The efficacy of self-guided internet and mobile-based interventions for preventing anxiety and depression - A systematic review and meta-analysis.

BACKGROUND: Anxiety and depression are highly prevalent mental disorders which are associated with a considerable personal and economic burden. As treatment alone has a minimal impact on prevalence, there is now a growing focus on interventions which may help prevent anxiety and depression. Internet and mobile based interventions have been identified as a useful avenue for the delivery of preventative programmes due to their scalability and accessibility. The efficacy of interventions that do not require additional support from a trained professional (self-guided) in this capacity is yet to be explored. METHOD: A systematic search was conducted on the Cochrane Library, PubMed, PsycARTICLES, PsycINFO, OVID, MEDline, PsycEXTRA and SCOPUS databases. Studies were selected according to defined inclusion and exclusion criteria. The primary outcome was evaluating the effect of self-guided internet and mobile based interventions on incidence of anxiety and depression. The secondary outcome was effect on symptom severity. RESULTS: After identifying and removing duplicates, 3211 studies were screened, 32 of which were eligible for inclusion in the final analysis. Nine studies also reported incidence data (depression = 7, anxiety = 2). The overall Risk Ratios for incidence of anxiety and depression were 0.86 (95% CI [0.28, 2.66], p = .79) and 0.67 (95% CI [0.48, 0.93], p = .02) respectively. Analysis for 27 studies reporting severity of depressive symptoms revealed a significant posttreatment standardised mean difference of -0.27 (95% CI [ -0.37, -0.17], p < .001) for self-guided intervention groups relative to controls. A similar result was observed for 29 studies reporting severity of anxiety symptoms with a standardised mean difference of -0.21 (95% CI [-0.31, -0.10], p < .001). CONCLUSIONS: Self-guided internet and mobile based interventions appear to be effective at preventing incidence of depression, though further examination of the data suggests that generalisability of this finding may be limited. While self-guided interventions also appear effective in reducing symptoms of anxiety and depression, their ability to prevent incidence of anxiety is less clear. A heavy reliance on symptom measures in the data analysed suggests future research could benefit from prioritising the use of standardised diagnostic measuring tools to assess incidence. Future systematic reviews should aim to include more data from grey literature and reduce the impact of study heterogeneity.

Understanding and supporting peer relationships in adolescents with acquired brain injury: A stakeholder engagement study.

Peer relationship difficulties in adolescents with acquired brain injury (ABI) are under-recognized and targets for intervention are unclear. From a social constructionist position, this study aimed to engage with stakeholders to develop a collaborative understanding of peer relationship difficulties in adolescents with ABI and seek consultation on what might be required to improve them. Focus groups and semi-structured interviews were conducted with four stakeholder groups: adolescents with ABI (n = 4); parents of adolescents with ABI (n = 7); adults who sustained an ABI in adolescence (n = 2); and specialist practitioners (n = 3). Qualitative data were analysed using thematic analysis. The analysis yielded 11 themes, grouped into two domains. The first, understanding peer relationship difficulties, included themes from "exclusion and a need to belong", to "loss of past self". The second, supporting peer relationships, comprised themes of "building understanding" and "meaningful social connection", amongst others. A logic model of stakeholder experiences of peer relationship difficulties was constructed. Difficulties with peers can increase vulnerability to feelings of loneliness, shame, and hopelessness for adolescents post-ABI. Stakeholders described that a meaningful intervention would be multi-layered, targeting change within the adolescent's environment and within the adolescent themselves. The presented logic model provides a framework for future intervention development.

Mood Disorders in Young People With Acquired Brain Injury: An Integrated Model.

