Note From the Editor

Background and AimsTo review published studies on the effectiveness of combining cognitive-behavioural therapy (CBT) and motivational interviewing (MI) to treat comorbid clinical and subclinical alcohol use disorder (AUD) and major depression (MDD) and estimate the effect of this compared with usual care. MethodsWe conducted systematic literature searches in PubMed, PsycINFO and Embase up to June 2013 and identified additional studies through cross-references in included studies and systematic reviews. Twelve studies comprising 1721 patients met our inclusion criteria. The studies had sufficient statistical power to detect small effect sizes. ResultsCBT/MI proved effective for treating subclinical and clinical AUD and MDD compared with controls, with small overall effect sizes at post-treatment [g=0.17, confidence interval (CI)=0.07-0.28, Pless than0.001 for decrease of alcohol consumption and g=0.27, CI: 0.13-0.41, Pless than0.001 for decrease of symptoms of depression, respectively]. Subgroup analyses revealed no significant differences for both AUD and MDD. However, digital interventions showed a higher effect size for depression than face-to-face interventions (g=0.73 and g=0.23, respectively, P=0.030). ConclusionsCombined cognitive-behavioural therapy and motivational interviewing for clinical or subclinical depressive and alcohol use disorders has a small but clinically significant effect in treatment outcomes compared with treatment as usual

Can a One-Item Mood Scale Do the Trick? Predicting Relapse over 5.5-Years in Recurrent Depression

To examine whether a simple Visual Analogue Mood Scale (VAMS) is able to predict time to relapse over 5.5-years.187 remitted recurrently depressed out-patients were interviewed using the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) and the 17-item Hamilton Depression rating scale (HAM-D) to verify remission status (HAM-D <10). All patients rated their current mood with the help of a Visual Analogue Mood Scale (VAMS) at baseline and at a follow-up assessment three months later. Relapse over 5.5-years was assessed by the SCID-I. Cox regression revealed that both the VAMS at baseline and three months later significantly predicted time to relapse over 5.5-years. Baseline VAMS even predicted time to relapse when the number of previous depressive episodes and HAM-D scores were controlled for. The baseline VAMS explained 6.3% of variance in time to relapse, comparable to the HAM-D interview.Sad mood after remission appears to play a pivotal role in the course of depression. Since a simple VAMS predicted time to relapse, the VAMS might be an easy and time-effective way to monitor mood and risk of early relapse, and offers possibilities for daily monitoring using e-mail and SMS.International Standard Randomized Controlled Trial Register Identifier: ISRCTN68246470

Overcome procrastination: Enhancing emotion regulation skills reduce procrastination

AbstractProcrastination is a widespread phenomenon that affects performance in various life domains including academic performance. Recently, it has been argued that procrastination can be conceptualized as a dysfunctional response to undesired affective states. Thus, we aimed to test the hypothesis that the availability of adaptive emotion regulation (ER) skills prevents procrastination.In a first study, cross-sectional analyses indicated that ER skills and procrastination were associated and that these connections were mediated by the ability to tolerate aversive emotions. In a second study, cross lagged panel analyses showed that (1) the ability to modify aversive emotions reduced subsequent procrastination and that (2) procrastination affected the subsequent ability to tolerate aversive emotions. Finally, in a third study, a two-arm randomized control trial (RCT) was conducted. Results indicated that systematic training of the ER skills tolerate and modify aversive emotions reduced procrastination. Thus, in order to overcome procrastination, emotion-focused strategies should be considered

Zero-shot personalization of speech foundation models for depressed mood monitoring

The monitoring of depressed mood plays an important role as a diagnostic tool in psychotherapy. An automated analysis of speech can provide a non-invasive measurement of a patient’s affective state. While speech has been shown to be a useful biomarker for depression, existing approaches mostly build population-level models that aim to predict each individual’s diagnosis as a (mostly) static property. Because of inter-individual differences in symptomatology and mood regulation behaviors, these approaches are ill-suited to detect smaller temporal variations in depressed mood. We address this issue by introducing a zero-shot personalization of large speech foundation models. Compared with other personalization strategies, our work does not require labeled speech samples for enrollment. Instead, the approach makes use of adapters conditioned on subject-specific metadata. On a longitudinal dataset, we show that the method improves performance compared with a set of suitable baselines. Finally, applying our personalization strategy improves individual-level fairness

