Internet-delivered treatment: its potential as a low-intensity community intervention for adults with symptoms of depression: protocol for a randomized controlled trial

BACKGROUND: Depression is a high prevalence disorder, displaying high rates of lifetime incidence, early age onset, high chronicity, and role impairment. In Ireland 12-month prevalence of depression has been reported to be 10.3%. A large percentage of affected individuals have no medical diagnosis nor seek treatment. Cognitive Behavior Therapy (CBT) has established itself as an option for the treatment of depression. Many Irish adults with depression find it difficult to access evidence-based CBT, this is due to several factors, like stigma and costs. However, systematic factors including the shortage of trained professionals and the relative underdevelopment of services also make access difficult. Stepped-care can increase access to evidence-based CBT. One option is tailored internet-delivered treatment programs. Preliminary research from Ireland needs now to include large-scale studies on effectiveness. Thus the current study seeks to examine the potential of an internet-delivered low-intensity treatment for symptoms of depression in an Irish adult community sample. METHOD/DESIGN: The study is a randomized controlled trial of an online CBT (iCBT) program for the treatment of adults with depressive symptoms. The trial will include an active treatment group and a waiting-list control group. The active condition will consist of 8 weekly modules of iCBT, with post-session feedback support. Participants in the waiting list will receive access to the treatment at week 8. Participants will complete the Beck Depression Inventory (BDI-II) and eligibility criteria will also apply. Primary outcomes are depressive symptoms. Secondary outcomes include quality of life indicators, significant events and satisfaction with online treatment. Data will be collected at baseline and at post-treatment, week 8, and at follow-up week 20 (3-months) and week 32 (6-months). Analysis will be conducted on the intention-to-treat basis. DISCUSSION: The study seeks to evaluate the effectiveness of an online delivered treatment for depression in a community sample of Irish adults with symptoms of depression. The study will be a first contribution and depending on the sample recruited the results may be generalizable to people with similar difficulties in Ireland and may therefore give insight into the potential of low-intensity interventions for Irish people with depressive symptoms. TRIAL REGISTRATION NUMBER: Current Controlled Trials ISRCTN03704676. DOI: 10.1186/ISRCTN0370467

Low-intensity internet-delivered treatment for generalized anxiety symptoms in routine care: protocol for a randomized controlled trial

BACKGROUND: Worldwide prevalence of generalized anxiety disorder (GAD) is considered high; in Europe lifetime prevalence has been estimated at 4.3 to 5.9%. High levels of anxiety disorders have been reported in university students, affecting 25 to 30% of the population. Young adults are some of the most vulnerable for the onset of mental health disorders and any stressors may act as a catalyst for their onset. The absence of resources can often mean that many do not seek treatment. Other factors that impede access to resources include such things as a lack of trained professionals, personal stigma, and waiting lists. Anxiety disorders can be treated successfully; indeed brief forms of cognitive-behavior therapy have been recommended. One potential avenue for research and development is that of delivering low-intensity interventions online for students with GAD. Therefore, the current study seeks to investigate the potential effectiveness for a low-intensity online CBT-based treatment for GAD in a service-based setting; implemented as one step in a stepped-care model. METHODS/DESIGN: The research is a service-based effectiveness study utilizing a randomized waiting-list controlled design. The active intervention consists of six weekly modules of online CBT. Participants are assigned a supporter who provides weekly post-session feedback on progress and exercises. Participants will complete the GAD-7 as the primary outcome measure. Secondary outcomes include pathological worry, depression and measures of well-being. At three-months follow-up data will be collected using the GAD-7, BDI-II, PSWQ, ED-Q5 and WSAS. Post-session data will be collected on significant in-session events in treatment (HAT). A satisfaction with treatment measure will be administered post-treatment (SAT). DISCUSSION: The study will be a contribution to the potential for a low-intensity internet-delivered program implemented in a service-based setting; implemented as one step in a stepped-care model. The study will be a contribution to the already established work in online treatments for anxiety worldwide. The study will assess the utility of an innovative digital health solution (SilverCloud) to deliver such interventions. TRIAL REGISTRATION: Current Controlled Trials ISRCTN16303842

Change Processes During Intensive Day Treatment for Anorexia: A Dyadic Interview Analysis of the Views of Adolescents and Parents

