Cognitive Behavior Therapy vs Mindfulness in Treatment of Prolonged Grief Disorder: A Randomized Clinical Trial.

Importance: Although grief-focused cognitive behavior therapies are the most empirically supported treatment for prolonged grief disorder, many people find this treatment difficult. A viable alternative for treatment is mindfulness-based cognitive therapy. Objective: To examine the relative efficacies of grief-focused cognitive behavior therapy and mindfulness-based cognitive therapy to reduce prolonged grief disorder severity. Design, Setting, and Participants: A single-blind, parallel, randomized clinical trial was conducted among adults aged 18 to 70 years with prolonged grief disorder, as defined in the International Classification of Diseases, 11th Revision, and assessed by clinical interview based on the Prolonged Grief-13 (PG-13) scale. Those with severe suicidal risk, presence of psychosis, or substance dependence were excluded. Between November 2012 and November 2022, eligible participants were randomized 1:1 to eleven 90-minute sessions of grief-focused cognitive behavior therapy or mindfulness-based cognitive therapy at a traumatic stress clinic in Sydney, Australia, with follow-up through 6 months. Interventions: Both groups received once-weekly 90-minute individual sessions for 11 weeks. Grief-focused cognitive behavior therapy comprised 5 sessions of recalling memories of the deceased, plus cognitive restructuring and planning future social and positive activities. Mindfulness-based cognitive therapy comprised mindfulness exercises adapted to tolerate grief-related distress. Main Outcomes and Measures: The primary outcome was change in prolonged grief disorder severity measured by the PG-13 scale assessed at baseline, 1 week posttreatment, and 6 months after treatment (primary outcome time point), as well as secondary outcome measures of depression, anxiety, grief-related cognition, and quality of life. Results: The trial included 100 participants (mean [SD] age, 47.3 [13.4] years; 87 [87.0%] female), 50 in the grief-focused cognitive behavior therapy condition and 50 in the mindfulness-based cognitive therapy condition. Linear mixed models indicated that at the 6-month assessment, participants in the grief-focused cognitive behavior therapy group showed greater reduction in PG-13 scale score relative to those in the mindfulness-based cognitive therapy group (mean difference, 7.1; 95% CI, 1.6-12.5; P = .01), with a large between-group effect size (0.8; 95% CI, 0.2-1.3). Participants in the grief-focused cognitive behavior therapy group also demonstrated greater reductions in depression as measured on the Beck Depression Inventory than those in the mindfulness-based cognitive therapy group (mean difference, 6.6; 95% CI, 0.5-12.9; P = .04) and grief-related cognition (mean difference, 14.4; 95% CI, 2.8-25.9; P = .02). There were no other significant differences between treatment groups and no reported adverse events. Conclusions and Relevance: In this study, grief-focused cognitive behavior therapy conferred more benefit for core prolonged grief disorder symptoms and associated problems 6 months after treatment than mindfulness-based cognitive therapy. Although both treatments may be considered for prolonged grief disorder, grief-focused cognitive behavior therapy might be the more effective choice, taking all factors into consideration. Trial Registration: anzctr.org.au Identifier: ACTRN12612000307808.

Positive affect training to reduce mental health problems during the COVID-19 pandemic: a proof-of-concept randomised clinical trial.

BACKGROUND: The social restrictions occurring during the pandemic contributed to loss of many sources of reward, which contributes to poor mental health. OBJECTIVE: This trial evaluated a brief positive affect training programme to reduce anxiety, depression and suicidality during the pandemic. METHODS: In this single-blind, parallel, randomised controlled trial, adults who screened positive for COVID-19-related psychological distress across Australia were randomly allocated to either a 6-session group-based programme based on positive affect training (n=87) or enhanced usual care (EUC, n=87). Primary outcome was total score on the Hospital Anxiety and Depression Scale-anxiety and depression subscales assessed at baseline, 1-week post-treatment, 3 months (primary outcome time point) as well as secondary outcome measures of suicidality, generalised anxiety disorder, sleep impairment, positive and negative mood and COVID-19-related stress. FINDINGS: Between 20 September 2020 and 16 September 2021, 174 participants were enrolled into the trial. Relative to EUC, at 3-month follow-up the intervention led to greater reduction on depression (mean difference 1.2 (95% CI 0.4 to 1.9)), p=0.003), with a moderate effect size (0.5 (95% CI 0.2 to 0.9)). There were also greater reduction of suicidality and improvement in quality of life. There were no differences in anxiety, generalised anxiety, anhedonia, sleep impairment, positive or negative mood or COVID-19 concerns. CONCLUSIONS: This intervention was able to reduce depression and suicidality during adverse experiences when rewarding events were diminished, such as pandemics. CLINICAL IMPLICATIONS: Strategies to improve positive affect may be useful to reduce mental health issues. TRIAL REGISTRATION NUMBER: ACTRN12620000811909.

