The relationship between rumination, depression and self-stigma in hazardous drinkers : an exploratory study

Background: Self-stigma may have an important impact on people living with alcohol use disorders, however, few studies have explored the relationship between rumination and depression on self-stigma for people with hazardous drinking. Objectives: This study aimed to explore the relationship between rumination, self-stigma and depressive symptomatology for those with hazardous drinking levels and the relationship between these and alcohol use severity. Method: Participants were recruited online between February and May of 2019 through paid advertising on a page created on Facebook by the researcher. Two hundred and one participants completed the online survey questionnaires, with 114 (56.7%) meeting the Alcohol Use Disorders Identification Test (AUDIT) criteria with a score of 8 or above indicating hazardous drinking. Results: Step-wise regression analyses found that self-stigma and rumination were significant predictors of alcohol severity. Depression and rumination were found to be significant predictors of self-stigma. At Step 1 only rumination was significant, with this scale significantly predicting 26% of the variance of the internalised stigma. Conclusion: Although rumination was not a significant predictor of alcohol use severity in this study, it appeared to play an important part in the self-stigma for people engaged in hazardous drinking. More research is needed to determine the mediating factors in this relationship and the impact of these for people with hazardous drinking levels over time

Personal recovery in psychological interventions for bipolar disorder : a systematic review

Objective: Psychological interventions comprise a critical aspect of treatment for bipolar disorder. However, many interventions to date have focussed on clinical recovery outcomes, such as relapse prevention, rather than preferred personal recovery outcomes of hope and a meaningful life. The aim of this review was to identify, appraise and synthesise information regarding the availability, content and efficacy of recovery-oriented psychological interventions for individuals with bipolar disorder. Methods: A systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Databases searched included PubMed, EMBASE, PsychINFO, CINAHL and SCOPUS. The inclusion criteria were studies that assessed a psychological intervention in participants with a diagnosis of bipolar disorder and assessed personal recovery outcomes either qualitatively or qualitatively. Results: Five articles were included from the titles assessed (N = 507). All studies (N = 5) employed recovery-focussed interventions based on principles of Cognitive Behaviour Therapy (CBT) and were quantitative designs. Two studies used online, self-paced interventions, two studies used group psychoeducation programs, and one study used individual manualised therapy. All studies found a significant improvement in personal recovery. No studies assessed personal recovery outcomes qualitatively. Conclusions: Whilst data is limited, initial evidence suggests that recovery-oriented interventions may be effective in improving personal recovery in people living with bipolar disorder. Limitation of this review include a focus on those studies that assessed personal recovery. Clinicians should consider personal recovery-orientated interventions in the treatment of bipolar disorder and further assess recovery outcomes as part of practice

Demographic and clinical differences between bipolar disorder patients with and without alcohol use disorders

Background: Bipolar disorder (BD) and alcohol use disorder (AUD) are two major independent causes of psychopathology in the general population. The prevalence of AUD in BD is high. Identifying the clinical and demographic features of patients with BD who may develop AUD could help with early identification and intervention. Methods: Data from 238 patients diagnosed with BD were gathered on alcohol use, social demographics, longitudinal course of BD, clinical features of the most severe lifetime manic and depressive episodes, comorbid physical diseases, anxiety disorders, and other substance use disorders. Results: We found that 74 of 238 BD patients had AUD (67 with alcohol dependence and 7 with alcohol abuse). Bivariate logistic regression analysis and multivariate logistic regression analysis found that the best predictors of AUD in patients with BD were being male (OR = 2.086, 95% CI = 1.094–3.979, p = 0.001), younger (OR = 0.965, 95% CI = 0.935–0.996, p = 0.026), and comorbidity with other unclassified substance dependence (OR = 10.817, 95% CI = 1.238–94.550, p = 0.031). Conclusions: Male, younger current age, and having other substance use disorders were independently associated with AUD

Paper 2 : a systematic review of narrative therapy treatment outcomes for eating disorders : bridging the divide between practice‑based evidence and evidence‑based practice

