Redefining the relationship in digital care: A qualitative study of the Digital Therapeutic Alliance.

Digital therapeutic programs are emerging almost daily, offering the potential to reduce healthcare access inequalities by providing more flexible and accessible care options. However, as with traditional healthcare, the issue of patient engagement is fundamental, and the latest research have reported that fewer than 30% of users complete these programs in their entirety. Hence, many authors emphasize the importance of studying the role of therapeutic alliances specifically adapted to digital care. The therapeutic alliance encompasses the collaborative aspects of the relationship between the therapist and the patient. In this context there is a need to reconceptualize the alliance within the context of digital healthcare as it can enhance engagement, adherence, and the effectiveness of such treatments. The objective of this qualitative study was to identify the components of the digital therapeutic alliance. A thematic analysis has identified three major themes that appear to constitute the digital therapeutic alliance among 44 users of an online program: trust in the program, perception of interactions, and feeling of consideration. These results prompted a discussion of the challenges of digital healthcare, including the terminology to use. The term "digital therapeutic adherence" is proposed, thereby opening up a field for research and clarification of this important concept distinct from traditional alliance.

Towards a better Comprehension and Management of Pain and Psychological Distress in Parkinson's: The Role of Catastrophizing.

OBJECTIVES: Pain is very prevalent in Parkinson's and challenging to manage. As many people with Parkinson's (PwP) with pain suffer from anxious and depressive symptoms, we examined the role of catastrophizing in mediating the relationship between pain and psychological distress for this population. METHODS: 169 international PwP completed an online survey with socio-demographic and medical data. Participants completed psychometric tests to assess their pain (King's Parkinson's Disease Pain Questionnaire, McGill Pain Questionnaire and Brief Pain Inventory), psychological distress (Beck Depression Inventory and Parkinson Anxiety Scale), pain coping strategies (Coping Strategies Questionnaire) and pain catastrophizing (Pain Catastrophizing Scale). RESULTS: Depending on the tool used, 82.8% to 95.2% of participants reported pain. 23.5 % and 67.5% of participants showed respectively significant levels of depressive and anxiety symptoms. Psychological distress was significantly correlated with the quality of pain (both sensory and affective dimensions). Statistical models highlighted the mediating role of catastrophizing in the relationship between psychological distress and pain in Parkinson's. CONCLUSION: These findings offer new perspectives toward understanding the underlying mechanisms of pain in Parkinson's and for effective therapeutic intervention goals to facilitate adaptation to pain symptoms in Parkinson's.

Anxiety, emotional processing and depression in people with multiple sclerosis.

BACKGROUND: Despite the high comorbidity of anxiety and depression in people with multiple sclerosis (MS), little is known about their inter-relationships. Both involve emotional perturbations and the way in which emotions are processed is likely central to both. The aim of the current study was to explore relationships between the domains of mood, emotional processing and coping and to analyse how anxiety affects coping, emotional processing, emotional balance and depression in people with MS. METHODS: A cross-sectional questionnaire study involving 189 people with MS with a confirmed diagnosis of MS recruited from three French hospitals. Study participants completed a battery of questionnaires encompassing the following domains: i. anxiety and depression (Hospital Anxiety and Depression Scale (HADS)); ii. emotional processing (Emotional Processing Scale (EPS-25)); iii. positive and negative emotions (Positive and Negative Emotionality Scale (EPN-31)); iv. alexithymia (Bermond-Vorst Alexithymia Questionnaire) and v. coping (Coping with Health Injuries and Problems-Neuro (CHIP-Neuro) questionnaire. Relationships between these domains were explored using path analysis. RESULTS: Anxiety was a strong predictor of depression, in both a direct and indirect way, and our model explained 48% of the variance of depression. Gender and functional status (measured by the Expanded Disability Status Scale) played a modest role. Non-depressed people with MS reported high levels of negative emotions and low levels of positive emotions. Anxiety also had an indirect impact on depression via one of the subscales of the Emotional Processing Scale ("Unregulated Emotion") and via negative emotions (EPN-31). CONCLUSIONS: This research confirms that anxiety is a vulnerability factor for depression via both direct and indirect pathways. Anxiety symptoms should therefore be assessed systematically and treated in order to lessen the likelihood of depression symptoms.