Purpose/Objective: Young people with paediatric acquired brain injury (pABI) are twice as likely to develop a mood disorder as their peers, frequently have significant unmet socio-emotional needs, and are at over double the risk of going on to use adult mental health services. Recent years have seen significant advances in the development of interventions for young people with mood disorders. However, evidence-based approaches to mood disorders in pABI are lacking and surprisingly little work has evaluated clinical and neuro-developmental models of mood disorders in this population. Method: We review the literature regarding key mechanisms hypothesised to account for the increased vulnerability to mood disorders in pABI: First, we summarise the direct neurocognitive consequences of pABI, considering the key areas of the brain implicated in vulnerability to mood disorders within a neurodevelopmental framework. Second, we outline five key factors that contribute to the heightened prevalence of mood disorders in young people following ABI. Finally, we synthesise these, integrating neuro-cognitive, developmental and systemic factors to guide clinical formulation. Results and Implications: We present a framework that synthesises the key mechanisms identified in our review, namely the direct effects of pABI, neurocognitive and neuroendocrine factors implicated in mood and anxiety disorders, maladaptive neuroplasticity and trauma, structural and systemic factors, and psychological adjustment and developmental context. This framework is the first attempt to provide integrated guidance on the multiple factors that contribute to elevated life-long risk of mood disorders following pABI.

Acceptance and commitment therapy for young brain tumour survivors: study protocol for an acceptability and feasibility trial.

INTRODUCTION: Survivors of childhood brain tumours have the poorest health-related quality of life of all cancer survivors due to the multiple physical and psychological sequelae of brain tumours and their treatment. Remotely delivered acceptance and commitment therapy (ACT) may be a suitable and accessible psychological intervention to support young people who have survived brain tumours. This study aims to assess the feasibility and acceptability of remotely delivered ACT to improve quality of life among these young survivors. METHODS AND ANALYSIS: This study is a two-arm, parallel group, randomised controlled trial comparing ACT with waitlist control at 12-week follow-up as the primary endpoint. Seventy-two participants will be recruited, who are aged 11-24 and have completed brain tumour treatment. Participants will be randomised to receive 12 weeks of ACT either immediately or after a 12-week wait. The DNA-v model of ACT will be employed, which is a developmentally appropriate model for young people. Feasibility will be assessed using the proportion of those showing interest who consent to the trial and complete the intervention. Acceptability will be assessed using participant evaluations of the intervention, alongside qualitative interviews and treatment diaries analysed thematically. A range of clinical outcome measures will also assess physical and mental health, everyday functioning, quality of life and service usage at 12-week follow-up. The durability of treatment effects will be assessed by further follow-up assessments at 24 weeks, 36 weeks and 48 weeks. ETHICS AND DISSEMINATION: Ethical approval was given by East Midlands, Nottingham 1 Research Ethics Committee (Reference: 20/EM/0237). Study results will be disseminated in peer-reviewed journals, through public events and relevant third sector organisations. TRIAL REGISTRATION: ISRCTN10903290; NCT04722237.

Clinical and cost-effectiveness of teen online problem-solving for adolescents who have survived an acquired brain injury in the UK: protocol for a randomised, controlled feasibility study (TOPS-UK).

INTRODUCTION: Paediatric acquired brain injury is a leading cause of mortality in children in the UK. Improved treatment during the acute phase has led to increased survival rates, although with life-long morbidity in terms of social and emotional functioning. This is the protocol for a feasibility randomised controlled trial with an embedded qualitative study and feasibility economic evaluation. If feasible, a later definitive trial will test the effectiveness and cost-effectiveness of an online intervention to enhance problem solving ability versus treatment as usual. METHODS AND ANALYSIS: Twenty-five adolescents and their families identified by primary or secondary care clinicians at participating UK National Health Service Trusts will be recruited and individually randomised in a 1:1 ratio to receive the online intervention or treatment as usual. Participants will be followed up by online questionnaires 17 weeks after randomisation to capture acceptability of the study and intervention and resource use data. Qualitative interviews will capture participants' and clinicians' experiences of the study. ETHICS AND DISSEMINATION: This study has been granted ethical approval by the South West-Exeter Research Ethics Committee (ref 17/SW/0083). Results will be disseminated via peer-reviewed publications and will inform the design of a larger trial. TRIAL REGISTRATION NUMBER: ISRCTN10906069.

Context-sensitive goal management training for everyday executive dysfunction in children after severe traumatic brain injury.

