Internet-delivered cognitive behavioral therapy for tinnitus compared to Internet-delivered mindfulness for tinnitus: a study protocol of a randomized controlled trial.

BACKGROUND: Tinnitus affects around 15% of the population and can be a debilitating condition for a sizeable part of them. However, effective evidence-based treatments are scarce. One recommended treatment for tinnitus is cognitive behavioral therapy which has been found to be effective when delivered online. However, more treatments including mindfulness-based interventions have been studied recently in an attempt to facilitate the availability of effective treatments. There are promising findings showing great effects in reducing tinnitus-induced distress and some evidence about the efficacy of such intervention delivered online. However, there is a lack of evidence on how these two treatments compare against one another. Therefore, the aim of this study will be to compare Internet-delivered cognitive behavioral therapy for tinnitus against an Internet-delivered mindfulness-based tinnitus stress reduction intervention in a three-armed randomized controlled trial with a waiting list control condition. METHODS: This study will be a randomized controlled trial seeking to recruit Lithuanian-speaking individuals suffering from chronic tinnitus. The self-report measure Tinnitus Handicap Inventory will be used. Self-referred participants will be randomized into one of three study arms: Internet-delivered cognitive behavioral therapy, Internet-delivered mindfulness-based tinnitus stress reduction intervention, or a waiting-list control group. Post-treatment measures will be taken at the end of the 8-week-long intervention (or waiting). Long-term efficacy will be measured 3 and 12 months post-treatment. DISCUSSION: Internet-delivered interventions offer a range of benefits for delivering evidence-based treatments. This is the first randomized controlled trial to directly compare Internet-delivered CBT and MBTSR for tinnitus in a non-inferiority trial. TRIAL REGISTRATION: ClinicalTrials.gov NCT05705323. Registered on January 30, 2023.

Unmet Healthcare Needs Predict Depression Symptoms among Older Adults.

Risk factors for depression in older adults include significant interpersonal losses, increasing social isolation, and deteriorating physical abilities and health that require healthcare. The effects of unmet healthcare needs on depression in older adults are understudied. This study aimed to analyze the association between unmet healthcare needs and symptoms of depression, sleep, and antidepressant medication while controlling for other significant factors among older adults. For this study, we used a multinational database from The Survey of Health, Ageing and Retirement in Europe (SHARE), containing data of individuals aged 50 and older. The final sample used in this research consisted of 39,484 individuals from 50 to 100 years (mean - 71.15, SD ± 9.19), 42.0 percent of whom were male. Three path models exploring relationships between symptoms of depression at an older age and unmet healthcare needs were produced and had a good model fit. We found that unmet healthcare needs were directly related to depression, activity limitations were related to depression directly and through unmet healthcare needs, whereas financial situation mostly indirectly through unmet healthcare needs. We discuss how depression itself could increase unmet healthcare needs.

Do emotion regulation difficulties mediate the association between neuroticism, insecure attachment, and prolonged grief?

In this study, we aimed to test the mediating role of emotion regulation difficulties between prolonged grief disorder symptoms and three risk factors: neuroticism, avoidant attachment, and anxious attachment. A total sample of 203 bereaved participants was included in the study. Path analysis revealed that emotion regulation difficulties partly mediated the links between neuroticism, avoidant attachment, and prolonged grief symptoms, and mediated the link between anxious attachment and prolonged grief symptoms. The findings suggested that emotion regulation difficulties might be an important factor contributing to prolonged grief symptoms among bereaved individuals with high neuroticism and insecure attachment.

Fear of Death and Death Acceptance Among Bereaved Adults: Associations With Prolonged Grief.

This study aimed to analyze fear of death and neutral acceptance of death after a significant loss and their associations with prolonged grief. The sample of the study included 239 bereaved participants. Time since the loss ranged from 6 to 72 months. We found that neutral acceptance of death was associated with older age, a natural cause of death, and the ability to find meaning in the death of a close one. Fear of death was negatively associated with the frequency of practicing religion. We found that fear of death but not neutral acceptance was significantly associated with prolonged grief symptoms.

A Brief Measure of the International Classification of Diseases-11 Adjustment Disorder: Investigation of Psychometric Properties in an Adult Help-Seeking Sample.

Adjustment disorder is one of the most prevalent mental disorders. However, there are almost no measures available for its assessment. We aimed to analyze the psychometric properties of a brief version of the International Classification of Diseases (ICD)-11 adjustment disorder scale (Adjustment Disorder New Module-8; ADNM-8) in a help-seeking sample. Data from 1,174 participants with an average age of 35 years who registered for the internet-based self-help adjustment disorder intervention were analyzed. Psychometric properties of the brief 8-item self-report (ADNM-8) scale measuring the 2 core adjustment disorder symptoms of preoccupation and failure to adapt were tested. Confirmatory factor analysis (CFA) was applied for the analysis of construct validity. CFA supported the 2-factor structure of ADNM-8. Further research is needed for validation of ADNM-8 in cross-cultural studies.

The structure of ICD-11 PTSD and complex PTSD in Lithuanian mental health services.

