A systematic review and meta-analysis of the effect of whole body cryotherapy on mental health problems.

OBJECTIVE: To give an overview of the nature and methodological quality of studies on whole body cryotherapy (WBC) as add-on intervention for mental health problems. METHODS: A meta-analysis according to PRISMA guidelines was conducted (Prospero registration: CRD42020167443). Databases MEDLINE, PsycINFO and the Cochrane Library were searched. Risk of bias was scored according to the Cochrane ROBINS-I-tool to which an extra bias-dimension of allegiance bias was added. Within and between Hedges' g pooled effect sizes were calculated for the main aspect of mental health measured. Treatment efficacy was examined using a random effects model. Heterogeneity was examined through identification of visual outliers and by I2 statistics. RESULTS: Out of 196 articles coming up from the search, ten studies met all inclusion criteria, six of which were (randomized) controlled trials. Together these studies report on a total of 294 participants receiving WBC. The within-group pooled effect size for mental health problems is large (Hedges' g = 1.63, CI: 1.05-2.21), with high heterogeneity (I2 = 93%). Subgroup analyses on depressive symptoms and quality of life (QOL) showed a diminution of heterogeneity to moderate. Effect sizes for depressive symptoms are very large (Hedges' g = 2.95, CI: 2.44-3.45) and for QOL medium (Hedges' g = 0.70, CI: 0.15-1.24). The between-group pooled effect size is medium (Hedges' g = 0.76, CI: 0.17-1.36). CONCLUSIONS: Results indicate preliminary evidence for WBC as efficacious add-on intervention for mental health problems, especially depressive symptoms. Further research in the form of RCTs with larger numbers of participants is needed.

The impact of childhood sexual trauma on intimacy and sexuality needs among people with non-affective psychosis.

BACKGROUND: Childhood trauma, in particular childhood sexual abuse (CSA), and unmet sexuality and intimacy needs are prevalent among people with psychosis spectrum disorders. The association between CSA and sexuality and intimacy needs over time in adults with psychosis spectrum disorders were examined. METHOD: Patients (n = 1119) were recruited as part of the Genetic Risk and OUtcome of Psychosis (GROUP) study, a representative cohort of patients with non-affective psychotic disorder. At baseline, three-year and six-year follow-up, sexuality and intimacy needs were assessed with the Camberwell Assessment of Needs. CSA was assessed with the Childhood Trauma Questionnaire. RESULTS: At baseline, sexuality (26%) and intimacy (40%) needs were prevalent; 90% of these needs remained unmet. Cross-sectionally, CSA was associated with sexuality needs (OR = 1.68, 95% CI: 1.13-2.04) and intimacy needs (OR = 1.75, 95% CI: 1.04- 1.77). Childhood emotional abuse (CEA) was also cross-sectionally associated with sexuality and intimacy needs. Others forms of trauma were not. Prospectively, CSA predicted incidence of a sexuality need (HR = 2.1, 95% CI: 1.23-3.74) as well as an intimacy need (HR = 1.7, 95% CI: 1.11-2.66), as did CEA (sexuality: HR = 1.8, 95% CI: 1.11-2.89; intimacy: HR = 1.4, 95% CI: 1.03-1.96). CSA and CEA were not associated with persistence of sexuality or intimacy. CONCLUSION: CSA and CEA are associated with a higher prevalence and incidence of sexuality and intimacy needs in patients with psychotic disorders. High rates of unmet sexuality and intimacy needs may indicate an underlying need for trauma-related treatment as well as a need for novel interventions targeting these needs.

One year follow-up and mediation in cognitive behavioral therapy and acceptance and commitment therapy for adult depression.

BACKGROUND: Existing therapies for depression are effective, but many patients fail to recover or relapse. To improve care for patients, more research into the effectiveness and working mechanisms of treatments is needed. We examined the long-term efficacy of Cognitive Behavioral Therapy (CBT) and Acceptance and Commitment Therapy (ACT) for Major Depressive Disorder (MDD), testing the hypothesis that CBT outperforms ACT and that both therapies work through their designated mechanisms of change. METHODS: We conducted a randomized controlled trial with 82 patients suffering from MDD. Data were collected before, during and after treatment, and at 12-month follow-up, assessing symptoms of depression, quality of life, dysfunctional attitudes, decentering, and experiential avoidance. RESULTS: Patients in both conditions reported significant and large reductions of depressive symptoms (d = - 1.26 to - 1.60) and improvement in quality of life (d = 0.91 to - 1.28) 12 months following treatment. Our findings indicated no significant differences between the two interventions. Dysfunctional attitudes and decentering mediated treatment effects of depressive symptoms in both CBT and ACT, whereas experiential avoidance mediated treatment effects in ACT only. CONCLUSIONS: Our results indicate that CBT is not more effective in treating depression than ACT. Both treatments seem to work through changes in dysfunctional attitudes and decentering, even though the treatments differ substantially. Change in experiential avoidance as an underlying mechanism seems to be an ACT-specific process. Further research is needed to investigate whether ACT and CBT may work differently for different groups of patients with depression. TRIAL REGISTRATION: clinicaltrials.gov; NCT01517503 . Registered 25 January 2012 - Retrospectively registered.

