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1.
Saúde Soc ; 31(1): e210294, 2022.
Article in Portuguese | WHO COVID, LILACS (Americas) | ID: covidwho-1817578

ABSTRACT

Resumo Este texto apresenta uma atividade grupal desenvolvida durante a epidemia de covid-19 em espaço virtual, com 13 participantes, estudantes e professores universitários. O objetivo foi oferecer um espaço de escuta protegido e criar estratégias para enfrentar a angústia e o medo decorrentes da epidemia. A ferramenta metodológica utilizada foi a intervenção grupal, realizada entre maio e agosto de 2020, que operou como uma rede de conversação. No grupo, produziu-se um diálogo horizontal com temas escolhidos conjuntamente e buscando soluções compartilhadas para diversos problemas. Este artigo analisa o diálogo ocorrido nos encontros em que se falou sobre o medo. Neles, os(as) participantes identificaram o medo da morte e da perda de pessoas amadas como aquele que desperta maior sofrimento, acentuado quando as pessoas estão distantes geograficamente. A avaliação mostrou que os encontros e os diálogos produziram alívio e bem-estar, e que trabalhar em plataforma virtual não constituiu empecilho à comunicação. Grupos de intervenção desenvolvidos em espaço virtual compõem metodologias de baixo custo, porém potentes, fáceis de operar e possíveis de serem nucleadas nos mais diversos coletivos.


Abstract This paper describes a virtual group activity developed during the covid-19 pandemic with 13 university students and professors. Based on a group intervention operating as a conversation network, carried out between May and August 2020, the goal was to offer a safe listening space and to create strategies to cope with the anguish and fear resulting from the pandemic. The group engaged in horizontal dialogue on topics chosen jointly, seeking shared solutions to various problems. This article analyzes the dialogue that took place during meetings where fear was discussed. In these meetings, participants identified the fear of death and loss of loved ones as the feelings that arouse the most suffering, heightened when people are geographically distant. The analysis showed that such meetings and dialogues produced relief and well-being, and that working on a virtual platform did not hinder communication. Intervention groups developed virtually are low-cost yet powerful methodologies, easy to operate and possible to be implemented in the most diverse collectives.


Subject(s)
Humans , Male , Female , Adaptation, Psychological , Mental Health , Death , Fear , Internet-Based Intervention , COVID-19
2.
J Alzheimers Dis ; 84(4): 1539-1550, 2021.
Article in English | MEDLINE | ID: covidwho-1771006

ABSTRACT

BACKGROUND: Approximately 50% of older adults with cognitive impairment suffer from insomnia. When untreated, pre-existing cognitive problems may be exacerbated and potentially contribute to further cognitive decline. One promising approach to maintain cognitive health is to improve sleep quantity and quality. OBJECTIVE: To determine feasibility, acceptability, and preliminary efficacy of Sleep Health Using the Internet for Older Adult Sufferers of Insomnia and Sleeplessness (SHUTi OASIS), an Internet-delivered cognitive behavioral therapy for insomnia (CBT-I) program in older adults with mild cognitive impairment (MCI). METHODS: Older adults with MCI and insomnia were recruited from hospital-based memory and sleep disorders clinics and enrolled in a single-arm pilot study. Participants completed the six cores of SHUTi OASIS, over nine weeks with two-week baseline and post-assessments using self-reported sleep diaries. Feasibility and acceptability were informed by usage statistics and qualitative interviews; preliminary efficacy was informed by patient-generated sleep data. RESULTS: Twelve participants enrolled and, on average, were 75.8 years of age. Ten participants completed the study and logged in most days. Most participants reported a positive overall experience, and interviews revealed successful and independent program management and completion. There were significant changes on all baseline to post-assessment sleep measures, including clinically meaningful improvements on the Insomnia Severity Index (13.5 to 8.3, p < 0.01), sleep efficiency, wake after sleep onset, and sleep onset latency (ps < 0.02). There was no statistically significant change in cognitive measures (p > 0.05). CONCLUSION: This study supports that older adults with cognitive impairment can independently complete CBT-I via the Internet and achieve clinical sleep improvements.


Subject(s)
Cognitive Behavioral Therapy , Cognitive Dysfunction/complications , Internet-Based Intervention , Sleep Initiation and Maintenance Disorders/therapy , Aged , Feasibility Studies , Female , Humans , Male , Pilot Projects , Self Report , Treatment Outcome
3.
Int J Environ Res Public Health ; 19(6)2022 03 20.
Article in English | MEDLINE | ID: covidwho-1760612

ABSTRACT

Eating disorders are among the most common clinical manifestations in children, and they are frequently connected with maternal psychopathological risk, internalizing/externalizing problems in children, and poor quality of mother-child feeding exchanges. During the COVID-19 lockdown, in person assessment and intervention were impeded due to the indications of maintaining interpersonal distancing and by limits to travel. Therefore, web-based methods were adopted to meet patients' needs. In this study N = 278 participants completed the SCL-90/R and the CBCL to examine the psychopathological symptoms of mothers and children (age of the children = 24 months); moreover, the dyads were video-recorded during feeding and followed an online video-feedback based intervention. Maternal emotional state, interactive conflict, food refusal in children, and dyadic affective state all improved considerably, as did offspring internalizing/externalizing problems and mothers' depression, anxiety, and obsession-compulsion symptoms. This study showed that video-feedback web-based intervention might be employed successfully to yield considerable beneficial effects.


