Prevention: an achievable goal in personalized medicine

In the past 15 years a considerable number of studies have found evidence that it may be possible to prevent the onset of some mental disorders. Most evidence is available for depressive disorders, but a growing number of studies have focused on anxiety disorders and psychotic disorders. This paper reviews the studies which have examined the effects of preventive interventions on the incidence of mental disorders in people who do not meet criteria for a mental disorder at baseline. More than 20 studies have examined prevention of depressive disorders, and they have found an overall reduction in the incidence of about 25% compared with control groups. The problem of identifying the most optimal target groups for preventive interventions is also illustrated. This is a problem because most risk indicators have a low specificity, and most people with a risk indicator do not develop a mental disorder. Finally, this paper will show how other statistics, such as the exposure rate, the attributable fraction, and the number needed to treat can help in identifying the most optimal target groups for preventive interventions

The Challenges of Improving Treatments for Depression

In the past few decades substantial progress has been made in the research and development of treatments for major depression. Many different types of medications and psychotherapy are currently available and rigorous studies have shown that antidepressants are more effective than placebo,1 and several types of psychotherapies are more effective than waiting list or other controls.2 These findings suggest that many patients with depression can be successfully treated. Based on these significant and positive effects, many of these treatments are included in treatment guidelines and are widely used in clinical practice. However, not all patients with depression recover with available treatments and several important challenges need to be resolved to improve existing treatments and to increase the number of patients who benefit from them

Wearable devices in the treatment of mental disorders: Motivational gadgets or new opportunities to improve treatments?

This is the pre-peer reviewed version of the following article: Wearable devices in the treatment of mental disorders: Motivational gadgets or new opportunities to improve treatments?, which has been published in final form at https://doi.org/10.1111/cpsp.12296. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived VersionsResearchers and clinicians in the field of cognitive behavioral therapy have always been interested in the use of technology. Beginning in the 1960s, when the idea of exposure therapy was only a decade old, researchers used long‐play records and tapes to record instructions for patients on how to apply exposure to themselves (Cuijpers et al., 2009; Kahn & Baker, 1968). In the 1980s and especially in the 1990s, the use of personal computers as supportive in the treatment of anxiety disorders was examined in a number of trials (Cuijpers et al., 2009). Most of these interventions, however, used face‐to‐face therapies as a model and translated these models to computers. The core ideas of the interventions did not change, and technology was used solely as a means to deliver the interventions. Since smartphones have become available for a large amount of the general population, this approach is changing rapidly (Linardon, Cuijpers, Carlbring, Messer, & Fuller‐Tyszkiewicz, 2019). Smartphones are typically carried all day by their owners and have a series of sensors that can measure location, speed, sound, movement, contact with other smartphone owners, the use of social media, etc. Additionally, smartphones allow for experience sampling, also called ecological momentary assessment, which is the measuring of mood, anxiety, stress, or any other subjective feeling during random moments throughout the day. Such measurements and wearable devices offer possibilities to measure elements and predictors of mental health in daily life in a way that has never been possible. Hunkin, King, and Zajac, in this issue of Clinical Psychology: Science and Practice (Hunkin, King, & Zajac, 2019), give an excellent overview of the current state of wearable devices that may be used in the treatment of anxiety disorders. This review shows that the field is moving forward quickly and that there are an increasing number of devices available

Technology and mental health

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/137574/1/da22636.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/137574/2/da22636_am.pd

Intervenciones basadas en internet para los trastornos depresivos: Una visión general

Research on psychotherapeutic internet interventions started in the late 1990s and since then a considerable number of trials have shown that these interventions are effective in the treatment of depression. There is also no reason to assume that they are less effective than face-to-face treatments. This knowledge can be applied in most major areas of mental health care, including preventive services, primary care, specialized mental health care, and general medical care. Internet services can also be organised outside regular mental health care services because no personal contact with patients is needed. Internet interventions can build directly on the many new technological applications of the internet and mobile technology, through ecological momentary assessment and intervention, serious gaming, avatars and automatic emotion recognition, as well as smartwatches. This overview has made it clear that research in this area is booming and that there are many possibilities for all kinds of innovative interventions and applications.A finales de los 90 comienzan las investigaciones sobre intervenciones psicoterapéuticas basadas en internet. Desde entonces gran cantidad de estudios han demostrado que son eficaces para tratar la depresión. No hay razón para suponer que son menos efectivos que los tratamientos tradicionales. Esto puede aplicarse en la mayoría de las áreas de atención para la salud mental, incluyendo servicios de prevención, atención primaria, atención especializada para la salud mental y atención médica general. Los servicios por Internet también pueden emplearse para la atención en salud mental, sin necesitar el contacto personal paciente-terapeuta. Además, pueden suponer nuevas aplicaciones tecnológicas aplicadas por internet y tecnología móvil, a través de la evaluación y la intervención ecológica momentánea, juegos serios, avatares y el reconocimiento automático de las emociones, así como smartwatches. Esta revisión constata el auge de la investigación en esta área y las muchas posibilidades para las intervenciones y aplicaciones innovadoras