Explicit and implicit attachment and the outcomes of acceptance and commitment therapy and cognitive behavioral therapy for depression.

BACKGROUND: Attachment theory predicts that patients who are not securely attached may benefit less from psychological treatment. However, evidence on the predictive role of attachment in the effectiveness of treatment for depression is limited. METHODS: Explicit attachment styles, levels of attachment anxiety and attachment avoidance, as well as implicit relational self-esteem and implicit relational anxiety were assessed in 67 patients with major depressive disorder (MDD) receiving Acceptance and Commitment Therapy (ACT) or Cognitive Behavioral Therapy (CBT). ANOVA and hierarchical regression analyses were performed to investigate the predictive power of explicit and implicit attachment measures on treatment outcome. RESULTS: Explicit attachment avoidance at pre-treatment significantly predicted reduction of depressive symptoms following treatment. Reductions in attachment anxiety and avoidance from pre- to post-treatment predicted better treatment outcomes. Neither one of the implicit measures, nor change in these measures from pre- tot post-treatment significantly predicted treatment outcome. CONCLUSIONS: Our findings show that attachment avoidance as well as reductions in avoidant and anxious attachment predict symptom reduction after psychological treatment for depression. Future research should use larger sample sizes to further examine the role of attachment orientation as moderator and mediator of treatment outcome. TRIAL REGISTRATION: clinicaltrials.gov; NCT01517503.

A Randomized Controlled Trial in Routine Clinical Practice Comparing Acceptance and Commitment Therapy with Cognitive Behavioral Therapy for the Treatment of Major Depressive Disorder.

BACKGROUND: Since current therapies for depression are effective but not for all patients alike, we need to further improve available treatments. Existing research suggests that acceptance and commitment therapy (ACT) may effectively treat major depressive disorder (MDD). We compared ACT with cognitive behavioral therapy (CBT) for depression, testing the hypothesis that CBT would outperform ACT. METHODS: We conducted a randomized controlled trial with 82 patients suffering from MDD. Data were collected before and after treatment and at the 6-month follow-up, assessing diagnosis, symptom levels of depression, and quality of life. RESULTS: After treatment, the rates of remission from depression were 75 and 80% for the ACT and CBT conditions, respectively. Patients in both conditions further reported significant and large reductions in depressive symptoms and improvement in quality of life from before to after treatment as well as at the follow-up. Our findings indicated no significant differences between the two intervention groups. CONCLUSION: Our results indicate that CBT is not more effective in treating depression than ACT. Further research is needed to investigate whether ACT and CBT work differently for different groups of patients with depression.

Prevention of anxiety disorders and depression by targeting excessive worry and rumination in adolescents and young adults: A randomized controlled trial.

BACKGROUND: This randomized controlled trial evaluated the efficacy of a preventive intervention for anxiety disorders and depression by targeting excessive levels of repetitive negative thinking (RNT; worry and rumination) in adolescents and young adults. METHODS: Participants (N = 251, 83.7% female) showing elevated levels of RNT were randomly allocated to a 6-week cognitive-behavioral training delivered in a group, via the internet, or to a waitlist control condition. Self-report measures were collected at pre-intervention, post-intervention, 3 m and 12 m follow-up. RESULTS: Both versions of the preventive intervention significantly reduced RNT (d = 0.53 to 0.89), and symptom levels of anxiety and depression (d = 0.36 to 0.72). Effects were maintained until 12 m follow-up. The interventions resulted in a significantly lower 12 m prevalence rate of depression (group intervention: 15.3%, internet intervention: 14.7%) and generalized anxiety disorder (group intervention: 18.0%, internet intervention: 16.0%), compared to the waitlist (32.4% and 42.2%, respectively). Mediation analyses demonstrated that reductions in RNT mediated the effect of the interventions on the prevalence of depression and generalized anxiety disorder. CONCLUSIONS: Results provide evidence for the efficacy of this preventive intervention targeting RNT and support a selective prevention approach that specifically targets a known risk factor to prevent multiple disorders.

When Thinking Impairs Sleep: Trait, Daytime and Nighttime Repetitive Thinking in Insomnia.

We performed two studies in individuals with sleep problems to investigate trait, daytime, and nighttime repetitive thinking as risk factors for insomnia. In Study 1, 139 participants completed questionnaires on worry, rumination, insomnia, anxiety, depression, and a sleep diary. Trait rumination and trait worry were not associated with sleep impairment. In Study 2, 64 participants completed similar measures and a daytime and nighttime sleep-related worry diary. Only nighttime sleep-related worry was consistently associated with sleep impairment. Overall, results indicate that nighttime sleep-related worry is important in the maintenance of insomnia, whereas effects of trait and daytime repetitive thinking are more benign. Treatment for insomnia can potentially be improved by focusing more on nighttime sleep-related worry.

The effect of verbal and imagery-based worry versus distraction on the emotional response to a stressful in-vivo situation.

