illness, and is a common residual symptom following treatment cessation that can increase the risk of relapse. Internet-based cognitive behavioural therapy for insomnia has demonstrated efficacy and acceptability to men who are less likely than women to seek help in standard care. We aim to evaluate whether internet delivered cognitive behavioural therapy for insomnia as an adjunct to a standard depression therapeutic plan can lead to improved mood outcomes.METHODS/DESIGN: Male participants aged 50 years or more, meeting Diagnostic and Statistical Manual of Mental Disorders criteria for current Major Depressive Episode and/or Dysthymia and self-reported insomnia symptoms, will be screened to participate in a single-centre double-blind randomised controlled trial with two parallel groups involving adjunctive internet-delivered cognitive behavioural therapy for insomnia and an internet-based control program. The trial will consist of a nine-week insomnia intervention period with a six-month follow-up period. During the insomnia intervention period participants will have their depression management coordinated by a psychiatrist using standard guideline-based depression treatments. The study will be conducted in urban New South Wales, Australia, where 80 participants from primary and secondary care and direct from the local community will be recruited. The primary outcome is change in the severity of depressive symptoms from baseline to week 12. DISCUSSION: This study will provide evidence on whether a widely accessible, evidence-based, internet-delivered cognitive behavioural therapy for insomnia intervention can lead to greater improvements than standard treatment for depression alone, in a group who traditionally do not readily access psychotherapy. The study is designed to establish effect size, feasibility and processes associated with implementing e-health solutions alongside standard clinical care, to warrant undertaking a larger more definitive clinical trial.Trial registration: Australian and New Zealand Clinical Trials Registry ACTRN12612000985886.The study is supported by beyondblue: the national depression and anxiety initiative National Priority Driven Research Program and funded through a donation from the Movember Foundation

The Rise of iWar: Identity, Information, and the Individualization of Modern Warfare

During a decade of global counterterrorism operations and two extended counterinsurgency campaigns, the United States was confronted with a new kind of adversary. Without uniforms, flags, and formations, the task of identifying and targeting these combatants represented an unprecedented operational challenge for which Cold War era doctrinal methods were largely unsuited. This monograph examines the doctrinal, technical, and bureaucratic innovations that evolved in response to these new operational challenges. It discusses the transition from a conventionally focused, Cold War-era targeting process to one optimized for combating networks and conducting identity-based targeting. It analyzes the policy decisions and strategic choices that were the catalysts of this change and concludes with an in depth examination of emerging technologies that are likely to shape how this mode of warfare will be waged in the future.https://press.armywarcollege.edu/monographs/1436/thumbnail.jp

Effective elements of cognitive behaviour therapy for psychosis: results of a novel type of subgroup analysis based on principal stratification

Background. Meta-analyses show that cognitive behaviour therapy for psychosis (CBT-P) improves distressing positive symptoms. However, it is a complex intervention involving a range of techniques. No previous study has assessed the delivery of the different elements of treatment and their effect on outcome. Our aim was to assess the differential effect of type of treatment delivered on the effectiveness of CBT-P, using novel statistical methodology. Method. The Psychological Prevention of Relapse in Psychosis (PRP) trial was a multi-centre randomized controlled trial (RCT) that compared CBT-P with treatment as usual (TAU). Therapy was manualized, and detailed evaluations of therapy delivery and client engagement were made. Follow-up assessments were made at 12 and 24 months. In a planned analysis, we applied principal stratification (involving structural equation modelling with finite mixtures) to estimate intention-to-treat (ITT) effects for subgroups of participants, defined by qualitative and quantitative differences in receipt of therapy, while maintaining the constraints of randomization. Results. Consistent delivery of full therapy, including specific cognitive and behavioural techniques, was associated with clinically and statistically significant increases in months in remission, and decreases in psychotic and affective symptoms. Delivery of partial therapy involving engagement and assessment was not effective. Conclusions. Our analyses suggest that CBT-P is of significant benefit on multiple outcomes to patients able to engage in the full range of therapy procedures. The novel statistical methods illustrated in this report have general application to the evaluation of heterogeneity in the effects of treatment

ERINYES: A CONTINUOUS AUTHENTICATION PROTOCOL

The need for user authentication in the digital domain is paramount as the number of digital interactions that involve sensitive data continues to increase. Advances in the fields of machine learning (ML) and biometric encryption have enabled the development of technologies that can provide fully remote continuous user authentication services. This thesis introduces the Erinyes protocol. The protocol leverages state of the art ML models, biometric encryption of asymmetric cryptographic keys, and a trusted third-party client-server architecture to continuously authenticate users through their behavioral biometrics. The goals in developing the protocol were to identify if biometric encryption using keystroke timing and mouse cursor movement sequences were feasible and to measure the performance of a continuous authentication system that utilizes biometric encryption. Our research found that with a combined keystroke and mouse cursor movement dataset, the biometric encryption system can perform with a 0.93% False Acceptance Rate (FAR), 0.00% False Reject Rate (FRR), and 99.07% accuracy. Using a similar dataset, the overall integrated system averaged 0% FAR, 2% FRR and 98% accuracy across multiple users. These metrics demonstrate that the Erinyes protocol can achieve continuous user authentication with minimal user intrusion.Lieutenant, United States NavyLieutenant, United States NavyApproved for public release. Distribution is unlimited

