Adolescent experiences of sexting: A systematic review of the qualitative literature, and recommendations for practice.

INTRODUCTION: Sexting among adolescents continues to garner interest across disciplines due to its prevalence in the lives of young people and the potential for extremely negative outcomes associated with the behavior. The present review aimed to integrate the existing qualitative research on adolescent sexting experiences, to provide empirically-supported recommendations for professionals working with adolescents. METHODS: A search of four databases relating to adolescent experiences of sexting was conducted, resulting in the inclusion of 28 studies in the review. Quality appraisal of these studies was completed in line with the Critical Appraisal Skills Profile qualitative checklist. RESULTS: Major themes in the qualitative studies were synthesized to generate recommendations for professionals. These recommendations are categorized as (a) "proactive" (enhancing positive and contextualized education and attempting to mitigate the likelihood of young people having negative experiences with sexting), (b) "responsive" (management of disclosures of distressing experiences with sexting, including image-based sexual abuse [IBSA]), and (iii) "clinical" (increasing awareness among clinicians of pertinent issues concerning intervention with young people who are engaging in sexting, or who have been victimized by IBSA). CONCLUSIONS: The qualitative literature was found to provide rich insight into adolescent experiences of sexting, thus allowing for the generation of evidence-based recommendations which are consistent with young peoples' own interests and preferences. Limitations in the existing literature base were discussed (e.g., lack of specificity in methodological reporting), and suggestions were given for future research (including the need to explore sexting experiences of LGBTQ + adolescents in more depth).

Hospital presenting suicidal ideation: A systematic review.

BACKGROUND: Research indicates that the emergency department is the primary setting for people to present with suicidal ideation. Attempting to provide interventions for this population depends greatly on understanding their needs and life circumstances at the time of presentation to services, therefore enabling more appropriate treatment pathways and services to be provided. AIM: This review aims to collate, evaluate and synthesize the empirical research focused on the population of people presenting to hospital settings with suicidal ideation. METHOD: A systematic literature search was performed. Articles that met a specified set of inclusion criteria including participants being over 18, not being admitted to hospital and presenting to an emergency department setting underwent a quality assessment and data analysis. The quality assessment used was the EPHPP Quality Assessment Tool for Quantitative Studies (Thomas et al., 2004). RESULTS: Twenty-seven articles were included in the review. Studies were quantitative and of reasonable methodological quality (Thomas et al., 2004). The literature was characterized by demographic information, mental health factors associated with the presentation to hospital and treatment pathways or outcomes reported. The reviewed research showed that people presenting to emergency departments with suicidal ideation were varying in age, gender, ethnic background and socio-economic status (SES). Large proportions of studies reported psychosocial factors alongside interpersonal struggles as the main presenting reason. The review highlights large variability across these factors. Mental health diagnosis was common, previous suicide attempt was a risk factor, and treatment pathways were unclear. The review identifies the outstanding gaps and weaknesses in this literature as well as areas in need of future research. CONCLUSIONS: In conclusion, the review highlights the prevalence of people reporting interpersonal factors as the reason for suicidal ideation and not mental health disorders or diagnosis. Despite this, no mention of trauma or life stories was made in any study assessing this population. Despite a large variation across studies making synthesis difficult, data proves clinically relevant and informative for future practice and guidance on areas needing further research.

The outcomes of sexting for children and adolescents: A systematic review of the literature.

INTRODUCTION: Given associated risks, sexting among children and adolescents has yielded significant interest in recent years. Several previous reviews have examined data on the prevalence, determinants, and correlates of sexting behaviour, however, in an ever-changing digital media context, a comprehensive overview of findings regarding its outcomes is warranted. This novel review aimed to systematically identify and conduct a narrative synthesis of empirical evidence regarding the outcomes of sexting involvement for children and adolescents. METHODS: Four databases were searched for peer-reviewed literature on sexting, and 54 articles were identified for inclusion in the review. The quality of included studies was appraised using Dixon-Woods et al. (2006) five question prompts. RESULTS: Four 'outcomes' categories were derived, namely, psychological (victimisation; sexual abuse/victimisation; mental health and quality of life; and emotional outcomes), behavioural (sexual activity, risk behaviours, and perpetration of abuse and harassment), relational (personal connections with others & reputational outcomes), and systems-level (distribution/public exposure of sexting content). CONCLUSIONS: Findings indicate that the outcomes of sexting for children and adolescents (aged ≤19 years) are wide-ranging, some positive and desirable, others negative and unwanted. Furthermore, identified outcomes were located along a continuum spanning benefits for adolescents' well-being and relationships, stigma and associated difficulties, and serious harm or trauma. Limitations (e.g., methodological constraints of studies) and implications (e.g., informing harm prevention/intervention initiatives; further large-scale and replication studies) are discussed within.

