Identifying mediators of cognitive behaviour therapy and exposure therapy for social anxiety disorder (SAD) using repeated measures

Background: Process research aims to identify mediators of therapy which can help increase the efficacy and optimization of therapy. The present study examined the role of estimated social cost, perceived social self-efficacy and perceived emotional control as potential mediators in Cognitive Behaviour Therapy (CBT) and Exposure Therapy (EXP) in individuals with social anxiety disorder. Methods: Fifty adults with a primary diagnosis of social anxiety disorder (SAD) were recruited from a tertiary treatment center and randomly assigned to receive either CBT (N=25) or EXP (N=25).Levels of social anxiety, estimated social cost, perceived social self-efficacy, and perceived emotional control were assessed at the beginning of each session. Multilevel modeling was used to estimate the effects of the above variables on social anxiety and examine differences between the two groups. Results: Changes in perceived social self-efficacy and estimated social cost predicted changes in social anxiety. Perceived emotional control was not a significant predictor of changes in social anxiety. There were no significant differences between the two groups. Limitations: The study has a small sample size, and there is a lack of adequate follow-up data. A single therapist delivered both interventions, which could limit external validity. Conclusions: Perceived social self-efficacy and estimated social cost emerged as mediators of both CBT and EXP. The two interventions had common meditational pathways, and there was an interactive bi-directional relationship between social anxiety and the studied mediators

Effectiveness of a brief lay counsellor-delivered, problem-solving intervention for adolescent mental health problems in urban, low-income schools in India: a randomised controlled trial

Background Mental health problems are a leading cause of disability in adolescents worldwide. Problem solving is a well-tested mental health intervention in many populations. We aimed to investigate the effectiveness of a brief, transdiagnostic problem-solving intervention for common adolescent mental health problems when delivered by non-specialist school counsellors in New Delhi, India. Methods This randomised trial was done in six government-run schools (three all-boys schools, two all-girls schools, and one co-educational school) that serve low-income communities. We recruited participants from grades 9 to 12 (ages 12–20 years) by selecting students with persistently elevated mental health symptoms accompanied by distress or functional impairment. Clinical eligibility criteria were assessed by research assistants using the Hindi-language version of the Strengths and Difficulties Questionnaire (SDQ), with reference to locally validated borderline cutoff scores of 19 or greater for boys and 20 or greater for girls on the SDQ Total Difficulties scale, an abnormal score of 2 or more on the SDQ Impact scale, and persistence of more than 1 month on the SDQ Chronicity index. Participants were randomly allocated (1:1) to problem solving delivered through a brief (2–3 week) counsellor-led intervention with supporting printed materials (intervention group), or problem solving delivered via printed booklets alone (control group). Primary outcomes were adolescent-reported mental health symptoms (SDQ Total Difficulties scale) and idiographic psychosocial problems (Youth Top Problems [YTP]) at 6 weeks. Primary analyses were done on an intention-to-treat basis at the 6-week endpoint. The trial is registered with ClinicalTrials.gov, NCT03630471. Findings Participants were enrolled between Aug 20, and Dec 4, 2018. 283 eligible adolescents were referred to the trial, and 251 (89%) of these were enrolled (mean age 15·61 years; 174 [69%] boys). 125 participants were allocated to each group (after accounting for one participant in the intervention group who withdrew consent after randomisation). Primary outcome data were available for 245 (98%) participants. At 6 weeks, the mean YTP scores were 3·52 (SD 2·66) in the intervention group and 4·60 (2·75) in the control group (adjusted mean difference –1·01, 95% CI –1·63 to –0·38; adjusted effect size 0·36, 95% CI 0·11 to 0·61; p=0·0015). The mean SDQ Total Difficulties scores were 17·48 (5·45) in the intervention group and 18·33 (5·45) in the control group (–0·86, –2·14 to 0·41; 0·16, –0·09 to 0·41; p=0·18). We observed no adverse events. Interpretation A brief lay counsellor-delivered problem-solving intervention combined with printed booklets seemed to have a modest effect on psychosocial outcomes among adolescents with diverse mental health problems compared with problem-solving booklets alone. This counsellor-delivered intervention might be a suitable first-line intervention in a stepped care approach, which is being evaluated in ongoing studies

Depression with and without preceding life event: Differential recognition and professional help-seeking inclination in youth?