Subject(s)
COVID-19 , Feeding and Eating Disorders , Internet-Based Intervention , Anxiety Disorders , COVID-19/epidemiology , Child, Preschool , Communicable Disease Control , Feeding and Eating Disorders/therapy , Female , Humans
4.
Int J Environ Res Public Health ; 19(5)2022 02 25.
Article in English | MEDLINE | ID: covidwho-1736902

ABSTRACT

Despite the widespread prevalence of mental health problems, most psychological distress remains untreated. Internet-based psychological interventions can be an essential tool for increasing treatment availability and accessibility. The main objective of the MindBlooming project is to design and implement an innovative Internet-based multi-approach treatment for university students suffering from psychological or physical problems. The intervention will focus on symptoms of depression, anxiety, sleep problems, self-destructive thoughts, job- and study-related stress and burnout, and chronic pain. It will be based on different approaches, primarily psychoeducation, Cognitive-Behavioral Treatment (CBT), and third-wave CBT. At the end of the treatment, user satisfaction and usability will be assessed. In addition, two further aims will be evaluating the treatment efficacy through a randomized controlled trial and tuning a predictive model through Machine Learning techniques. The intervention consists of a 7-week treatment on two problematic areas according to each students' personal needs, identified through an initial assessment. Besides the treatment assigned following the initial screening, participants will also be assigned to a different module to improve their relational skills. The treatment, which can be accessed through a mobile app, consists of psychoeducational videos followed by related exercises. We expect MindBlooming to be a remarkable tool for promoting the mental health of university students.


Subject(s)
Anxiety , Internet-Based Intervention , Anxiety/therapy , Anxiety Disorders , Humans , Internet , Students/psychology , Universities
5.
Brain Behav Immun ; 87: 40-48, 2020 07.
Article in English | MEDLINE | ID: covidwho-1719336

ABSTRACT

In addition to being a public physical health emergency, Coronavirus disease 2019 (COVID-19) affected global mental health, as evidenced by panic-buying worldwide as cases soared. Little is known about changes in levels of psychological impact, stress, anxiety and depression during this pandemic. This longitudinal study surveyed the general population twice - during the initial outbreak, and the epidemic's peak four weeks later, surveying demographics, symptoms, knowledge, concerns, and precautionary measures against COVID-19. There were 1738 respondents from 190 Chinese cities (1210 first-survey respondents, 861 s-survey respondents; 333 respondents participated in both). Psychological impact and mental health status were assessed by the Impact of Event Scale-Revised (IES-R) and the Depression, Anxiety and Stress Scale (DASS-21), respectively. IES-R measures PTSD symptoms in survivorship after an event. DASS -21 is based on tripartite model of psychopathology that comprise a general distress construct with distinct characteristics. This study found that there was a statistically significant longitudinal reduction in mean IES-R scores (from 32.98 to 30.76, p < 0.01) after 4 weeks. Nevertheless, the mean IES-R score of the first- and second-survey respondents were above the cut-off scores (>24) for PTSD symptoms, suggesting that the reduction in scores was not clinically significant. During the initial evaluation, moderate-to-severe stress, anxiety and depression were noted in 8.1%, 28.8% and 16.5%, respectively and there were no significant longitudinal changes in stress, anxiety and depression levels (p > 0.05). Protective factors included high level of confidence in doctors, perceived survival likelihood and low risk of contracting COVID-19, satisfaction with health information, personal precautionary measures. As countries around the world brace for an escalation in cases, Governments should focus on effective methods of disseminating unbiased COVID-19 knowledge, teaching correct containment methods, ensuring availability of essential services/commodities, and providing sufficient financial support.


Subject(s)
Anxiety/epidemiology , Coronavirus Infections/epidemiology , Depression/epidemiology , Pneumonia, Viral/epidemiology , Stress Disorders, Post-Traumatic/epidemiology , Stress, Psychological/epidemiology , Adolescent , Adult , Anxiety/psychology , Anxiety/therapy , Betacoronavirus , COVID-19 , Child , China/epidemiology , Coronavirus Infections/prevention & control , Depression/psychology , Depression/therapy , Epidemics , Female , Hand Hygiene , Health Behavior , Humans , Internet-Based Intervention , Longitudinal Studies , Male , Masks , Mental Health , Middle Aged , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Psychotherapy , SARS-CoV-2 , Stress Disorders, Post-Traumatic/psychology , Stress Disorders, Post-Traumatic/therapy , Stress, Psychological/psychology , Stress, Psychological/therapy , Young Adult
6.
J Med Internet Res ; 24(2): e30880, 2022 02 03.
Article in English | MEDLINE | ID: covidwho-1714893