Self-compassion, trauma, and posttraumatic stress disorder: A systematic review.

Self-compassion has emerged as an important construct in the mental health literature. Although conceptual links between self-compassion and trauma are apparent, a review has not been completed to examine whether this association is supported by empirical research findings. To systematically summarize knowledge on the association between trauma and/or posttraumatic stress disorder (PTSD) and self-compassion. Searches were conducted in PsycINFO, PubMed, Ovid Medline, Web of Science, Embase, and PILOTS databases, and papers reporting a direct analysis on the relationship between these constructs were identified. The search yielded 35 studies meeting inclusion criteria. Despite considerable heterogeneity in study design, sample, measurement, and trauma type, there was consistent evidence to suggest that increased self-compassion is associated with less PTSD symptomatology and some evidence to suggest that reduced fear of self-compassion is associated with less PTSD symptomatology. There was tentative evidence to suggest that interventions based, in part or whole, on a self-compassion model potentially reduce PTSD symptoms. Although findings are positive for the association between increased self-compassion and reduced PTSD symptoms, the precise mechanism of these protective effects is unknown. Prospective and longitudinal studies would be beneficial in clarifying this. The review also highlighted the variability in what is and should be referred to as trauma exposure, indicating the need for further research to clarify the concept.

Qualitative Synthesis of Young People's Experiences With Technology-Assisted Cognitive Behavioral Therapy: Systematic Review.

BACKGROUND: Cognitive behavioral therapy (CBT) for young people is increasingly being provided using technology-assisted formats. Although there is increasing evidence regarding the efficacy of such approaches, as illustrated by quantitative systematic reviews, the literature has also highlighted challenges with implementation factors, including high attrition rates and variable user engagement. Qualitative review methods can help to address the factors that impact young peoples' experience of technology-assisted cognitive behavioral therapy (tech-assisted CBT) and, thus, enable us to better understand such implementation factors. To date, no such qualitative synthesis exists. OBJECTIVE: The primary aim of this review was to systematically identify and synthesize the qualitative literature concerning the experiences of young people who have used tech-assisted CBT. METHODS: This systematic review applied Thomas and Harden's 2008 qualitative thematic synthesis approach. This involved line-by-line coding of the results sections of included studies and an inductive analysis on identified themes, followed by the generation of analytical themes through a process of iteration and interpretation of the descriptive themes. PsycINFO, ACM Digital Library, PubMed, EMBASE, and JMIR Publications databases were searched. The inclusion criteria were (1) studies involving school-aged young people over preschool age (6 years) but under the age of 18 years, (2) use of any form of tech-assisted CBT for any time period, (3) a stated focus of qualitative data to document the experiences of participants, and (4) studies published in English. The exclusion criteria were (1) interventions only provided face-to-face with no technological component, (2) only focused on the performance of the technology rather than participant experience, and (3) numerical data that sought to represent qualitative data. RESULTS: A total of 14 studies were included in this review. Overall, these studies represented interventions for low mood and anxiety (n=10), trauma or self-harm (n=2), and physical difficulties (n=2). Overall, 5 analytical themes emerged on young people's experiences with tech-assisted CBT: (1) helpfulness, (2) therapeutic process, (3) transferability, (4) gameplay experience, and (5) limitations. In addition, these analytical themes contained the following subthemes: positive experiences, tech-assisted CBT versus face-to-face CBT, understanding of a CBT model, process of change, skills development, application to everyday life settings, parental involvement, character relatedness, playability, negative experiences, and broad content. CONCLUSIONS: Overall, young people's experiences with tech-assisted CBT were mostly positive. The use of gaming environments, relatable characters, concrete metaphors, and age-appropriate narratives contributed to these positive experiences. Evidence suggests that technology can help to mediate face-to-face relationships with therapists and help young people to understand the CBT model. Clear barriers also emerged, including over-reliance on reading and writing skills and dissatisfaction with overly generalized content and comparison with commercial technologies. TRIAL REGISTRATION: International Prospective Register of Systematic Reviews (PROSPERO) CRD42018103388; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42018103388.