Influence of early maladaptive schemas, depression, and anxiety on the intensity of self-reported cognitive complaint in older adults with subjective cognitive decline.

BACKGROUND: Subjective cognitive decline (SCD) designates a self-reported cognitive decline despite preserved cognitive abilities. This study aims to explore, in older adults with SCD, the association between intensity of self-reported cognitive complaint and psychological factors including Young's early maladaptive schemas (EMSs) (i.e. enduring cognitive structures giving rise to beliefs about oneself and the world), as well as depression and anxiety. METHODS: Seventy-six subjects (69.22 years ± 6.1) with intact cognitive functioning were recruited through an advertisement offering free participation in an intervention on SCD. After undergoing a neuropsychological examination (including global cognition (MMSE) and episodic memory (FCSRT)) and a semi-structured interview to assess depressive symptoms (MADRS), they completed a set of online self-reported questionnaires on SCD (McNair questionnaire), Young's EMSs (YSQ-short form), depression (HADS-D), and anxiety (HADS-A and trait-STAI-Y). RESULTS: The McNair score did not correlate with the neuropsychological scores. Instead, it was highly (r > 0.400; p < 0.005) correlated with trait anxiety and three EMSs belonging to the "Impaired autonomy and performance" domain: Dependence/incompetence, Failure to achieve and Vulnerability to harm or illness. Our final regression model comprising depression, anxiety, and these three EMSs as predictors (while controlling for age, gender, and objective cognition) accounted for 38.5% of the observed variance in SCD intensity. CONCLUSIONS: The level of cognitive complaint is significantly associated with Young's EMSs in the category of "Impaired autonomy and performance". We assume that SCD may primarily be driven by profound long-term inner beliefs about oneself that do not specifically refer to self-perceived memory abilities.

Anxiety and Coping Strategy Changes in Multiple Sclerosis Patients Initiating Fingolimod: The GRACE Prospective Study.

The objective of this prospective study was to assess the changes in anxiety levels, and their relationship with coping strategies over the first four months of fingolimod treatment in patients with relapsing remitting multiple sclerosis (RRMS). Data were collected at the inclusion visit (Visit 1) and 4 months later (Visit 2). We used the Hospital Anxiety and Depression Scale (HADS) to assess the level of anxiety and the Coping Inventory for Stressful Situations scale to assess the coping strategies used when engaged with stressful situations. The HADS anxiety scores were compared between Visits 1 and 2, according to the preferred coping strategy. At Visit 1, half of the 198 patients included were considered to be anxious (doubtful or in a certain way). The same proportion preferentially used an avoidance-oriented strategy and one-third preferentially used an emotion-oriented strategy. The mean HADS anxiety score decreased significantly (p = 0.001) at Visit 2 (8.1 ± 4.0) compared to Visit 1 (8.8 ± 4.3), particularly in the group of patients who used an emotion-oriented strategy (p = 0.002). In conclusion, the initiation of fingolimod in patients with RRMS is followed by a decrease of anxiety levels which vary according to the coping strategy used.

[Caregivers faced with anxiety-depressive disorders in elderly people with severe dementia]. / Soignants et troubles anxio-dépressifs des personnes âgées atteintes de démence sévère.

A survey of 104 caregivers in nursing homes assesses their knowledge of anxiety-depressive disorders in patients with severe dementia with aphasia and their proposed treatment. Despite a lack of training, information and tools to assess these disorders and offer adapted care, this survey highlights in particular caregivers' concern for these issues.

Alexithymia and gambling: a risk factor for all gamblers?

The purpose of this study was to investigate alexithymia (in relation with depression) in three groups of French gamblers (n = 186) recruited in their gambling location: at the racetracks (n = 80 males; mean age 28.1 years), in the slot machine rooms (n = 65; 29 males, 36 females; mean age 34.6 years), and in the traditional gaming rooms (n = 41 males; mean age 36 years). Gambling behavior was measured by the South Oaks Gambling Screen and DSM-IV criteria for pathological gambling, Alexithymia by the Toronto Alexithymia Scale (TAS-20) and depression with the Beck Depression Inventory (BDI-13). For racetracks and slot machine gambling, pathological gamblers differed from non-pathological gamblers, regarding their alexithymia scores. These results remained stable after controlling for depression scores among the racetracks gamblers only. The relationship between alexithymia and depression depends on the type of pathological gambler. These findings are consistent with the idea of identifying clinically distinct subgroups of gamblers.

