A systematic review of online interventions for mental health in low and middle income countries : a neglected field

Background. Low and middle income countries (LMICs) are facing an increase of the impact of mental health problems while confronted with limited resources and limited access to mental health care, known as the ‘mental health gap’. One strategy to reduce the mental health gap would be to utilize the internet to provide more widely-distributed and low cost mental health care. We undertook this systematic review to investigate the effectiveness and efficacy of online interventions in LMICs. Methods. We systematically searched the data-bases PubMed, PsycINFO, JMIR, and additional sources. MeSH terms, Thesaurus, and free text keywords were used. We included all randomized controlled trials (RCTs) of online interventions in LMICs. Results. We found only three articles reported results of RCTs on online interventions for mental health conditions in LMICs, but none of these interventions was compared with an active control condition. Also, the mental health conditions were diverse across the three studies. Conclusions. There is a dearth of studies examining the effect of online interventions in LMICs, so we cannot draw a firm conclusion on its effectiveness. However, given the effectiveness of online interventions in high income countries and sharp increase of internet access in LMICs, online interventions may offer a potential to help reduce the ‘mental health gap’. More studies are urgently needed in LMICs

Network destabilization and transition in depression : new methods for studying the dynamics of therapeutic change

The science of dynamic systems is the study of pattern formation and system change. Dynamic systems theory can provide a useful framework for understanding the chronicity of depression and its treatment. We propose a working model of therapeutic change with potential to organize findings from psychopathology and treatment research, suggest new ways to study change, facilitate comparisons across studies, and stimulate treatment innovation. We describe a treatment for depression that we developed to apply principles from dynamic systems theory and then present a program of research to examine the utility of this application. Recent methodological and technological developments are also discussed to further advance the search for mechanisms of therapeutic change

Breaking the Rhythm of Depression: Cognitive Behavior Therapy and Relapse Prevention for Depression

A crucial part of the treatment of depression is the prevention of relapse and recurrence. Psychological interventions, especially cognitive behavior therapy (CBT) are helpful in preventing relapse and recurrence in depression. The effectivity of four types of relapse prevention cognitive behavior therapy strategies will be addressed, i.e. acute prophylactic cognitive behavior therapy, continuation cognitive behavior therapy, sequential cognitive behavior therapy and cognitive behavior therapy in partial remission. Specific ingredients of three sequential cognitive behavior therapy programs (well-being cognitive therapy, preventive cognitive therapy, and mindfulness-based cognitive therapy) will be discussed as applied after remission in patients that experienced previous depressive episodes. Sequential preventive cognitive behavior therapy after acute treatment may be an attractive alternative treatment for many patients who currently use antidepressants for years and years to prevent relapse and recurrence. This is an extremely challenging issue to research thoroughly. Future studies must rule out what intervention for whom is the best protection against relapse and recurrence in depression

Imagery Rescripting : The Impact of Conceptual and Perceptual Changes on Aversive Autobiographical Memories

BACKGROUND: Imagery rescripting (ImRs) is a process by which aversive autobiographical memories are rendered less unpleasant or emotional. ImRs is thought only to be effective if a change in the meaning-relevant (semantic) content of the mental image is produced, according to a cognitive hypothesis of ImRs. We propose an additional hypothesis: that ImRs can also be effective by the manipulation of perceptual features of the memory, without explicitly targeting meaning-relevant content. METHODS: In two experiments using a within-subjects design (both N = 48, community samples), both Conceptual-ImRs-focusing on changing meaning-relevant content-and Perceptual-ImRs-focusing on changing perceptual features-were compared to Recall-only of aversive autobiographical image-based memories. An active control condition, Recall + Attentional Breathing (Recall+AB) was added in the first experiment. In the second experiment, a Positive-ImRs condition was added-changing the aversive image into a positive image that was unrelated to the aversive autobiographical memory. Effects on the aversive memory's unpleasantness, vividness and emotionality were investigated. RESULTS: In Experiment 1, compared to Recall-only, both Conceptual-ImRs and Perceptual-ImRs led to greater decreases in unpleasantness, and Perceptual-ImRs led to greater decreases in emotionality of memories. In Experiment 2, the effects on unpleasantness were not replicated, and both Conceptual-ImRs and Perceptual-ImRs led to greater decreases in emotionality, compared to Recall-only, as did Positive-ImRs. There were no effects on vividness, and the ImRs conditions did not differ significantly from Recall+AB. CONCLUSIONS: Results suggest that, in addition to traditional forms of ImRs, targeting the meaning-relevant content of an image during ImRs, relatively simple techniques focusing on perceptual aspects or positive imagery might also yield benefits. Findings require replication and extension to clinical samples

