An mHealth intervention for the treatment of patients with an eating disorder: A multicenter randomized controlled trial

Objective: The current multicentre randomized controlled trial assessed the clinicalefficacy of a combined mHealth intervention for eating disorders (EDs) based on cog-nitive behavioral therapy (CBT).Method: A total of 106 ED patients from eight different public and private mentalhealth services in Spain were randomly assigned to two parallel groups. Patients ofthe experimental group (N = 53) received standard face-to-face CBT plus a mobileintervention through an application called “TCApp,” which provides self-monitoringand an online chat with the therapist. The control group (N = 53) received standard face-to-face CBT only. Patients completed self-report questionnaires on ED symp-tomatology, anxiety, depression, and quality of life, before and after treatment.Results: Significant reductions in primary and secondary outcomes were observedfor participants of both groups, with no differences between groups. Results alsosuggested that the frequency with which patients attended their referral mentalhealth institution after the intervention was lower for patients in the experimentalgroup than for those in the control group.Discussion: The current study showed that CBT can help to reduce symptoms relat-ing to ED, regardless of whether its delivery includes online components in additionto traditional face-to-face treatment. Besides, the additional component offered bythe TCApp does not appear to be promising from a purely therapeutic perspectivebut perhaps as a cost-effective tool, reducing thus the costs and time burden associ-ated with weekly visits to health professionals.The current study is part of a broader project titled “mHealth: Chal-lenges and opportunities for health systems” which receives funding from RecerCaixa of “La Caixa” Foundation.Peer ReviewedPostprint (author's final draft

Psychiatric comorbidity and maternal distress among adolescent eating disorder patients: a comparison with substance use disorder patients

High rates of comorbidity are found among eating disorder (ED) patients, which may negatively affect treatment outcome and prognosis. However, there is a shortage of studies in Spain using clinician administered interviews to assess rates of comorbidity among these patients, particularly in adolescents. This study aimed to evaluate Axis I psychiatric diagnoses in adolescent patients with an ED and to compare them with patients with a distinct disorder with adolescent onset, substance use disorder (SUD) patients. Considering that maternal psychological distress is another factor involved in ED prognosis, a secondary aim was to examine the relationship between patient's psychological variables and maternal distress (depression and anxiety). The cross-sectional study included 50 ED patients, 48 SUD patients, and their mothers. More than half of the patients received a diagnosis for a comorbid disorder. Internalizing problems were more common among EDs and externalizing disorders were the most common comorbidities among SUDs, similar to findings from other countries. Maternal distress was associated with higher levels of depression and symptom severity in patients. No differences in distress were found between mothers of patients with a comorbid diagnosis and those without. Elevated anxiety or depression in mothers did not increase the likelihood of patients having a particular primary diagnosis. In short, while both ED and SUD patients presented high rates of comorbidity, the types of comorbid diagnoses were specific to each group. Assessing for the presence of comorbid disorders and targeting maternal psychological distress may guide treatment interventions and improve patient prognosisDr. Sepulveda has a postdoctoral Ramon and Cajal scholarship from the Spanish Ministry of Science and Innovation (RYC-2009-05092) as well as a project funded from the same Ministry (PSI2011-23127). Dr. Anastasiadou was awarded with a Research Fellowship for students of PhD Programmes distinguished with Mention of Excellence. Dr. Graell is a member of the Spanish Psychiatric Research Network (CIBERSAM

Online consultations in mental healthcare: Modelling determinants of use and experience based on an international survey study at the onset of the pandemic