Favorite YouTubers as a source of health information during quarantine: viewers trust their favorite YouTubers with health information.

During quarantine, between March and May 2020, YouTubers disseminated information about Covid-19 and the quarantine. The objectives of this study are (1) to explore whether YouTubers are considered as reliable sources of information regarding quarantine by French social media users, (2) to evaluate the link between the parasocial relationship with a favorite YouTuber and the level of trust in the information provided by this YouTuber and (3) to test the effectiveness of the favorite YouTuber as a source of information about the benefit of quarantine. Data from 596 participants were collected through an online survey, among whom, 251 had a favorite YouTuber. Wilcoxon signed-rank tests and ordered logistic regressions were used to explore two research questions and to test two hypotheses. Results show that (1) information about the benefit of quarantine from the favorite YouTuber is considered just as reliable as information from journalists, friends or family members, (2) the intensity of the parasocial relationship with the favorite YouTuber is positively and significantly associated with the level of trust in that favorite YouTuber, (3) having received trusted information about the benefit of quarantine from one's favorite YouTubers is positively and significantly associated with the perception of the utility of quarantining. This study identifies YouTubers as important sources for health communication.

Quality of life in relation to mood, coping strategies, and dyskinesia in Parkinson's disease.

Given the variability of the results found in the literature, the current study is a step toward better clarifying the influence of motor and nonmotor factors on quality of life in Parkinson's disease. A total of 135 participants with Parkinson's disease were selected. Semistructured interviews were carried out, after which their mental and cognitive states were assessed using different scales (MINI, MADRS, EHD, HAMA). Finally, all participants completed 3 self-report questionnaires: 2 assessing coping strategies (WCC, CHIP) and 1, quality of life (Parkinson's disease questionnaire-39). It appears that the presence of dyskinesia, depression, and anxiety were linked to a poor quality of life. Interestingly, some different coping strategies, namely diversion as well as emotional strategies, were associated with a poor quality of life. These results encourage us to develop interventions focused on coping strategies and tailored to the emotional and clinical characteristics of each patient.

Coping strategy and anxiety evolution in multiple sclerosis patients initiating interferon-beta treatment.

This study (ACSEPT) aimed to assess anxiety evolution according to coping strategy in patients with multiple sclerosis (MS) during their first months of treatment with interferon (IFN)-beta1a. Recently diagnosed relapsing-remitting MS (RRMS) patients (n = 255) were included and received standardized information on MS. At inclusion, the preferred coping mode was determined using the Coping Inventory for Stressful Situations (CISS). Anxiety and depression were assessed at inclusion and after 3 months using the Spielberger State-Trait Anxiety Inventory and the Beck Depression Inventory, respectively. At inclusion, the preferred coping strategy was task-oriented for most patients (53%), 51% were considered as anxious, and the mean Beck depression score was low. Emotion-oriented patients were more anxious and more depressed than the 2 other coping groups (task- and avoidance-oriented). During the first 3 months of IFN treatment, the anxiety level slightly decreased in the total population, more intensively in the emotion-oriented group, and there were no clinically significant changes in the Beck depression score. Anxiety and depression remained stable or decreased during the first 3 months of IFN treatment, depending on coping strategy. Identifying these coping strategies during therapy initiation may allow customized support and improve treatment adherence.

Subtypes of French pathological gamblers: comparison of sensation seeking, alexithymia and depression scores.

Recent data suggest the importance of identifying subtypes of pathological gamblers. This research studies sensation seeking, alexithymia and depression among a general population of French gamblers who play different types of game. Those games include games available in cafés (two cafés located in Paris suburb) like lottery, scratch-cards, etc., horse betting at the racetrack (five racetracks closest to Paris), slot machines and traditional games (roulette and card games) at the casino of Enghien-les-Bains (casino nearest to Paris). Sensation seeking was measured with the SSS form V, alexithymia with the TAS-20, and depression with the BDI-13. Pathological racetrack gamblers (42 males; mean age 29.1 years), who play active games involving skills, have the highest sensation seeking scores and are the most prone to alexithymia. Pathological gamblers playing the slot machines (12 males; 15 females; mean age 35.7 years) and games available in cafés (57 males; mean age 32.6 years), thus playing passive games that involve chance only, have low sensation seeking scores. Slot machines gamblers display alexithymia and have the highest depression scores. Pathological gamblers playing traditional games (15 males; mean age 37.8 years), games that involve strategy, do not perform well on any of these scales. These findings are consistent with the idea that clinically distinct subgroups of pathological gamblers can be identified. People displaying typical features could be attracted by specific games.