Background. Day programmes for severe adolescent anorexia nervosa offer an alternative to inpatient admission for some cases, but there is only one service of this kind in the UK. Processes of change during treatment for anorexia are currently poorly understood. Aim. Explore how adolescents with anorexia and their parents understood the helpful and unhelpful factors and processes that impacted them during day hospital treatment for the adolescent’s anorexia. Methodology. A critical realist paradigm was used to qualitatively explore the views of 16 participants. Participants were recruited from the Intensive Treatment Programme at the Maudsley Hospital at the end of treatment. Dyadic Interviews Analysis (DIA) was used to compare and contrast the narratives of the seven adolescent-parent pairs after two inductive reflexive thematic analyses were conducted for the group of eight adolescents and the group of eight parents separately. Findings. The author’s DIA created sixteen subthemes across five themes: "It was kind of like ... last hope" - Families have experienced prior treatment failure and its impact; "She got with the programme very quickly" – Programme structure and authority enable eatingand safety; "Like me she didn’t feel so alone anymore" – Moving from isolated distress to a shared or supported struggle; "Just sort of gone over the bridge a little bit." - Progress made in the programme and progress still to be made; "I think there's positives and negatives to them all." (Evie-A) – what helps progress can also hinder it. Conclusions. The findings can be conceptualised within Fonagy’s ideas regarding therapeutic change, including epistemic trust and mentalisation. Anorexia-specific factors and processes are equally important to consider, namely control and collaboration, externalisation of anorexia, the role of peer support, and the potential for family members to experience the impact of the adolescent’s anorexia and treatment non-response as traumatic

Change processes during intensive day programme treatment for adolescent Anorexia Nervosa: a dyadic interview analysis of adolescent and parent views

Background: Day programmes for adolescent anorexia nervosa (AN) can function as an alternative to inpatient admissions and/or an increase in outpatient treatment intensity. Processes of change during treatment for AN are currently poorly understood. This study aimed to explore how adolescents with AN and their parents understood the helpful and unhelpful factors and processes that impacted them during day programme treatment. Method: A critical realist paradigm was used to qualitatively explore the views of 16 participants. Participants were recruited from the Intensive Treatment Programme (ITP) at the Maudsley Center for Child and Adolescent Eating Disorders (MCCAED) at the end of treatment. Dyadic Interview Analysis (DIA) was used to compare and contrast the narratives of the seven adolescent–parent pairs after two inductive reflexive thematic analyses were conducted for the group of eight adolescents and the group of eight parents separately. Results: Eight subthemes across three themes were identified: 1) “Like me she didn't feel so alone anymore”—families connect with staff, peers, and each other; 2) “You have to eat because ITP say so”—the programme provides families with containment through its structure and authority; and 3) “I found that I was using the skills I learnt there like in multiple aspects of my life, not just around food”—families take in new ideas and generalize these into their lives. These interconnected themes generated hope and change. However, helpful elements individually could be unhelpful if one or more of the other factors were missing. For example, staff firmness, which participants often found helpful (theme two), could be experienced as harshness when adolescents did not feel related to as individuals (theme one). Conclusion: The findings can be conceptualized within recent descriptions regarding the therapeutic change, including epistemic trust and mentalization. Treatment characteristics, such as intensity and containment, as well as illness-specific factors and processes, such as control and collaboration, the role of peer support, and the potential for family members to experience the impact of the adolescent's AN and treatment non-response as traumatic, are equally important to consider

First joint observation by the underground gravitational-wave detector, KAGRA, with GEO 600

We report the results of the first joint observation of the KAGRA detector with GEO600. KAGRA is a cryogenic and underground gravitational-wave detector consisting of a laser interferometer with three-kilometer arms, and located in Kamioka, Gifu, Japan. GEO600 is a British–German laser interferometer with 600m arms, and located near Hannover, Germany. GEO600 and KAGRA performed a joint observing run from April 7 to 20, 2020. We present the results of the joint analysis of the GEO–KAGRA data for transient gravitational-wave signals, including the coalescence of neutron-star binaries and generic unmodeled transients. We also perform dedicated searches for binary coalescence signals and generic transients associated with gamma-ray burst events observed during the joint run. No gravitational-wave events were identified. We evaluate the minimum detectable amplitude for various types of transient signals and the spacetime volume for which the network is sensitive to binary neutron-star coalescences. We also place lower limits on the distances to the gamma-ray bursts analysed based on the non-detection of an associated gravitational-wave signal for several signal models, including binary coalescences. These analyses demonstrate the feasibility and utility of KAGRA as a member of the global gravitational-wave detector network

Table_1_Change processes during intensive day programme treatment for adolescent anorexia nervosa: a dyadic interview analysis of adolescent and parent views.docx

BackgroundDay programmes for adolescent anorexia nervosa (AN) can function as an alternative to inpatient admissions and/or an increase in outpatient treatment intensity. Processes of change during treatment for AN are currently poorly understood. This study aimed to explore how adolescents with AN and their parents understood the helpful and unhelpful factors and processes that impacted them during day programme treatment.MethodA critical realist paradigm was used to qualitatively explore the views of 16 participants. Participants were recruited from the Intensive Treatment Programme (ITP) at the Maudsley Center for Child and Adolescent Eating Disorders (MCCAED) at the end of treatment. Dyadic Interview Analysis (DIA) was used to compare and contrast the narratives of the seven adolescent–parent pairs after two inductive reflexive thematic analyses were conducted for the group of eight adolescents and the group of eight parents separately.ResultsEight subthemes across three themes were identified: 1) “Like me she didn't feel so alone anymore”—families connect with staff, peers, and each other; 2) “You have to eat because ITP say so”—the programme provides families with containment through its structure and authority; and 3) “I found that I was using the skills I learnt there like in multiple aspects of my life, not just around food”—families take in new ideas and generalize these into their lives. These interconnected themes generated hope and change. However, helpful elements individually could be unhelpful if one or more of the other factors were missing. For example, staff firmness, which participants often found helpful (theme two), could be experienced as harshness when adolescents did not feel related to as individuals (theme one).ConclusionThe findings can be conceptualized within recent descriptions regarding the therapeutic change, including epistemic trust and mentalization. Treatment characteristics, such as intensity and containment, as well as illness-specific factors and processes, such as control and collaboration, the role of peer support, and the potential for family members to experience the impact of the adolescent's AN and treatment non-response as traumatic, are equally important to consider.</p