OBJECTIVES: To assess the effectiveness of a metacognitive training intervention, based on an adapted Goal Management Training and Ylvisaker's principles, on 3 activity domains of executive functions: (1) prospective memory (PM) performance in ecological setting, (2) complex cooking task management, and (3) daily executive functioning (EF) at home and at school. PARTICIPANTS: Five children aged 8 to 14 years, who were 3 to 11 years post-severe traumatic brain injury, experiencing severe EF difficulties in daily life. DESIGN: Single-case experimental design and assessment of EF twice prior to intervention, postintervention, and 3 and 6 months postintervention. Progress was monitored by a weekly ecological PM score. The effect on EF was assessed using the Children's Cooking Task. Transfer to the child's natural context was assessed by parental and teacher questionnaires and Goal Attainment Scaling. RESULTS: All children improved both on the measure of PM and on questionnaires of daily EF. Two children improved on the Children's Cooking Task but returned to their preintervention level in a novel cooking task at follow-up. Participation of school personnel and parents in the program was low. CONCLUSIONS: It is feasible but challenging to use Goal Management Training in children with traumatic brain injury. Further research is needed in relation to how to promote generalization and how to increase the involvement of the child's "everyday people" in the intervention.

Quality of life in children with acquired brain injury: parent perspectives 1-5 years after injury.

PRIMARY OBJECTIVE: To obtain parental ratings of children's quality of life, cognitive, emotional and behavioural functioning, as well as ratings of service provision, following traumatic brain injury (TBI). RESEARCH DESIGN: A retrospective, cross-sectional study. METHODS AND PROCEDURES: Parents of 47 children with mild or moderate-severe TBI completed standardized questionnaires evaluating quality of life (PedsQL 4.0) and cognitive, emotional and behavioural functioning (Strengths and Difficulties Questionnaire). Data collected was compared with published normative data for these scales. Views regarding parental experiences of care and their ratings of service provision were also obtained. RESULTS: Quality of life was significantly lower in 13-times as many children with TBI than expected from the normative population. Parents reported that more than 43% of children with TBI had cognitive, emotional and behavioural difficulties that impacted on their daily life. Whilst high levels of social deprivation were found, this did not fully explain the significantly raised levels of difficulties. Another factor associated with this poor outcome was the absence of systematic, routine follow-up or intervention. CONCLUSIONS: Parents frequently reported poor quality of life and cognitive, emotional and behavioural problems in their children following TBI. These preliminary findings indicate that children, after TBI, are at risk of developing persistent clinical problems and require follow-up beyond the acute period of their recovery.

Practitioner review: cognitive rehabilitation for children with acquired brain injury.

BACKGROUND: The need to address acquired cognitive impairments is increasing in child populations seen across a range of settings. However, current clinical practice following brain injury in children does not necessarily incorporate the use of cognitive rehabilitation models or techniques. The aim of this paper is to review the literature in this area. METHODS: All published interventions targeting the cognitive domains of attention, memory and/or executive function that could be identified were reviewed. Different cognitive rehabilitation techniques are briefly described and the clinical and research implications of the findings are discussed. RESULTS: Eleven papers, involving 54 children and adolescents receiving intervention, were identified. This literature describes generalised cognitive rehabilitation programmes as well as more specific strategies targeting focal deficits. CONCLUSIONS: There is an absence of randomised controlled trials and a very limited number of studies using other methodological approaches, providing at this time no conclusive evidence for the efficacy of cognitive rehabilitation for children with acquired brain injury, but a clear need to address a range of methodological difficulties in this field of enquiry.

A developmental framework for memory rehabilitation in children.

Memory difficulties in adults with acquired brain injuries have been reported in the literature for some time. In recent years, the consequences of memory difficulties from acquired and neurodevelopmental disorders in children have also been investigated. Initial studies have suggested that, like adults, children can experience severe and specific memory deficits. However, there are important developmental differences, both in terms of the nature of cognitive difficulties experienced, and the subsequent consequences for learning, educational attainment and everyday living. Despite the advances made in developmental memory studies, as yet, there appears to be scant literature to guide effective rehabilitation specifically targeted at children. As a starting point, it may be appropriate to consider adaptation of adult rehabilitation strategies to address memory problems in children. This paper describes some of the common principles and practices of adult rehabilitation strategies and then considers the validity of such strategies against developmental models of the memory system and child's learning environment. In particular, four important areas are highlighted: the development of normal memory functions in children, the range of cognitive deficits that can occur in a developing brain, the interaction of memory deficits with other immature cognitive skills and the context of the psycho-social environment in which rehabilitation may take place.