Background: Narrative therapy has been proposed to have practice-based evidence however little is known about its research evidence-base in the treatment of eating disorders. The aim of this study was to conduct a systematic review of the outcome literature of narrative therapy for eating disorders. Method: Treatment outcome data were extracted from 33 eligible included studies following systematic search of five data bases. The study is reported according to Preferred Reporting items for Systematic Reviews and Meta-Analyses guidelines. Results: Of the identified 33 studies, 3 reported positive outcomes using psychometric instruments, albeit some were outdated. Otherwise, reported outcomes were based on therapy transcript material and therapist reports. The most commonly reported treatment outcome was in relation to shifts in identity narratives and improved personal agency with a trend towards under-reporting shifts in ED symptoms. Some improvements were reported in interpersonal and occupational engagement, reduced ED symptoms, and improved quality of life, however, there was an absence of standardized measures to support these reports. Conclusions: This systematic review found limited support for narrative therapy in the treatment of eating disorders through practice-based evidence in clinician reports and transcripts of therapy sessions. Less is known about systematic treatment outcomes of narrative therapy. There is a need to fill this gap to understand the effectiveness of narrative therapy in the treatment of EDs through systematic (1) Deliveries of this intervention; and (2) Reporting of outcomes. In doing so, the research arm of narrative therapy evidence base will become more comprehensively known

Predictors of digital technology-based mental health programs in young adults for mental health support

Technology-based platforms are widely used to deliver mental health support. The aim of this study was to explore factors associated with the use of technology-based mental health platforms by students who may be vulnerable to develop a mental health condition in an Australian psychology student sample. Participants were 1146 students (18–30 years) at an Australian university who completed a survey regarding their current mental health symptoms and lifetime use of technology-based platforms. The student’s country of birth, having a previous mental health diagnosis, having a family member with a mental illness and greater stress scores predicted any type of online/technology-use. Greater symptoms correlated with lower helpfulness of online mental health programs and websites. Apps were perceived as more helpful by those with a mental illness history and associated with higher stress scores. The use of any type of technology-based platform was high in the sample overall. Further research may clarify why mental health programs are less popular, and how these platforms may be utilised to support mental health outcomes

Transdiagnostic group cognitive behaviour therapy for anxiety in bipolar disorder : a pilot feasibility and acceptability study

Objective: Anxiety is prominent for many people living with bipolar disorder, yet the benefit of psychological interventions in treating this co-morbidity has been minimally explored and few studies have been conducted in a group format. This study aimed to assess the feasibility and acceptability of a transdiagnostic cognitive behaviour therapy group anxiety programme (CBTA-BD) for people living with bipolar disorder. Methods: Participants were recruited to take part in a 9-week group therapy programme designed to treat anxiety in bipolar disorder using cognitive behaviour therapy. They were assessed by structured interview (SCID-5 RV) to confirm the diagnosis of bipolar disorder and assessed for anxiety disorders. Self-report questionnaires—DASS (depression, anxiety, stress), ASRM (mania), STAI (state and trait anxiety) and Brief QOL.BD (quality of life) pre- and post-treatment were administered. Results: Fourteen participants enrolled in the programme, with 10 participants (5 male; 5 female) completing the follow-up assessments. Two groups (one during working hours, the other outside working hours) were conducted. The programme appeared acceptable and feasible with a mean of 6.9 (77%) sessions attended, though five (50%) participants completed less than 3 weeks homework. Conclusion: The transdiagnostic cognitive behaviour therapy group anxiety programme (CBTA-BD) proved feasible and acceptable for participants; however, homework compliance was poor. A larger randomised pilot study is needed to assess the benefits of the intervention on symptom measures and address homework adherence, possibly through providing support between sessions or tailoring it more specifically to participant needs

Use of self-care strategies in the management of bipolar disorder and their relationship to symptoms, illness intrusiveness, and quality of life

Background: The benefits of self-care have been reported in other chronic illnesses, but bipolar disorder research has focused primarily on medication management. This study explored the use of self-care strategies by people living with bipolar disorder and the relationships between the use of self-care strategies and symptoms, illness intrusiveness, and quality of life. Methods: Eighty participants with bipolar disorder were recruited to participate in an online survey. Participants provided clinical backgrounds and self-reported current symptoms of depression, mania, anxiety, stress, perceived illness intrusiveness and the frequency of use, and perceived helpfulness of 69 self-care strategies. Results: A range of self-care strategies were endorsed, including "spend time with your pet or other animal," as well as creative pursuits. "Abstain from recreational drugs" was the strategy most commonly endorsed as being used frequently, while "get enough sleep" was most commonly rated as being the most helpful. Greater frequency of use of self-care strategies was significantly associated with improved quality of life, reduced illness intrusiveness, and reduced depression, anxiety, and stress scores, but not self-reported mania scores. Conclusions: This study provides support for strategies relating to sleep, and drug and alcohol abstinence, and for several strategies yet to be explored such as spending time with pets. Future studies should explore the use of these strategies longitudinally and how depression symptoms may mediate the relationship between the use of self-care strategies, quality of life, and illness intrusiveness