Evaluation of a computerized cognitive behavioural therapy programme, MindWise (2.0), for adults with mild-to-moderate depression and anxiety.

OBJECTIVES: To investigate the acceptability and utility of a newly developed computerized cognitive behavioural therapy (cCBT) programme, MindWise (2.0), for adults attending Irish primary care psychology services. METHOD: Adult primary care psychology service users across four rural locations in Ireland were invited to participate in this study. A total of 60 service users participated in the MindWise (2.0) treatment group and compared to 22 people in a comparison waiting list control group. Participants completed pre- and post-intervention outcome measures of anxiety, depression, and work/social functioning. RESULTS: At post-intervention, 25 of 60 people in the MindWise (2.0) condition had fully completed the programme and 19 of 22 people in the waiting list condition provided time 2 data. Relative to those in the control group, the MindWise (2.0) participants reported significantly reduced symptoms of anxiety and no change in depression or work/social functioning. CONCLUSIONS: The newly developed cCBT programme, MindWise (2.0), resulted in significant improvements on a measure of anxiety and may address some barriers to accessing more traditional face-to-face mental health services for adults in a primary care setting. Further programme development and related research appears both warranted and needed to lower programme drop-out, establish if gains in anxiety management are maintained over time, and support people in a primary care context with depression. PRACTITIONER POINTS: There is a growing evidence base that computerized self-help programmes can assist in a stepped-care approach to adult mental health service provision. These programmes require further development to address issues such as high dropout, the development of equally effective transdiagnostic content, and greater effectiveness in the country of origin. This study evaluated the acceptability and utility of a brief online CBT programme for adults referred due to anxiety or low mood to primary care psychology services in the national health service in Ireland. Results indicate that 42% of people completed the programme and experienced a significant reduction in anxiety but not depression and no improvement in work or social adjustment compared to similar adults on a waiting list for services. This study suggests the programme warrants further development and research and may in time become a useful and suitable intervention within the national health service in Ireland.

A systematic review of the evidence regarding cognitive therapy skills that assist cognitive behavioural therapy in adults who have an intellectual disability.

BACKGROUND: Cognitive behavioural therapy (CBT) is being increasingly adapted for use with people who have an intellectual disability. However, it remains unclear whether inherent cognitive deficits that are present in adults who have an intellectual disability preclude the use of cognitive-based therapies. This review aims to systematically examine "cognitive therapy skills" in adults who have an intellectual disability that assist engagement in CBT. METHOD: Two authors independently reviewed titles and abstracts of articles located through electronic database searching. RESULTS: Outcomes of the 18 studies selected for full-text review are mixed and limited by a moderately high risk of bias. CONCLUSIONS: The authors suggest eleven findings from research areas of emotion recognition, cognitive mediation, discriminating between thoughts, feelings and behaviours, linking events and emotions that have implications for the design of CBT programmes and future research for this population.

Computer-assisted cognitive behavioural therapy: The experiences of adults who have an intellectual disability and anxiety or depression.

BACKGROUND: Despite its evidence base in the general population, computerized cognitive behavioural therapy (cCBT) has not yet been adapted for use with people with intellectual disability. This study aimed to explore the experiences of adults with an intellectual disability who played a cCBT program. METHOD: Twenty-four adults (with a mild or moderate intellectual disability and clinically significant anxiety or depression) who were in the treatment arm of a pilot randomized controlled trial evaluating the cCBT program were individually interviewed. Thematic analysis was used to analyse and report themes within the data. RESULTS: Participants found playing the program to be an enjoyable and novel experience and that it was challenging and helpful. It allowed them to develop and reflect on relationships and increased their awareness of thoughts, feelings and behaviours. CONCLUSIONS: Combining technology with CBT is an effective way to reduce barriers to accessing mental health interventions and technology for this population.

