Acceptability and proof of concept of internet-delivered treatment for depression, anxiety, and stress in university students: protocol for an open feasibility trial

BACKGROUND: In recent years, university counseling and mental health services have reported an increase in the number of clients seeking services and in yearly visits. This trend has been observed at many universities, indicating that behavioral and mental health issues pose significant problems for many college students. The aim of this study is to assess the acceptability and proof of concept of internet-delivered treatment for depression, anxiety, and stress for university students. METHODS/DESIGN: The study is an open feasibility trial of the SilverCloud programs for depression (Space from Depression), anxiety (Space from Anxiety), and stress (Space from Stress). All three are 8-module internet-delivered CBT (iCBT) intervention programs. Participants are assigned a supporter who provides weekly feedback on progress and exercises. Participants will complete the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and stress subscale of the Depression, Anxiety, Stress Scale-21 (DASS-21) as the outcome measures for the depression, anxiety, and stress interventions, respectively. Other outcomes include measures of acceptability of, and satisfaction, with the intervention. Data will be collected at baseline, 8 weeks and 3-month follow-up. DISCUSSION: It is anticipated that the study will inform the researchers and service personnel of the programs' potential to reduce depression, anxiety, and stress in a student population as well as the protocols to be employed in a future trial. In addition, it will provide insight into students' engagement with the programs, their user experience, and their satisfaction with the online delivery format

Internet addiction: a systematic review of epidemiological research for the last decade

In the last decade, Internet usage has grown tremendously on a global scale. The increasing popularity and frequency of Internet use has led to an increasing number of reports highlighting the potential negative consequences of overuse. Over the last decade, research into Internet addiction has proliferated. This paper reviews the existing 68 epidemiological studies of Internet addiction that (i) contain quantitative empirical data, (ii) have been published after 2000, (iii) include an analysis relating to Internet addiction, (iv) include a minimum of 1000 participants, and (v) provide a full-text article published in English using the database Web of Science. Assessment tools and conceptualisations, prevalence, and associated factors in adolescents and adults are scrutinised. The results reveal the following. First, no gold standard of Internet addiction classification exists as 21 different assessment instruments have been identified. They adopt official criteria for substance use disorders or pathological gambling, no or few criteria relevant for an addiction diagnosis, time spent online, or resulting problems. Second, reported prevalence rates differ as a consequence of different assessment tools and cut-offs, ranging from 0.8% in Italy to 26.7% in Hong Kong. Third, Internet addiction is associated with a number of sociodemographic, Internet use, and psychosocial factors, as well as comorbid symptoms and disorder in adolescents and adults. The results indicate that a number of core symptoms (i.e., compulsive use, negative outcomes and salience) appear relevant for diagnosis, which assimilates Internet addiction and other addictive disorders and also differentiates them, implying a conceptualisation as syndrome with similar etiology and components, but different expressions of addictions. Limitations include the exclusion of studies with smaller sample sizes and studies focusing on specific online behaviours. Conclusively, there is a need for nosological precision so that ultimately those in need can be helped by translating the scientific evidence established in the context of Internet addiction into actual clinical practice

Mental Health and Wellbeing in England: the Adult Psychiatric Morbidity Survey 2014

This report presents findings of a survey of mental illness and wellbeing among people aged 16 and over living in private households in England. The survey was commissioned by NHS Digital and funded by the Department of Health, and is the fourth in a series of surveys of adult mental health

Eating disorder services for young people in Ireland: perspectives of service providers, service users and the general adolescent population

Objectives: This paper illuminates how national eating disorder (ED) policy translates into day-to-day practice by exploring how ED services are experienced by those who deliver and use them. Methods: A mixed-methods approach was used, which combined qualitative and quantitative techniques. The paper collates data from three studies: (i) an interview study exploring the lived experiences of young people with EDs (n =8), their parents (n =5) and their healthcare professionals (n =3); (ii) a national survey of health professionals’ perspectives on existing ED services (n =171); (iii) a nationwide survey of secondary-school students’ eating concerns and patterns of help - seeking (n=290). Results: The qualitative interviews with young people and their parents revealed feelings of isolation and helplessness. Young people expressed interest in patient support groups, while parents desired greater support for the family unit. Parents were highly critical of available services, particularly in relation to access. These criticisms were echoed in the survey of healthcare professionals, who reported many barriers to delivering effective care. Clinicians were almost unanimous in calling for care pathways to be clarified via a standardised treatment protocol. The survey of adolescents indicated widespread reluctance to seek help regarding eating concerns: over one-third expressed concern about their own eating habits, but half of these had not divulged their concerns to anyone. Participants’ preferred pathways of help-seeking revolved around family and friends, and adolescents were unsure about routes of access to professional support. 3 Conclusions: The research demonstrates that many aspects of national ED policy have not been implemented in practice. The paper highlights specific gaps and suggests ways they can be redressed