ABSTRACT

BACKGROUND: Internet-based treatment programs present a solution for providing access to pain management for those unable to access clinic-based multidisciplinary pain programs. Attrition from internet interventions is a common issue. Clinician-supported guidance can be an important feature in web-based interventions; however, the optimal level of therapist guidance and expertise required to improve adherence remains unclear. OBJECTIVE: The aim of this study is to evaluate whether augmenting the existing Reboot Online program with telephone support by a clinician improves program adherence and effectiveness compared with the web-based program alone. METHODS: A 2-armed, CONSORT (Consolidated Standards of Reporting Trials)-compliant, registered randomized controlled trial with one-to-one group allocation was conducted. It compared a web-based multidisciplinary pain management program, Reboot Online, combined with telephone support (n=44) with Reboot Online alone (n=45) as the control group. Participants were recruited through web-based social media and the This Way Up service provider network. The primary outcome for this study was adherence to the Reboot Online program. Adherence was quantified through three metrics: completion of the program, the number of participants who enrolled into the program, and the number of participants who commenced the program. Data on adherence were collected automatically through the This Way Up platform. Secondary measures of clinical effectiveness were also collected. RESULTS: Reboot Online combined with telephone support had a positive effect on enrollment and commencement of the program compared with Reboot Online without telephone support. Significantly more participants from the Reboot Online plus telephone support group enrolled (41/44, 93%) into the course than those from the control group (35/45, 78%; χ21=4.2; P=.04). Furthermore, more participants from the intervention group commenced the course than those from the control group (40/44, 91% vs 27/45, 60%, respectively; χ21=11.4; P=.001). Of the participants enrolled in the intervention group, 43% (19/44) completed the course, and of those in the control group, 31% (14/45) completed the course. When considering the subgroup of those who commenced the program, there was no significant difference between the proportions of people who completed all 8 lessons in the intervention (19/40, 48%) and control groups (14/27, 52%; χ21=1.3; P=.24). The treatment efficacy on clinical outcome measures did not differ between the intervention and control groups. CONCLUSIONS: Telephone support improves participants' registration, program commencement, and engagement in the early phase of the internet intervention; however, it did not seem to have an impact on overall course completion or efficacy. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12619001076167; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12619001076167.


Subject(s)
Internet-Based Intervention , Pain Management , Australia , Humans , Internet , Telephone , Treatment Outcome
7.
Pediatr Allergy Immunol ; 33(2): e13731, 2022 02.
Article in English | MEDLINE | ID: covidwho-1700683

ABSTRACT

BACKGROUND: Parents of children with food allergies (CwFA) experience reduced quality of life (QoL) and may have reduced access to in-person interventions in the COVID-19 pandemic. This trial developed and evaluated an online, self-help, information provision website, aimed at improving QoL in parents of CwFA. METHODS: In a single-blinded, randomised controlled trial (RCT), participants were randomised to either receive access to the website or a waiting-list control. At baseline, post-intervention (week 4) and follow-up (week 8), measures of parental food allergy-related QoL, depression, anxiety, stress, intolerance of uncertainty (IU) and self-efficacy were obtained. RESULTS: A total of 205 participants were randomised; 97% were females, 91% white and 78% educated ≥ degree level, with a mean age of 38.95 years (SD = 6.89). 44.9% (n = 92) were retained at follow-up. The arms did not significantly differ on any outcome at any time point. For a sub-group of participants above the clinical cut-off for depression at baseline, the intervention may have improved QoL. Participants reported the website content as useful and accessible, but accessed it infrequently. In baseline data, IU and self-efficacy were significantly associated with QoL. CONCLUSION: While the COVID-19 pandemic has encouraged greater provision of online interventions, our RCT suggests this particular website is not suitable for this population in general, although future research could examine its efficacy for depressed parents of CwFA, to increase confidence that the sub-group finding was not a Type 1 error. The baseline data suggest IU and self-efficacy remain potential proximal targets for intervention.


Subject(s)
COVID-19 , Food Hypersensitivity , Internet-Based Intervention , Adult , COVID-19/epidemiology , Child , Female , Food Hypersensitivity/therapy , Humans , Parents , Quality of Life , SARS-CoV-2
8.
J Med Internet Res ; 24(1): e29559, 2022 01 13.
Article in English | MEDLINE | ID: covidwho-1662502

ABSTRACT

BACKGROUND: eHealth tools have the potential to meet the mental health needs of individuals who experience barriers to accessing in-person treatment. However, most users have less than optimal engagement with eHealth tools. Coaching from peer specialists may increase their engagement with eHealth. OBJECTIVE: This pilot study aims to test the feasibility and acceptability of a novel, completely automated web-based system to recruit, screen, enroll, assess, randomize, and then deliver an intervention to a national sample of military veterans with unmet mental health needs; investigate whether phone-based peer support increases the use of web-based problem-solving training compared with self-directed use; and generate hypotheses about potential mechanisms of action for problem-solving and peer support for future full-scale research. METHODS: Veterans (N=81) with unmet mental health needs were recruited via social media advertising and enrolled and randomized to the self-directed use of a web-based problem-solving training called Moving Forward (28/81, 35%), peer-supported Moving Forward (27/81, 33%), or waitlist control (26/81, 32%). The objective use of Moving Forward was measured with the number of log-ins. Participants completed pre- and poststudy measures of mental health symptoms and problem-solving confidence. Satisfaction was also assessed post treatment. RESULTS: Automated recruitment, enrollment, and initial assessment methods were feasible and resulted in a diverse sample of veterans with unmet mental health needs from 38 states. Automated follow-up methods resulted in 46% (37/81) of participants completing follow-up assessments. Peer support was delivered with high fidelity and was associated with favorable participant satisfaction. Participants randomized to receive peer support had significantly more Moving Forward log-ins than those of self-directed Moving Forward participants, and those who received peer support had a greater decrease in depression. Problem-solving confidence was associated with greater Moving Forward use and improvements in mental health symptoms among participants both with and without peer support. CONCLUSIONS: Enrolling and assessing individuals in eHealth studies without human contact is feasible; however, different methods or designs are necessary to achieve acceptable participant engagement and follow-up rates. Peer support shows potential for increasing engagement in web-based interventions and reducing symptoms. Future research should investigate when and for whom peer support for eHealth is helpful. Problem-solving confidence should be further investigated as a mechanism of action for web-based problem-solving training. TRIAL REGISTRATION: ClinicalTrials.gov NCT03555435; http://clinicaltrials.gov/ct2/show/NCT03555435.