Time perspective differences between depressed patients and non-depressed participants, and their relationships with depressive and anxiety symptoms.

BACKGROUND: Time perspective (TP) can be described as an individual's attitude towards his personal past, present and future. Literature suggests that it plays a role in several areas of psychological functioning (self-efficacy, coping) and impacts actual thoughts and behaviors. However, TP has seldom been studied in mental health, despite previous studies suggesting that the temporal profile is altered in depressed patients. This study investigates the differences of TP between depressed patients and non-depressed participants, and its relationship with depressive and anxiety symptoms. METHODS: 45 patients diagnosed with major depressive disorder were compared to 43 non-depressed participants recruited in the general population. Participants were asked to answer time perspective (ZTPI), depression (BDI-13) and anxiety (STAI-Y) self-report inventories. Statistical analysis included comparisons of scores between depressed patients and non-depressed participants, correlation and regression analysis. RESULTS: Results indicate that TP is significantly altered in depressed patients. They display a more negative view of their past, a less hedonistic perspective towards their present, and a more fatalistic perspective when compared to non-depressed participants. Regression analysis shows that depressive and anxiety symptoms are associated with negative past and fatalistic present, and similar results are found with correlation analysis. LIMITATIONS: The size of the sample was small, and longitudinal studies are needed to understand the dynamics and causal relationship between TP and depression. CONCLUSIONS: These results underline the importance of considering TP in depressed patients, and encourage an in depth study of the relationship between TP and mood disorders. Therapeutic perspectives are discussed.

What relation is there between deep brain stimulation and coping strategies in Parkinson's disease?

We investigated the effect of the deep brain stimulation (DBS) on coping strategies while taking depression into account. Patients with Parkinson's disease (PD) were divided into three groups matched for sex, age, and disease severity: one, just before DBS, another at 12 months post DBS, and a group of patients not being considered for DBS. Each patient was asked to complete two self-reports about their coping styles: The ways of coping check list and the coping with health, injuries, and problems scale. The Montgomery and Asberg depression rating scale was assessed by a psychologist. After control for depression, significant differences were noticed concerning two coping strategies: instrumental (P < 0.01) and emotional (P < 0.05) ones, with higher instrumental coping strategies (seeking more information) for patients prior DBS and higher emotional strategies (avoidance, emotional preoccupation) for patients not being considered for surgery. These results confirmed our clinical impression that coping strategies differ as a function of the surgical status of PD patients.

Multimethod alexithymia assessment in adolescents and young adults with a cannabis use disorder.

The value of alexithymia assessments in medical and psychiatric research is well documented, but such assessments in cannabis abusers are scarce. Moreover, despite repeated calls for multimethod alexithymia evaluations, researchers typically use 1 self-report only: the 20-item Toronto Alexithymia Scale. Herein, we evaluated (1) the psychometric properties of the Observer Alexithymia Scale (OAS), (2) the correspondence between 3 alexithymia measures, (3) OAS raters' affect and its relationship to OAS scores, and (4) cannabis abusers' alexithymic features. Eighty-seven cannabis abusers completed self-reports measuring alexithymia (Toronto Alexithymia Scale, Bermond-Vorst Alexithymia Questionnaire-B), depression (13-item Beck Depression Inventory), and anxiety (State and Trait Anxiety Inventory-Form Y) and asked relatives to rate them using the OAS. The raters also completed the self-report scales. The OAS met acceptable reliability and validity standards, with the exception of relatively low interrater reliability for one of its subscales. Rater affect appeared to influence OAS scores, albeit slightly. Patients' OAS scores were higher than scores reported for people-in-general samples and lower than those for outpatient clinical samples. Alexithymia rates were similar to those previously reported in cannabis abusers. Our results demonstrated the adequacy and appropriateness of the OAS in these (and related) clinical samples, which may encourage multimethod alexithymia assessments in both research and clinical practice.

