Skills training followed by either EMDR or narrative therapy for posttraumatic stress disorder in adult survivors of childhood abuse: a randomized controlled trial.

Background: Individuals suffering from PTSD following childhood abuse represent a large subgroup of patients attending mental health services. The aim of phase-based treatment is to tailor treatment to the specific needs to childhood abuse survivors with PTSD with a Skills Training in Affective and Interpersonal Regulation (STAIR) phase, in which emotion dysregulation and interpersonal problems are targeted, and a trauma-focused phase.Objective: The purpose of this study was to compare STAIR + Eye Movement Desensitization and Reprocessing (EMDR) vs. STAIR + Narrative Therapy (NT) as treatments for PTSD following childhood-onset trauma in a routine clinical setting.Method: Sixty-eight adults were randomly assigned to STAIR/EMDR (8 STAIR-sessions followed by 12 EMDR-sessions) or STAIR/NT (8 STAIR-sessions followed by 12 NT-sessions). Assessments took place at pre-treatment, after each treatment phase and at 3 and 12 months post-intervention follow-up. Primary outcomes were interviewer-rated and self-reported symptom levels of PTSD. Secondary outcomes included symptom levels of depression and disturbances in emotion regulation and interpersonal skills.Results: Multilevel analyses in the intent-to-treat sample indicated that patients in both treatments improved substantially on PTSD symptom severity (CAPS: d = 0.81 to 1.29; PDS: d = 1.68 to 2.15), as well as on symptom levels of depression, anxiety, emotion regulation, dissociation and interpersonal skills. Effects increased or were maintained until 12-month follow-up. At mid-treatment, after STAIR, patients in both treatments improved moderately on PTSD symptom severity (PDS: d = 1.68 to 2.15), as well as on symptom levels of depression (BDI: d = .32 to .31). Symptoms of anxiety, emotion dysregulation, interpersonal problems and dissociation were not decreased after STAIR. There were no significant differences between the two conditions on any outcome.Conclusion: PTSD in adult survivors of childhood interpersonal trauma can effectively be treated by phase-based interventions using either EMDR or NT in the trauma-processing phase.Trial registration: ClinicalTrials.gov identifier: NCT01443182..

The study directly compares Skills Training in Affective and Interpersonal Regulation (STAIR) followed by either EMDR or Narrative Therapy in the trauma-processing phase in routine clinical setting.The brief phase-based treatment was found to be effective in reducing both symptoms of PTSD as well as emotion regulation and interpersonal problems in survivors of childhood abuse.Posttraumatic Stress Disorder in adult survivors of childhood interpersonal trauma can effectively be treated by phase-based interventions using either EMDR or Narrative Therapy in the trauma-processing phase.

[Online schema therapy: a cross-sectional survey among Dutch therapists]. / Schematherapie via beeldbellen; crosssectioneel onderzoek onder therapeuten.

BACKGROUND: Long waiting lists exist for the treatment of personality disorders, which can be shortened by using videoconference treatment. During the COVID-19 pandemic, by necessity, videoconferencing was used to provide schema therapy, a specific treatment for personality disorders. AIM: To investigate therapist experience of schema therapy via videoconferencing during the pandemic. METHOD: In an observational cross-sectional study, 83 schema therapists completed a questionnaire about the period prior to, and during the COVID-19 pandemic. We investigated their experience, use of, and attitude toward videoconferencing, as well as the extent to which the effectiveness of videoconferencing and face to face (F2F) schema therapy for personality disorders was found to be comparable. RESULTS: Schema therapists rated their experience with videoconferencing therapy for personality disorders during the COVID-19 pandemic positively, its use increased during this period, and therapists’ attitudes became more positive. However, the majority found videoconferencing therapy less effective than F2F treatment. Almost half of the therapists used shorter sessions or adapted exercises during videoconferencing therapy. CONCLUSION: Although therapists were increasingly positive about video conferencing therapy, they believed that F2F treatment is more effective. Randomized efficacy studies of videoconferencing therapy compared to F2F therapy are needed, also examining patients’ experiences with both forms.