Introduction: While online consultations have shown promise to be a means for the effective delivery of high -quality mental healthcare and the first implementations of these digital therapeutic contacts go back nearly two decades, uptake has remained limited over the years. The onset of the COVID-19 pandemic dramatically altered this relative standstill and created a unique turning point, with a massive amount of both professionals and clients having first hands-on experiences with technology in mental healthcare.Objective: The current study aimed to document the uptake of online consultations and explore if specific characteristics of mental health professionals across and beyond Europe could predict this.Methods: An international survey was designed to assess mental health professionals' (initial) experiences with online consultations at the onset of the pandemic: their willingness to make use of them and their prior and current experiences, alongside several personal characteristics. Logistic mixed-effects models were used to identify predictors of the use of online consultations, personal experience with this modality, and the sense of telepresence.Results: A total of 9115 healthcare professionals from 73 countries participated of which about two-thirds used online consultations during the initial COVID-19 outbreak. The current study identifies multiple determinants relating to the use and experience of online consultations, including the professionals' age, experience with the technology before the outbreak, the professional context, and training.Conclusions: Despite strong evidence supporting the relevance of training in digital mental health, this is clearly still lacking. Nevertheless, the COVID-19 pandemic presented a first, and potentially transformative, experience with online consultations for many healthcare professionals. The insights from this study can help supportprofessionals and, importantly, (mental) healthcare organisations to create optimal circumstances for selective and high-quality continued use of online consultations

Internet- and mobile-based psychological interventions: applications, efficacy, and potential for improving mental health.

The majority of mental health disorders remain untreated. Many limitations of traditional psychological interventions such as limited availability of evidence-based interventions and clinicians could potentially be overcome by providing Internet- and mobile-based psychological interventions (IMIs). This paper is a report of the Taskforce E-Health of the European Federation of Psychologists’ Association and will provide an introduction to the subject, discusses areas of application, and reviews the current evidence regarding the efficacy of IMIs for the prevention and treatment of mental disorders. Meta-analyses based on randomized trials clearly indicate that therapist-guided stand-alone IMIs can result in meaningful benefits for a range of indications including, for example, depression, anxiety, insomnia, or posttraumatic stress disorders. The clinical significance of results of purely self-guided interventions is for many disorders less clear, especially with regard to effects under routine care conditions. Studies on the prevention of mental health disorders (MHD) are promising. Blended concepts, combining traditional face-to-face approaches with Internet- and mobile-based elements might have the potential of increasing the effects of psychological interventions on the one hand or to reduce costs of mental health treatments on the other hand. We also discuss mechanisms of change and the role of the therapist in such approaches, contraindications, potential limitations, and risk involved with IMIs, briefly review the status of the implementation into routine health care across Europe, and discuss confidentiality as well as ethical aspects that need to be taken into account, when implementing IMIs. Internet- and mobile-based psychological interventions have high potential for improving mental health and should be implemented more widely in routine care

Social Support, Mental Health and Cardiac Disease

Worldwide, cardiac disease is the major cause of morbidity and death. Evidence has demonstrated that several psychosocial factors (i.e. depression, anxiety, type A behavioral pattern, type D personality, anger trait, low social support) combined with traditional risk factors (e.g., smoking, diabetes, drinking, lack of adherence to medical treatment, familiarity), could increase the onset’ risk of a cardiac disease or affect its prognosis. Among these psychosocial factors, a major role is played by social support. Evidence has in fact shown that low or no social support is strictly related to other negative psychological conditions (e.g., anxiety or depression), that in turn could lead, directly or indirectly, to the onset of a cardiac disease or to an adverse prognosis. Conversely, a good social support could have a cardioprotective effect on individuals suffering of cardiovascular diseases. However, literature has suggested that the health benefits of social support are overall moderated by their affiliative quality. Due to the central role of social support in the etiology and prognosis of a cardiac disease, the importance of taking it into account in cardiac rehabilitation and preventive programs will be discussed

Efficacy of time- and frequency-domain heart rate variability features in stress detection and their relation with coping strategies