Service user involvement in the evaluation of psycho-social intervention for self-harm: a systematic literature review

Background: The efficacy of interventions and treatments for self-harm is well researched. Previous reviews of the literature have highlighted the lack of definitively effective interventions for self-harm and have highlighted the need for future research. These recommendations are also reflected in clinical guidelines published by the National Institute for Health and Clinical Excellence (NICE, 2004) which also call for service user involvement in studies of treatment efficacy. Aims: A systematic review was undertaken to determine i) what contributions service users have made to the evaluation of psychosocial interventions ii) by what methods have service users been involved iii) in what ways could service user involvement supplement empirical evidence for interventions

The words of the body: psychophysiological patterns in dissociative narratives

Trauma has severe consequences on both psychological and somatic levels, even affecting the genetic expression and the cell\u2019s DNA repair ability. A key mechanism in the understanding of clinical disorders deriving from trauma is identified in dissociation, as a primitive defense against the fragmentation of the self originated by overwhelming experiences. The dysregulation of the interpersonal patterns due to the traumatic experience and its detrimental effects on the body are supported by influent neuroscientific models such as Damasio\u2019s somatic markers and Porges\u2019 polyvagal theory. On the basis of these premises, and supported by our previous empirical observations on 40 simulated clinical sessions, we will discuss the longitudinal process of a brief psychodynamic psychotherapy (16 sessions, weekly frequency) with a patient who suffered a relational trauma. The research design consists of the collection of self-report and projective tests, pre-post therapy and after each clinical session, in order to assess personality, empathy, clinical alliance and clinical progress, along with the verbatim analysis of the transcripts trough the Psychotherapy Process Q-Set and the Collaborative Interactions Scale. Furthermore, we collected simultaneous psychophysiological measures of the therapeutic dyad: skin conductance and hearth rate. Lastly, we employed a computerized analysis of non-verbal behaviors to assess synchrony in posture and gestures. These automated measures are able to highlight moments of affective concordance and discordance, allowing for a deep understanding of the mutual regulations between the patient and the therapist. Preliminary results showed that psychophysiological changes in dyadic synchrony, observed in body movements, skin conductance and hearth rate, occurred within sessions during the discussion of traumatic experiences, with levels of attunement that changed in both therapist and the patient depending on the quality of the emotional representation of the experience. These results go in the direction of understanding the relational process in trauma therapy, using an integrative language in which both clinical and neurophysiological knowledge may take advantage of each other

Eating disorder literacy and stigmatising attitudes towards anorexia, bulimia and binge eating disorder among adolescents

Little research has investigated adolescents’ understanding of eating disorders (EDs) or attitudes towards people affected by EDs. This impedes the development of targeted health promotion interventions. In the current study, 290 adolescents viewed a vignette depicting a target with either Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder, Depression or Type 1 Diabetes. Subsequent questionnaires assessed understanding of and attitudes towards the disorder described . Adolescents recognised the symptoms of depression significantly more frequently than any ED. Relative to depression and Type 1 diabetes, participants held targets with EDs more personally responsible for their illness and ascribed them more negative personality characteristics. The data revealed a particularly unfavourable view of Binge Eating Disorder, which was conceptualised as a failure of self-discipline rather than a medical condition. The results confirm previous findings that EDs are more stigmatised than other mental or physical health conditions and extend the findings to an adolescent cohort

Self-reported Experiences of Students with Autism Spectrum Disorder in Higher Education: A Population-based Sample

Postsecondary education functions as the gateway to a host of positive adult outcomes, including financial independence, employment opportunities, and independent living. Despite this fact, few young adults with autism spectrum disorder (ASD) attend and remain enrolled in higher education. There is an urgent need for studies that better characterize college students with ASD using population-based samples. The current study examines the self-reported experiences of 206 college freshmen (N=103 students with self-identified ASD) who participated in a national survey at the end of their freshman year. ASD and no-ASD groups were matched on demographic characteristics and compared on domains of psychological stress, social self-confidence, connection to campus, self-regulated learning, and campus service use. Students with ASD reported significantly higher levels of psychological stress and significantly lower levels of social self-confidence compared to neurotypical peers. On all other domains, students with ASD were similar to their typically-developing counterparts. Findings have implications for the development of services and programs at higher education institutions that support all students