Subject(s)
Internet-Based Intervention , Veterans , Feasibility Studies , Humans , Mental Health , Pilot Projects
9.
J Med Internet Res ; 23(2): e22197, 2021 02 25.
Article in English | MEDLINE | ID: covidwho-1573649

ABSTRACT

BACKGROUND: To control the COVID-19 pandemic, people should adopt protective behaviors at home (self-isolation, social distancing, putting shopping and packages aside, wearing face coverings, cleaning and disinfecting, and handwashing). There is currently limited support to help individuals conduct these behaviors. OBJECTIVE: This study aims to report current household infection control behaviors in the United Kingdom and examine how they might be improved. METHODS: This was a pragmatic cross-sectional observational study of anonymous participant data from Germ Defence between May 6-24, 2020. Germ Defence is an open-access fully automated website providing behavioral advice for infection control within households. A total of 28,285 users sought advice from four website pathways based on household status (advice to protect themselves generally, to protect others if the user was showing symptoms, to protect themselves if household members were showing symptoms, and to protect a household member who is at high risk). Users reported current infection control behaviors within the home and intentions to change these behaviors. RESULTS: Current behaviors varied across all infection control measures but were between sometimes (face covering: mean 1.61, SD 1.19; social distancing: mean 2.40, SD 1.22; isolating: mean 2.78, SD 1.29; putting packages and shopping aside: mean 2.75, SD 1.55) and quite often (cleaning and disinfecting: mean 3.17, SD 1.18), except for handwashing (very often: mean 4.00, SD 1.03). Behaviors were similar regardless of the website pathway used. After using Germ Defence, users recorded intentions to improve infection control behavior across all website pathways and for all behaviors (overall average infection control score mean difference 0.30, 95% CI 0.29-0.31). CONCLUSIONS: Self-reported infection control behaviors other than handwashing are lower than is optimal for infection prevention, although handwashing is much higher. Advice using behavior change techniques in Germ Defence led to intentions to improve these behaviors. Promoting Germ Defence within national and local public health and primary care guidance could reduce COVID-19 transmission.


Subject(s)
COVID-19/prevention & control , COVID-19/transmission , Infection Control/methods , Internet-Based Intervention , COVID-19/epidemiology , Cross-Sectional Studies , Disease Transmission, Infectious/prevention & control , Family Characteristics , Health Behavior , Humans , SARS-CoV-2 , Surveys and Questionnaires , United Kingdom/epidemiology
10.
Trials ; 22(1): 913, 2021 Dec 11.
Article in English | MEDLINE | ID: covidwho-1571922

ABSTRACT

BACKGROUND: Theoretical models of insomnia suggest that stressful life events, such as the COVID-19 pandemic, can cause acute insomnia (short-term disruptions to sleep). Early interventions may prevent short-term sleep problems from progressing to insomnia disorder. Although cognitive behavioural therapy for insomnia (CBT-I) is effective in treating insomnia disorder, this can be time and resource-intensive. Further, online interventions can be used to deliver treatment to a large number of individuals. The objective of this study is to investigate if an online behavioural intervention, in the form of a leaflet, which has been successfully used alongside CBT-I for acute insomnia, can reduce symptoms of acute insomnia in poor sleepers. METHODS: A total of 124 self-reported good and poor sleepers will be enrolled in an online stratified randomised controlled trial. After baseline assessments (T1), participants will complete a 1-week pre-intervention sleep monitoring period (T2) where they will complete daily sleep-diaries. Poor sleepers (n = 62) will be randomly allocated to an invention or wait-list group, where they will receive the intervention (T3), or will do so after a 28-day delay. Good sleepers (n = 62) will be randomly assigned to an intervention or no intervention group. All participants will complete a 1-week post intervention sleep monitoring period using daily sleep diaries (T4). Participants will be followed up at 1 week (T5), 1 month (T6) and 3 months (T7) post intervention. The primary outcome measure will be insomnia severity, measured using the Insomnia Severity Index. Secondary outcome measures will include subjective mood and subjective sleep continuity, measured using sleep diaries. Data will be analysed using an intention-to-treat approach. DISCUSSION: It is expected that this online intervention will reduce symptoms of acute insomnia in self-reported short-term poor sleepers, and will also prevent the transition to poor sleep in good sleepers. We expect that this will demonstrate the feasibility of online interventions for the treatment and prevention of acute insomnia. Specific advantages of online approaches include the low cost, ease of administration and increased availability of treatment, relative to face-to-face therapy. TRIAL REGISTRATION: ISRCTN43900695 (Prospectively registered 8th of April 2020).


