Early Eye Movement Desensitisation and Reprocessing (EMDR) intervention in a disaster mental health care context

‘Early psychological intervention’ is defined as commencing treatment within three months of the traumatic event, with the aim to prevent or treat posttraumatic stress disorder, ongoing distress or acute stress disorder. In natural disaster situations, specific issues may limit the amount of time available for treatment and the possibility of interventions. Eye Movement Desensitisation and Reprocessing (EMDR) can be used without regard to these limits. The aim of the study is to evaluate the effects of EMDR, Recent Traumatic Episode Protocol (R-TEP) provided within three months of the traumatic event to a large sample of individuals exposed to the earthquake that hit Emilia Romagna Region (Northern Italy) in 2012. This study is based on a retrospective review of medical records collected during the activities of psychological and psychosocial unit in the immediate aftermath of earthquake. In total, 529 participants completed the Impact of Event Scale Revised (IES-R) (pre e post treatment). In order to provide a comparison similar to a waitlist-like control group, a method of cohort analysis was applied. In addition, possible time dependent effect was tested. ET (early-treated sample, participants treated within one month after the earthquake) and LT (late-treated sample, participants treated after the first month from the earthquake) reported at post-treatment an improvement to a level below the IES-R cutoff (65.8% of the ET sample and 64.02% of the LT sample). Control group analogue and time-outcome correlation suggest that positive changes in symptoms were likely due to the treatment provided and not merely to the time lapse from the traumatic event. The results of this study suggest that EMDR is a viable treatment option in response to a disaster crisis and in reducing psychological distress of acutely traumatized individuals within the context of a natural disaster.     

Eye movement desensitization and reprocessing as a therapeutic intervention for traumatized children and adolescents: a systematic review of the evidence for family therapists

Eye movement desensitization and reprocessing (EMDR) is a relatively new form of psychotherapy for post‐traumatic symptoms of relevance to systemic therapists. The literature available on individual EMDR in traumatized children is reviewed in this article. A sample of eight studies was examined, consisting of three controlled trials, two uncontrolled studies and three case reports or series. The controlled trials compared EMDR with waiting list controls or cognitive behavioural therapy (CBT). The study samples were small and their methodological quality variable. In all the studies, the results suggested a positive effect for EMDR but did not appear superior to CBT. It is therefore possible that systemic interventions may be improved by the integration of EMDR and family therapy with children and adolescents.     

Internet-based vs. face-to-face cognitive behavior therapy for psychiatric and somatic disorders: an updated systematic review and meta-analysis

During the last two decades, Internet-delivered cognitive behavior therapy (ICBT) has been tested in hundreds of randomized controlled trials, often with promising results. However, the control groups were often waitlisted, care-as-usual or attention control. Hence, little is known about the relative efficacy of ICBT as compared to face-to-face cognitive behavior therapy (CBT). In the present systematic review and meta-analysis, which included 1418 participants, guided ICBT for psychiatric and somatic conditions were directly compared to face-to-face CBT within the same trial. Out of the 2078 articles screened, a total of 20 studies met all inclusion criteria. Results showed a pooled effect size at post-treatment of Hedges g = .05 (95% CI, ?.09 to .20), indicating that ICBT and face-to-face treatment produced equivalent overall effects. Study quality did not affect outcomes. While the overall results indicate equivalence, there have been few studies of the individual psychiatric and somatic conditions so far, and for the majority, guided ICBT has not been compared against face-to-face treatment. Thus, more research, preferably with larger sample sizes, is needed to establish the general equivalence of the two treatment formats.     

No effects of eye movements on the encoding of the visuospatial sketchpad and the phonological loop in healthy participants: Possible implications for eye movement desensitization and reprocessing therapy

Horizontal eye movement is an essential component of the psychological intervention “eye movement desensitization and reprocessing” (EMDR) used in posttraumatic stress disorder. A hypothesized mechanism of action is an overload of the visuospatial sketchpad and/or the phonological loop of the working memory.     