Habituation of distress during exposure and its relationship to treatment outcome in post-traumatic stress disorder and prolonged grief disorder.

Background: Reliving distressing memories is a core component of treatments for post-traumatic stress disorder (PTSD) and prolonged grief disorder (PGD). There is little understanding of how reliving these memories functions in the treatment of these disorders.Objective: This study investigated whether reliving functions comparably in the treatment of PTSD and PGD, and whether it is comparably related to treatment outcome.Method: This study conducted a reanalysis of patients with either PTSD (n = 55) or PGD (n = 45) who underwent treatments that comprised at least four sessions of reliving memories of either their traumatic experience or the loss of the deceased person.Results: PTSD participants displayed greater habituation of distress across sessions during reliving than PGD participants. Between-session reduction in distress during reliving was associated with symptom remission in PTSD, but this pattern was not observed in PGD.Conclusion: This pattern of findings indicates that although reliving appears to be a useful strategy for treating both PTSD and PGD, this strategy does not function comparably in the two conditions and may involve distinct mechanisms.

Reliving distressing memories is key to treatment of PTSD and prolonged grief disorder.Distress during memory reliving habituated in PTSD treatment more than in treatment of grief.Habituation of distress during treatment predicted remission of symptoms in PTSD but not grief.

DATaR: Depth Augmented Target Redetection using Kernelized Correlation Filter.

Unlike deep learning which requires large training datasets, correlation filter-based trackers like Kernelized Correlation Filter (KCF) use implicit properties of tracked images (circulant structure) for training in real time. Despite their popularity in tracking applications, there exists significant drawbacks of the tracker in cases like occlusions and out-of-view scenarios. This paper attempts to address some of these drawbacks with a novel RGB-D Kernel Correlation tracker in target re-detection. Our target re-detection framework not only re-detects the target in challenging scenarios but also intelligently adapts to avoid any boundary issues. Our results are experimentally evaluated using (a) standard dataset and (b) real time using the Microsoft Kinect V2 sensor. We believe this work will set the basis for improvement in the effectiveness of kernel-based correlation filter trackers and will further the development of a more robust tracker.

Augmenting trauma-focused psychotherapy for post-traumatic stress disorder with brief aerobic exercise in Australia: a randomised clinical trial.

BACKGROUND: Although exposure therapy is central in most front-line psychotherapies of post-traumatic stress disorder (PTSD), many patients do not respond to this treatment. We aimed to investigate the effects of brief aerobic exercise on the efficacy of exposure therapy in reducing the severity of PTSD. METHODS: We did a single-blind, parallel, randomised controlled trial in Sydney, NSW, Australia. We included adults (aged ≥18 years) with clinician-diagnosed PTSD. We excluded participants aged 70 years or older, with imminent suicidal risk (reporting suicidal plan), presence of psychosis or substance dependence, history of moderate-to-severe traumatic brain injury, or presence of a physical disorder or impairment that might be exacerbated by aerobic exercise (eg, back pain). We randomly assigned participants (1:1) to nine 90-min weekly sessions of exposure therapy for PTSD with 10 min aerobic exercise or to the control group of exposure therapy with 10 min passive stretching. The primary outcome was PTSD severity measured by the clinician-administered PTSD scale 2 (CAPS-2), independently assessed at baseline, 1 week after treatment, and 6 months after treatment (primary outcome timepoint). FINDINGS: Between Dec 12, 2012, and July 25, 2018, we enrolled 130 participants with PTSD, with 65 (50%) participants randomly assigned to exposure therapy with exercise and 65 (50%) to exposure therapy with passive stretching, including 79 (61%) women and 51 (39%) men, with a mean age of 39·1 years (SD 14·4; range 18-69). 99 (76%) participants were White, 14 (11%) were Asian, and 17 (13%) were listed as other. At the 6-month follow-up assessment, participants in the exposure therapy with exercise group showed greater reductions in CAPS-2 scores relative to those in the exposure therapy with stretching group (mean difference 12·1 [95% CI 2·4-21·8]; p=0·023), which resulted in a moderate effect size of 0·6 (0·1-1·1). No adverse events associated with the intervention were reported. The trial was prospectively registered on the Australian and New Zealand Clinical Trials Registry, ACTRN12612000185864. INTERPRETATION: Brief aerobic exercise has the potential to augment long-term gains of exposure therapy for PTSD, which accords with evidence from studies in animals and humans on the role of exercise in modulating the extinction learning processes. This strategy might offer a simple and affordable means to augment treatment gains for exposure therapy in people with PTSD. FUNDING: Australian National Health and Medical Research Council.