Subject(s)
COVID-19 , Internet-Based Intervention , Humans , Pandemics , Randomized Controlled Trials as Topic , SARS-CoV-2 , Self Report , Sleep
11.
Nat Hum Behav ; 6(2): 258-268, 2022 02.
Article in English | MEDLINE | ID: covidwho-1565719

ABSTRACT

The COVID-19 pandemic has potentially increased the risk for adolescent depression. Even pre-pandemic, <50% of youth with depression accessed care, highlighting needs for accessible interventions. Accordingly, this randomized controlled trial (ClinicalTrials.gov: NCT04634903 ) tested online single-session interventions (SSIs) during COVID-19 in adolescents with elevated depression symptoms (N = 2,452, ages 13-16). Adolescents from all 50 US states, recruited via social media, were randomized to one of three SSIs: a behavioural activation SSI, an SSI teaching that traits are malleable and a supportive control. We tested each SSI's effects on post-intervention outcomes (hopelessness and agency) and three-month outcomes (depression, hopelessness, agency, generalized anxiety, COVID-19-related trauma and restrictive eating). Compared with the control, both active SSIs reduced three-month depressive symptoms (Cohen's d = 0.18), decreased post-intervention and three-month hopelessness (d = 0.16-0.28), increased post-intervention agency (d = 0.15-0.31) and reduced three-month restrictive eating (d = 0.12-17). Several differences between active SSIs emerged. These results confirm the utility of free-of-charge, online SSIs for high-symptom adolescents, even in the high-stress COVID-19 context.


Subject(s)
Anxiety , COVID-19/psychology , Cognitive Behavioral Therapy/methods , Depression , Feeding Behavior/psychology , Internet-Based Intervention , Adolescent , Adolescent Behavior , Anxiety/psychology , Anxiety/therapy , Behavioral Symptoms/diagnosis , Behavioral Symptoms/therapy , Depression/diagnosis , Depression/psychology , Depression/therapy , Female , Humans , Male , Outcome Assessment, Health Care/methods , SARS-CoV-2 , Social Isolation/psychology
12.
BMJ Open ; 11(11): e051641, 2021 11 30.
Article in English | MEDLINE | ID: covidwho-1546522

ABSTRACT

INTRODUCTION: Development of fully internet-based programs could provide a new avenue to improve access to healthcare for problem gamblers. In this project, we aim to assess the efficacy of a web-based cognitive intervention targeting inhibitory control among problem gamblers, using a randomised controlled design. As impaired inhibitory control is involved in self-regulation difficulties in behavioural addictions, it represents a particularly relevant cognitive process to target for an online psychological intervention. METHODS AND ANALYSIS: This will be a single-blinded, randomised, comparative therapeutic web-based, controlled trial. Up to 200 non-treatment seeking adult problem gamblers with a Problem Gambling Severity Index-recent (PGSI-recent) score ≥5 will be included. The intervention will be a computerised cognitive training program targeting inhibitory skills. The comparator, an active control, will be a computerised neutral sensorial program. Both programs will be carried out under similar conditions: biweekly online training for 6 weeks and optional telephone support will be offered to patients for debriefing. The main objective of the study is to assess the clinical efficacy of the online cognitive training program at 6 weeks, measured with the PGSI-recent. The secondary objectives are to assess the efficacy on the gambling behaviour assessed by the account-based gambling data, on the self-reported gambling practice, and on the inhibition performance at the neuropsychological level at 6, 14 and 52 weeks. We will also assess the acceptability of this program and the preferred level of guidance. Data analysis will be in intention-to-treat. ETHICS AND DISSEMINATION: This randomized controlled trial will be executed in compliance with the Helsinki Declaration, and was approved by the local ethics boards (Comité de Protection des Personnes) in October 2017. The findings will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER: NCT03673800.


Subject(s)
Behavior, Addictive , Gambling , Internet-Based Intervention , Adult , Behavior, Addictive/therapy , Gambling/therapy , Humans , Internet , Randomized Controlled Trials as Topic , Self Report , Treatment Outcome
13.
Brain Behav ; 11(11): e2361, 2021 11.
Article in English | MEDLINE | ID: covidwho-1530110

ABSTRACT

BACKGROUND: Online repetitive transcranialmagnetic stimulation (rTMS) has been shown to modulate working memory (WM) performance in a site-specific manner, with behavioral improvements due to stimulation of the dorsolateral prefrontal cortex (DLPFC), and impairment from stimulation to the lateral parietal cortex (LPC). Neurobehavioral studies have demonstrated that subprocesses of WM allowing for the maintenance and manipulation of information in the mind involve unique cortical networks. Despite promising evidence of modulatory effects of rTMS on WM, no studies have yet demonstrated distinct modulatory control of these two subprocesses. The current study therefore sought to explore this possibility through site-specific stimulation during an online task invoking both skills. METHODS: Twenty-nine subjects completed a 4-day protocol, in which active or sham 5Hz rTMS was applied over the DLPFC and LPC in separate blocks of trials while participants performed tasks that required either maintenance alone, or both maintenance and manipulation (alphabetization) of information. Stimulation targets were defined individually based on fMRI activation and structural network properties. Stimulation amplitude was adjusted using electric field modeling to equate induced current in the target region across participants. RESULTS: Despite the use of advanced techniques, no significant differences or interactions between active and sham stimulation were found. Exploratory analyses testing stimulation amplitude, fMRI activation, and modal controllability showed nonsignificant but interesting trends with rTMS effects. CONCLUSION: While this study did not reveal any significant behavioral changes in WM, the results may point to parameters that contribute to positive effects, such as stimulation amplitude and functional activation.