The potential of low-intensity and online interventions for depression in low- and middle-income countries

The World Health Organization (WHO) reports that low- and middle-income countries (LMICs) are confronted with a serious ‘mental health gap’, indicating an enormous disparity between the number of individuals in need of mental health care and the availability of professionals to provide such care (WHO in 2010). Traditional forms of mental health services (i.e. face-to-face, individualised assessments and interventions) are therefore not feasible. We propose three strategies for addressing this mental health gap: delivery of evidence-based, low-intensity interventions by non-specialists, the use of transdiagnostic treatment protocols, and strategic deployment of technology to facilitate access and uptake. We urge researchers from all over the world to conduct feasibility studies and randomised controlled studies on the effect of low-intensity interventions and technology supported (e.g. online) interventions in LMICs, preferably using an active control condition as comparison, to ensure we disseminate effective treatments in LMICs

Two commuting operators associated with a tridiagonal pair

Let \K denote a field and let V denote a vector space over \K with finite positive dimension. We consider an ordered pair of linear transformations A:V\to V and A*:V \to V that satisfy the following four conditions: (i) Each of A,A* is diagonalizable; (ii) there exists an ordering {V_i}_{i=0}^d of the eigenspaces of A such that A*V_i\subseteq V_{i-1}+V_i+V_{i+1} for 0\leq i\leq d, where V_{-1}=0 and V_{d+1}=0; (iii) there exists an ordering {V*_i}_{i=0}^{\delta} of the eigenspaces of A* such that AV*_i\subseteq V*_{i-1}+V*_i+V*_{i+1} for 0\leq i\leq\delta, where V*_{-1}=0 and V*_{\delta+1}=0; (iv) there does not exist a subspace W of V such that AW\subseteq W, A*W\subseteq W, W\neq0, W\neq V. We call such a pair a TD pair on V. It is known that d=\delta; to avoid trivialities assume d\geq 1. We show that there exists a unique linear transformation \Delta:V\to V such that (\Delta -I)V*_i\subseteq V*_0+V*_1+...+V*_{i-1} and \Delta(V_i+V_{i+1}+...+V_d)=V_0 +V_{1}+...+V_{d-i} for 0\leq i \leq d. We show that there exists a unique linear transformation \Psi:V\to V such that \Psi V_i\subseteq V_{i-1}+V_i+V_{i+1} and (\Psi-\Lambda)V*_i\subseteq V*_0+V*_1+...+V*_{i-2} for 0\leq i\leq d, where \Lambda=(\Delta-I)(\theta_0-\theta_d)^{-1} and \theta_0 (resp \theta_d) denotes the eigenvalue of A associated with V_0 (resp V_d). We characterize \Delta,\Psi in several ways. There are two well-known decompositions of V called the first and second split decomposition. We discuss how \Delta,\Psi act on these decompositions. We also show how \Delta,\Psi relate to each other. Along this line we have two main results. Our first main result is that \Delta,\Psi commute. In the literature on TD pairs there is a scalar \beta used to describe the eigenvalues. Our second main result is that each of \Delta^{\pm 1} is a polynomial of degree d in \Psi, under a minor assumption on \beta.Comment: 36 page