ABSTRACT
Previous lab findings have indicated that excessive worry may impair cognitive performance and problem solving capabilities but it is unclear if excessive worry also leads to broader impairments in general functioning. We report a secondary process data analysis of a large randomized waitlist-controlled trial (N = 670) of a self-guided online psychological intervention for dysfunctional worry related to the Covid-19 pandemic. Specific aims were to investigate (1) if improvements in general functioning were mediated by reductions in worry related to Covid-19 during the acute intervention phase, and (2) if reduced worry related to Covid-19 during acute intervention phase had a positive long-term impact on general functioning up to 1 year after the end of the intervention. To address aim 1, we used a mediation analysis framework where outcome (general functioning measured with an adapted version of the Work and Social Adjustment Scale) and the hypothesized mediator (worry measured with an adapted version of the Generalised Anxiety Disorder 7-Item Scale) were administered weekly during the controlled phase of the trial of 3 weeks. To address aim 2, we investigated if reductions in worry during the 3-week treatment period predicted improved general functioning at 1- and 12 months after treatment completion. Results showed that improvements in general functioning at week 3 were mediated by reductions in worry during the first 2 weeks of treatment (indirect effect estimate -0.08; 95% CI -0.15, -0.02). A sensitivity analysis indicated that the mediation effects dropped significantly when the residual correlation values between the mediator and the outcome exceeded r = 0. A reversed causation model was not significant. Additionally, reductions in worry during treatment predicted subsequent improvements in general functioning at both 1- and 12-month follow-ups (p < .05, -.001). Altogether, these results provide further support of the importance of targeting worry as a way to improve functioning among the large population of individuals with high levels of worry.
Subject(s)
COVID-19 , Cognitive Behavioral Therapy , Humans , Mediation Analysis , Pandemics , Anxiety/psychology , Cognitive Behavioral Therapy/methods , Treatment OutcomeABSTRACT
Long-term follow-up data from trials of digital mental health interventions are rare. This study reports 2-year follow-up data from a non-inferiority trial (N = 152) comparing stepped-care (internet-delivered cognitive behavioral therapy [CBT] followed by traditional in-person CBT if needed) vs in-person CBT for pediatric obsessive-compulsive disorder. Both treatment groups had comparable long-term effects, with the majority of participants being responders (stepped-care 66 %; in-person CBT 71 %) 2 years after the end of treatment.
ABSTRACT
BACKGROUND: The current study explored how to recruit patients soon after a traumatic event, to deliver a novel intervention in a new emergency department in Sweden. This brief behavioral intervention aims to prevent intrusive memories and is delivered soon after trauma in the emergency department. In the UK, it has shown promising results. Traumatic events resulting in admission to the emergency department (e.g., road traffic accidents) may result in subsequent mental health problems such as post-traumatic stress disorder, where intrusive memories of the trauma constitute a core clinical feature. Early interventions that prevent intrusive memories after psychological trauma are lacking. Specific aims were to explore identification of eligible patients (aim 1), fitting in with emergency department staff routines to deliver the study protocol (aim 2), and using the patients' own smartphones to deliver intervention/control task (aim 3). Two changes to the previous study were (i) extending the trauma types included (ii) a new control condition, also by smartphone. METHODS: This is an explorative observational study. Data was both analyzed descriptively and using the Framework method. RESULTS: We identified several possible ways to recruit patients, and establish a sense of embeddedness in the Swedish emergency department context and a positive appreciation from staff. The study protocol was tested with 8 participants. Tasks both in the intervention and control condition were readily delivered via patients' own smartphones. CONCLUSION: Recruitment of patients and smartphone delivery of the intervention indicates initial feasibility. Researcher presence and administration of study procedures was successfully fitted to emergency department routines and well received by staff. Further pilot work is warranted, underscoring the importance of our collaboration between nursing and psychology.
ABSTRACT
BACKGROUND: The number of refugees is the highest ever worldwide. Many have experienced trauma in home countries or on their escape which has mental health sequelae. Intrusive memories comprise distressing scenes of trauma which spring to mind unbidden. Development of novel scalable psychological interventions is needed urgently. AIMS: We propose that brief cognitive science-driven interventions should be developed which pinpoint a focal symptom alongside a means to monitor it using behavioural techniques. The aim of the current study was to assess the feasibility and acceptability of the methodology required to develop such an intervention. METHOD: In this study we recruited 22 refugees (16-25 years), predominantly from Syria and residing in Sweden. Participants were asked to monitor the frequency of intrusive memories of trauma using a daily diary; rate intrusions and concentration; and complete a 1-session behavioural intervention involving Tetris game-play via smartphone. RESULTS: Frequency of intrusive memories was high, and associated with high levels of distress and impaired concentration. Levels of engagement with study procedures were highly promising. CONCLUSIONS: The current work opens the way for developing novel cognitive behavioural approaches for traumatized refugees that are mechanistically derived, freely available and internationally scalable.