Telemedicina en oftalmología durante la pandemia de COVID-19: una experiencia piloto / Open-care telemedicine in ophthalmology during the COVID-19 pandemic: a pilot study

OBJETIVO: Reportar una experiencia piloto de atención por telemedicina en la especialidad de oftalmología, en el periodo de confinamiento por la pandemia por COVID-19. MÉTODOS: Estudio descriptivo. Se describen características demográficas y clínicas de pacientes atendidos en periodo de confinamiento de 10 semanas. Se evalúa la satisfacción de los pacientes y médicos participantes mediante una encuesta en línea. RESULTADOS: En las primeras 10 semanas, se realizaron 291 atenciones de telemedicina oftalmológica. Los principales motivos de consulta fueron afecciones inflamatorias de la superficie ocular y párpados (79,4%), seguido de requerimientos administrativos (6,5%), afecciones no inflamatorias de la superficie ocular (5,2%), sospecha de estrabismo (3,4%) y síntomas vitreorretinales (3,1%); 22 pacientes (7,5%) fueron derivados a atención presencial inmediata. El nivel de satisfacción con la prestación fue alto, tanto en médicos (100%), como en pacientes (93,4%). CONCLUSIONES: La atención oftalmológica por telemedicina en periodo de pandemia es un instrumento de utilidad para realizar un filtro de potenciales consultas presenciales, ya sea electivas o de urgencia, y para reducir potencialmente el riesgo de contagio por COVID-1

BACKGROUND: To report a pilot experience of telemedicine in ophthalmology in open-care modality (i.e. direct video call), in a confinement period due to the COVID-19 pandemic. METHODS: Descriptive study of the demographic and clinical characteristics of patients attended in a 10-week confinement period. Reported satisfaction of the participating patients and doctors was evaluated through an online survey. RESULTS: In the 10-week period, 291 ophthalmologic telemedicine consultations were performed. The main reasons for consultation were inflammatory conditions of the ocular surface and eyelids (79.4%), followed by administrative requirements (6.5%), non-inflammatory conditions of the ocular surface (5.2%), strabismus suspicion (3.4%) and vitreo-retinal symptoms (3.1%). According to previously defined criteria, 22 patients (7.5%) were referred to immediate face-to-face consultation. The level of satisfaction was high, both in doctors (100%) and in patients (93.4%). CONCLUSIONS: Open-care modality of telemedicine in ophthalmology during the pandemic period is a useful instrument to filter potential face-to-face consultations, either elective or emergency, and potentially reduce the risk of COVID-19 infection

Open-care telemedicine in ophthalmology during the COVID-19 pandemic: a pilot study. / Telemedicina en oftalmología durante la pandemia de COVID-19: una experiencia piloto.

BACKGROUND: To report a pilot experience of telemedicine in ophthalmology in open-care modality (i.e. direct video call), in a confinement period due to the COVID-19 pandemic. METHODS: Descriptive study of the demographic and clinical characteristics of patients attended in a 10-week confinement period. Reported satisfaction of the participating patients and doctors was evaluated through an online survey. RESULTS: In the 10-week period, 291 ophthalmologic telemedicine consultations were performed. The main reasons for consultation were inflammatory conditions of the ocular surface and eyelids (79.4%), followed by administrative requirements (6.5%), non-inflammatory conditions of the ocular surface (5.2%), strabismus suspicion (3.4%) and vitreo-retinal symptoms (3.1%). According to previously defined criteria, 22 patients (7.5%) were referred to immediate face-to-face consultation. The level of satisfaction was high, both in doctors (100%) and in patients (93.4%). CONCLUSIONS: Open-care modality of telemedicine in ophthalmology during the pandemic period is a useful instrument to filter potential face-to-face consultations, either elective or emergency, and potentially reduce the risk of COVID-19 infection.

Improvement of Conflict Handling: Hand-Holding During and After Conflict Discussions Affects Heart Rate, Mood, and Observed Communication Behavior in Romantic Partners.

Improved conflict handling is important to reduce relational discord. Touch potentially has beneficial effects on three important characteristics of conflict discussions, i.e., physiological reactivity, affect and communication behavior. We studied effects of hand-holding between partners during conflict discussions (N = 47 student couples) and after conflict discussions (N = 53 student and N = 45 clinical couples). During conflict discussions hand-holding caused lower heart rate reactivity, higher positive affect and improved communication in men, and in women lower positive affect but improved communication. After conflict discussions hand-holding resulted in lower heart rate reactivity and higher heart rate variability in student couples and higher positive affect in student and clinical couples. Touch seems a promising add-on intervention in couple therapy.

