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Experts Urge Huge Expansion of Online Therapy For Mental Illness

A “massive and growing” mental health burden across the world can only be tackled successfully with a major expansion of online psychiatric resources such as virtual clinics and web-based psychotherapies, specialists said on Tuesday.

With resources tight and the global mental health system only serving around 10 percent of patients even now, specialists speaking at the European Congress on Psychiatry (ECP) said the web is the only option for significant extra treatment capacity.

The World Health Organization (WHO) said last week mental disorders – in particular depression – are now the leading cause of ill health and disability worldwide.

Rates of depression have risen by more than 18 percent since 2005, the WHO says, and a lack of support for mental health combined with a common fear of stigma means many do not get the treatment they need. [L2N1H70MW]

Michael Krausz, a professor of psychiatry at the University of British Columbia in Canada, and a leading specialist at the World Psychiatric Association, said “E-mental health” should be a major part of the answer.

“Through a proactive approach we can create an additional virtual system of care which could build capacity, improve the quality of care and make mental health care more effective,” he told the ECP.

Web-based psychological treatments such as online cognitive behavior therapy (CBT) have proven effective in several conditions including depression and anxiety. Krausz said there is also potential for online CBT to be modified for conditions such as post-traumatic stress disorder (PTSD).

“Online assessments, web-based psychotherapies,… and online research strategies will significantly change the field,” he told the congress.

Technologies like virtual reality and artificial intelligence can also be used in certain therapies for anxiety, and various online games and apps are being developed to support treatment of depression in children.

In another example, scientists at King’s College London have developed an avatar-based system to help treat people with schizophrenia who hear distressing voices.

(Reporting by Kate Kelland,; Editing by Stephen Powell)         Mon Apr 3, 2017


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The Number 1 Cause of Ill Health Worldwide

Depression is the leading cause of disability and ill health worldwide.

There are over 300 million living with depression around the world.

This represents an increase of 18% between 2005 and 2015, according to figures put out by the World Health Organisation (WHO).

Almost 50% of people who are depressed do not get any treatment, even in high-income countries.

Two important reasons are:

  • Lack of support for people with mental health problems,
  • and stigma.

The WHO is currently running a year-long campaign called “Depression: let’s talk”.

Dr Shekhar Saxena, Director of the Department of Mental Health and Substance Abuse at WHO, said:

“The continuing stigma associated with mental illness was the reason why we decided to name our campaign ‘Depression: let’s talk’.
For someone living with depression, talking to a person they trust is often the first step towards treatment and recovery.”

Depression usually includes the following, lasting for two weeks or more:

  • loss of interest in activities that used to be enjoyed,
  • persistent sadness,
  • and problems with everyday activities.

Dr Saxena said:

“A better understanding of depression and how it can be treated, while essential, is just the beginning.
What needs to follow is sustained scale-up of mental health services accessible to everyone, even the most remote populations in the world.”

 

source: PsyBlog


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This Simple Realisation Linked To 80% Depression Recovery

Six months later, 80% had recovered from depression, researchers found.

Rumination — thinking about the causes and consequences of depressing events — is common in depression.

However, simply realising that you don’t have to ruminate can be liberating, new research suggests.

When people learned to reduce how much they ruminated, 80% had recovered after six months (including 10 weeks of therapy).

Professor Roger Hagen, who led the research, said:

“Anxiety and depression give rise to difficult and painful negative thoughts.
Many patients have thoughts of mistakes, past failures or other negative thoughts.
Metacognitive therapy addresses thinking processes.”
One of the problems in depression is that people…
“…think too much, which MCT [metacognitive therapy] refers to as ‘depressive rumination’.

Rather than ruminating so much on negative thoughts, MCT helps patients to reduce negative thought processes and get them under control.”

Taking control of your thoughts is an important part of modern cognitive therapies.