BACKGROUND AND OBJECTIVES: According to the Contrast Avoidance Model of worry, worrying induces prolonged negative affect and arousal and thereby suppresses sharp shifts in negative affect. The verbal and abstract nature of worry may be responsible for these effects as verbal thinking has been found to lead to less emotional and physiological responding than imagery. The present study was designed to test the Contrast Avoidance Model and to examine the role of verbal vs. imagery-based thinking during worrying.. METHODS: 125 participants were exposed to a social-evaluative stressor. Before the stressor, they were randomized into three different groups (1) verbal worrying about the upcoming stressor, (2) imagery-based worrying, or (3) distraction. Self-reported affect and physiological arousal, as well as heart rate, respiratory sinus arrhythmia and skin conductance level (SCL) were monitored. RESULTS: In line with the Contrast Avoidance Model, worrisome thinking (1) led to immediately increased self-reported negative affect and arousal as well as SCL, but (2) attenuated a further increase in self-reported negative affect and arousal in response to the stressor. No effect of style of worrying (verbal vs. imagery) was found.. LIMITATIONS: Effects were rather small and mostly confined to self-report data. CONCLUSION: By and large, our findings support the Contrast Avoidance Model of worry with regard to self-report measures and extend earlier findings by using an in-vivo stressor. The role of thinking style on the contrast avoidance effect as well as the contrast avoidance effect on physiological measures need to be explored in more detail..

Development and assessment of brief versions of the Penn State Worry Questionnaire and the Ruminative Response Scale.

OBJECTIVES: Worry and depressive rumination have been found to be involved in the onset and maintenance of a range of psychological disorders. The development of brief screening measures for excessive worry and depressive rumination is therefore desirable to facilitate the assessment of worry and rumination in prevention and treatment settings where routine administration of full questionnaires is not practical due to time-related constraints. DESIGN AND METHODS: Using the Penn State Worry Questionnaire (PSWQ) and the Ruminative Response Scale (RRS) as gold standard starting points, brief versions of these measures were developed in a large sample of adolescents (N = 1,952) and results were cross-validated in two independent samples (N = 1,954; N = 457). RESULTS: The brief versions demonstrated acceptable to high internal consistency (brief PSWQ: α = .84-.91; brief RRS: α = .78-.81) and correlated highly with the full questionnaires (brief PSWQ: r = .91-.94; brief RRS: r = .88-.91). In addition, they showed high sensitivity (brief PSWQ: .90-.92; brief RRS: .90-.93), and high specificity (brief PSWQ: .88-.90; brief RRS: .80-.87) to detect excessive worry and rumination. The validity of the brief measures was further supported by demonstrating that the brief measures showed similar differences in scores between males and females as the full measures as well as substantial relationships to other measures of repetitive negative thinking and symptom measures of anxiety and depression. Finally, the brief measures predicted future symptoms of anxiety and depression. CONCLUSIONS: The brief versions of the PSWQ and RRS are time-efficient and valid instruments for the screening of worry and depressive rumination. Their use in clinical practice is recommended to inform treatment and/or to select individuals at risk for development of psychological disorders who may benefit from preventive interventions.

Intuition, Affect, and Peculiar Beliefs.

Research with college students has found that intuitive thinking (e.g., using hunches to ascribe meaning to experiences) and positive affect interactively predict ideas of reference and odd/magical beliefs. We investigated whether these results would generalize to a diverse community sample of adults that included individuals with elevated levels of peculiar perceptions and beliefs. We measured positive and negative affect and intuitive thinking through questionnaires, and peculiar beliefs (i.e., ideas of reference and odd/magical beliefs) through structured clinical interviews. We found that peculiar beliefs were associated with intuitive thinking and negative affect, but not positive affect. Furthermore, in no instance did the interaction of affect and intuitive thinking predict peculiar beliefs. These results suggest that there are important differences in the factors that contribute to peculiar beliefs between college students and clinically meaningful samples.

Psychometric properties of the Five Facets Mindfulness Questionnaire (FFMQ) in a meditating and a non-meditating sample.

The factor structure, internal consistency, construct validity, and predictive validity of the Dutch version of the Five Facet Mindfulness Questionnaire (FFMQ-NL) were studied in a sample of meditators (n = 288) and nonmeditators (n = 451). A five-factor structure was demonstrated in both samples, and the FFMQ-NL and its subscales were shown to have good internal consistencies. Meditators scored higher on all facets of the FFMQ-NL than the participants in the nonmeditating sample. For both samples, expected negative correlations between most mindfulness facets (all except for the Observing facet) and the constructs of alexithymia, thought suppression, rumination, worry, and dissociation were found. The Observing facet of the FFMQ-NL showed an unexpected positive correlation with thought suppression in the nonmeditating sample. Furthermore, as expected, mindfulness facets were negatively related to psychological symptoms, and all mindfulness facets except for Observing and Describing significantly predicted psychological symptoms. Overall, the Dutch FFMQ demonstrated favorable psychometric properties, commensurate with its (original) English language version.