Computerised cognitive-behavioural therapy for adults with intellectual disability: randomised controlled trial.

BackgroundDespite the evidence base for computer-assisted cognitive-behavioural therapy (CBT) in the general population, it has not yet been adapted for use with adults who have an intellectual disability.AimsTo evaluate the utility of a CBT computer game for adults who have an intellectual disability.MethodA 2 × 3 (group × time) randomised controlled trial design was used. Fifty-two adults with mild to moderate intellectual disability and anxiety or depression were randomly allocated to two groups: computerised CBT (cCBT) or psychiatric treatment as usual (TAU), and assessed at pre-treatment, post-treatment and 3-month follow-up. Forty-nine participants were included in the final analysis.ResultsA significant group × time interaction was observed on the primary outcome measure of anxiety (Glasgow Anxiety Scale for people with an Intellectual Disability), favouring cCBT over TAU, but not on the primary outcome measure of depression (Glasgow Depression Scale for people with a Learning Disability). A medium effect size for anxiety symptoms was observed at post-treatment and a large effect size was observed after follow-up. Reliability of Change Indices indicated that the intervention produced clinically significant change in the cCBT group in comparison with TAU.ConclusionsAs the first application of cCBT for adults with intellectual disability, this intervention appears to be a useful treatment option to reduce anxiety symptoms in this population.

Comparing young people's experience of technology-delivered v. face-to-face mindfulness and relaxation: two-armed qualitative focus group study.

BackgroundThe current popularity of mindfulness-based practices has coincided with the increase in access to mobile technology. This has led to many mindfulness apps and programs becoming available, some specifically for children. However, little is known about the experience of engaging with mindfulness through these mediums.AimsTo explore children's experience of mindfulness delivered both face-to-face and through a computer game to highlight any differences or similarities.MethodA two-armed qualitative focus groups design was used to explore children's experiences. The first arm offered mindfulness exercises in a traditional face-to-face setting with guided meditations. The second arm offered mindfulness exercises through a computer game avatar.ResultsThemes of relaxation, engagement, awareness, thinking, practice and directing attention emerged from both arms of focus groups. Subthematic codes highlight key differences as well as similarities in the experience of mindfulness.ConclusionsThese results indicate that mindfulness delivered via technology can offer a rich experience.

Effectiveness of a freely available computerised cognitive behavioural therapy programme (MoodGYM) for depression: Meta-analysis.

OBJECTIVE: To investigate the effectiveness of a freely available computerised cognitive behavioural therapy programme (MoodGYM) for depression (primary outcome), anxiety and general psychological distress in adults. METHOD: We searched PsycINFO, CINAHL Plus, MEDLINE, EMBASE, Social Science Citation Index and references from identified papers. To assess MoodGYM's effectiveness, we conducted random effects meta-analysis of identified randomised controlled trials. RESULTS: Comparisons from 11 studies demonstrated MoodGYM's effectiveness for depression symptoms at post-intervention, with a small effect size ( g = 0.36, 95% confidence interval: 0.17-0.56; I2 = 78%). Removing the lowest quality studies ( k = 3) had minimal impact; however, adjusting for publication bias reduced the effect size to a non-significant level ( g = 0.17, 95% confidence interval: -0.01 to 0.38). Comparisons from six studies demonstrated MoodGYM's effectiveness for anxiety symptoms at post-intervention, with a medium effect size ( g = 0.57, 95% confidence interval: 0.20-0.94; I2 = 85%). Although comparisons from six studies did not yield significance for MoodGYM's effectiveness for general psychological distress symptoms, the small effect size approached significance ( g = 0.34, 95% confidence interval: -0.04 to 0.68; I2 = 79%). Both the type of setting (clinical vs non-clinical) and MoodGYM-developer authorship in randomised controlled trials had no meaningful influence on results; however, the results were confounded by the type of control deployed, level of clinician guidance, international region of trial and adherence to MoodGYM. CONCLUSIONS: The confounding influence of several variables, and presence of publication bias, means that the results of this meta-analysis should be interpreted with caution. Tentative support is provided for MoodGYM's effectiveness for symptoms of depression and general psychological distress. The programme's medium effect on anxiety symptoms demonstrates its utility for people with this difficulty. MoodGYM benefits from its free accessibility over the Internet, but adherence rates can be problematic and at the extreme can fall below 10%. We conclude that MoodGYM is best placed as a population-level intervention that is likely to benefit a sizeable minority of its users.

