Barriers and facilitators to community-based psycho-oncology services: a qualitative study of health professionals’ attitudes to the feasibility and acceptability of a shared care model

Psychological therapies combined with medication are effective treatments for depression and anxiety in patients with cancer. However, the psycho-oncology workforce is insufficient to meet patient need and is hard to access outside of major cities. To bridge this gap, innovative models of care are required. Implementation of a new model of care requires attention to the facilitators and barriers. The aim of this study was to explore stakeholders' attitudes to the feasibility and acceptability of a community-based, shared care model for the treatment of depression and anxiety.Semi-structured interviews were conducted with community-based clinical psychologists (n=10), general practitioners (n=6) and hospital-based psychologists working in psycho-oncology (n=9). Framework analysis was conducted to identify key themes.All stakeholders perceived the model as feasible and acceptable. Potential barriers/facilitators to implementation were summarised under six key themes: (1) initiative, ownership and autonomy, (2) resources, (3) pathway establishment, (4) support, (5) skill acquisition, and (6) patient engagement. Facilitators included quality communication between health professionals across primary and tertiary care, and appropriate education and support for community-based clinicians.This in-depth exploration of Australian health professionals' perceptions of the feasibility and acceptability of a community-based model of psycho-oncology care revealed that most clinicians were willing to adopt the proposed changes into practice. An RCT of a shared care intervention for depressed patients with cancer is needed

Treating youth depression and anxiety: a randomised controlled trial examining the efficacy of computerised versus face-to-face cognitive behaviour therapy

Barriers to accessing psychologists for the treatment of depression and anxiety include a shortage of specialised therapists, long waiting lists, and the affordability of therapy. This study examined the efficacy of a computerised-based self-help program (MoodGYM) delivered in-conjunction with face-to-face cognitive behavioural therapy (CBT) to expand the delivery avenues of psychological treatment for young adults (aged 18-25 years). Eighty-nine participants suffering from depression and/or generalised anxiety were randomly allocated to a control intervention or to one of three experimental groups: receiving face-to-face CBT, receiving computerised CBT (cCBT), or receiving treatment in-conjunction (face-to-face CBT and cCBT). While MoodGYM did not significantly decrease depression in comparison to the control group, significant decreases were found for anxiety. MoodGYM delivered in-conjunction with face-to-face CBT is more effective in treating symptoms of depression and anxiety compared with standalone face-to-face or cCBT. This study suggests that for youth who are unable to access face-to-face therapy-such as those in rural or remote regions, or for communities in which there is stigma attached to seeking help-computerised therapy may be a viable option. This is an important finding, especially in light of the current capacity-to-treat and accessibility problems faced by youth when seeking treatment for depression and/or anxiety

The use of computerized self-help packages to treat adolescent depression and anxiety

Despite the efficacy of cognitive-behavioral therapy (CBT) in treating adolescent anxiety, few sufferers seek treatment. Barriers to accessing psychologists include a shortage of skilled therapists, long waiting lists, and affordability. The Internet is a medium possibly able to address issues of accessibility and affordability. This study aimed to assess the efficacy of online therapy in the treatment and prevention of adolescent anxiety and depression. Participants (N=38) were randomly allocated to one of four conditions: online CBT, face-to-face CBT, combined face-to-face/online CBT, and control. Combined face-to-face/online CBT is more effective in treating symptoms of depression and anxiety compared to stand-alone online or face-to-face therapy. The present study suggests that for those who are unable to access face-to-face therapy, computerized therapy may be a viable option. This is an important finding, especially in light of current capacity to treat and accessibility problems faced in the treatment of adolescent depression and anxiety.17 page(s

The international dissemination of evidence-based parenting interventions: impact on practitioner content and process self-efficacy

Implementation of evidence-based parenting programs with parents most in need is important for reducing maladaptive child behavior problems. However, effective implementation is limited by numerous factors including practitioners’ self-efficacy in the delivery of an intervention to a parent, and their lack of confidence in parent consultation skills. This study explores changes in self-efficacy of 5109 practitioners from diverse countries, professional and qualification backgrounds, who received standardized training in the Triple P – Positive Parenting Program between 2007 and 2012. Practitioners were assessed for perceived adequacy of skills and confidence in the delivery of strategies and approaches necessary for the effective delivery of Triple P, pre- and post-training. Results overall confirm that training was associated with significant improvement in both content and process efficacy. While no significant differences in practitioner self-efficacy were found between professional and qualification groups, there were post-training differences between country groups and in practitioners’ sense of competence in consulting with parents about child behavior and appropriate parenting. Implications of these findings are discussed in the context of a growing and diverse health workforce and in developing training protocols that cross different language and regional groups