Subject(s)
Internet-Based Intervention , Memory, Short-Term , Humans , Prefrontal Cortex , Transcranial Magnetic Stimulation
14.
Eur J Psychotraumatol ; 12(1): 1984049, 2021.
Article in English | MEDLINE | ID: covidwho-1506934

ABSTRACT

Background: Frontline healthcare workers, recovered COVID+ patients who had severe illness, and close others of COVID+ patients who have recovered or died are at risk for clinical levels of mental health symptoms in the context of the COVID-19 pandemic. RESTORE (Recovering from Extreme Stressors Through Online Resources and E-health) was specifically designed for this context. RESTORE is a transdiagnostic guided online intervention adapted from evidence-based cognitive-behavioural therapies. Objectives: RESTORE was designed to address depression, anxiety, and posttraumatic stress disorder symptoms associated with exposure to COVID-19-related traumatic and extreme stressors, and to overcome multiple barriers to accessing psychotherapies. Method: This paper describes the intervention components and platform, as well as the principles used to develop RESTORE. Current research and future directions in developing and testing RESTORE are outlined. Results: Preliminary data from an initial uncontrolled trial evaluating RESTORE in frontline healthcare workers is highly promising. Conclusion: We believe RESTORE has great potential to provide accessible, evidence-based psychological intervention to those in great need.


Antecedentes: Los trabajadores de salud de primera línea, los pacientes de COVID positivo recuperados que tenían una enfermedad grave y las personas cercanas a los pacientes de COVID positivo que se han recuperado o fallecido están en riesgo de presentar niveles clínicos de síntomas de salud mental en el contexto de la pandemia de COVID-19. RESTORE (por sus siglas en inglés: Recovering from Extreme Stressors Through Online Resources and E-health: Recuperación de estresores extremos a través de recursos en línea y salud electrónica) fue diseñada específicamente para este contexto. RESTORE es una intervención en línea guiada transdiagnóstica adaptada de terapias cognitivo-conductuales basadas en la evidencia.Objetivos: RESTORE fue diseñado para abordar la depresión, la ansiedad y los síntomas del trastorno de estrés postraumático asociados con la exposición a factores estresantes traumáticos y extremos relacionados con COVID-19, y para superar múltiples barreras para acceder a psicoterapias.Método: Este artículo describe los componentes y la plataforma de la intervención, así como los principios utilizados para desarrollar RESTORE. Se describen las investigaciones actuales y las direcciones futuras para desarrollar y testear RESTORE.Resultados: Los datos preliminares de un ensayo inicial no controlado que evalúa RESTORE en trabajadores de salud de primera línea son muy prometedores.Conclusión: Creemos que RESTORE tiene un gran potencial para brindar una intervención psicológica accesible y basada en la evidencia a quienes más lo necesitan.


Subject(s)
Anxiety/therapy , COVID-19/psychology , Cognitive Behavioral Therapy , Depression/therapy , Health Personnel/psychology , Internet-Based Intervention , Stress Disorders, Post-Traumatic/therapy , Anxiety/psychology , COVID-19/epidemiology , Depression/psychology , Humans , Mental Health , Pandemics , SARS-CoV-2 , Stress Disorders, Post-Traumatic/psychology
15.
PLoS One ; 16(11): e0256323, 2021.
Article in English | MEDLINE | ID: covidwho-1502055

ABSTRACT

BACKGROUND: The SARS-CoV-2 pandemic has led to a mental health crisis on a global scale. Epidemiological studies have reported a drastic increase in mental health problems, such as depression and anxiety, increased loneliness and feelings of disconnectedness from others, while resilience levels have been negatively affected, indicating an urgent need for intervention. The current study is embedded within the larger CovSocial project which sought to evaluate longitudinal changes in vulnerability, resilience and social cohesion during the pandemic. The current second phase will investigate the efficacy of brief online mental training interventions in reducing mental health problems, and enhancing psychological resilience and social capacities. It further provides a unique opportunity for the prediction of intervention effects by individual biopsychosocial characteristics and preceding longitudinal change patterns during the pandemic in 2020/21. METHODS: We will examine the differential effects of a socio-emotional (including 'Affect Dyad') and a mindfulness-based (including 'Breathing Meditation') intervention, delivered through a web- and cellphone application. Participants will undergo 10 weeks of intervention, and will be compared to a retest control group. The effectiveness of the interventions will be evaluated in a community sample (N = 300), which is recruited from the original longitudinal CovSocial sample. The pre- to post-intervention changes, potential underlying mechanisms, and prediction thereof, will be assessed on a wide range of outcomes: levels of stress, loneliness, depression and anxiety, resilience, prosocial behavior, empathy, compassion, and the impact on neuroendocrine, immunological and epigenetic markers. The multi-method nature of the study will incorporate self-report questionnaires, behavioral tasks, ecological momentary assessment (EMA) approaches, and biological, hormonal and epigenetic markers assessed in saliva. DISCUSSION: Results will reveal the differential effectiveness of two brief online interventions in improving mental health outcomes, as well as enhancing social capacities and resilience. The present study will serve as a first step for future application of scalable, low-cost interventions at a broader level to reduce stress and loneliness, improve mental health and build resilience and social capacities in the face of global stressors. TRIAL REGISTRATION: This trial has been registered on May 17, 2020 with the ClinicalTrials.gov NCT04889508 registration number (clinicaltrials.gov/ct2/show/NCT04889508).