Síntomas visuales y oculares sin causa: La necesidad de un enfoque psicosomático en oftalmología / Unexplained ocular and visual symptoms: The need for a psychosomatic approach in Ophthalmology

INTRODUCCIÓN: Es reconocida la asociación de algunos síntomas somáticos sin causa orgánica con conflictos psíquicos. En oftalmología existen pocos estudios que evalúen esta asociación, y en los actuales Programas de Formación de Residentes en Oftalmología no se incluye entrenamiento formal en Psicosomática. Esto determina que los fenómenos psicosomáticos en la clínica oftalmológica no sean reconocidos, reduciendo la eficacia terapéutica, la satisfacción de pacientes y médicos, e incrementando los costos en salud. El objetivo de este estudio fue caracterizar a pacientes con síntomas visuales/oculares idiopáticos (SVI) y estimar la prevalencia de indicadores de conflictos psíquicos (CP) en ellos. Materiales y métodos: Se reclutaron pacientes con SVI durante 12 meses en una consulta oftalmológica. Descartando causa orgánica, se pesquisó en la historia clínica indicadores de CP: diagnóstico psiquiátrico, uso de psicofármacos, enfermedades psicosomáticas en otros órganos y presencia de crisis biográficas recientes. Se comparó resultados con grupo control. RESULTADOS: Se registraron 39 pacientes con SVI, con una incidencia aproximada del 3%, siendo el 74% mujeres, y su edad promedio 41,8 años. Los SVI más frecuentes fueron: irritación de la superficie ocular (51%) y trastornos visuales inespecíficos (17%). Todos los pacientes presentaron al menos un criterio de CP, incluyendo 46,2% psicodiagnóstico, 48,7% usuarios psicofármacos, 48,7% crisis biográficas recientes y 64% enfermedades psicosomáticas en otros órganos. La frecuencia de psicodiagnóstico y enfermedades psicosomáticas en otros órganos fue estadísticamente superior (p < 0,05) con relación al grupo control. CONCLUSIONES: Pacientes con SVI presentan una alta frecuencia de indicadores de CP. Aunque no es posible asumir un rol causal de los CP en los SVI, su presencia debe alertar al oftalmólogo de la necesidad de la apropiada evaluación e intervención psicológica

INTRODUCTION: Psychogenic causes for some somatic symptoms have been widely recognised. In Ophthalmology however, there are few studies that address this issue, and current Ophthalmology Training Programs do not include formal teaching in Psychosomatics. Psychosomatic phenomena in ophthalmology are probably under-diagnosed, which may reduce therapeutic effectiveness, decrease patient and physician satisfaction, and increase health costs due to multiple consultations and prescriptions. The aims of this study were to describe patients with unexplained visual/ocular symptoms (UVOS), and to estimate the prevalence of psychological distress (PD) among them. MATERIALS AND METHODS: Consecutive adults with UVOS were recruited over a 12 month period. Complete medical history and ocular examination were performed to rule out organic disease. Psychological Distress was defined by the presence of one or more of the following criteria: psychiatric diagnosis, use of psychotropic medication, psychosomatic disease in other organs, and biographical crisis in the last 6 months. Results were compared with a control group. RESULTS: A total of 39 cases of UVOS were recruited, corresponding approximately to 3% prevalence. The large majority (74%) were female. The mean age was 41.8 years. The most common complaints were ocular surface irritation symptoms (51%) and unspecific visual disturbances (17%). At least 1 of the PD criteria was found in 100%, including 46.2% with psychiatric comorbidity, 48.7% with psychotropic medications, 64% with psychosomatic disease in other organs, and 48.7% with recent life-stressful events. PD indicators were statistically higher compared with control group (P < .05). CONCLUSIONES: There was a high frequency of PD indicators in patients with UVOS. Although the causative role of PD remains unclear, the presence of UVOS should warn the ophthalmologist of an underlying psychic conflict and to make an appropriate psychological intervention

Unexplained ocular and visual symptoms: The need for a psychosomatic approach in Ophthalmology. / Síntomas visuales y oculares sin causa: La necesidad de un enfoque psicosomático en oftalmología.