Treating internet use disorders via the internet? Results of a two-armed randomized controlled trial

Background and aims: Internet Use Disorders (IUDs) are emerging as a societal challenge. Evidence-based treatment options are scarce. Digital health interventions may be promising to deliver psychological treatment to individuals with IUDs directly in their online setting. The aim of this study was to evaluate the efficacy of a digital health intervention for IUDs compared to a waitlist control group (WCG). Methods: In a two-armed randomized controlled trial, N = 130 individuals showing IUDs (Internet Addiction Test; IAT ≥49) were randomly allocated to the intervention group (IG; n = 65) or WCG (n = 65). The intervention consisted of 7 sessions based on cognitive behavioral therapy. The primary outcome was IUD symptom severity measured via the IAT at post treatment 7 weeks after randomization. Secondary outcomes included IUD symptoms (Compulsive Internet Use Scale; CIUS), quality of life, depressive and anxiety symptoms, and other psychosocial variables associated with IUDs. Results: Participants were on average 28.45 years old (SD = 10.59) and 50% identified as women, 49% as men, and 1% as non-binary. The IG (n = 65) showed significantly less IUD symptom severity (IAT) (d = 0.54, 95% CI 0.19–0.89) and symptoms (d = 0.57, 95% CI 0.22–0.92) than the WCG (n = 65) at post-treatment. Study attrition was 20%. Effects on all other secondary outcomes were not significant. On average, participants completed 67.5% of the intervention. Discussion and Conclusions: A digital health intervention could be a promising first step to reduce IUD symptom severity

Evaluating the efficacy and cost-effectiveness of web-based indicated prevention of major depression: design of a randomised controlled trial

BACKGROUND: Major depressive disorder (MDD) imposes a considerable disease burden on individuals and societies. Web-based interventions have shown to be effective in reducing depressive symptom severity. However, it is not known whether web-based interventions may also be effective in preventing the onset of MDD. The aim of this study is to evaluate the (cost-) effectiveness of an indicated web-based guided self-help intervention (GET.ON Mood Enhancer Prevention) on the onset of MDD. METHODS/DESIGN: A randomised controlled trial (RCT) will be conducted to compare the (cost-) effectiveness of the GET.ON Mood Enhancer Prevention training with a control condition exclusively receiving online-based psychoeducation on depression. Adults with subthreshold depression (N = 406) will be recruited from the general population and randomised to one of the two conditions. The primary outcome is time to onset of MDD within a 12-months follow-up period. MDD will be assessed according to DSM-IV criteria as assessed by the telephone-administered Structured Clinical Interview for DSM-IV (SCID). Time to onset of MDD will be assessed using life charts. Secondary outcomes include changes on various indicators of depressive symptom severity, anxiety and quality of life from baseline to post-treatment, to a 6-month and a 12-month follow up. Additionally, an economic evaluation using a societal perspective will be conducted to examine the intervention’s cost-effectiveness. DISCUSSION: This is one of the first randomised controlled trials that examines the effect of an indicated guided self-help web-based intervention on the incidence of major depression. If shown to be effective, the intervention will contribute to reducing the disease burden due to MDD in the general population. TRIAL REGISTRATION: German Clinical Trial Registration DRKS00004709

Standalone smartphone apps for mental health—a systematic review and meta-analysis

