Cell phone-supported cognitive behavioural therapy for anxiety disorders: a protocol for effectiveness studies in frontline settings

The resulting protocol (NCT01205191 at clinicaltrials.gov) for use in frontline clinical practice in which effectiveness, adherence, and the role of the therapists are analyzed, provides evidence for what are truly valuable cell phone-supported CBT treatments and guidance for the broader introduction of CBT in health services.Original Publication:Joakim Ekberg, Toomas Timpka, Magnus Bång, Anders Fröberg, Karin Halje and Henrik Eriksson, Cell phone-supported cognitive behavioural therapy for anxiety disorders: a protocol for effectiveness studies in frontline settings., 2011, BMC medical research methodology, (11), 3.http://dx.doi.org/10.1186/1471-2288-11-3Copyright: BioMed Centralhttp://www.biomedcentral.com

Digital IAPT: the effectiveness & cost-effectiveness of internet-delivered interventions for depression and anxiety disorders in the Improving Access to Psychological Therapies programme: study protocol for a randomised control trial

BACKGROUND: Depression and anxiety are common mental health disorders worldwide. The UK's Improving Access to Psychological Therapies (IAPT) programme is part of the National Health Service (NHS) designed to provide a stepped care approach to treating people with anxiety and depressive disorders. Cognitive Behavioural Therapy (CBT) is widely used, with computerised and internet-delivered cognitive behavioural therapy (cCBT and iCBT, respectively) being a suitable IAPT approved treatment alternative for step 2, low- intensity treatment. iCBT has accumulated a large empirical base for treating depression and anxiety disorders. However, the cost-effectiveness and impact of these interventions in the longer-term is not routinely assessed by IAPT services. The current study aims to evaluate the clinical and cost-effectiveness of internet-delivered interventions for symptoms of depression and anxiety disorders in IAPT. METHODS: The study is a parallel-groups, randomised controlled trial examining the effectiveness and cost-effectiveness of iCBT interventions for depression and anxiety disorders, against a waitlist control group. The iCBT treatments are of 8 weeks duration and will be supported by regular post-session feedback by Psychological Wellbeing Practitioners. Assessments will be conducted at baseline, during, and at the end of the 8-week treatment and at 3, 6, 9, and 12-month follow-up. A diagnostic interview will be employed at baseline and 3-month follow-up. Participants in the waitlist control group will complete measures at baseline and week 8, at which point they will receive access to the treatment. All adult users of the Berkshire NHS Trust IAPT Talking Therapies Step 2 services will be approached to participate and measured against set eligibility criteria. Primary outcome measures will assess anxiety and depressive symptoms using the GAD-7 and PHQ-9, respectively. Secondary outcome measures will allow for the evaluation of long-term outcomes, mediators and moderators of outcome, and cost-effectiveness of treatment. Analysis will be conducted on a per protocol and intention-to-treat basis. DISCUSSION: This study seeks to evaluate the immediate and longer-term impact, as well as the cost effectiveness of internet-delivered interventions for depression and anxiety. This study will contribute to the already established literature on internet-delivered interventions worldwide. The study has the potential to show how iCBT can enhance service provision, and the findings will likely be generalisable to other health services. TRIAL REGISTRATION: Current Controlled Trials ISRCTN ISRCTN91967124. DOI: https://doi.org/10.1186/ISRCTN91967124 . Web: http://www.isrctn.com/ISRCTN91967124 . Clinicaltrials.gov : NCT03188575. Trial registration date: June 8, 2017 (prospectively registered)

Protocol for a randomised controlled trial investigating the effectiveness of an online e-health application compared to attention placebo or sertraline in the treatment of generalised anxiety disorder