INTRODUCTION: Psychogenic causes for some somatic symptoms have been widely recognised. In Ophthalmology however, there are few studies that address this issue, and current Ophthalmology Training Programs do not include formal teaching in Psychosomatics. Psychosomatic phenomena in ophthalmology are probably under-diagnosed, which may reduce therapeutic effectiveness, decrease patient and physician satisfaction, and increase health costs due to multiple consultations and prescriptions. The aims of this study were to describe patients with unexplained visual/ocular symptoms (UVOS), and to estimate the prevalence of psychological distress (PD) among them. MATERIALS AND METHODS: Consecutive adults with UVOS were recruited over a 12 month period. Complete medical history and ocular examination were performed to rule out organic disease. Psychological Distress was defined by the presence of one or more of the following criteria: psychiatric diagnosis, use of psychotropic medication, psychosomatic disease in other organs, and biographical crisis in the last 6 months. Results were compared with a control group. RESULTS: A total of 39 cases of UVOS were recruited, corresponding approximately to 3% prevalence. The large majority (74%) were female. The mean age was 41.8 years. The most common complaints were ocular surface irritation symptoms (51%) and unspecific visual disturbances (17%). At least 1 of the PD criteria was found in 100%, including 46.2% with psychiatric comorbidity, 48.7% with psychotropic medications, 64% with psychosomatic disease in other organs, and 48.7% with recent life-stressful events. PD indicators were statistically higher compared with control group (P<.05). CONCLUSIONES: There was a high frequency of PD indicators in patients with UVOS. Although the causative role of PD remains unclear, the presence of UVOS should warn the ophthalmologist of an underlying psychic conflict and to make an appropriate psychological intervention.

Subjective emotional responses to IAPS pictures in patients with borderline personality disorder, cluster-C personality disorders, and non-patients.

According to Linehan (1993), emotion dysregulation is a central feature of borderline personality disorder (BPD). We hypothesized that patients with BPD are emotionally hyperresponsive. For BPD treatment, it is important to evaluate this hypothesis, because, if it is supported, therapeutic interventions could be designed to help patients to better manage hyperemotional reactions. We investigated the subjective reactions (in terms of valence and arousal) of patients with BPD to visual emotional stimuli of the International Affective Picture System (IAPS). We hypothesized that, compared to patients with Cluster-C personality disorders and non-patients, BPD patients would show higher scores on the arousal dimension and higher negative scores on the valence dimension when rating IAPS pictures with varying degrees of arousal and valence. Ratings of valence and arousal for 40 IAPS pictures were collected from 39 borderline personality disorder (BPD), 36 patients diagnosed with Cluster-C personality disorders (PD), and a group of 226 non-patients. Contrary to expectations, BPD patients did not differ from the non-patients. This indicates that their self-report scores do not reflect hypersensitivity. We found that patients with BPD showed lower scores on arousal than Cluster-C PD patients. The scores on valence suggested that Cluster-C PD patients also experienced more positive emotions than BPD patients.

Treating repetitive suicidal intrusions using eye movements: study protocol for a multicenter randomized clinical trial.

BACKGROUND: Suicide is a major public health problem, and it remains unclear which processes link suicidal ideation and plans to the act of suicide. Growing evidence shows that the majority of suicidal patients diagnosed with major depression or bipolar disorder report repetitive suicide-related images and thoughts (suicidal intrusions). Various studies showed that vividness of negative as well as positive intrusive images may be reduced by dual task (e.g. eye movements) interventions taxing the working memory. We propose that a dual task intervention may also reduce frequency and intensity of suicidal imagery and may be crucial in preventing the transition from suicidal ideation and planning to actual suicidal behaviour. This study aims a) to evaluate the effectiveness of an Eye Movement Dual Task (EMDT) add-on intervention targeting suicidal imagery in depressed patients, b) to explore the role of potential moderators and mediators in explaining the effect of EMDT, and c) to evaluate the cost-effectiveness of EMDT. METHODS: We will conduct a multi-center randomized clinical trial (RCT) evaluating the effects of EMDT in combination with usual care (n = 45) compared to usual care alone (n = 45). Participants will fill in multiple online batteries of self-report questionnaires as well as complete a semi-structured interview (Intrusion Interview), and online computer tasks. The primary outcome is the frequency and intrusiveness of suicidal imagery. Furthermore, the vividness, emotionality, and content of the suicidal intrusions are evaluated; secondary outcomes include: suicidal behaviour and suicidal ideation, severity of depression, psychological symptoms, rumination, and hopelessness. Finally, potential moderators and mediators are assessed. DISCUSSION: If proven effective, EMDT can be added to regular treatment to reduce the frequency and vividness of suicidal imagery. TRIAL REGISTRATION: The study has been registered on October 17th, 2018 at the Netherlands Trial Register, part of the Dutch Cochrane Centre ( NTR7563 ).