Memory bias for threatening information related to anxiety: an updated meta-analytic review

The evidence for an anxiety-related memory bias is contradictory. We compiled 171 articles published until October 2016 including a group with clinical or subclinical anxiety and a control group in tasks involving implicit or explicit memory using threatening stimuli. There was an anxiety-related memory bias in free recall tasks, but it was not observed in another memory task. The between-groups differences showed that the anxious group recalled more threatening stimuli than the control group (d?=?0.321). When we compared the group differences (anxious vs. control participants) in the within-groups effect (threatening vs. neutral stimuli), a moderate effect size emerged (d_bw?=?0.714). This anxiety-related memory bias was observed with shallow processing, that is consistent with attentional biases related to anxiety. There was also evidence that high-anxious persons recall fewer positive stimuli. Future research is needed to investigate whether this result is a memory or encoding bias and explore other moderator variables.     

Pilot randomised controlled trial of counselling in a community mental health setting: Pitfalls and learnings

The establishment of counselling and psychotherapy as “evidence‐based” interventions is contingent on the effective implementation of randomised controlled trials (RCTs) in real‐world clinical settings. This paper identifies some of the pitfalls that led to the termination of a practical RCT in a community mental health setting. It reflects upon the significance of the lessons learned by drawing on similar challenges that are documented in the wider literature. Issues surrounding staff turnover, counsellor engagement and procedural clarity are discussed, as is the conflict between the time required for research procedures and counsellors’ clinical time constraints. In our recommendations, we recognise the decisive role of collaboration and counsellor motivation in research partnerships, and the significance of clinical relevance, communication, training and research co‐production in achieving them. Time commitment is identified as the pivotal challenge in the formation and maintenance of collaborative research, but one that also must be overcome for the advancement of the counselling and psychotherapy field.     

老年人心理韧性与幸福感的关系:一项元分析

采用元分析方法探讨老年人心理韧性和幸福感之间的关系, 通过文献检索和筛选, 共有42篇中英文文献, 75个独立样本纳入元分析(N = 12856)。结果显示, 老年人心理韧性和幸福感、生活满意度、积极情感呈显著正相关关系, 与消极情感之间呈显著负相关关系; 两者之间的关系受心理韧性的测量工具、文化背景、文献质量、文献年份、样本量和样本人群年龄的影响。研究结果为心理韧性如何影响老年人幸福感提供了较为精确的估计, 对于提高老年人幸福感进而实现成功老化具有重要意义。     

2010~2020中国内地大学生心理健康问题检出率的元分析

估计我国大学生心理健康问题的检出率, 能够为心理健康政策完善和教育活动开展提供证据支持。对2010~2020年我国大学生主要心理健康问题检出率及影响因素进行元分析, 结果表明, 睡眠问题、抑郁、自我伤害在大学生中较为突出; 近10年, 大学生焦虑、抑郁、睡眠问题和自杀未遂的检出率显著上升, 自我伤害的检出率显著下降; 测量工具、检出标准和检出时间是导致检出率大小不一的关键因素; 整体而言, 东北和中部地区大学生的心理健康情况优于西部和东部大学生; 性别、生源地、独生与否对大学生心理健康问题检出率的影响均不显著。未来应重视研制适合我国大学生的心理健康测评工具并确定检出标准, 同时据此积极开展心理行为问题的筛查与控制。     

共情与亲社会行为关系的元分析

本研究采用元分析的方法探讨共情与亲社会行为之间的关系以及影响二者关系的调节因素。通过文献检索, 共获得76项研究和77个独立效应量, 包含了20352名被试。异质性检验表明, 选择随机效应模型比较合适; 漏斗图和Egger’s检验结果显示, 本元分析不存在发表偏差; 主效应检验发现, 共情与亲社会行为呈显著正相关(r = 0.38, p < 0.001); 调节效应检验表明, 二者关系受被试年龄和共情测量工具类型的调节, 但不受文化背景的影响。     