The Effectiveness of Functional Family Therapy for Adolescent Behavioral and Substance Misuse Problems: A Meta-Analysis.

A systematic review of published and unpublished English language articles identified 14 studies containing 18 comparisons between functional family therapy (FFT) and another condition in the treatment of adolescent disruptive behavior and substance use disorders. In 11 of these comparisons, assignment to conditions was random, while nonrandom assignment occurred in seven studies. For both random and nonrandom comparisons, separate meta-analyses were conducted for subgroups of studies depending on the type of comparison group used. Data from studies of untreated control groups (CTL), treatment as usual (TAU), and well-defined alternative treatments (ALTs) were analyzed separately. Effect sizes from these six meta-analyses were as follows: random assignment FFT versus CTL (k = 3, d = 0.48, p < .01); random assignment FFT versus TAU (k = 3, d = .20, ns); random assignment FFT versus ALT (k = 5, d = .35, p < .05); nonrandom assignment FFT versus CTL (k = 2, d = .90, ns); nonrandom assignment FFT versus TAU (k = 2, d = .08, ns); and nonrandom assignment FFT versus ALT (k = 3, d = .75, p < .001). These results provide support for the effectiveness of FFT compared with untreated controls and well-defined ALTs, such as cognitive behavior therapy, other models of family therapy, and individual and group therapy for adolescents.

Exploring Client and Therapist Experiences of Sexual Offender Intervention: Developing a Model of "Significant Events".

This research explored the therapeutic events both clients and therapists from community-based treatment interventions for perpetrators of sexual abuse identify as significant in their experience of psychological therapy. A qualitative design was utilized to address this research objective. The sample for the present research is comprised of three different treatment programs for sexual offending. Twenty-five clients and nine therapists participated in the study. Two qualitative measures were used to elicit client and therapist responses. Significant Aspects of Therapy Form was administered every second treatment session during each intervention program. The Significant Aspects Follow-Up Interview was conducted with a sub-sample of participants at the conclusion of each treatment module. Thematic analysis was used to identify significant themes noted by clients and therapists from forms and interviews. Thematic analysis resulted in a model of significant events in therapy. In this model, significant events were categorized into six domains. The six domains were as follows: (a) the process of therapy, (b) making changes and progress in therapy, (c) content and structure of therapy, (d) therapist contributions, (e) negative contributions to therapy, and (f) other factors Each domain further contained between 6 and 18 themes, which are also reported. This study found much overlap and similarity in the experiences of therapy between clients of sexual offender therapy and general psychotherapy. Furthermore, there is overlap between therapists and clients in the aspects of therapy they identify as significant. The implications of these findings on effective service development and comprehensive service evaluations are discussed.

Effectiveness of cognitive behavioural therapy for anxiety and depression in primary care: a meta-analysis.

BACKGROUND: Cognitive behavioural therapy (CBT) is increasingly being delivered in primary care, in a variety of delivery formats such as guided self-help CBT, telephone-based CBT, computerized CBT and standard, one-to-one CBT. However, the vast majority of research has focused on CBT in specialized services, and no previous meta-analysis has examined CBT's effectiveness across delivery formats in primary care. OBJECTIVE: To determine the effectiveness of multi-modal CBT (i.e. CBT across delivery formats) for symptoms of anxiety and depression, in primary care. METHODS: A meta-analysis of CBT-focused RCTs, for symptoms of anxiety or depression, in primary care. The authors searched four databases. To be included, RCTs had to be set in primary care or have primary care participants. RESULTS: Twenty-nine RCTs were included in three separate meta-analyses. Results showed multi-modal CBT was more effective than no primary care treatment (d =0.59), and primary care treatment-as-usual (TAU) (d = 0.48) for anxiety and depression symptoms. Moreover, multi-modal CBT in addition to primary care TAU was shown to be more effective than primary care TAU for depression symptoms (no comparisons of this kind were available for anxiety) (d = 0.37). CONCLUSIONS: The results from conducted meta-analyses indicate that multi-modal CBT is effective for anxiety and depression symptoms in primary care. Furthermore, based on CBT's economic viability, increasing the provision of CBT in primary care seems justified. Future research should examine if varying levels of qualification among primary care CBT practitioners impacts on the effectiveness of CBT in this setting.