The effectiveness of individual schema therapy in older adults with borderline personality disorder: Protocol of a multiple-baseline study.

BACKGROUND: The treatment of borderline personality disorder (BPD) has been examined extensively in adults up to the age of fifty in the past quarter of a century, but there is still a world to discover in treating BPD in older adults. The aim of the study is to investigate the effectiveness of schema therapy in older adults with BPD. METHODS/DESIGN: A multiple baseline design is used in which participants are randomly assigned to baseline length. The primary outcome measure is assessed weekly and consists of the credibility of negative core beliefs. Secondary outcome measures are quality of life, psychological distress, early maladaptive schemas, schema modes, severity of BPD symptoms and meeting the criteria for BPD. Ten older adults (age > 60 years) with BPD are treated with schema therapy, with weekly sessions during one year. This treatment phase is preceded by a baseline phase varying from 4 to 8 weeks. After treatment, there is a 6-month follow-up phase with monthly booster sessions. DISCUSSION: To our knowledge, this is the first empirical study of the effectiveness of psychotherapeutic treatment for BPD in older adults. Because of the different manifestation of BPD in later life, besides section II DSM-5 criteria, the alternative, dimensional model for personality disorders of DSM-5 is used to assess BPD in older adults. TRIAL REGISTRATION: The Netherlands National Trial Register NTR7107. Registered 11 March 2018.

Intimate stimuli result in fronto-parietal activation changes in anorexia nervosa.

BACKGROUND: Intimacy is a key psychological problem in anorexia nervosa (AN). Empirical evidence, including neurobiological underpinnings, is however, scarce. OBJECTIVE: In this study, we evaluated various emotional stimuli including intimate stimuli experienced in patients with AN and non-patients, as well as their cerebral response. METHODS: Functional magnetic resonance imaging was conducted using stimuli with positive, neutral, negative and intimate content. Participants (14 AN patients and 14 non-patients) alternated between passive viewing and explicit emotion regulation. RESULTS: Intimate stimuli were experienced less positively in AN patients compared to non-patients. AN patients showed decreased cerebral responses in superior parietal cortices in response to positive and intimate stimuli. Intimate stimuli led to stronger activation of the orbitofrontal cortex, and lower activation of the bilateral precuneus in AN patients. Orbitofrontal responses decreased in AN patients during explicit emotion regulation. CONCLUSIONS: These results show that intimate stimuli are of particular importance in AN patients, who show experiential differences compared to non-patients and altered activation of orbitofrontal and parietal brain structures. This supports that AN patients have difficulties with intimacy, attachment, self-referential processing and body perception. LEVEL OF EVIDENCE: Level III, case-control study.

[Cognitive therapy and interpersonal psychotherapy for major depressive disorder: how do they work, how long, and for whom?] / Cognitieve therapie en interpersoonlijke psychotherapie voor depressie: hoe werken ze, hoe lang en voor wie?

BACKGROUND: Although the effectiveness of cognitive therapy (ct) and interpersonal psychotherapy (ipt) for depression has been well established, little is known about how, how long and for whom they work.
AIM: To summarize findings from a large rct to the (differential) effects and mechanisms of change of ct/ipt for depression.
METHOD: 182 adult depressed outpatients were randomized to ct (n = 76), ipt (n = 75), or a two-month wait-list-control condition (n = 31). Primary outcome was depression severity (bdi-ii). Other outcomes were quality of life, social and general psychological functioning and various potential process measures. Interventions were compared at the end of treatment, and up to 17 months follow-up.
RESULTS: Overall, ct and ipt were both superior to the wait-list, but did not differ significantly from one another. However, the pathway through which therapeutic change occurred appeared to be different for ct and ipt, and many patients were predicted to have a clinically meaningful advantage in one of the two interventions. We did not find empirical support for the theoretical models of change.
CONCLUSION: (Long-term) outcomes of ct and ipt appear to not differ significantly. The field would benefit from further refinement of research methods to disentangle mechanisms of change, and from advances in the field of personalized medicine.