Subject(s)
COVID-19/epidemiology , COVID-19/psychology , Internet-Based Intervention , Mindfulness , Adolescent , Adult , Aged , Anxiety/complications , Anxiety/epidemiology , COVID-19/complications , COVID-19/therapy , Depression/complications , Depression/epidemiology , Emotions , Female , Humans , Internet , Male , Meditation , Mental Health , Middle Aged , Resilience, Psychological , SARS-CoV-2 , Social Behavior , Surveys and Questionnaires , Treatment Outcome , Young Adult
16.
J Psychiatr Res ; 146: 228-233, 2022 02.
Article in English | MEDLINE | ID: covidwho-1500096

ABSTRACT

INTRODUCTION: The psychological wellbeing of healthcare workers has been impacted by the high levels of stress many have experienced during the Coronavirus Disease 2019 (COVID-19) pandemic. This study aimed to examine the feasibility and acceptability of a brief online course focused on introducing evidence-based skills that could increase resilience and decreases emotional distress in healthcare workers during the pandemic. MATERIALS AND METHODS: Employees of a large healthcare system completed a mental health survey at baseline, and then one month and two months after some employees participated in an online resilience-enhancement course consisting of three 12-19 min videos focused on mindfulness, mentalization, and self-compassion. RESULTS: A total of 554 participants completed the baseline survey, endorsing moderate to high levels of emotional distress. Of those who completed all three assessments and participated in the course (n = 38), significant improvements in resilience and reductions in emotional distress were found one and two months later, in comparison to those who did not participate in the course (n = 110). DISCUSSION: These findings suggest that a brief, online intervention can improve the mental health of healthcare workers during a crisis such as the COVID-19 pandemic.


Subject(s)
COVID-19 , Internet-Based Intervention , Resilience, Psychological , Health Personnel , Humans , Pandemics , SARS-CoV-2
17.
PLoS One ; 16(11): e0259525, 2021.
Article in English | MEDLINE | ID: covidwho-1496541

ABSTRACT

INTRODUCTION: Alcohol and substance misuse are a public health priority. The World Health Organisation (WHO) estimates that harmful alcohol use accounts for 5.1% of the global burden of disease and that 35.6 million people worldwide are affected by substance misuse. The Coronavirus Disease (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has disrupted delivery of face-to-face alcohol and substance misuse interventions and has forced the development of alternative remote interventions or adaptation to existing ones. Although existing research on remote interventions suggests they might be as effective as face-to-face delivery, there has been a lack of systematic exploration of their content, the experience of service users, and their effectiveness for behavioural outcomes. This review will provide a narrative synthesis of the behaviour change techniques (BCT) contained in interventions for alcohol and/or substance misuse and their association with effectiveness. METHODS AND ANALYSIS: Systematic searches will be conducted in MEDLINE, Scopus, PsycINFO (ProQuest), and the Cochrane Library. Included studies will be those reporting remote interventions focusing on alcohol and/or substance misuse among adults living in the community and which have a primary behaviour change outcome (i.e., alcohol levels consumed). Data extraction will be conducted by one author and moderated by a second, and risk of bias and behaviour change technique (BCT) coding will be conducted by two authors independently. A narrative synthesis will be undertaken focussing upon the association of BCTs with intervention effectiveness using promise ratios. PATIENT AND PUBLIC INVOLVEMENT (PPI): The Public Involvement in Research Group (PIRG), part of the NIHR-funded PHIRST, will be involved in refining the review questions, eligibility criteria, data synthesis and dissemination. DISSEMINATION: Dissemination will be through an academic peer reviewed publication, alongside other outputs to be shared with non-academic policy, professional, and public audiences, including local authorities, service users and community organisations.


Subject(s)
Alcoholism/therapy , Behavior Therapy , Internet-Based Intervention , Substance-Related Disorders/therapy , Ethanol , Humans , Internet-Based Intervention/trends
18.
Biomed Res Int ; 2021: 8400241, 2021.
Article in English | MEDLINE | ID: covidwho-1476886

ABSTRACT

This study is aimed at examining the feasibility and effectiveness of aerobic and resistance training (WeActive) and mindful exercise (WeMindful) interventions in improving physical activity (PA), psychological well-being (PWB), and subjective vitality among college students. Participants in this study were 77 college students who were randomly assigned to either the WeActive group (n = 43) or the WeMindful group (n = 28). The WeActive group attended two 30-minute aerobic and resistance training sessions per week, and the WeMindful group attended two 30-minute yoga and mindful exercise sessions per week for eight weeks. All participants completed the International Physical Activity Questionnaire, the World Health Organization-Five Well-Being Index, and the Subjective Vitality Scale before and after the intervention, as well as the Assessing Feasibility and Acceptability Questionnaire at the end of the intervention. The primary study outcome measures were PA, PWB, and subjective vitality. A repeated-measures ANCOVA indicated a significant main effect of time for total PA (F = 7.89, p = 0.006, η 2 = 0.049), vigorous PA (F = 5.36, p = 0.024, η 2 = 0.022), and walking (F = 7.34, p = 0.009, η 2 = 0.042) in both intervention groups. There was a significant interaction effect of time and group for PWB (F = 11.26, p = 0.001, η 2 = 0.022), where the WeActive group experienced a decrease in PWB scores while participants in the WeMindful group experienced an increase in PWB scores over time. There was a main effect of group for subjective vitality (F = 8.91, p = 0.007, η 2 = 0.088), indicating that the WeMindful group experienced a greater increase in subjective vitality than the WeActive group. Further, the participants in both groups indicated that the synchronized and asynchronized Zoom-based WeActive and WeMindful interventions were acceptable, appropriate, and feasible for participants. This study demonstrated that mindful exercise is effective in increasing PA, PWB, and subjective vitality while aerobic and resistance training may only be effective in increasing PA.


