Telephone-Based Behavioral Activation with Mental Imagery for Depression in Older Adults in Isolation During the covid-19 Pandemic: Long-term Results from a Pilot Trial.

OBJECTIVES: The covid-19 pandemic has highlighted the need for psychological interventions for depression that can be delivered remotely to older adults. Pellas et al. (2022) conducted a pilot trial on the preliminary effectiveness of a four-week telephone-delivered Behavioral Activation with Mental Imagery (BA-MI) intervention to N= 38 adults 65 years and older with clinically significant depressive symptoms living in isolation due to covid-19 in Sweden. This study assessed the feasibility of follow-up assessments and within-group symptom change over a six-month post-intervention period. METHODS: Retention rates at post-intervention and follow-up assessments of depressive symptoms (MADRS-S) at five time points were assessed (baseline, post-intervention, 1-, 3-, and 6-month follow-up). Effect sizes (Hedges' g) for within-group change scores were calculated between each time point. RESULTS: Retention rates over time were 95, 82, 89, and 84%. Mean MADRS-S score was 18.26 at baseline, 13.69 at post-intervention (g= .68), 13.42 at 1 month (g= .74), 13.82 at 3 months (g= .74), and 15.59 at 6 months (g= .41). CONCLUSIONS: Long-term follow-ups were feasible. Within-group decreases in depressive symptoms were maintained with medium effect sizes at 6 months post-intervention. CLINICAL IMPLICATIONS: Telephone-based BA-MI may be a feasible intervention for depressive symptoms in older adults in isolation with maintained effects over time.

COVID-19 Vaccine Mandates: Attitudes and Effects on Holdouts in a Large Australian University Population.

Many governments and institutions mandated COVID-19 vaccines. In late 2021, we sought to ascertain the perspectives of staff and students from The University of Western Australia about the State or the University mandating COVID-19 vaccines. The survey captured vaccination status and intentions along with attitudes towards mandates and potential types of exemptions with 2878 valid responses which were quantitatively analysed and 2727 which were qualitatively analysed. The study found generally high levels of vaccination or intent, and strong support for mandates, underpinned by beliefs that vaccination is a moral duty and that mandates make campus feel safer. These sentiments were not more prevalent amongst individuals with comorbidities; often healthy individuals supported mandates to reduce their risk of transmitting disease to vulnerable family members. Individuals with comorbidities were, however, more supportive of excluding the unvaccinated from campus. Most opponents were unvaccinated, and many indicated that mandate policies would backfire, making them less likely to vaccinate. Despite the strong overall support, 41% of respondents did not want to see non-compliant staff or students lose their positions, and only 35% actively sought this. Institutions or governments introducing mandates should emphasise community concerns about catching COVID-19 and becoming sick or transmitting the disease to vulnerable loved ones.

Social activity promotes resilience against loneliness in depressed individuals: a study over 14-days of physical isolation during the COVID-19 pandemic in Australia.

Loneliness is a subjectively perceived state of social isolation that is associated with negative emotional, cognitive, and physical health outcomes. Physical distancing and shelter-in-place public health responses designed to curb COVID-19 transmission has led to concerns over elevated risk of loneliness. Given that physical isolation does not necessitate social isolation in the age of digital communication, this study investigated the relationship between the frequency of social interaction and loneliness over a two-week period in people engaging in physical distancing and examined whether this relationship was moderated by physical isolation level, age, or depression. A self-selected sample of N = 469 individuals across Australia who were engaged in physically distanced living completed daily surveys for 14-days during April to June of 2020. Multilevel modelling showed that more frequent social interaction with close, but not intermediate or distant contacts, was uniquely associated with lower loneliness. In addition, being younger, more depressed, more anxious, or having a mental health condition diagnosis (past or present) were also independently associated with higher loneliness. Critically, depression was the only significant moderator of the relationship between social interaction and loneliness over time, where more frequent social interaction with close contacts buffered against loneliness over time in high depression individuals only. The findings suggest that encouraging social activity with close contacts may promote resilience against loneliness in individuals with elevated depression symptoms.

Telephone-based behavioral activation with mental imagery for depression: A pilot randomized clinical trial in isolated older adults during the Covid-19 pandemic.

OBJECTIVES: To shield vulnerable persons, particularly the elderly, during the Covid-19 pandemic governments around the world have advised to use social distancing and self-isolation. Social isolation might put older adults at an increased risk for mental health problems such as depression. There is a need for brief, easy-accessible psychological treatments for depressive symptoms that can be delivered remotely. The aim of this study was to investigate the feasibility, acceptability, and preliminary efficacy of telephone-delivered Behavioral Activation with Mental Imagery (BA-MI) for the treatment of depressive symptoms in individuals 65 years and older living in isolation during the Covid-19 pandemic. METHODS: In this open-label pilot randomized clinical trial, N = 41 individuals aged 65 years or older with clinically significant symptoms of depression were randomly assigned to either a BA-MI treatment condition, or an Attention-Assessment control condition delivered over the telephone over a 4-week period. RESULTS: Depressive symptoms decreased more in the treatment condition compared to the control condition. At post-treatment, 2 out of 16 participants in the treatment condition met diagnostic criteria for depression compared to 9 out of 13 in the control condition. Most participants in the treatment condition were satisfied with the treatment and few adverse effects were observed. CONCLUSIONS: This pilot study suggests that behavioral activation with mental imagery delivered over the telephone is feasible, acceptable, and potentially efficacious for the treatment of depressive symptoms in older individuals living in isolation. Replication in larger samples is needed.

Developing thinking around mental health science: the example of intrusive, emotional mental imagery after psychological trauma.

INTRODUCTION: One route to advancing psychological treatments is to harness mental health science, a multidisciplinary approach including individuals with lived experience and end users (e.g., Holmes, E. A., Craske, M. G., & Graybiel, A. M. (2014). Psychological treatments: A call for mental-health science. Nature, 511(7509), 287-289. doi:10.1038/511287a). While early days, we here illustrate a line of research explored by our group-intrusive imagery-based memories after trauma. METHOD/RESULTS: We illustrate three possible approaches through which mental health science may stimulate thinking around psychological treatment innovation. First, focusing on single/specific target symptoms rather than full, multifaceted psychiatric diagnoses (e.g., intrusive trauma memories rather than all of posttraumatic stress disorder). Second, investigating mechanisms that can be modified in treatment (treatment mechanisms), rather than those which cannot (e.g., processes only linked to aetiology). Finally, exploring novel ways of delivering psychological treatment (peer-/self-administration), given the prevalence of mental health problems globally, and the corresponding need for effective interventions that can be delivered at scale and remotely for example at times of crisis (e.g., current COVID-19 pandemic). CONCLUSIONS: These three approaches suggest options for potential innovative avenues through which mental health science may be harnessed to recouple basic and applied research and transform treatment development.