Mental health nurses’ support to caregivers of older adults with severe mental illness : a qualitative study

Background: Literature has shown the serious impact of severe mental illness on the daily life of caregivers. We studied reported caregiver support practices by mental health nurses for use in the development of a nursing intervention. We aimed to explore current caregiver support practices by mental health nurses. Methods: Twenty-one participants completed semi-structured interviews, and 17 participants attended two focus groups. All interviews were audio-taped, transcribed and coded for qualitative analysis. Results: The diversity in caregiver support could best be described by three prototypes: the tolerator, the preventer and the concerner, representing three approaches of involvement with caregivers. At one end of the spectrum are mental health nurses (MHN) who are essentially only concerned with the wellbeing of the care recipient and see the caregiver as a potential impediment in reaching the client’s goals. We call these the tolerators. At the other end of the spectrum are the MHNs who see the caregiver and the care recipient as inextricably connected with each other. In these cases the MHN directs her/his intervention towards both the informal caregiver and the care recipient. We call these the concerners. In the middle position are MHNs who realize that caregivers are important agents in the achievement of the client’s goals, and therefore consider preventing them from becoming overburdened as an important goal. We call these the preventers. Conclusions: Based on the extent to which the MHNs believe that the informal caregiver plays a necessary role in the client’s support system, and the degree to which they feel responsible for the caregiver’s wellbeing, three MHN prototypes can be distinguished. These prototypes determine how the nurses’ vision directs their understanding of their role and responsibilities and the content of their behaviour. This implies that a change in behaviour needs to be preceded by a change in vision. Therefore, promoting family support cannot be achieved by one-size-fits-all-programmes

The Effectiveness of Cognitive Bias Modification Interventions for Substance Addictions: A Meta-Analysis

BACKGROUND AND AIMS:Cognitive bias modification (CBM) interventions, presumably targeting automatic processes, are considered particularly promising for addictions. We conducted a meta-analysis examining randomized controlled trials (RCTs) of CBM for substance addiction outcomes. METHODS:Studies were identified through systematic searches in bibliographical databases. We included RCTs of CBM interventions, alone or in combination with other treatments, for any type of addiction. We examined trial risk of bias, publication bias and possible moderators. Effects sizes were computed for post-test and follow-up, using a random-effects model. We grouped outcome measures and reported results for addiction (all related measures), craving and cognitive bias. RESULTS:We identified 25 trials, 18 for alcohol problems, and 7 for smoking. At post-test, there was no significant effect of CBM for addiction, g = 0.08 (95% CI -0.02 to 0.18) or craving, g = 0.05 (95% CI -0.06 to 0.16), but there was a significant, moderate effect on cognitive bias, g = 0.60 (95% CI 0.39 to 0.79). Results were similar for alcohol and smoking outcomes taken separately. Follow-up addiction outcomes were reported in 7 trials, resulting in a small but significant effect of CBM, g = 0.18 (95% CI 0.03 to 0.32). Results for addiction and craving did not differ by substance type, sample type, delivery setting, bias targeted or number of sessions. Risk of bias was high or uncertain in most trials, for most criteria considered. Meta-regression analyses revealed significant inverse relationships between risk of bias and effect sizes for addiction outcomes and craving. The relationship between cognitive bias and respectively addiction ESs was not significant. There was consistent evidence of publication bias in the form of funnel plot asymmetry. CONCLUSIONS:Our results cast serious doubts on the clinical utility of CBM interventions for addiction problems, but sounder methodological trials are necessary before this issue can be settled. We found no indication that positive effects on biases translate into effects on addiction outcomes

Internet-administered cognitive behavior therapy for health problems: a systematic review

Cognitive-behavioral interventions are the most extensively researched form of psychological treatment and are increasingly offered through the Internet. Internet-based interventions may save therapist time, reduce waiting-lists, cut traveling time, and reach populations with health problems who can not easily access other more traditional forms of treatments. We conducted a systematic review of twelve randomized controlled or comparative trials. Studies were identified through systematic searches in major bibliographical databases. Three studies focused on patients suffering from pain, three on headache, and six on other health problems. The effects found for Internet interventions targeting pain were comparable to the effects found for face-to-face treatments, and the same was true for interventions aimed at headache. The other interventions also showed some effects, although effects differed across target conditions. Internet-delivered cognitive-behavioral interventions are a promising addition and complement to existing treatments. The Internet will most likely assume a major role in the future delivery of cognitive-behavioral interventions to patients with health problems