A randomized controlled trial of the computerized CBT programme, MoodGYM, for public mental health service users waiting for interventions.

OBJECTIVES: To evaluate the effectiveness of the computerized CBT (cCBT) programme, MoodGYM, for the reduction in symptoms of general psychological distress (the primary outcome), depression, anxiety, stress, and impaired daily functioning. DESIGN: A randomized controlled trial, with a waiting list control condition, in a routine clinical setting. METHODS: Participants were 149 public mental health service users (aged 18-61 [M = 35.3 years; SD = 10.3]) waiting for interventions. Self-report outcome measures were administered online at baseline and post-intervention (i.e., after 32 days). RESULTS: After high dropout rates, a post-intervention completers analysis examined 28 MoodGYM participants and 38 waiting list control participants. MoodGYM was significantly more effective than the waiting list control for the reduction of symptoms of general psychological distress (F[1, 64] = 4.45; p < .05) and stress (F[1, 64] = 5.35; p < .05) but not depression, anxiety, or impaired daily functioning. CONCLUSIONS: Due to their high associated dropout rates, self-help cCBT programmes such as MoodGYM should not be provided as front-line treatments. However, as it is likely to be agreeable and beneficial to some service users, perhaps self-help cCBT should be provided as an additional treatment option.

The power threat meaning framework 5 years on - A scoping review of the emergent empirical literature.

Since its release the Power Threat Meaning Framework (PTMF) has received considerable interest and uptake. However, there have not yet been any attempts to review the scope of this emergent literature. This scoping review aimed to identify and synthesize: (1) all empirical research which utilized the PTMF in their methodologies, (2) the characteristics of these studies, (3) the different ways in which these studies utilized the PTMF, and (4) the key findings of these studies. This review was conducted in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) scoping review extension (PRISMA-ScR). Following systematic searches of academic databases and grey literature, 17 studies meeting eligibility criteria were included. These papers were subject to critical appraisal, data charting, and narrative synthesis. This review identified four uses of the PTMF: (1) PTMF-informed data collection, (2) PTMF-informed data analysis, (3) Experiences of/views on the PTMF, and (4) PTMF-informed psychological practices. This evidence-base demonstrated the merits of utilizing the PTMF across a range of disciplines, settings, and populations. This heterogeneity also presents challenges for evidence synthesis. Implications for research (e.g. importance of the coherent and consistent approach to research) and practice/policy (e.g. professional training, collaboration, service-level barriers) are considered.

Consensus on the perceived presence of transtheoretical principles of change in routine psychotherapy practice: A survey of clinicians and researchers.

Goldfried (1982) hypothesized that there are five transtheoretical principles of change that guide routine psychotherapy practice. This survey investigated if there is consensus on the perceived presence of these principles in the approaches of a professionally diverse pool of psychotherapy clinicians and researchers. One thousand nine hundred ninety-eight participants, aged 21-85 years (M = 50.4 years, SD = 15.59) and representing a wide variety of theoretical orientations, completed an online survey. For consensus to be indicated, 95% confidence intervals of mean agreement scores had to be above 4.0 (out of 5). Mean agreement levels in response to "the extent to which you agree that the following principles are present in your own approach to psychotherapy" indicated consensus for all five principles: (a) fostering hope, positive expectations, and motivation (M = 4.58; 95% CI [4.53, 4.62]); (b) facilitating the therapeutic alliance (M = 4.76; 95% CI [4.73, 4.80]); (c) increasing awareness and insight (M = 4.66; 95% CI [4.63, 4.70]); (d) encouraging corrective experiences (M = 4.44; 95% CI [4.39, 4.48]); (e) emphasizing ongoing reality testing (M = 4.15; 95% CI [4.09, 4.20]). These findings were unaffected by age, gender, working patterns, practice (clinician or researcher), and years of experience; however, consensus on the final two principles was not indicated for both psychodynamic and experiential psychotherapists. The demonstrated consensus surrounding the transtheoretical principles of change corresponds with their consistently yielded outcome associations in previous research. The combination of these evidence sources points to the importance of the principles in routine psychotherapy practice, which warrants further investigation. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Pesky gNATs for children experiencing low mood and anxiety - A pragmatic randomised controlled trial of technology-assisted CBT in primary care.

