Self-care interventions to assist family physicians with mental health care of older patients during the COVID-19 pandemic: Feasibility, acceptability, and outcomes of a pilot randomized controlled trial.

BACKGROUND: The COVID-19 pandemic has required family physicians to rapidly address increasing mental health problems with limited resources. Vulnerable home-based seniors with chronic physical conditions and commonly undermanaged symptoms of anxiety and depression were recruited in this pilot study to compare two brief self-care intervention strategies for the management of symptoms of depression and/or anxiety. METHODS: We conducted a pilot RCT to compare two tele-health strategies to address mental health symptoms either with 1) validated CBT self-care tools plus up to three telephone calls from a trained lay coach vs. 2) the CBT self-guided tools alone. The interventions were abbreviated from those previously trialed by our team, to enable their completion in 2 months. Objectives were to assess the feasibility of delivering the interventions during a pandemic (recruitment and retention); and assess the comparative acceptability of the interventions across the two groups (satisfaction and tool use); and estimate preliminary comparative effectiveness of the interventions on severity of depression and anxiety symptoms. Because we were interested in whether the interventions were acceptable to a wide range of older adults, no mental health screening for eligibility was performed. RESULTS: 90 eligible patients were randomized. 93% of study completers consulted the self-care tools and 84% of those in the coached arm received at least some coaching support. Satisfaction scores were high among participants in both groups. No difference in depression and anxiety outcomes between the coached and non-coached participants was observed, but coaching was found to have a significant effect on participants' use and perceived helpfulness of the tools. CONCLUSION: Both interventions were feasible and acceptable to patients. Trained lay coaching increased patients' engagement with the tools. Self-care tools offer a low cost and acceptable remote activity that can be targeted to those with immediate needs. While effectiveness results were inconclusive, this may be due to the lack of eligibility screening for mental health symptoms, abbreviated toolkit, and fewer coaching sessions than those used in our previous effective interventions. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT0460937.

A novel stress-based intervention reduces cigarette use in non-treatment seeking smokers.

Tobacco use is the leading cause of preventable mortality worldwide. Since current smoking cessation aids show only modest efficacy, new interventions are needed. Given the evidence that stress is a potent trigger for smoking, the present randomized clinical trial tested whether stress could augment the effects of a memory updating (retrieval-extinction) intervention. Non-treatment seeking smokers (n = 76) were assigned to one of four conditions composed of either a stressful or non-stressful psychosocial challenge followed by either smoking or neutral cues. Ten minutes after this manipulation, all underwent a 60-minute extinction procedure during which they viewed smoking-related videos and images and manipulated smoking paraphernalia. Compared to participants who were not exposed to the laboratory stressor, the stressor-exposed groups exhibited greater psychophysiological responses during their intervention and greater decreases in cigarette use at two- and six-weeks follow-up independent of smoking cue exposure. Together, these findings suggest that the ability of stress to activate cigarette seeking processes can be exploited to decrease cigarette use. With replication, the stress-based intervention could become a novel strategy for decreasing cigarette use in non-treatment seeking smokers.Clinicaltrials.gov identifier: NCT04843969.

Autobiographical memory in mild cognitive impairment and Alzheimer's disease: a comparison between the Levine and Kopelman interview methodologies.

Previous studies have produced inconsistent results concerning the two components of autobiographical memory--personal semantic memory and episodic memory. Results in subjects with mild cognitive impairment (MCI) and dementia of Alzheimer's type (DAT) have varied concerning the existence of a temporal gradient in retrograde amnesia. These results have important theoretical implications regarding multiple trace theory versus standard consolidation models of long-term memory (LTM). We investigated whether this variability arises from differences in the methods used in assessing autobiographical memory. We examined patterns of memory impairment in 20 healthy elderly controls, 20 MCI subjects, and 10 DAT subjects using the Autobiographical Memory Interview (AMI) of Kopelman and the Autobiographical Interview (AI) of Levine. Both the AMI and AI were modified to allow for the test scores to be derived from a single interview without fatiguing the subjects. On the AMI, DAT subjects were significantly impaired on both components of autobiographical memory--episodic memory and personal semantics--with episodic memory showing a significant though gentle temporal gradient sparing childhood memories. Using the AI test, subjects with DAT showed impaired recall of episodic details (but not personal semantics), again with a gentle temporal gradient. Differences between the two interview methods (fewer epochs in the AMI; fewer memories per epoch in the AI) were found to have a significant impact on the pattern of findings; fewer epochs in the AMI brought out the temporal gradient, and fewer memories per epoch (in the AI) diminished it. These data show the importance of technical details of the different tests in favouring one versus another LTM theory. The data are not purely compatible with either theory.