Comparative randomized trial of an online cognitive-behavioral therapy program and an online support group for depression and anxiety

This study examined the effects of an online cognitive behavior therapy (CBT) program (MoodGYM) compared with an online support group (MoodGarden) in decreasing symptoms of depression and anxiety, and improving dysfunctional thoughts, online social support, and CBT literacy in young adults. Thirty-nine university students (aged 18-25) with elevated scores on the Kessler Psychological Distress Scale were allocated to either the MoodGYM, MoodGarden or control condition. Relative to the control condition, participation in the MoodGYM group significantly improved anxiety symptoms and CBT literacy. Similarly, participation in the MoodGarden group significantly improved anxiety symptoms and online social support relative to the control condition. Although it appears that these online resources are beneficial, further research is needed to determine their long-term efficacy. Furthermore, qualitative participant evaluations indicated that improvements may need to be made to MoodGYM to ensure that young adults remain engaged with the program.7 page(s

Is care really shared? A systematic review of collaborative care (shared care) interventions for adult cancer patients with depression

Abstract Background Collaborative care involves active engagement of primary care and hospital physicians in shared care of patients beyond usual discharge summaries. This enhances community-based care and reduces dependence on specialists and hospitals. The model, successfully implemented in chronic care management, may have utility for treatment of depression in cancer. The aim of this systematic review was to identify components, delivery and roles and responsibilities within collaborative interventions for depression in the context of cancer. Methods Medline, PsycINFO, CINAHL, Embase, Cochrane Library and Central Register for Controlled Trials databases were searched to identify studies of randomised controlled trials comparing a treatment intervention that met the definition of collaborative model of depression care with usual care or other control condition. Studies of adult cancer patients with major depression or a non-bipolar depressive disorder published in English between 2005 and January 2018 were included. Cochrane checklist for risk of bias was completed (Study Prospero registration: CRD42018086515). Results Of 8 studies identified, none adhered to the definition of ‘collaborative care’. Interventions delivered were multi-disciplinary, with care co-ordinated by nurses (n = 5) or social workers (n = 2) under the direction of psychiatrists (n = 7). Care was primarily delivered in cancer centres (n = 5). Care co-ordinators advised primary care physicians (GPs) of medication changes (n = 3) but few studies (n = 2) actively involved GPs in medication prescribing and management. Conclusions This review highlighted joint participation of GPs and specialist care physicians in collaborative care depression management is promoted but not achieved in cancer care. Current models reflect hospital-based multi-disciplinary models of care. Protocol registration The protocol for this systematic review has been registered with PROSPERO. The registration number is CRD42018086515

Digital Interventions for Mental Disorders:Key Features, Efficacy, and Potential for Artificial Intelligence Applications

Mental disorders are highly prevalent and often remain untreated. Many limitations of conventional face-to-face psychological interventions could potentially be overcome through Internet-based and mobile-based interventions (IMIs). This chapter introduces core features of IMIs, describes areas of application, presents evidence on the efficacy of IMIs as well as potential effect mechanisms, and delineates how Artificial Intelligence combined with IMIs may improve current practices in the prevention and treatment of mental disorders in adults. Meta-analyses of randomized controlled trials clearly show that therapist-guided IMIs can be highly effective for a broad range of mental health problems. Whether the effects of unguided IMIs are also clinically relevant, particularly under routine care conditions, is less clear. First studies on IMIs for the prevention of mental disorders have shown promising results. Despite limitations and challenges, IMIs are increasingly implemented into routine care worldwide. IMIs are also well suited for applications of Artificial Intelligence and Machine Learning, which provides ample opportunities to improve the identification and treatment of mental disorders. Together with methodological innovations, these approaches may also deepen our understanding of how psychological interventions work, and why. Ethical and professional restraints as well as potential contraindications of IMIs, however, should also be considered. In sum, IMIs have a high potential for improving the prevention and treatment of mental health disorders across various indications, settings, and populations. Therefore, implementing IMIs into routine care as both adjunct and alternative to face-to-face treatment is highly desirable. Technological advancements may further enhance the variability and flexibility of IMIs, and thus even further increase their impact in people’s lives in the future