Treating complex depression with cognitive behavioural therapy

Barton, Stephen; Armstrong, Peter V.; Wicks, Louise; Freeman, Elizabeth W.; Meyer, Thomas D.

doi:10.1017/s1754470x17000149

Cited by 14 publications

(14 citation statements)

References 15 publications

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“…Alternative therapeutic techniques such as acceptance and commitment therapy, problem-solving therapy, psychodynamic therapy, mindfulness therapy, and interpersonal psychotherapy are also worth exploring in conjunction with eHealth to promote sleep and well-being. Considering the structured nature of CBT, it might not be beneficial for people with complex needs, and it fails to address deeper causes or the possible underlying causes of mental illness, such as childhood experience, family history, or relations [ 91 ]. In addition, the typical treatment period for CBT is 6 to 20 weeks, which, to some extent, requires people to adhere to a long period.…”

Section: Discussionmentioning

confidence: 99%

eHealth-Based Psychosocial Interventions for Adults With Insomnia: Systematic Review and Meta-analysis of Randomized Controlled Trials

Deng¹,

Kleij²,

Shen³

et al. 2023

J Med Internet Res

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Background Worldwide, insomnia remains a highly prevalent public health problem. eHealth presents a novel opportunity to deliver effective, accessible, and affordable insomnia treatments on a population-wide scale. However, there is no quantitative integration of evidence regarding the effectiveness of eHealth-based psychosocial interventions on insomnia. Objective We aimed to evaluate the effectiveness of eHealth-based psychosocial interventions for insomnia and investigate the influence of specific study characteristics and intervention features on these effects. Methods We searched PubMed, Embase, Web of Science, PsycINFO, and the Cochrane Central Register of Controlled Trials from database inception to February 16, 2021, for publications investigating eHealth-based psychosocial interventions targeting insomnia and updated the search of PubMed to December 6, 2021. We also screened gray literature for unpublished data. Eligible studies were randomized controlled trials of eHealth-based psychosocial interventions targeting adults with insomnia. Random-effects meta-analysis models were used to assess primary and secondary outcomes. Primary outcomes were insomnia severity and sleep quality. Meta-analyses were performed by pooling the effects of eHealth-based psychosocial interventions on insomnia compared with inactive and in-person conditions. We performed subgroup analyses and metaregressions to explore specific factors that affected the effectiveness. Secondary outcomes included sleep diary parameters and mental health–related outcomes. Results Of the 19,980 identified records, 37 randomized controlled trials (13,227 participants) were included. eHealth-based psychosocial interventions significantly reduced insomnia severity (Hedges g=−1.01, 95% CI −1.12 to −0.89; P<.001) and improved sleep quality (Hedges g=−0.58, 95% CI −0.75 to −0.41; P<.001) compared with inactive control conditions, with no evidence of publication bias. We found no significant difference compared with in-person treatment in alleviating insomnia severity (Hedges g=0.41, 95% CI −0.02 to 0.85; P=.06) and a significant advantage for in-person treatment in enhancing sleep quality (Hedges g=0.56, 95% CI 0.24-0.88; P<.001). eHealth-based psychosocial interventions had significantly larger effects (P=.01) on alleviating insomnia severity in clinical samples than in subclinical samples. eHealth-based psychosocial interventions that incorporated guidance from trained therapists had a significantly greater effect on insomnia severity (P=.05) and sleep quality (P=.02) than those with guidance from animated therapists or no guidance. Higher baseline insomnia severity and longer intervention duration were associated with a larger reduction in insomnia severity (P=.004). eHealth-based psychosocial interventions significantly improved each secondary outcome. Conclusions eHealth interventions for insomnia are effective in improving sleep and mental health and can be considered a promising treatment for insomnia. Our findings support the wider dissemination of eHealth interventions and their further promotion in a stepped-care model. Offering blended care could improve treatment effectiveness. Future research needs to elucidate which specific intervention components are most important to achieve intervention effectiveness. Blended eHealth interventions may be tailored to benefit people with low socioeconomic status, limited access to health care, or lack of eHealth literacy.