道歉在信任修复中的作用:来自元分析的证据

采用元分析方法对道歉的信任修复效果进行探讨。通过中英文献检索,共有18篇文献36个独立样本符合元分析标准(N=4731)。元分析的结果表明,道歉在信任修复中起到一定促进作用,呈中等效应量(d=0.44)。调节效应检验发现,信任违背类型的调节作用显著,相比于诚实型信任违背,道歉对能力型信任违背有较好的修复效果。此外,控制组设置对道歉的信任修复效果具有显著的调节作用,以沉默为控制组的信任修复效果优于以否认为控制组的信任修复效果。信任类型、道歉所包含的成分以及测量工具的调节作用均不显著。     

The relationship between self-harm and alexithymia: A systematic review and meta-analysis

Self-harm, defined for the purpose of this review as any act of self-injury without explicit suicidal intent, is an increasing public health concern, with potential long-term implications for those who engage in it. Previous research has identified a correlational relationship between self-harm and alexithymia, an emotion processing deficit characterized by difficulties identifying and describing feelings, and an externally orientated thinking style. Through a systematic search of the literature, the current review examines the association between alexithymia and self-harm. A meta-analysis based on 23 studies found a significant, positive relationship between self-harm and alexithymia, with a medium effect size (g = 0.57, 95% CI 0.46–0.69). All 23 studies used the Toronto Alexithymia Scale (TAS20) to measure alexithymia. The alexithymia subcomponents difficulty identifying feelings and difficulty describing feelings were significantly associated with self-harm, but there was no significant association between self-harm and externally orientated thinking. The effect size of the relationship was significantly larger in adolescent samples compared with adult samples and in female compared with male samples. The definition of self-harm did not affect the effect size of the relationship between alexithymia and self-harm and the results are consistent with previous meta-analyses focused more narrowly on non-suicidal self-injury and, separately, suicidal behaviors. Heterogeneity between the included studies was high. The results support an affect regulation model of self-harm, in which self-harm is used to regulate an emotional experience that is poorly understood.     

Internet-delivered cognitive behavioral therapy for panic disorder with or without agoraphobia: a systematic review and meta-analysis

ABSTRACT

The current systematic review and meta-analysis examined the efficacy and effectiveness of internet-delivered cognitive behavioral therapy (iCBT) on panic disorder and agoraphobia symptom severity. Twenty-seven studies were identified. Results from nine randomised controlled trials (RCTs) showed that iCBT outperformed waiting list and information controls for panic (g = 1.22) and agoraphobia (g = .91) symptoms, but the quality of RCTs varied and heterogeneity was high. Results from three RCTs suggested iCBT may have similar outcomes to face-to-face CBT in reducing panic and agoraphobia symptoms. Within-group effect sizes between baseline and post-treatment were large for panic (n = 29, g = 1.16) and medium for agoraphobia symptom severity (n = 18, g = .73). Subgroup analyses of within-group pre/post treatment effect sizes showed larger within-group effect sizes for efficacy studies (n = 15) compared to effectiveness studies (n = 14) for panic severity (g = 1.38 vs. g = .98) but not agoraphobia severity. There was no impact of program length, inclusion or arousal reduction techniques, or degree of clinician support. Within-group effects of iCBT suggest the reduction in panic and agoraphobia symptom severity is maintained at 3–6 month follow-up (n = 12).     