Heart Rate Variability (HRV) is a reliable biomarker of the Autonomic Nervous System (ANS) activity and it is widely used to characterize the stress response induced by different laboratory stress tasks. Even if acute stress responses have been previously investigated, researchers are still wondering which HRV indices are more effective for stress assessment. In the present study, we extracted several time- and frequency-domain HRV parameters and investigated which ones are better able to discriminate between a stressful and a non-stressful condition. Moreover, we explored the possibility of a linear correlation between such parameters and certain coping strategies, during three laboratory stress tasks (Montreal Imaging Stress Task, Stroop Color-Word, Speech). The effect size computed for each considered HRV parameter indicate that the average RR interval and the normalized power in low frequency (LF) band were the most effective parameters for the detection of mental stress. As regards the second hypothesis, normalized power in high frequency (HF) band during Speech was found significantly and negatively correlated with specific subscales of the administered questionnaires (CERQ-S and COPE-NVI), suggesting a possible association between the higher use of social support (SS) and other blame (OB) coping strategies and stronger autonomic responses during the Speech task

Insecure attachment and technology addiction among Italian young adults: the mediating role of impulsivity, alexithymia and general psychological distress

Introduction: The majority of previous studies (Schimmenti et al., 2014) have investigated the direct effect of insecurity attachment with youth's internet and smartphone addiction. However, the potential mediators of this relation have been understudied. In this contribution, we examined the mediating role of some psychological risk factors (i.e., impulsivity, psychological distress and alexithymia) in the relation between insecure attachment dimensions (i.e., attachment anxiety and attachment avoidance) and technology addiction (i.e. problematic Internet use, smartphone addiction and Internet addiction). In addition, we also tested the moderating role of gender. Materials and Methods: Data were collected from 539 Italian adolescents and young adults, mostly females (N = 378; 70.1%), aged 19.76 ± 1.99 years. Participants completed self-report measures of attachment insecurity, psychological risk factors and technology addiction. Results: Main results from multi-group path analysis model showed that attachment anxiety had no direct effect on technology addiction,whereas attachment avoidance had a small negative direct effect, but only among women. Anxiety and avoidant attachment dimensions were significantly and positively associated with technology addiction only through the increase of all psychological risk factors. Finally, no moderation effect of gender was found. Discussion: Findings suggested that higher levels of insecure attachment dimensions are associated with higher levels of impulsivity, psychological distress and alexithymia that in turn contribute to the increase of technology addiction. Such findings might have relevant implications to inform any treatment plan for young adults who are overinvolved with technology activities and so to deliver patient-tailored interventions

Could fNIRS Promote Neuroscience Approach in Clinical Psychology?

The purpose of the present commentary is to consider new perspectives of investigation methods used in clinical psychology studies. We propose that functional Near-Infrared Spectroscopy (fNIRS) has several important advantages over currently used methods. This technique opens the opportunity to transfer psychophysiological evidences in clinical settings, for example to evaluate psychophysiological underpinnings of depressive symptomatology. Indeed, fNIRS technology might be promisingly used to find out objective biomarkers of relapse risk of depression after pharmacological and psychotherapeutic treatments

A Serial Mediation Model of Insecure Attachment and Psychological Distress: The Role of Dispositional Shame and Shame-Coping Styles

Shame is an intense, difficult to regulate, self-conscious emotion that predicts aspects of poor psychological functioning and is also strongly related to early relationships. Attachment insecurities, which constitute non-specific risk factors for psychological maladjustment, have been associated with an individual’s tendency to experience shame. In this study, we sought to examine the serial mediating roles of dispositional shame and shame-coping styles (i.e., attack other, attack self, withdrawal and avoidance) in the association between anxious and avoidant attachment, and psychological distress. Using a cross-sectional design, self-reported data were collected. The study sample included 978 respondents (57% female) with a mean age of 32.17 ± 13.48 years. The results of the path analysis indicated that both attachment dimensions were sequentially associated with dispositional shame and then with the attack self shame-coping style, which was, in turn, positively related to psychological distress. Further, attachment insecurities were sequentially associated with dispositional shame and then with the avoidance shame-coping style, which was, in turn, negatively related to psychological distress. The model was gender invariant, suggesting that the serial mediation worked in a similar way for men and women. The practical implications of these findings are discussed