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Section: Discussionmentioning

confidence: 99%

eHealth-Based Psychosocial Interventions for Adults With Insomnia: Systematic Review and Meta-analysis of Randomized Controlled Trials

Deng¹,

Kleij²,

Shen³

et al. 2023

J Med Internet Res

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“…All the above factors were considered in this CT-PTSD conceptualisation of COVID ICU-PTSD. This approach has been described by Barton et al (2017) where they consider the case of complex depression with other co-morbid disorders. They define complexity as cases having 'multiple moving parts' which could have a bearing on the disorder specific treatment plans.…”

Section: Discussionmentioning

confidence: 99%

IAPT CBT treatment for PTSD following COVID-19-related intensive care admission – a case study

Skilbeck

2022

tCBT

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The current case study was conducted as part of the National Health Services and Health Education England implemented IAPT top-up training in trauma-focused cognitive therapy for post-traumatic stress disorder (PTSD). There has been an increase in the number of clients presenting to IAPT with COVID-19 intensive care unit PTSD since the pandemic. However, there are no current unitary guidelines for psychological therapy for this population. Treatment of PTSD using individual trauma-focused cognitive therapy has been shown to be effective for ICU-PTSD. The National Institute for Health and Care Excellence treatment guidelines recommend adapting existing protocols. This study describes how these recommendations were used in the treatment of COVID-19 ICU-PTSD in a 46-year-old male. It illustrates the use of trauma-focused cognitive therapy for PTSD and how ICU trauma memories including hallucinations were conceptualised. It also illustrates how the challenges of co-morbid panic attacks, long COVID and remote working were managed. The client attended 16 individual, 60- to 90-minute video sessions of trauma-focused cognitive therapy, conducted weekly via Microsoft Teams over a period of five months. The treatment plan was conducted in collaboration with the client’s general practitioner, physiotherapists, cardiopulmonary specialists, and his family. Treatment included a timeline, written narrative and imaginal reliving. It also applied stimulus discrimination, behavioural experiments and site visit. At the end of treatment, the client no longer showed clinically important symptoms of PTSD as assessed on the PCL-5 and interview. This was sustained at 3-month follow-up. Key learning aims. It is hoped that the reader will increase their understanding of the following: (1) Delivery of trauma-focused cognitive therapy for ICU-PTSD. (2) Cognitive conceptualisation of the trauma memory including hallucinations. (3) Management of co-morbid symptoms.

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“…It is now well-appreciated that, along with biological and psychological factors, social factors contribute to negative mental health outcomes ( 1 ). Social isolation is predictive of greater mental health difficulties for both elders ( 2 ) and children ( 3 ).…”

Section: Introductionmentioning

confidence: 99%

Privacy-Preserving Social Ambiance Measure From Free-Living Speech Associates With Chronic Depressive and Psychotic Disorders

et al. 2021

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A social interaction consists of contributions by the individual, the environment and the interaction between the two. Ideally, to enable effective assessment and interventions for social isolation, an issue inherent to depressive and psychotic illnesses, the isolation must be identified in real-time and at an individual level. However, research addressing sociability deficits is largely focused on determining loneliness, rather than isolation, and lacks focus on the richness of the social environment the individual revolves in. In this paper, We describe the development of an automated, objective and privacy-preserving Social Ambiance Measure (SAM) that converts unconstrained audio recordings collected from wrist-worn audio-bands into four levels, ranging from none to active. The ambiance levels are based on the number of simultaneous speakers, which is a proxy for overall social activity in the environment. Results show that social ambiance patterns and time spent at each ambiance level differed between participants with depressive or psychotic disorders and healthy controls. Individuals with depression/psychosis spent less time in diverse environments and less time in moderate/active ambiance levels. Moreover, social ambiance patterns are found associated with the severity of self-reported depression, anxiety symptoms and personality traits. The results in this paper suggest that objectively measured social ambiance can be used as a marker of sociability, and holds potential to be leveraged to better understand social isolation and develop effective interventions for sociability challenges, thus improving mental health outcomes.

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Treating complex depression with cognitive behavioural therapy

Cited by 14 publications

References 15 publications

eHealth-Based Psychosocial Interventions for Adults With Insomnia: Systematic Review and Meta-analysis of Randomized Controlled Trials

eHealth-Based Psychosocial Interventions for Adults With Insomnia: Systematic Review and Meta-analysis of Randomized Controlled Trials

IAPT CBT treatment for PTSD following COVID-19-related intensive care admission – a case study

Privacy-Preserving Social Ambiance Measure From Free-Living Speech Associates With Chronic Depressive and Psychotic Disorders

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