BACKGROUND: Compared to the evidence base for adult populations, less is known about the effectiveness of technology-assisted CBT interventions for children aged 12 and under in real-world settings. AIMS: This study aimed to evaluate the effectiveness of a technology-assisted CBT intervention called Pesky gNATs in primary care psychology services. METHODS: A 2 × 3 (group by time) waitlist randomised controlled trial design was applied (n = 122), using the total internalising score from the Child Behaviour Checklist (CBCL) as the primary outcome measure; and a range of secondary outcomes. Participants were recruited from primary care services across Ireland and were assessed at baseline (Time 1), post-intervention (Time 2), and a follow-up at 3 months (Time 3). Repeated measures ANOVAs were used to analyse the data; in addition to Cohen's d for effect sizes, and the reliable change index (RCI) for clinically meaningful change. RESULTS: Overall, no significant between-group differences were found on primary or secondary measures. Both intervention and waitlist control groups experienced significantly positive change across all timepoints. However, participant retention rate at Time 2 was 66%; and fell to 44% at Time 3. Intervention group feedback from children and parent at Time 2 indicated high levels of acceptability and satisfaction with Pesky gNATs. The RCI showed a statistically significant result at Time 2: more participants from the intervention group (n = 9) moved from clinical to non-clinical levels on the primary outcome than did waitlist control participants (n = 0); but no differences were found at Time 3. CONCLUSION: This RCT did not demonstrate that Pesky gNATs is effective in providing clinically significant levels of change for low mood and anxiety. However, participant feedback showed high levels of acceptability and positive experiences However, given the high attrition rate and implementation challenges, further research is required to ascertain the effectiveness of technology-assisted CBT interventions such as Pesky gNATs.

Universal process-based CBT for positive mental health in early adolescence: A cluster randomized controlled trial.

Early adolescence is a key developmental phase for promoting positive mental health and preventing psychological difficulties. Despite calls to develop the evidence base for universal interventions in early adolescence and the promise of process-based CBT, the literature is devoid of empirical investigations of the efficacy of universal process-based CBT in this cohort. This cluster randomized controlled trial aimed to extend the empirical literature by evaluating the efficacy of a six-session universal process-based CBT intervention in elementary schools. Twenty-nine schools were randomly allocated to intervention or waiting list control groups. Six hundred four participants completed measures of positive mental health, resilience, emotional literacy, and mindfulness at baseline, post-intervention, and six-week follow-up. Although participants reported that the intervention was satisfactory, it did not yield significantly superior growth rates on the outcome measures than the control condition at post-intervention or follow-up. Implications of the findings and directions for future research are discussed.

A controlled evaluation of a prison-based sexual offender intervention program.

The effectiveness of a prison-based cognitive behavioral program designed to modify psychological risk factors associated with sexual offending was evaluated. The Irish Prison Service Sexual Offender Intervention Programme, is a manualized 10-month Cognitive Behaviour Therapy [CBT] program involving three 2-hour group sessions per week, which are facilitated by a team of clinical psychologists and probation officers. Improvements in 38 consecutive referrals to the program were compared with the status of 38 untreated offenders who were similar in marital status, age when they left school, occupational status prior to imprisonment, offence type, presence of previous convictions, and current sentence length. All research participants completed the same assessment protocol, which evaluated psychological factors associated with sexual offending at times equivalent to pre- and postintervention. Compared with the untreated control group, program participants showed statistically significant improvement on some but not all self-report measures of cognitive distortions, empathy, interpersonal skills, self-regulation, and relapse prevention. Motivation to change among the untreated control group was not associated with change in psychological functioning in the absence of the assistance of the treatment program. Implications for sexual offender intervention delivery are considered.