Navigating Risk in Vendor Data Privacy Practices: An Analysis of Elsevier\u27s ScienceDirect

Executive Summary As libraries transitioned from buying materials to licensing content, serious threats to privacy followed. This change shifted more control over library user data (and whether it is collected or kept at all) from the local library to third-party vendors, including personal data about what people search for and what they read. This transition has further reinforced the move by some of the largest academic publishers to move beyond content and become data analytics businesses that provide platforms of tools used throughout the research lifecycle that can collect user data at each stage. These companies have an increasing incentive to collect and monetize the rich streams of data that these platforms can generate from users. As a result, user privacy depends on the strength of privacy protections guaranteed by vendors (e.g., negotiated for in contracts), and a growing body of evidence indicates that this should be a source of concern. User tracking that would be unthinkable in a physical library setting now happens routinely through such platforms. The potential integration of this tracking with other lines of business, including research analytics tools and data brokering services, raises pressing questions for users and institutions. Elsevier provides an important case study in this dynamic. Elsevier is many academic libraries’ largest vendor for collections, and its platforms span the knowledge production process, from discovery and idea generation to publication to evaluation. Furthermore, Elsevier’s parent company, RELX, is a leading data broker. Its “risk” business, which provides services to corporations, governments, and law enforcement agencies based on expansive databases of personal data, has surpassed its Elsevier division in revenue and profitability. For these reasons, it is important to carefully consider Elsevier’s privacy practices, the risks they may pose, and proactive steps to protect users. This analysis focuses on ScienceDirect due to its position as a leading discovery platform for research as well as the Elsevier product that researchers are most likely to interact with regularly. Based on our findings, many of ScienceDirect\u27s data privacy practices directly conflict with library privacy standards and guidelines. The data privacy practices identified in our analysis are like the practices found in many businesses and organizations that track and harvest user data to sustain privacy-intrusive data-driven business models. The widespread data collection, user tracking and surveillance, and disclosure of user data inherent to these business models run counter to the library\u27s commitment to user privacy as specified in the ALA Code of Ethics, Library Bill of Rights, and the IFLA Statement on Privacy in the Library Environment. Examples of current ScienceDirect practices found in our analysis that conflict with these standards include: • Use of web beacons, cookies, and other invasive web surveillance methods to track user behavior outside and beyond the ScienceDirect website • Extensive collection of a broad range of personal data (e.g., behavioral and location data) from ScienceDirect combined with personal data harvested from sources beyond ScienceDirect (i.e., third parties in and outside of RELX and data brokers as stated in Elsevier’s Privacy Policy and U.S. Consumer Privacy Notice) • Collection of personal data by third parties, including search engines, social media platforms, and other personal-data aggregators and profilers such as Google, Adobe, Cloudflare, and New Relic, through extensive use of third-party trackers on the ScienceDirect site • Disclosure of personal data to other Elsevier products and the potential for disclosure of personal data to other business units within RELX, including risk products and services sold to corporations, governments, and law enforcement agencies • Processing and disclosure of personal data (and personal data inferred from personal data) for targeted, personalized advertising and marketing In particular, ScienceDirect’s U.S. Consumer Privacy Notice, posted and updated in 2023, raises important concerns. The notice describes the disclosure of detailed user data—including geolocation data, sensitive personal information, and inference data used to create profiles on individuals—both for wide-ranging internal use and to external third parties, including “affiliates” and “business and joint venture partners.” The collection and disclosure of data about who someone is, where they are, and what they search for and read by the same overarching company that provides sophisticated surveillance and data brokering products to corporations, governments, and law enforcement should be alarming. These practices raise the question of whether simultaneous ownership of key academic infrastructure alongside sophisticated surveillance and data brokering businesses should be permitted at all—by users, by institutions, or by policymakers and regulatory authorities. Our analysis cannot definitively confirm whether personal data derived from academic products is currently being used in data brokering or “risk” products. Nevertheless, ScienceDirect’s privacy practices highlight the need to be aware of this risk, which is not mitigated by privacy policy revisions or potential verbal assurances concerning specific data uses. Privacy policies can be changed unilaterally, and denials are not legally binding. To be meaningful, any privacy guarantee a vendor makes must be durable, verifiable, and not limited to a particular jurisdiction. As many of the largest publishers reinvent themselves as platform businesses, users and institutions should actively evaluate and address the potential privacy risks as this transition occurs rather than after it is complete. In closely analyzing the privacy practices of the leading vendor in this transition, this report highlights the need for institutions to be proactive in responding to these risks and provides initial steps for doing so. This report underscores the significant expertise and capacity required for any institution to understand even one vendor’s privacy practices—and the power asymmetry this creates between vendors and libraries. Collaborative efforts, such as SPARC’s Privacy & Surveillance Community of Practice, can plan a key role in supporting future action to address the real privacy risks posed by vendors’ platforms. This report closes with options that institutions may consider to mitigate these risks over the short and longer term