Professor Hagen said:

“Instead of reacting by repeatedly ruminating and thinking ‘how do I feel now?’ you can try to encounter your thoughts with what we call ‘detached mindfulness.’

You can see your thoughts as just thoughts, and not as a reflection of reality.
Most people think that when they think a thought, it must be true.
For example, if I think that I’m stupid, this means I must be stupid.
People strongly believe that their thoughts reflect reality.”

Many patients who took part in the study were pleasantly surprised, said Professor Hagen:

“The patients come in thinking they’re going to talk about all the problems they have and get to the bottom of it, but instead we try to find out how their mind and thinking processes work.
You can’t control what you think, but you can control how you respond to what you think.”

The study was published in the journal Frontiers in Psychology (Hagen et al., 2017).

 

MARCH 19, 2017
source: PsyBlog


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Beating Depression May Be All About Learning to Ignore Negative Thoughts

A promising type of therapy focuses on quitting the worry cycle.

People who struggle with anxiety or depression often ruminate on negative thoughts, like past missteps or feelings that they’re not good enough. The secret to better mental health may be learning how not to dwell on these thoughts, according to new research by a group of British and Norwegian researchers.

Their study focuses on a technique called metacognitive therapy, or MCT, which was developed in Europe in the 1990s. MCT trains people to lessen the ruminative process, says study co-author Stian Solem, PhD, associate professor of psychology at the Norwegian University of Science and Technology.

In the United States and Europe, the current recommended treatments for depression and anxiety are medications and cognitive behavioral therapy, or CBT. Sometimes called talk therapy, CBT encourages people to analyze their negative thoughts and challenge whether they’re really true.

That’s what makes MCT different: Instead of drilling deeper into those thoughts, MCT helps people reduce negative thought processes and take control over them, says Solem.

Solem and his colleagues tested the MCT method in 20 patients with depression, who attended 10 therapy sessions over a 10-week period. The study also involved a control group of 19 people who were wait-listed for MCT, and receive no treatment for the first 10 weeks.

After those 10 weeks, about 80% of patients in the MCT group reported a full recovery from depression symptoms, based on a standard screening questionnaire. Anxiety symptoms also improved overall, and no patients reported worsening of their condition. In comparison, only about 5% of patients in the control group had a similar recovery.

Six months after completing MCT, recovery rates were similar, with only a few patients reporting relapses. Studies on CBT have shown that only 40% to 48% of patients are recovered after treatment, the authors write, and between 40% and 60% relapse within two years.

For a lot of people, the authors say, realizing that they don’t have to worry and ruminate about things can be quite liberating. They say MCT patients are often pleasantly surprised that they didn’t have to rehash all of their problems in their therapy sessions.

Smaller studies at the University of Manchester, where MCT was developed, have also shown that this method can be effective at treating depression—but this is the first published study to involve a control group. This helps support the theory that improvements are really from the therapy, and not just symptoms getting better on their own over time.

The researchers say a soon-to-be-published Danish study also found similar results. They hope that, with these findings, MCT becomes more popular in Norway and around the world.

MCT has not yet caught on in the United States, says Solem, and no U.S. practitioners are included in the MCT Institute’s online database of registered therapists. (The MCT Institute is in the process of developing self-help materials, its website states, but these aren’t yet available.) However, Solem says that the principles of MCT can be helpful for most people, even without formal training.

“Many of our patients have conflicted beliefs concerning worry and rumination,” Solem told Health in an email. “They experience that it is uncontrollable, exhausting, and dangerous—‘I can go mad,’ ‘I can make myself sick.’” At the same time, they think they need to ruminate in order to find answers and prevent danger.

“In MCT we often start out with postponing worry and rumination (which most people are able to do) and later we use something called detached mindfulness,” he says. “It involves being aware of the trigger thought, but choosing not to engage in it.”