Videoconferencing-delivered psychological intervention for the treatment of COVID-19 related psychological distress in University students: study protocol for a randomised controlled trial in India.

BACKGROUND: The mental health impacts of the COVID-19 pandemic have been profound. This paper outlines the study protocol for a trial that tests the efficacy of a brief group-based psychological intervention (Coping with COVID; CWC), relative to Supportive Counselling, to reduce distress associated with COVID-19 in a young adult population in Bangalore, India. METHODS: A single-blind, parallel, randomized controlled trial will be carried out via video conferencing in a small group format. Following informed consent, adults that screen positive for levels of psychological distress (Kessler 10 (K-10 score ≥ 20) and have access to a videoconferencing platform will be randomised to an adapted version of CWC (n = 90) or Supportive Counselling (SC) (n = 90). The primary outcome will be reduction in psychological distress including anxiety and depression at 2-months post treatment. Secondary outcomes include worry, positive wellbeing, and stress in relation to COVID-19. DISCUSSION: This treatment trial will assess whether CWC will result in reduced distress relative to Supportive Counselling in a young adult population in Bangalore, India. This study will yield important insights into the role of nonspecific factors versus the intervention's components in impacting COVID-19 related distress. TRIAL REGISTRATION: This trial was prospectively registered on the Australian New Zealand Clinical Trials Registry (ACTRN12621001064897). ETHICS AND DISSEMINATION: Ethics approval has been obtained from the participating institution, CHRIST University in Bangalore. Results of the trial will be submitted for publication in peer reviewed journals and findings presented at scientific conferences and to key service providers and policy makers.

Effectiveness of a Videoconferencing-Delivered Psychological Intervention for Mental Health Problems during COVID-19: A Proof-of-Concept Randomized Clinical Trial.

INTRODUCTION: Anxiety and depression have increased markedly during the COVID-19 pandemic. There is a lack of evidence-based strategies to address these mental health needs during the pandemic. OBJECTIVE: We aim to conduct a proof-of-concept trial of the efficacy of a brief group-based psychological intervention delivered via videoconferencing for adults in Australia distressed by the pandemic. METHODS: In this single-blind, parallel, randomised controlled trial, adults who screened positive for COVID-related psychological distress across Australia were randomly allocated to either a 6-session group-based program based on behavioural principles (n = 120) or enhanced usual care (EUC, n = 120). Primary outcome was total score on the Hospital Anxiety and Depression (HADS) anxiety and depression subscales assessed at baseline, 1 week posttreatment, 2 months (primary outcome time point), and 6 months after treatment, as well as secondary outcome measures of worry, sleep impairment, anhedonia, mood, and COVID-19-related stress. RESULTS: Between May 20, 2020, and October 20, 2020, 240 patients were enrolled into the trial. Relative to EUC, at 2 months participants receiving intervention showed greater reduction on anxiety (mean difference, 1.4 [95% CI, 0.3 to 2.6], p = 0.01; effect size, 0.4 [95% CI, 0.1 to 0.7]) and depression (mean difference, 1.6 [95% CI, 0.4 to 2.8], p = 0.009; effect size, 0.4 [95% CI, 0.2 to 0.7]) scales. These effects were maintained at 6 months. There were also greater reductions of worry, anhedonia, COVID-19-related fears, and contamination fears. CONCLUSIONS: This trial provides initial evidence that brief group-based behavioural intervention delivered via videoconferencing results in moderate reductions in common psychological problems arising during the COVID-19 pandemic. This program may offer a viable and scalable means to mitigate the rising mental health problems during the pandemic.

Discovery of novel inhibitors targeting Plasmodium knowlesi dihydrofolate reductase using molecular docking and molecular dynamics simulation.

Plasmodium knowlesi, recognized as the fifth Plasmodium parasite, is the least studied malaria parasite. It is a significant cause of morbidity and mortality in the South-East Asia region. Enzymes of folate synthesis, especially dihydrofolate reductase (DHFR), is a well-approved drug target in other Plasmodium species, but its role in Plasmodium knowlesi is poorly studied. This work characterizes PkDHFR as a drug target and identifies inhibitors that can withstand the upcoming problem of resistance. The 3D structure of the PkDHFR target is modelled using comparative modelling, and further, it is refined and validated using energy minimization and torsional angle analysis methods. We extracted 13 compounds from DrugBank and ZINC databases using the "target similarity search" criteria. These compounds were categorized based on their binding affinity (-4.49 to -10.08 kcal/mol) and pose prediction against the active site of PkDHFR. Later on, the top 5 PkDHFR-compound complexes with high or equivalent binding affinity to its natural ligand (dihydrofolate) have undergone for dynamics. The simulation experiments reveal the higher stability of DB00563-PkDHFR complex and less conformational fluctuations and share a similar degree of compactness throughout the simulation trajectory. The MM/GBSA calculation of free energy of DB00563 is also the least (-72.84 kcal/mol) compared to others. Furthermore, the flexible side chain of DB00563 can bind and block the active site of PkDHFR more efficiently. Thus, the identified drug may be considered as a potential candidate for treating P. knowlesi malaria.