Validation of the Spanish version of the Borderline Personality Disorder Checklist (BPD Checklist) in a sample of BPD patients: Study of psychometric properties

Background and objectives: Borderline Personality Disorder (BPD) is one of the most complex personality disorders (PD). The Borderline Personality Disorder Checklist (BPD Checklist) is an instrument specifically designed to assess the burden of BPD symptoms according to DSM-IV/5 criteria in the past month. Methods: Our goal was to adapt and validate the BPD Checklist in Spanish and to study its psychometric properties, i.e. reliability and validity. We administered it in a sample of BPD patients (n = 342) and in a sample of patients with other PD diagnoses (n = 190). Results: The results obtained indicated that the psychometric properties of the Spanish version of the BPD Checklist are similar to those of the original version of the instrument. The internal consistency indices were generally good to excellent. The total score and the subscales of the BPD Checklist discriminated between diagnostic samples. As expected, the subscales were associated with the scores on the SCID-II and self-rating measures. Conclusions: Our results are consistent with the original version of BPD Checklist. In general, it is an adequate instrument for clinical screening and to assess the subjective burden of BPD experienced by the patient in the past month

No disponible

[Cost-effectiveness of psychotherapy for personality disorders. A systematic review on economic evaluation studies]. / Kosteneffectiviteit van psychotherapie voor persoonlijkheidsstoornissen; een systematisch literatuuronderzoek van economische evaluatiestudies.

BACKGROUND: So far, there has not been a complete overview of the cost-effectiveness of psychotherapy for patients with a personality disorder.
AIM: To provide an overview of scientific literature on the cost-effectiveness of psychotherapy for patients with a personality disorder.
METHOD: We reviewed the literature systematically, searching the NHS EED, PubMed and PsycINFO databases. We concentrated solely on full economic evaluations of treatments in which all patients had a personality disorder.
RESULTS: Most studies concluded that at least one of the psychotherapeutic treatments investigated was cost-effective. Dialectical behavior therapy was studied the most; schema therapy came next, followed by cognitive behavioural therapy.
CONCLUSION: In general, scientific evidence indicates that psychotherapeutic treatments for patients with personality disorders are cost-effective relative to the comparator treatments. This is important information because it can influence decisions on whether the costs of psychotherapy should be reimbursed.

Clinical effectiveness of cognitive therapy v. interpersonal psychotherapy for depression: results of a randomized controlled trial.

BACKGROUND: Although both cognitive therapy (CT) and interpersonal psychotherapy (IPT) have been shown to be effective treatments for major depressive disorder (MDD), it is not clear yet whether one therapy outperforms the other with regard to severity and course of the disorder. This study examined the clinical effectiveness of CT v. IPT in a large sample of depressed patients seeking treatment in a Dutch outpatient mental health clinic. We tested whether one of the treatments was superior to the other at post-treatment and at 5 months follow-up. Furthermore, we tested whether active treatment was superior to no treatment. We also assessed whether initial depression severity moderated the effect of time and condition and tested for therapist differences. METHOD: Depressed adults (n = 182) were randomized to either CT (n = 76), IPT (n = 75) or a 2-month waiting list control (WLC) condition (n = 31). Main outcome was depression severity, measured with the Beck Depression Inventory - II (BDI-II), assessed at baseline, 2, 3, and 7 months (treatment phase) and monthly up to 5 months follow-up (8-12 months). RESULTS: No differential effects between CT and IPT were found. Both treatments exceeded response in the WLC condition, and led to considerable improvement in depression severity that was sustained up to 1 year. Baseline depression severity did not moderate the effect of time and condition. CONCLUSIONS: Within our power and time ranges, CT and IPT appeared not to differ in the treatment of depression in the acute phase and beyond.

Subclinical psychotic experiences and bipolar spectrum features in depression: association with outcome of psychotherapy.

BACKGROUND: Subthreshold psychotic and bipolar experiences are common in major depressive disorder (MDD). However, it is unknown if effectiveness of psychotherapy is altered in depressed patients who display such features compared with those without. The current paper aimed to investigate the impact of the co-presence of subclinical psychotic experiences and subclinical bipolar symptoms on the effectiveness of psychological treatment, alone or in combination with pharmacotherapy. METHOD: In a naturalistic study, patients with MDD (n = 116) received psychological treatment (cognitive behavioural therapy or interpersonal psychotherapy) alone or in combination with pharmacotherapy. Depression and functioning were assessed six times over 2 years. Lifetime psychotic experiences and bipolar symptoms were assessed at the second time point. RESULTS: Subclinical psychotic experiences predicted more depression over time (ß = 0.20, p < 0.002), non-remission [odds ratio (OR) 7.51, p < 0.016] and relapse (OR 3.85, p < 0.034). Subthreshold bipolar symptoms predicted relapse (OR 1.16, p < 0.037). CONCLUSIONS: In general, subclinical psychotic experiences have a negative impact on the course and outcome of psychotherapy in MDD. Effects of subclinical bipolar experiences were less prominent.