TRIALS STUDY PROTOCOL Open Access

Low-intensity internet-delivered treatment for generalized anxiety symptoms in routine care: protocol for a randomized controlled tria

Effectiveness of an internet-delivered intervention for generalized anxiety disorder in routine care: A randomised controlled trial in a student population

AbstractBackgroundCognitive behavioural therapy is one of the main and preferred treatments for generalized anxiety disorder. Numerous barriers can hinder an individual from seeking or receiving appropriate treatment; internet-delivered CBT interventions offer a relatively new means of increasing access to treatment.MethodsA service-based effectiveness randomised waiting list control trial examined the impact of an internet-delivered CBT intervention, Calming Anxiety, amongst Irish university students (N=137). Primary outcome was self-reported GAD and secondary outcomes included depression and work and social functioning.ResultsAnalyses returned inconclusive results. Both treatment and waiting list conditions displayed significant decreases in anxiety symptoms post-treatment, but we did not observe a significant between-group effect (p=0.076). Significant within-group differences from pre to post time points were observed for depression (BDI-II) and work and social functioning (WASA), and between group differences were also significant for depression (d=0.46) and functioning (d=0.36). Both groups demonstrated cases of remission and recovery from anxiety, however differences in the number of cases reaching clinically meaningful change between conditions were non-significant.ConclusionsSeveral explanations regarding the results are presented, examining issues related to active waiting lists, study limitations and treatment expectancies.Trial registration: Current Controlled Trials ISRCTN16303842

Telomere dysfunction impairs intestinal differentiation and predisposes to diet-induced colitis

AbstractIntestinal epithelium dysfunction causes barrier defects, malabsorption and dysbiosis, predicting local and systemic disease, morbidity and mortality in humans. However, the underlying causes are not well understood. Here we show that telomere shortening is a host intrinsic factor that impairs enterocyte differentiation. The presence of such undifferentiated enterocytes is associated with barrier disruption and malabsorption of nutrients, such as fructose. A fructose-rich diet causes increased fructose spillover to the colon and induces colitis in a microbiome-dependent manner. The microbiome uses fructose to synthesize essential metabolites, including NAD precursors, that complement the host’s low NAD pool in the inflamed colon. Thus, telomere shortening drives enterocyte dysfunction and predisposes to diet-induced colitis through barrier disruption, increased nutrient flux to the colon and modulation of the microbiome. This differerentiation defect expands the canonical stem cell failure-centered view of how telomere shortening impacts the intestine and predisposes to intestinal disease in conditions associated with short telomeres.</jats:p

NPM1 mutations define a specific subgroup of MDS and MDS/MPN patients with favorable outcomes with intensive chemotherapy

Abstract Nucleophosmin (NPM1) mutations are common in acute myeloid leukemia and are associated with high remission rates and prolonged survival with intensive chemotherapy. NPM1 mutations are rare in myelodysplastic syndromes (MDS) or myelodysplastic/myeloproliferative neoplasm (MDS/MPN), and the clinical outcomes of these patients, when treated with intensive chemotherapy, are unknown. We retrospectively evaluated the clinicopathologic characteristics and the impact of therapy in 31 patients with MDS or MDS/MPN and NPM1 mutations. Next-generation sequencing was performed at diagnosis in 22 patients. Median age was 62 years (range, 19-86). Twenty-four patients (77%) had normal karyotype, and all had multilineage dysplasia. Most patients could be classified as MDS with excess blasts (19/31, 61%). NPM1 mutations were detected at a median allele frequency of 0.38 (range, 0.09-0.49). Mutation burden did not correlate with bone marrow blast frequency, and its clearance seemed to be associated with decreased morphologic dysplasia. Ten of the 31 patients (32%) received cytotoxic chemotherapy, 20 (65%) hypomethylating agents, and 1 (4%) lenalidomide. Sequential sequencing was available in 16 (52%) patients, and mutation burden correlated with disease status and response to therapy. Patients treated with chemotherapy had higher complete response rates (90% vs 28%, P = .004), longer median progression-free survival (not reached vs 7.5 months, P = .023), and overall survival (not reached vs 16 months, P = .047). Intensive chemotherapy and allogeneic stem cell transplantation (SCT) may be associated with improved clinical outcomes in patients with NPM1-mutated MDS or MDS/MPN who are candidates for this form of therapy.</jats:p