Background: Generalised anxiety disorder (GAD) is a high prevalence, chronic psychiatric disorder which commonly presents early in the lifespan. Internet e-health applications have been found to be successful in reducing symptoms of anxiety and stress for post traumatic stress disorder (PTSD), panic disorder, social phobia and depression. However, to date, there is little evidence for the effectiveness of e-health applications in adult GAD. There are no studies which have directly compared e-health applications with recognised evidence-based medication. This study aims to determine the effectiveness of a web-based program for treating GAD relative to sertraline and attention placebo.Methods/Design: 120 community-dwelling participants, aged 18-30 years with a clinical diagnosis of GAD will be recruited from the Australian Electoral Roll. They will be randomly allocated to one of three conditions: (i) an online treatment program for GAD, E-couch (ii) pharmacological treatment with a selective serotonin re-uptake inhibitor (SSRI), sertraline (a fixed-flexible dose of 25-100 mg/day) or (iii) an attention control placebo, HealthWatch. The treatment program will be completed over a 10 week period with a 12 month follow-up.Discussion: As of February 2010, there were no registered trials evaluating the effectiveness of an e-health application for GAD for young adults. Similarly to date, this will be the first trial to compare an e-health intervention with a pharmacological treatment.Trial Registration: Current Controlled Trials ISRCTN76298775

Consideraciones preventivas para detectar la presencia del papilomavirus

The papillomavirus (HPV) is a common infection and most people contract at some point in their lives. The maximum incidence of HPV infectionoccurs in adolescence, shortly after the initiation of sexual activity, and most infections resolve spontaneously within two years, however, although there is no cure for This infection, warts, lesions and precancerous and cancerous changes caused by the virus can be treated. The objective of this research work, developed under a documentary methodology, is focused on making a review of the available scientific literature that mainly responds to what HPV is, what its types, how it is detected and what are the other technological alternatives for it. , what are considered the influential risk factors, what are the vaccines against HPV, how can infection be prevented and finally what with preventive considerations for detection, all with the purpose of providing updated material that defines these aspects. To this end, more than sixteen physical and digital sources were chosen, located in databases such as: Redalyc, Imbiomed, SciELO, Dialnet, Medlineplus, WHO, PAHO / PAHO, SCIelo, intramed, among others, which support the ideas presented here , and which consequently serve as a basis to conclude that it is still very important that programs provide information to the population in general about the prevention of HPV infection, other sexually transmitted infections and healthy sexual behaviors, However, both for those countries or governments that through their policies have already officially hosted some HPV test and for those who are still in that process, for these purposes, it is also advisable in terms of preventive considerations to detect the HPV. VPH, that take into consideration the clinicalvalidation of the test, operational and logistical aspects, in addition to the costs and benefits of the testing.O papilomavírus (HPV) é uma infecção comum e a maioria das pessoas se contrai em algum momento de suas vidas. A incidência máxima de infecção por HPV ocorre na adolescência, logo após o início da atividade sexual, e a maioria das infecções se resolve espontaneamente dentro de dois anos, embora não haja cura para essa infecção, verrugas, lesões e alterações pré-cancerosas e cancerígenas causadas pelo vírus. Pode ser tratado. O objetivo deste trabalho de pesquisa, desenvolvido sob uma metodologia documental, é focado em fazer uma revisão da literatura científica disponível que responda principalmente ao que é HPV, quais seus tipos, como é detectado e quais são as outras alternativas tecnológicas para o mesmo. , quais são os fatores de risco influentes, quais são as vacinas contra o HPV, como a infecção pode ser prevenida e, finalmente, quais as considerações preventivas para detecção, tudo com o objetivo de fornecer material atualizado que defina esses aspectos. Para tanto, foram escolhidas mais de dezesseis fontes físicas e digitais, localizadas em bases de dados como: Redalyc, Imbiomed, SciELO, Dialnet, Medlineplus, OMS, OPAS / OPAS, SCIelo, intramed, entre outras, que apóiam as ideias aqui apresentadas, e que, consequentemente, servem como base para concluir que ainda é muito importante que os programas forneçam informações à população em geral sobre a prevenção da infecção pelo HPV, outras infecções sexualmente transmissíveis e comportamentos sexuais saudáveis,no entanto, tanto para países como para governos que suas políticas já realizaram oficialmente alguns testes de HPV e, para aqueles que ainda estão nesse processo, para esses fins, também é aconselhável em termos de considerações preventivas para detectaro HPV. VPH, que leva em consideração a validação clínica do teste, aspectos operacionais e logísticos, além dos custos e benefícios dotesteEl papilomavirus (VPH) es una infección común y la mayoría de las personas contraen en algún momento de su vida. La incidencia máxima de la infección por el VPH se presenta en la adolescencia, poco después de la iniciación de la actividad sexual, y la mayoría de las infecciones se resuelven espontáneamente en un plazo de dos años, sin embargo, aunque no hay una cura para esta infección, las verrugas, lesiones y cambios precancerosos y cancerosos causados por el virus pueden ser tratados. El objetivo de este trabajo investigativo, desarrollado bajo un metodología documental, se centra en realizar una revisión a la literatura científica disponible que principalmente responda a qué es el VPH, cuáles con sus tipos, cómo se detecta y cuáles son las otras alternativas tecnológicas para ello, cuáles son considerados los fatores de riesgo influyentes, cales son las vacunas contra el VPH, cómo puede prevenirse la infección y finalmente cuales con las consideraciones preventivas para la detección, todo ello con la finalidad de proporcionar un material actualizado que defina dichos aspectos. Para ello se escogieron más de dieciséis fuentes físicas, y digitales, ubicadas en bases de datos tales como: Redalyc, Imbiomed, SciELO, Dialnet, Medlineplus, OMS, OPS/PAHO, SCIelo, intramed, entre otras, que fundamentan las ideas aquí planteadas, y que consecuentemente sirven de base para concluir que aún sigue siendo muy importante que mediante programas se brinde la información a la población en general sobre la prevención de la infección por el VPH, de las otras infecciones de transmisión sexual y de comportamientos sexuales sanos, sin embargo, tanto para aquellos países o gobiernos que mediante sus políticas ya han acogido oficialmente alguna prueba para la detección del VPH como para los que aún están en ese proceso, a tales fines, es igualmente recomendable en cuanto a las consideraciones preventivas para detectar el VPH, que tengan en consideración la validación clínica de la prueba, aspectos operacionales y logísticos, además de los costos y beneficios de la prueba