Background: Low rates of professional help seeking for depression by youth is a well known global challenge. The study aimed at examining whether there might be differences in the rates of recognition of a hypothetical problem as a mental health problem when depressive symptoms are depicted as occurring in the context of a negative life event as compared to when these symptoms are depicted as occurring without any negative life event. The relationship between recognition as a mental health problem and help-seeking inclination from mental health professionals was also examined. Methods: Three hundred college youths within 18–25 years of age range formed the sample. Two vignettes describing moderate depression were used for all the participants. These two vignettes had identical content except that one of these mentioned a negative life event preceding the onset of depression. Each of these vignettes was followed by items to elicit recognition of the problem and inclination to seek help from mental health professionals if one was experiencing a similar problem. Results: Depressive symptoms arising in the context of a negative life event were less likely to be labeled as mental health problem and also less likely to be identified as depression. Accurate recognition of the problem as a mental health problem went hand in hand with significantly higher inclination to seek help from mental health professionals, but this was evident only in the vignette describing depressive symptoms without negative life event. Conclusion: The findings have implications for further research and for designing programs to improve help seeking for depression in Indian youth

Brief cognitive behavior therapy in patients with social anxiety disorder: A preliminary investigation

Context: Cognitive behavior therapy (CBT) is the treatment of choice in anxiety disorders. However, there is little evidence for the effectiveness brief CBT in social anxiety. Aims: We examined the effectiveness of a brief CBT of six sessions in patients with social anxiety disorder. Settings and Design: A single case design study baseline; post and 1 month follow-up was adopted. Materials and Methods: Seven patients with a DSM IV diagnosis of social anxiety underwent 6 weekly sessions of brief CBT. Their diagnosis was confirmed using structured diagnostic interviews. They were assessed at baseline, post and 1-month follow-up on CGI- Severity, Leibowitz Social Anxiety Scale (LSAS), Social Phobia Rating Scale, Brief Fear of Negative Evaluation, and Beck′s Depression Inventory. Statistical Analysis: Data were analyzed using the method of clinical significance. Results: Results indicated that brief CBT was effective in reducing social anxiety in all patients. Brief CBT was also effective in reducing social avoidance and self consciousness. However, brief CBT was not effective in reducing fear of negative evaluation in all patients, suggesting the need for longer duration for cognitive changes in some dysfunctional beliefs. Conclusions: This preliminary case series indicates that brief CBT may be a promising and a cost and time effective approach to managing for social anxiety

Felt needs for psychological training to enhance performance: Perspectives of youth engaged in competitive sports

Background: Individuals undergoing training in competitive sports are required to deal with various challenges such as real and perceived pressures to perform and invest sustained efforts in rigorous training regimens. Global literature indicates successful inclusion of psychological components in the training of sportspersons. It is well recognized that training programs need to be designed keeping in view the local contextual factors as well as felt needs. However, there are very few studies from India that have explored felt needs of individuals training in competitive sports. Aim: The study was conducted to explore felt needs for psychological inputs in youth selected for training in various sports by the Youth Empowerment and Sports Department, Government of Karnataka. Method: The sample composed of 166 youth (males = 98 females = 68), aged between 16 and 21 years, residing in state sports hostels of Bengaluru and Mysuru and undergoing training in competitive sports. A ten-item survey prepared based on the literature review, and a pilot study was used to assess felt needs for training in psychological aspect for performance enhancement. Results: Learning ways to maintain motivation for sports practice despite ups and downs in performance/other obstacles, maintaining self-esteem, managing disappointments, managing anger, and handling stress related to injuries received highest endorsements (75% or more) as strong felt needs in the overall sample. Only a few differences emerged between genders and age groups. Conclusion: The study has implications for integrating psychological training into the routine training of young sportspersons engaged in competitive sports