2010~2020中国内地小学生心理健康问题检出率的元分析

我国小学生心理健康问题的检出率莫衷一是, 为整合调查结果并分析其原因, 对2010~2020年来检索到的相关研究进行了元分析。结果显示：(1)小学生心理健康问题的检出率由高到低依次是睡眠问题(25.2%, 95% CI = [0.16, 0.37])、抑郁(14.6%, 95% CI = [0.12, 0.18])、焦虑(12.3%, 95% CI = [0.06, 0.23])、攻击行为(4.1%, 95% CI = [0.02, 0.10])、退缩(3.8%, 95% CI = [0.02, 0.06])、违纪行为(3.7%, 95% CI = [0.02, 0.07])、躯体化(3.6%, 95% CI = [0.02, 0.07])。(2)测量工具、检出标准、检出时间是导致小学生心理健康问题检出率不一致的关键因素。总体而言, 我国小学生除了睡眠问题、抑郁和焦虑检出率偏高外, 整体心理健康状况尚可。未来应开发适合中国小学生的心理健康状况测评工具及检出标准, 为心理健康问题的预防和精准干预提供支持。     

内疚与亲社会行为的关系：来自元分析的证据

内疚作为一种典型的道德情绪, 被认为具有亲社会作用, 但很多研究却发现内疚并不总能促进亲社会行为。为了明确内疚对亲社会行为的作用, 分析造成结论分歧的可能原因, 本研究采用元分析方法探讨了特质内疚与亲社会行为的关系以及状态内疚对亲社会行为的影响。共有46篇文献92个独立样本纳入元分析(N = 17248)。元分析结果表明：(1)特质内疚与亲社会行为之间存在中等程度的正相关, 二者之间的关系受到亲社会行为类型的调节, 相比较捐赠、助人、环保行为等, 特质内疚与补偿之间的相关更强; (2)启动内疚状态能显著提升个体的亲社会行为, 但两者之间的关联呈较小的效应量, 亲社会行为对象在其中起到调节作用, 感到内疚的个体更愿意对受害方做出亲社会行为; (3) p曲线(p-curve)分析发现, 两个元分析研究的p曲线均呈显著右偏态, 表明特质内疚与亲社会行为的关系以及状态内疚对亲社会行为的影响均存在真实的效应, 而不是出版偏倚或者p hacking导致。     

2010~2020中国内地初中生心理健康问题检出率的元分析

初中生心理健康问题的检出率在诸多研究中存在很大分歧, 未能为心理健康政策制定和服务体系建设提供充分依据。为明确心理健康问题的整体检出率并澄清其影响因素, 对2010~2020年检索到的文献进行了元分析。结果发现, 初中生面临不同程度的心理健康问题, 其中焦虑、抑郁和自我伤害检出率排在前三位; 初中生心理健康问题随年代发展呈恶化趋势, 其中焦虑和自杀企图尤为明显; 初中生心理健康问题检出率饱受测量工具、检出标准和检出时间不统一的影响; 初中生心理健康问题检出率整体上随年级而增加, 其中焦虑尤为明显; 女生的心理健康问题检出率高于男生, 自杀尤为明显; 中西部地区的初中生比东北和东部地区更容易出现心理健康问题, 尤其是焦虑和自我伤害。未来应立足中国大地研制科学的测量工具和筛查标准并建立心理健康动态监测体系和学校心理健康服务体系。     

Internet-delivered transdiagnostic and tailored cognitive behavioral therapy for anxiety and depression: a systematic review and meta-analysis of randomized controlled trials

Anxiety and depressive disorders are often comorbid. Transdiagnostic and tailored treatments seem to be promising approaches in dealing with comorbidity. Although several primary studies have examined the effects of Internet-delivered cognitive behavior therapy (iCBT) for anxiety and depression, no meta-analysis including different types of iCBT that address comorbidity has been conducted so far. We conducted systematic searches in databases up to 1 July 2016. Only randomized trials comparing transdiagnostic/tailored iCBT for adult anxiety and/or depression with control groups were included. Nineteen randomized trials with a total of 2952 participants that met inclusion criteria were analyzed. The quality of the studies was high, however the blinding criteria were not fulfilled. The uncontrolled effect size (Hedges’ g) of transdiagnostic/tailored iCBT on anxiety and depression outcomes was large and medium for quality of life. The controlled effect size for iCBT on anxiety and depression outcomes was medium to large (anxiety: g = .82, 95% CI: .58–1.05, depression: g = .79, 95% CI: .59–1.00) and medium on quality of life (g = .56, 95% CI: .37–.73). Heterogeneity was small (quality of life) to moderate (anxiety, depression). There was a large effect on generic outcome measures and a moderate effect on comorbidities. When compared to disorder-specific treatments there were no differences on anxiety and quality of life outcomes, however there were differences in depression outcomes. Transdiagnostic and tailored iCBT are effective interventions for anxiety disorders and depression. Future studies should investigate mechanisms of change and develop outcome measures for these interventions.     