 By Amanda MacMillan       March 15, 2017


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Depression Top Cause of Disability, WHO Says

Youth, pregnant or post-partum women, and the elderly are three groups particularly vulnerable

More than 4 per cent of the world’s population lives with depression, and women, youth and the elderly are the most prone to its disabling effects, the World Health Organization (WHO) said on Thursday.

An estimated 322 million people suffered depressive disorders in 2015, a rise of 18.4 per cent in a decade, as people live longer, the United Nations agency said in a report.

Global economic losses exceed $1 trillion US a year, it said, referring to lost productivity due to apathy or lack of energy that lead to an inability to function at work or cope with daily life.

“Depression is the single largest contributor to years lived with disability. So it’s the top cause of disability in the world today,” Dr. Dan Chisholm of WHO’s Department of Mental Health and Substance Abuse told a news briefing.

Depression is 1.5 times more common among women than men, he said. A further 250 million people suffer anxiety disorders, including phobias, panic attacks, obsessive-compulsive behaviour and post-traumatic stress disorder, the report said. Some 80 per cent of those stricken with mental illness live in low- and middle-income countries.

“That puts paid to the notion of these disorders being diseases of the rich or the affluent, that is not the case. In fact in many countries people who are affected by poverty, unemployment, civil strife and conflict are actually at higher risk of certainly anxiety disorders and also depression,” Chisholm said.

depression
Depression is 1.5 times more common among women than men,
according to the World Health Organization.

Three age groups are particularly vulnerable to depression — youth, pregnant or post-partum women, and the elderly.

“The pressures on today’s youth are like no other generation perhaps,” Chisholm said. “Another target group is women who are pregnant or have just given birth. Depression around that period is actually extremely common, around 15 per cent of women will suffer not just ‘the blues’, but a diagnosable case of depression.”

Retirees are also susceptible. “When we stop working or we lose our partner we become more frail, more subject to physical diseases and disorders like depression do become more common.”

An estimated 800,000 people die by suicide each year, a “pretty horrifying figure”, Chisholm said.

“It is more common in males in higher income countries but more common in females in lower- and middle-income countries.”

The WHO is running a campaign to tackle stigma and misconceptions called “Depression: Let’s Talk.”

“We feel that is a key first step, that if we want to bring mental health, depression and other mental disorders out of the shadows, we need to be able to talk about it,” Chisholm said.

Where to get help

Kids Help Phone – 1-800-668-6868 (Phone), Live Chat (online chat counselling) – visit http://www.kidshelpphone.ca

Canadian Association for Suicide Prevention: Find a 24-hour crisis centre

If you’re worried someone you know may be at risk of suicide, you should talk to them, says the Canadian Association of Suicide Prevention. Here are some warning signs:

  • Suicidal thoughts.
  • Substance abuse.
  • Purposelessness.
  • Anxiety.
  • Feeling trapped.
  • Hopelessness and helplessness.
  • Withdrawal.
  • Anger.
  • Recklessness.
  • Mood changes.

 

related:
 
Feb 23, 2017    source:  Thompson Reuters   www.cbc.ca


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Self-Guided Cognitive Behavioral Therapy May Help Depression

Online programs offering cognitive behavioral therapy (CBT) without the therapist can reduce depression symptoms for some, according to a new review of existing research on the topic.

Automated CBT programs, or iCBT, which work to change a patient’s non-productive thoughts, attitudes and beliefs, are designed to make it easier for people to get therapy at low cost and with less fear of stigmatization.

But recent large trials have produced conflicting answers about whether such self-guided internet-based therapy is effective.

In the new analysis, researchers attempted to resolve the issue by examining data from 13 studies comparing iCBT to alternative treatments or to a placebo and involving a total of 3,832 patients.

Compared to the 1,603 depressed patients in control groups – who received other treatments, care from a general practitioner, attention placebo or were put on a waiting list – people who used the iCBT websites were significantly more likely to show improvement.

And when it was effective, online cognitive therapy was just as likely to work regardless of the patient’s degree of depression.