Subject(s)
Exercise/psychology , Internet-Based Intervention/statistics & numerical data , Mental Health , Physical Fitness/psychology , Students/psychology , Yoga/psychology , Adult , Feasibility Studies , Female , Humans , Male , Surveys and Questionnaires , Young Adult
19.
PLoS One ; 16(3): e0248507, 2021.
Article in English | MEDLINE | ID: covidwho-1468152

ABSTRACT

Science communication has been increasingly viewed as a necessity and obligation of scientists in recent years. The rise of Web 2.0 technologies, such as social media, has made communication of science to the public more accessible as a whole. While one of the primary goals of science communication is to increase public engagement, there is very little research to show the type of communication that fosters the highest levels of engagement. Here we evaluate two social medial platforms, Instagram and TikTok, and assess the type of educational science content (ESC) that promotes user awareness and overall engagement. Specifically, we measured the level of engagement between static and dynamic posts on Instagram, and lecture-style and experimental videos on TikTok. User engagement is measured through the analysis of relative number of likes, comments, shares, saves, and views of each post in the various categories. We found that users interact with ESC significantly more (p<0.05) when the content is presented in dynamic ways with a component of experimentation. Together, we took the findings of this study and provided a series of suggestions for conducting science communication on social media, and the type of ESC that should be used to promote better user outcomes.


Subject(s)
COVID-19/epidemiology , Health Communication/methods , Information Dissemination/methods , Internet-Based Intervention , Pandemics , Social Media , Awareness , COVID-19/psychology , Education, Distance , Humans
20.
J Med Internet Res ; 23(10): e26104, 2021 10 05.
Article in English | MEDLINE | ID: covidwho-1463394

ABSTRACT

BACKGROUND: Washing hands helps prevent transmission of seasonal and pandemic respiratory viruses. In a randomized controlled trial (RCT) during the swine flu outbreak, participants with access to a fully automated, digital intervention promoting handwashing reported washing their hands more often and experienced fewer respiratory tract infections than those without access to the intervention. Based on these findings, the intervention was adapted, renamed as "Germ Defence," and a study was designed to assess the preliminary dissemination of the intervention to the general public to help prevent the spread of seasonal colds and flu. OBJECTIVE: This study compares the process evaluations of the RCT and Germ Defence dissemination to examine (1) how web-based research enrollment procedures affected those who used the intervention, (2) intervention usage in the 2 contexts, and (3) whether increased intentions to wash hands are replicated once disseminated. METHODS: The RCT ran between 2010 and 2012 recruiting participants offline from general practices, with restricted access to the intervention (N=9155). Germ Defence was disseminated as an open access website for use by the general public from 2016 to 2019 (N=624). The process evaluation plan was developed using Medical Research Council guidance and the framework for Analyzing and Measuring Usage and Engagement Data. Both interventions contained a goal-setting section where users self-reported current and intended handwashing behavior across 7 situations. RESULTS: During web-based enrolment, 54.3% (17,511/32,250) of the RCT participants dropped out of the study compared to 36.5% (358/982) of Germ Defence users. Having reached the start of the intervention, 93.8% (8586/9155) of RCT users completed the core section, whereas 65.1% (406/624) of Germ Defence users reached the same point. Users across both studies selected to increase their handwashing in 5 out of 7 situations, including before eating snacks (RCT mean difference 1.040, 95% CI 1.016-1.063; Germ Defence mean difference 0.949, 95% CI 0.766-1.132) and after blowing their nose, sneezing, or coughing (RCT mean difference 0.995, 95% CI 0.972-1.019; Germ Defence mean difference 0.842, 95% CI 0.675-1.008). CONCLUSIONS: By comparing the preliminary dissemination of Germ Defence to the RCT, we were able to examine the potential effects of the research procedures on uptake and attrition such as the sizeable dropout during the RCT enrolment procedure that may have led to a more motivated sample. The Germ Defence study highlighted the points of attrition within the intervention. Despite sample bias in the trial context, the intervention replicated increases in intentions to handwash when used "in the wild." This preliminary dissemination study informed the adaptation of the intervention for the COVID-19 health emergency, and it has now been disseminated globally. TRIAL REGISTRATION: ISRCTN Registry ISRCTN75058295; https://www.isrctn.com/ISRCTN75058295.


Subject(s)
COVID-19 , Internet-Based Intervention , Hand Disinfection , Humans , Pandemics/prevention & control , SARS-CoV-2
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