社会经济地位与抑郁的关系：系统综述和元分析

社会经济地位与抑郁的关系在既有研究中存在分歧,为明确两者间的整体关联强度及其影响因素,对纳入的56项研究(65个效应值)进行了元分析。结果发现：社会经济地位与抑郁存在显著的负相关(r=-0.15,95%CI [-0.18,-0.12]),但相关程度较低。此外,社会经济地位与抑郁的关系受社会经济地位测量工具、测量类型和测量形式,抑郁测量工具以及取样年代调节,但不受性别、年龄、设计类型以及个体主义文化指数的调节。该结果提示社会经济地位劣势可能是导致民众抑郁的重要风险因素。在贫富差距日益扩大的时代,关心社会底层群众生存和发展困境并建立长久而有效的帮扶机制可从社会面减少抑郁的发病率。     

道德外语效应及其调节变量：来自元分析的证据

同一个道德决策情景使用外语(相比母语)呈现时,个体会表现出更强的功利性倾向,即道德外语效应。随着研究的深入,结论并不一致。本研究运用元分析方法首次探讨了语言类型(母语vs.外语)对道德判断中功利性倾向的影响,并分析了相关的调节变量。通过文献检索及梳理,共有19篇文献46个独立样本97个效应量符合元分析标准(N=9672)。结果显示存在较小但稳定的道德外语效应(g=0.23);调节效应分析表明,道德外语效应受故事类型的影响,在个人道德两难故事中存在较小但稳定的外语效应(g=0.32),但在非个人道德两难故事(g=0.11)与日常道德评价故事中(g=0.12)不存在外语效应;非个人道德两难故事中的外语效应受记分方式的影响,多点记分在该故事类型下存在效应(g=0.27),二点记分不存在效应(g=0.05);性别和语系类型没有显著的调节效应。这些结果表明语言类型对个体面对道德困境时的选择倾向有一定程度的影响,道德故事类型和记分方式在未来的研究中需要加以考虑。     

Transdiagnostic group CBT for anxiety disorders: the unified protocol in mental health services

Comorbidity among the anxiety disorders is common and may negatively impact treatment outcome. Potentially, transdiagnostic cognitive-behavioral treatments (CBT) deal more effectively with comorbidity than standard CBT. The present study tested the effectiveness of The Unified Protocol (UP) applied to Mental Health Services. Pre-post-treatment effects were examined for psychiatric outpatients with anxiety disorders receiving UP treatment in groups. Forty-seven patients (mean-age = 34.1 (SD = 9.92), 77% females) with a principal diagnosis of anxiety were included. We found significant and clinically meaningful changes in the primary outcomes Clinical Global Impression Severity Scale (CGI-S; d = 1.36), Hamilton Anxiety Scale (HARS; d = .71), and WHO-5 Well-being Index (WHO-5; d = .54). Also, comorbid depressive symptoms and levels of positive and negative affect changed significantly after treatment. Patients with high levels of comorbidity profited as much as patients with less comorbidity; however, these patients had higher scores after treatment due to higher symptom burden at onset. Patients with comorbid depression profited more from treatment than patients without comorbid depression. The treatment effects found in the present study correspond to treatment effects of other TCBT studies, other UP group studies, and effectiveness studies on standard CBT for outpatients. The results indicate that the UP can be successfully applied to a MHS group setting, demonstrating positive effects on anxiety and depressive symptoms for even highly comorbid cases.