Effect of Information, Education, and Communication activity on health literacy of cardiovascular diseases among school-going adolescents in Delhi.

BACKGROUND: Heart attack and stroke account for >80% of deaths due to cardio-vascular diseases (CVDs) in India. Adolescents are the most susceptible group to adopt risky behaviors causing CVDs such as use of tobacco and alcohol, sedentary lifestyle, and unhealthy diet. This study was conducted to assess the health literacy of CVDs such as heart attack and stroke among school-going adolescents and change in health literacy after different information, education, and communication (IEC) activities. MATERIALS AND METHODS: It was a school-based interventional study conducted in two schools among students of classes 6, 7, and 8. The educational interventions were done in the form of pamphlets, posters, and lectures on heart attack and stroke. The postintervention data were collected 2 weeks after the first intervention and 3 months after the last intervention. RESULTS: There were a higher proportion of students with satisfactory level of knowledge of heart attack and stroke both at 2 weeks and 3 months after the interventions in both the schools, and the results were statistically significant (P < 0.05). CONCLUSION: The health literacy regarding CVDs has improved when compared to baseline after IEC activities among school-going adolescents.

Brief videoconferencing psychological intervention for reducing COVID-19 related distress: study protocol for a randomized controlled trial.

BACKGROUND: Globally COVID-19 has had a profound impact on the psychological wellbeing of millions of people, and there is an urgent imperative to address elevated levels of distress during the COVID-19 pandemic. The World Health Organization (WHO) has developed Problem Management Plus (PM+), a low intensity psychological intervention for adults experiencing psychological distress. This paper outlines the study protocol for a trial that tests the effectiveness of an adapted version of PM+ to reduce distress associated with COVID-19. METHODS: A single-blind, parallel, randomized controlled trial will be carried out for distressed people across Australia. via video conferencing on a small group basis. Following informed consent, adults that screen positive for levels of psychological distress (General Health Questionnaire-12 (GHQ-12 score ≥ 3) and have access to videoconferencing platform will be randomised to an adapted version of gPM+ (n = 120) or enhanced treatment as usual (ETAU) (n = 120). The primary outcome will be reduction in psychological distress including anxiety and depression at 2-months post treatment. Secondary outcomes include worry, sleep problems, anhedonia, social support, and stress in relation to COVID-19. DISCUSSION: The trial aims assess whether an adapted version of videoconferencing PM+ that is specifically designed to target COVI-19 related distress will result in reduced distress relative to enhanced usual care. TRIAL REGISTRATION: This trial was prospectively registered on the ANZCTR on 14/4/20 ( ACTRN12620000468921 ).

Deep Attention Models for Human Tracking Using RGBD.

Visual tracking performance has long been limited by the lack of better appearance models. These models fail either where they tend to change rapidly, like in motion-based tracking, or where accurate information of the object may not be available, like in color camouflage (where background and foreground colors are similar). This paper proposes a robust, adaptive appearance model which works accurately in situations of color camouflage, even in the presence of complex natural objects. The proposed model includes depth as an additional feature in a hierarchical modular neural framework for online object tracking. The model adapts to the confusing appearance by identifying the stable property of depth between the target and the surrounding object(s). The depth complements the existing RGB features in scenarios when RGB features fail to adapt, hence becoming unstable over a long duration of time. The parameters of the model are learned efficiently in the Deep network, which consists of three modules: (1) The spatial attention layer, which discards the majority of the background by selecting a region containing the object of interest; (2) the appearance attention layer, which extracts appearance and spatial information about the tracked object; and (3) the state estimation layer, which enables the framework to predict future object appearance and location. Three different models were trained and tested to analyze the effect of depth along with RGB information. Also, a model is proposed to utilize only depth as a standalone input for tracking purposes. The proposed models were also evaluated in real-time using KinectV2 and showed very promising results. The results of our proposed network structures and their comparison with the state-of-the-art RGB tracking model demonstrate that adding depth significantly improves the accuracy of tracking in a more challenging environment (i.e., cluttered and camouflaged environments). Furthermore, the results of depth-based models showed that depth data can provide enough information for accurate tracking, even without RGB information.