Emotional feeling in patients suffering from amyotrophic lateral sclerosis.

OBJECTIVE: Amyotrophic lateral sclerosis (ALS) is a fatal and progressive neurodegenerative disorder involving motor neurons of the cerebral cortex, brain stem and spinal cord. Besides the motor signs, cognitive disorders and apathy may be present and may impact the survival time. These elements are therefore to be taken into consideration for medical care because they can influence the disease evolution. The literature shows low psychopathological disorders in this population despite its poor prognosis. The main objective of this study is to explore the emotional feeling in apathetic and non-apathetic patients in relation to their anxiety and depressive symptoms. METHODS: We included 152 patients at the day hospital for the follow-up of their illness, with an average age of 61±12.2 years. All filled the following self-administered questionnaires: EPN-31 (emotional feeling), HADS (for anxiety and depressive symptoms) and the Marin's apathy evaluation scale. Most of the patients (n=110) had also a cognitive assessment with the ALS-CBS scale. RESULTS: 42% of patients could be considered as apathetic and they felt both positive and negative emotions whose frequency was related to the presence and intensity of anxiety and depressive symptoms. The only significant differences were that apathetic and anxious patients experienced more negative emotions including sadness, shame and anger than non-apathetic and anxious patients. Apathy was negatively correlated with cognitive functioning and survival time. CONCLUSIONS: These results highlighted the negative impact that apathy seemed to have on the evolution of this disease. However, apathetic patients didn't show emotional blunting and were able to name and feel positive and negative emotions; and even feel more negative emotions than non-apathetic patients when they were anxious. A better understanding of apathetic and no apathetic patients' emotional feelings should lead to a more personalized care for the ALS patients.

Sensation seeking in a community sample of French gamblers: Comparison between strategic and non-strategic gamblers.

The purpose of this research is to examine the relationship between sensation seeking and gambling disorder (GD) in a community sample of gamblers (when controlling for the effect of substance use, gender and age) and see whether sensation seeking scores depend on the gambling activity when comparing strategic and non-strategic gamblers. A total of 380 gamblers was recruited. First, pathological gamblers (PGs) (n =143) were compared to non-pathological gamblers (NPGs) (n =237). Second, strategic gamblers (n =93) were compared to non-strategic gamblers (n =110). Sociodemographic data, gambling behavior (SOGS, DSM-IV), tobacco and alcohol use (CAGE), and sensation seeking (SSS) were evaluated. PGs have higher boredom susceptibility scores than NPGs and this factor is associated with GD. Nevertheless, the relationship between sensation seeking and GD depends on the gambling activity. In fact, sensation seeking is associated with GD in strategic gamblers only. PGs playing strategic games display different profiles from non-strategic PGs. Thus, factors associated with GD differ when the gambling activity is taken into account. These findings are consistent with the idea of it being essential to identify clinically distinct subgroups of PGs in the treatment of GD.

Is alexithymia related to cannabis use disorder? Results from a case-control study in outpatient adolescent cannabis abusers.

OBJECTIVE: In recent decades, alexithymia has been considered a risk factor for multiple somatic and psychiatric conditions. Yet, whereas alexithymia has been extensively studied in adults with a substance misuse, only one study has reported data on cannabis abusers from the general population. Hence, our main objective was to explore alexithymia in a clinical sample of treatment-seeking young outpatients with a DSM-IV cannabis dependence or abuse diagnosis compared to controls. METHODS: 120 young patients (95 males - mean age 17.9years (SD=2.8; 14 to 25)) with a cannabis dependence or abuse (DSM-IV-TR criteria evaluated with the MINI), seeking treatment in an addiction unit, and 110 healthy control subjects (77 males - mean age 18.2years (SD=3.4; 14 to 25)) participated in the study. They completed a battery of self-reports measuring alexithymia (TAS-20; BVAQ-B), depression (BDI-13) and state and trait anxiety (STAI). RESULTS: 35.3% of cannabis users were alexithymic, and logistic regression analysis showed that the alexithymic components of difficulties identifying and describing feelings combined with trait anxiety predicted group membership. CONCLUSION: This first study on young cannabis abusers and dependent subjects further emphasizes the importance of considering the affective style, and particularly the anxious temperament and alexithymia features, as factors associated with substance misuse during late adolescence.