While smartphone usage is ubiquitous, and the app market for smartphone apps targeted at mental health is growing rapidly, the evidence of standalone apps for treating mental health symptoms is still unclear. This meta-analysis investigated the efficacy of standalone smartphone apps for mental health. A comprehensive literature search was conducted in February 2018 on randomized controlled trials investigating the effects of standalone apps for mental health in adults with heightened symptom severity, compared to a control group. A random-effects model was employed. When insufficient comparisons were available, data was presented in a narrative synthesis. Outcomes included assessments of mental health disorder symptom severity specifically targeted at by the app. In total, 5945 records were identified and 165 full-text articles were screened for inclusion by two independent researchers. Nineteen trials with 3681 participants were included in the analysis: depression (k = 6), anxiety (k = 4), substance use (k = 5), self-injurious thoughts and behaviors (k = 4), PTSD (k = 2), and sleep problems (k = 2). Effects on depression (Hedges’ g = 0.33, 95%CI 0.10–0.57, P = 0.005, NNT = 5.43, I2 = 59%) and on smoking behavior (g = 0.39, 95%CI 0.21–0.57, NNT = 4.59, P ≤ 0.001, I2 = 0%) were significant. No significant pooled effects were found for anxiety, suicidal ideation, self-injury, or alcohol use (g = −0.14 to 0.18). Effect sizes for single trials ranged from g = −0.05 to 0.14 for PTSD and g = 0.72 to 0.84 for insomnia. Although some trials showed potential of apps targeting mental health symptoms, using smartphone apps as standalone psychological interventions cannot be recommended based on the current level of evidence

For whom are internet-based occupational mental health interventions effective? Moderators of internet-based problem-solving training outcome

AbstractInternet-based problem-solving training (IPST) effectively reduces depressive symptoms in employees. Yet, it is unknown which employees benefit most from this particular treatment. The study aimed to identify predictors and moderators of treatment outcome in IPST offered to employees with depressive symptoms. Within a randomized controlled trial (N=150), designed to test the effectiveness of IPST, variables that predict and moderate the effects of IPST when compared with a waitlist control group (WLC) were explored. The outcome was change in depression severity, assessed using the Center for Epidemiological Studies Depression Scale (CES-D). Both depression severity and other psychopathological symptoms and potential predictors/moderators were assessed as self-reports at baseline (t1) and in follow-up assessments after seven weeks (t2), three months (t3) and six months (t4). Higher depression severity at baseline predicted improvement in depressive symptomology in follow-up assessments after seven weeks, and three- and six months. Depression severity moderated the effectiveness of IPST assessed at six-month follow-up. Simple slope analyses revealed that the long-term effectiveness of the intervention was more pronounced among participants with high (CES-D range: 33–44, M=37.0, SD=3.2) and moderate (CES-D range: 14–32, M=23.1, SD=5.6) depression baseline scores, compared to participants displaying low depression baseline scores (CES-D range: 5–13, M=9.0, SD=2.2). No indication was found that participants presenting low depression severity at baseline significantly benefitted from IPST in the long-term. IPST might be appropriate for employees with a wide range of different characteristics. While there appears to be no reason to exclude employees with severe depression from Internet-based occupational mental health interventions, for employees low in depression severity, watchful waiting or potentially no intervention should be considered. These findings may not apply to other low-intensity interventions and/or target groups

Case report for an internet- and mobile-based intervention for internet use disorder

Background and aimsInternet use disorder (IUD), characterized as the inability to control one’s internet use, is associated with reduced quality of life and mental health comorbidities such as depression, substance abuse, or anxiety. Evidence-based treatment options are scarce due to the novelty of the diagnosis. Internet- and mobile-based interventions (IMI) may be an effective means to deliver psychological treatment to individuals with IUD as they address affected individuals in their online setting. This study presents a newly developed IMI for IUD disclosing treatment satisfaction and preliminary effects by exemplifying with a case report.MethodsThe case of a female participant with IUD, characterized by an excessive use of social media, is analyzed. The case report follows the CARE guidelines and presents qualitative and quantitative outcomes regarding potential symptom reduction measured by the Internet Addiction Test (IAT) and Compulsive Internet Use Scale (CIUS), treatment satisfaction measured by the Client Satisfaction Questionnaire (CSQ) and feasibility by analyzing participant’s written feedback during treatment.ResultsThe case report shows that internet- and mobile-based interventions may be feasible in supporting an individual in reducing symptoms of IUD as well as depressive symptoms, anxiety and procrastination behavior. Treatment satisfaction was reported as good.Discussion and conclusionsThis case report illustrates that IMIs can have the potential to be an easily accessible and possibly effective treatment option for IUD. Case studies on IMIs may provide insights into important mechanisms for symptom change. Further studies are needed to expand our understanding of this diverse disorder to provide adequate treatment