A randomized clinical trial of cognitive behavioral therapy and interpersonal psychotherapy for panic disorder with agoraphobia.

BACKGROUND: Interpersonal psychotherapy (IPT) seems to be as effective as cognitive behavioral therapy (CBT) in the treatment of major depression. Because the onset of panic attacks is often related to increased interpersonal life stress, IPT has the potential to also treat panic disorder. To date, a preliminary open trial yielded promising results but there have been no randomized controlled trials directly comparing CBT and IPT for panic disorder. METHOD: This study aimed to directly compare the effects of CBT versus IPT for the treatment of panic disorder with agoraphobia. Ninety-one adult patients with a primary diagnosis of DSM-III or DSM-IV panic disorder with agoraphobia were randomized. Primary outcomes were panic attack frequency and an idiosyncratic behavioral test. Secondary outcomes were panic and agoraphobia severity, panic-related cognitions, interpersonal functioning and general psychopathology. Measures were taken at 0, 3 and 4 months (baseline, end of treatment and follow-up). RESULTS: Intention-to-treat (ITT) analyses on the primary outcomes indicated superior effects for CBT in treating panic disorder with agoraphobia. Per-protocol analyses emphasized the differences between treatments and yielded larger effect sizes. Reductions in the secondary outcomes were equal for both treatments, except for agoraphobic complaints and behavior and the credibility ratings of negative interpretations of bodily sensations, all of which decreased more in CBT. CONCLUSIONS: CBT is the preferred treatment for panic disorder with agoraphobia compared to IPT. Mechanisms of change should be investigated further, along with long-term outcomes.

One-year follow-up results of unsupported online computerized cognitive behavioural therapy for depression in primary care: A randomized trial.

OBJECTIVE: To report the one-year follow-up results of computerized cognitive behavioural therapy (CCBT), offered online without professional support, for depression compared with usual GP care and a combination of both treatments. To explore potential relapse prevention effects of CCBT. METHODS: 303 depressed patients were randomly allocated to (a) unsupported online CCBT (b) treatment as usual (TAU), or (c) CCBT and TAU combined. We had a 12-month follow-up period. Primary outcome measure was the Beck Depression Inventory II. Self-reported health care use was also measured. KEY FINDINGS: At 12 months, no statistically significant differences between the three interventions are found in the intention-to-treat population for depressive severity, reliable improvement, remission, and relapse. In the first quarter, differences in health care consumption between the three interventions are significant (i.e. less GP contacts, less antidepressant medication, and less specialist mental health care in the CCBT group), but these differences disappear over time. CONCLUSIONS: Unsupported online CCBT is not superior to TAU by a GP for depression. With equal effects, CCBT alone leads to less health care consumption than TAU and CCBT&TAU. Overall effects are modest in all interventions, which can be explained by the finding that the use of health care services decreases despite the lack of substantial improvements.

Improving adherence and effectiveness of computerised cognitive behavioural therapy without support for depression: a qualitative study on patient experiences.

BACKGROUND: Several studies have evaluated the efficacy and effectiveness of computerized cognitive behavioural therapy (CCBT) for depression, but research on the patient perspective is limited. AIMS: To gain knowledge on patient experiences with the online self-help CCBT program Colour Your Life (CYL) for depression, and find explanations for the low treatment adherence and effectiveness. METHOD: Qualitative data were collected through semi-structured interviews with 18 patients. Interviewees were selected from a CCBT trial. An inductive, content analysis of the interviews was performed. RESULTS: The main theme throughout the interviews concerns barriers and motivators experienced with CCBT. The most important barriers included experiences of a lack of identification with and applicability of CCBT-CYL, lack of support to adhere with the program or to gain deeper understanding, and inadequate computer/Internet skills, equipment, or location. Confusion between CCBT and Internet questionnaires resulted in no CCBT uptake of some study participants. Motivators included experiencing self-identification and improvement through CCBT-CYL, participating in a scientific study, and the freedom and anonymity associated with online computer self-help. The addition of support to CCBT was suggested as an improvement towards adherence and the course content. CONCLUSION: The CCBT program CYL in its current form does not work for a large group of people with depressive symptoms. More tailoring, the provision of support (professional or lay) and good computer conditions could improve CCBT.