Combining Standard Conventional Measures and Ecological Momentary Assessment of Depression, Anxiety and Coping Using Smartphone Application in Minor Stroke Population: A Longitudinal Study Protocol.

Context: Stroke has several consequences on survivors' daily life even for those who experience short-lasting neurological symptoms with no functional disability. Depression and anxiety are common psychological disorders occurring after a stroke. They affect long-term outcomes and quality of life but they are difficult to diagnose because of the neurobiological consequences of brain lesions. Current research priority is given to the improvement of the detection and prevention of those post-stroke psychological disorders. Although previous studies have brought promising perspectives, their designs based on retrospective tools involve some limits regarding their ecological validity. Ecological Momentary Assessment (EMA) is an alternative to conventional instruments that could be a key in research for understanding processes that underlined post-stroke depression and anxiety onset. We aim to evaluate the feasibility and validity of anxiety, depression and coping EMA for minor stroke patients. Methods: Patients hospitalized in an Intensive Neuro-vascular Care Unit between April 2016 and January 2017 for a minor stroke is involved in a study based on an EMA methodology. We use a smartphone application in order to assess anxiety and depression symptoms and coping strategies four times a day during 1 week at three different times after stroke (hospital discharge, 2 and 4 months). Participants' self-reports and clinician-rates of anxiety, depression and coping are collected simultaneously using conventional and standard instruments. Feasibility of the EMA method will be assessed considering the participation and compliance rate. Validity will be the assessed by comparing EMA and conventional self-report and clinician-rated measures. Discussion: We expect this study to contribute to the development of EMA using smartphone in minor stroke population. EMA method offers promising research perspective in the assessment and understanding of post-stroke psychological disorders. The development of EMA in stroke population could lead to clinical implications such as remotely psychological follow-ups during early supported discharge. Trial registration: European Clinical Trials Database Number 2014-A01937-40.

Impact of Skin Toxicities Associated with Targeted Cancer Therapies on Body Image: A Prospective Study.

BACKGROUND AND OBJECTIVE: Body-image issues associated with dermatological side effects induced by anticancer-targeted therapies have not been specifically explored until now despite growing literature about their impact on quality of life. Prospective and longitudinal investigations were needed. The aim of our study was to describe body-image changes occurring with cutaneous toxicities and their psychosocial impact on patients. PATIENTS AND METHODS: Thirty-three patients were evaluated four times during the first 3 months of targeted therapy in terms of body satisfaction, physical attitudes and depression with validated and ad hoc questionnaires. The NCI-CTCAE V4.0 was used to grade adverse dermatological events. Descriptive and inferential analyses were conducted with SPSS 14.0 software. RESULTS: Ninety-four per cent of the patients developed skin toxicities. Body satisfaction remained stable and slightly better than average over this period. About one-third of the patients reported body-image issues at baseline. Body satisfaction and depression levels at baseline appeared to be significantly associated with body-image issues after 3 months of therapy. CONCLUSION: In the framework of regular dermatological monitoring, skin toxicities did not appear to be associated with body-image issues. Body satisfaction and depressive symptoms at the beginning of targeted therapy emerged as critical factors that practitioners should consider in order to prevent deterioration of body image that could impact on quality of life and compromise compliance.

Impact of dermatologic adverse events induced by targeted therapies on quality of life.

BACKGROUND: Investigations about the impact of dermatologic adverse events on quality of life in the context of targeted therapies are quite recent and results vary in some dimensions. This article aims to summarize the existing data and to clarify needs in terms of clinical management and future research. METHODS: A literature review was done with Pubmed, Medline, Scopus and PsycInfo databases and it combined the empirical studies published in English and in French over the past ten years. RESULTS AND CONCLUSIONS: Dermatologic adverse events globally have a low to moderate impact on quality of life, mainly in the physical and emotional domains. Reasons for inter-individual variations in adjustment and long-term impact are still not well known. Making quality of life assessments systematic, making early referrals of patients to dermatology consultations and giving more attention to individual experience were identified as measures that could help prevent deterioration in quality of life.