“People with severe depression at the beginning of the treatment had a similar response to treatment as people with mild or moderate depression,” chief author Eirini Karyotaki of the EMGO Institute for Health and Care Research in Amsterdam told Reuters Health by email.

Not surprisingly, patients who adhered best to the iCBT treatment and completed the online sessions did better than those who did not.

depression

 

When the researchers looked at the sociodemographic and clinical characteristics of the volunteers, they were unable to uncover any factors that increased the likelihood of a successful outcome, according to the report in JAMA Psychiatry.

Based on the success rates, Karyotaki and her team calculate that the intervention would need to be given to eight patients in order to achieve 50 percent symptom reduction in one patient.

“This can be clinically relevant if you consider that in low- and middle- income countries there is no infrastructure for mental health. When self-guided iCBT is disseminated worldwide, the overall impact can be high, because of the large numbers of people that can be reached with it,” Karyotaki said.

Five of the studies evaluated in the meta-analysis used the publicly-available iCBT program at deprexis.com.

Patients from Australia, Germany, the Netherlands, Spain, Switzerland and the United Kingdom made up the patient pool. The programs they used required between five and 11 sessions. “Each online session lasts approximately one hour and most of the times patients are advised to follow one session per week,” Karyotaki said.

The researchers caution that they were unable to assess whether how long a person had been depressed influenced the effectiveness of the iCBT treatment. “Duration of symptoms is important because individuals with chronic depressive symptoms may not always respond rapidly to treatment,” they write.

And before the practice is widely adopted as routine care, limitations of the therapy, such as high dropout rates and the small effects compared to in-person or guided internet therapy need to be addressed, they write.

By Gene Emery        Wed Feb 22, 2017        Reuters Health
 
SOURCE: bit.ly/2l84tQN JAMA Psychiatry, online February 22, 2017.         www.reuters.com


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How To Beat Major Depression With The Right Diet

World-first study reveals how diet can treat major depression.

Improving dietary quality successfully treats major depression, a large new study finds.

The three-month study recruited people with major depressive disorder.

One group were given support from a clinical dietitian.

A control group were given access to social support, which is also beneficial for depression.

Those in the dietary group saw great improvements in depressive symptoms.

At the end of the study one-third of people who had changed their diet were in remission from depression.

This compared to only 8% in the social support group.

Professor Felice Jacka, the study’s first author, said:

“We’ve known for some time that there is a clear association between the quality of people’s diets and their risk for depression.
This is the case across countries, cultures and age groups, with healthy diets associated with reduced risk, and unhealthy diets associated with increased risk for depression.
However, this is the first randomised controlled trial to directly test whether improving diet quality can actually treat clinical depression.”

diet

The dietitian encouraged people to eat more of the following food types:

  • vegetables,
  • fruits,
  • whole grains,
  • legumes,
  • fish,
  • lean red meats,
  • olive oil,
  • and nuts.

At the same time people were discouraged from eating:

  • sweets,
  • refined cereals,
  • fried food,
  • fast-food,
  • processed meats,
  • and sugary drinks.

Professor Jacka continued:

“These results were not explained by changes in physical activity or body weight, but were closely related to the extent of dietary change.
Those who adhered more closely to the dietary program experienced the greatest benefit to their depression symptoms.”

The study suggests that dietitians should be made available to those being treated for depression.

Professor Jacka said:

“Mental disorders account for the leading cause of disability worldwide, with depression accounting for the large proportion of that burden.
While approximately half of sufferers are helped by currently available medical and psychological therapies, new treatment options for depression are urgently needed.
Importantly, depression also increases the risk of and, in turn, is also increased by common physical illnesses such as obesity, type 2 diabetes and heart disease.
Successfully improving the quality of patients’ diets would also benefit these illnesses.”

The study was published in the journal BMC Medicine (Jacka et al., 2017).

FEBRUARY 15, 2017                source: PsyBlog