Background: The updated 11th edition of International Classification of Diseases (ICD-11) is expected to be released by the WHO in 2018. Disorders specifically associated with stress will be included in a separate chapter in ICD-11, and will include a revision of ICD-10 PTSD as well as a new diagnosis of complex posttraumatic stress disorder (CPTSD). The proposed symptom structures of ICD-11 PTSD and CPTSD have been validated in several studies previously, however few studies have used the International Trauma Questionnaire (ITQ), a specific measure for ICD-11 PTSD and CPTSD. Given that ICD-11 PTSD and CPTSD diagnoses are intended to be applicable across different cultures and nations, it is important that the constructs be evaluated across diverse populations and languages. Objective: Study of the psychological impact of trauma is relatively new in Lithuania, coinciding with its independence from the Soviet Union in the 1990s. Studies thus far reveal a population suffering from the effects of long-term and systematic political oppression and violence. The aim of this study was to assess the validity of the symptoms and structure of PTSD and CPTSD in a Lithuanian treatment-seeking sample as measured by the ITQ. Method: A total of 280 patients from outpatient mental health centres participated in this study. PTSD and CPTSD symptoms were measured with the ITQ. We applied confirmatory factor analysis (CFA) and latent class analysis (LCA) for analysis of data. Results and conclusions: Our study supported the ICD-11 factor structure of CPTSD, and a three-class model was supported in LCA analysis with a PTSD class, a CPTSD class, and a low symptom class. Findings support the factorial and discriminant validity of the ICD-11 proposals for PTSD and CPTSD in a unique clinical population.

Planteamiento: Está previsto que la OMS publique la onceava versión actualizada de la Clasificación Internacional de Enfermedades (CIE-11) en 2018. Los trastornos específicamente relacionados con el estrés se incluirán en un capítulo separado en la CIE-11 e incluirán una revisión del TEPT de la CIE-10, así como un nuevo diagnóstico de trastorno de estrés postraumático complejo (TEPT-C). Las estructuras de síntomas propuestas para el TEPT y el TEPT-C de la CIE-11 han sido validadas en varios estudios previamente, sin embargo, solo unos pocos estudios han utilizado el Cuestionario Internacional de Trauma (ITQ, por sus siglas en inglés), una medida específica para el TEPT y el TEPT-C de la CIE-11. Dado que los diagnósticos de TEPT y TEPT-C de la CIE-11 pretenden aplicarse en diferentes culturas y naciones, es importante que los constructos se evalúen en diversas poblaciones e idiomas.Objetivos: El estudio del impacto psicológico del trauma es relativamente nuevo en Lituania, coincidiendo con su independencia de la Unión Soviética en la década de 1990 y los estudios hasta el momento revelan una población que sufre los efectos de la opresión y la violencia política sistemáticas a largo plazo. El objetivo de este estudio fue evaluar la validez de los síntomas y la estructura del TEPT y el TEPT-C en una muestra lituana que buscaba tratamiento, medida con el ITQ.Método: Participaron en este estudio un total de 280 pacientes de centros ambulatorios de salud mental. Los síntomas de TEPT y TEPT-C se midieron con el ITQ. Aplicamos el Análisis Factorial Confirmatorio (CFA, por sus siglas en inglés) y el Análisis de Clase Latente (LCA, por sus siglas en inglés) para el análisis de datos.Resultados y conclusiones: Nuestro estudio apoyó la estructura de factores del TEPT-C de la CIE-11 y respaldó un modelo de tres clases en el análisis de LCA con una clase de TEPT, una clase de TEPT-C y una clase de pocos síntomas. Los hallazgos respaldan la validez factorial y discriminante de las propuestas de la CIE-11 para el TEPT y el TEPT-C en una población clínica singular.

The role of therapist support on effectiveness of an internet-based modular self-help intervention for adjustment disorder: a randomized controlled trial.

BACKGROUND: Adjustment disorder is among the most often diagnosed mental health disorders. Still, there is a lack of specific interventions available for adjustment disorder. OBJECTIVES: The aim of this study was to test if an internet-based self-help intervention for adjustment disorder could be effective without therapist involvement. DESIGN: A parallel group randomized controlled trial design was used to test the effectiveness of the Brief Adjustment Disorder Intervention (BADI) - an internet-based intervention for adjustment disorder. METHODS: In total 1077 participants were randomized into two conditions: BADI intervention and BADI intervention with therapist support. The main outcome measures were symptoms of adjustment disorder and well-being. RESULTS: Pre-intervention to post-intervention adjustment disorder effect size for the BADI intervention group was d = 0.64, and for the BADI with therapist support group the effect size was d = 0.53. CONCLUSIONS: The present study supported the effectiveness of the BADI intervention. Our findings also indicated that adding therapist support to the standard BADI intervention did not significantly improve the outcomes.

Internet-Based Self-Help Intervention for ICD-11 Adjustment Disorder: Preliminary Findings.

Adjustment disorder is one of the most diagnosed mental disorders. However, there is a lack of studies of specialized internet-based psychosocial interventions for adjustment disorder. We aimed to analyze the outcomes of an internet-based unguided self-help psychosocial intervention BADI for adjustment disorder in a two armed randomized controlled trial with a waiting list control group. In total 284 adult participants were randomized in this study. We measured adjustment disorder as a primary outcome, and psychological well-being as a secondary outcome at pre-intervention (T1) and one month after the intervention (T2). We found medium effect size of the intervention for the completer sample on adjustment disorder symptoms. Intervention was effective for those participants who used it at least one time in 30-day period. Our results revealed the potential of unguided internet-based self-help intervention for adjustment disorder. However, high dropout rates in the study limits the generalization of the outcomes of the intervention only to completers.