Mental health mobile application usage in young adults with a family history of mental illness

Objective: Young adults with a family history of mental illness are at increased risk of developing mental disorders. The current study aimed to assess how young at-risk individuals use mental health applications (MHAs) in comparison with those not at-risk, and whether these groups differed in the types of MHAs used, how helpful they found MHAs, and their reasons for and against using MHAs. Method: An online survey was conducted where young adults aged 18–30 years (N = 525; 389 female) were asked about their immediate family history of any diagnosis of any mental illness and their use of MHAs. The responses were analysed using chi-square tests of independence. Results: Young adults with a family history of mental illness (N = 271) were more likely to report using MHAs and more likely to use MHAs for mental wellbeing than those who did not have a family history of mental illness. They were also more likely not to use MHAs if they were not useful or did not want to use them. Individuals who identified as “other” genders were also more likely to use MHAs while males were less likely to use MHAs. Conclusions: MHAs may be a viable avenue to engage at-risk individuals in targeted treatment and suggests the need to develop apps tailored to this population. It is recommended that future research explores the efficacy of MHAs in reducing psychiatric symptomatology in the at-risk population, and how apps may be used by clinicians most effectively as part of treatment

[In Press] Use of mobile mindfulness apps in young adults with depression : results from a cross-sectional survey

With increasing smartphone ownership, studies have examined whether mobile mindfulness applications (MMAs) can reduce depression symptoms. However, no studies have examined how real-world, self-directed MMA use may differ between depressed and nondepressed populations nor assessed this use in a sample of young adults. An online international survey was conducted with 726 participants, aged 18–30 years taking part, and assessed whether MMA use, perceived helpfulness of MMAs, reasons for and against MMA use, and frequency and recency of MMA use differed across categories of depression severity (no depression N = 229, mild–moderate N = 212, severe–extreme N = 285) as measured via the Depression, Anxiety and Stress Scale (DASS-21) depression subscale. Young adults with severe–extreme depression were more likely to report using MMAs, compared with participants with mild–moderate depression and no depression groups. Participants with severe–extreme depression were most likely to use MMAs for their own well-being, citing knowledge barriers and lack of efficacy as reasons for not using MMAs. Participants with severe–extreme and mild–moderate depression found MMAs less helpful than those with no depression symptoms. These findings suggest young adults with severe depression symptoms may view MMAs as viable self-help tools for mental well-being. Future app development should consider severely depressed populations as potential users and psychologists in practice should further be aware that young adults with severe depression are using mindfulness apps to support their mental health and well-being. Assessment of mindfulness app use by young adults may be important when considering psychological treatment for this population

Psychological interventions for young people at risk for bipolar disorder : a systematic review

Objectives: Several studies have recently been conducted that have explored the benefits of psychological interventions in reducing symptomatology or improving outcomes in young people at-risk of developing bipolar disorder. The aim of this review was to explore if such interventions reduce current psychiatric symptoms and prevent the development of new symptoms. Methods: A systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Databases searched were MEDLINE, EMBASE, PsychInfo, CINAHL and SCOPUS from January 1990 until August 2018. The inclusion criteria were young people aged under 30 years with a family history of bipolar disorder and any empirical studies that contained a psychological or psychoeducation intervention. Results: A total of 7 articles (N = 138, 55 males) were included (mean age ranged from 12 to 15 years). Interventions conducted included Family Focussed Therapy, Interpersonal and Social Rhythm Therapy, and Mindfulness-based Cognitive Therapy for Children. Significant results were found in some studies, depending on the sample's initial symptoms, with reduced time to relapse and reduced symptoms of anxiety, depression and hypo/mania being found. Limitations: No studies have explored if interventions may delay the time to onset of first hypo/manic episodes and only two randomised controlled trials were identified. Conclusions: Some significant results were noted with lower symptoms of anxiety, depression and hypo/mania being found in some studies. It is currently unclear if psychological interventions may prevent the development of bipolar disorder or other psychiatric symptoms over time; further longitudinal studies are required