Failure to extinguish fear and genetic variability in the human cannabinoid receptor 1

Contains fulltext : 107888.pdf (publisher's version ) (Open Access)Failure to extinguish fear can lead to persevering anxiety and has been postulated as an important mechanism in the pathogenesis of human anxiety disorders. In animals, it is well documented that the endogenous cannabinoid system has a pivotal role in the successful extinction of fear, most importantly through the cannabinoid receptor 1. However, no human studies have reported a translation of this preclinical evidence yet. Healthy medication-free human subjects (N=150) underwent a fear conditioning and extinction procedure in a virtual reality environment. Fear potentiation of the eyeblink startle reflex was measured to assess fear-conditioned responding, and subjective fear ratings were collected. Participants were genotyped for two polymorphisms located within the promoter region (rs2180619) and the coding region (rs1049353) of cannabinoid receptor 1. As predicted from the preclinical literature, acquisition and expression of conditioned fear did not differ between genotypes. Crucially, whereas both homozygote (G/G, N=23) and heterozygote (A/G, N=68) G-allele carriers of rs2180619 displayed robust extinction of fear, extinction of fear-potentiated startle was absent in A/A homozygotes (N=51). Additionally, this resistance to extinguish fear left A/A carriers of rs2180619 with significantly higher levels of fear-potentiated startle at the end of the extinction training. No effects of rs1049353 genotype were observed regarding fear acquisition and extinction. These results suggest for the first time involvement of the human endocannabinoid system in fear extinction. Implications are that genetic variability in this system may underlie individual differences in anxiety, rendering cannabinoid receptor 1 a potential target for novel pharmacological treatments of anxiety disorders