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Treating Insomnia First Can Help With Mental Health Problems

New research has found that treating insomnia with online cognitive behavioral therapy could in turn help treat mental health problems such as anxiety, depression, and paranoia.

Carried out by researchers at the Sleep and Circadian Neuroscience Institute, University of Oxford, the team set out to try to improve sleep in a group of university students with insomnia to look at sleep’s effect on paranoia (excessive mistrust), anxiety, and depression.

The study, which involved 3,755 participants, is thought to be the largest ever randomized controlled trial of a psychological treatment for mental health and the first study large enough to determine the effects of treating insomnia on psychotic experiences.

Participants were randomly split into two groups, with one group receiving online cognitive behavior therapy (CBT) for insomnia while the other group received access to standard treatments.

The six sessions of cognitive-behavioral therapy included behavioral, cognitive and educational components, such as learning to associate bed with sleep, encouraging people to put time aside to reflect on their day before going to bed, and facilitating a pro-sleep environment.

The interactive program also used information from the participants’ daily sleep diaries to tailor the advice.

Participants’ mental health was also monitored through a series of online questionnaires at 0, 3, 10 and 22 weeks from the start of the treatment.

After analyzing the results the team found that participants who received the CBT sleep treatment showed large reductions in insomnia, as well as small, sustained reductions in paranoia and hallucinatory experiences.

CBT treatment also helped improve other mental health problems including depression, anxiety, nightmares, and psychological well-being, as well as daytime work and home functioning.

“Sleep problems are very common in people with mental health disorders, but for too long insomnia has been trivialized as merely a symptom, rather than a cause, of psychological difficulties. This study turns that old idea on its head, showing that insomnia may actually be a contributory cause of mental health problems,” commented the study’s lead author Daniel Freeman.

“A good night’s sleep really can make a difference to people’s psychological health. Helping people get better sleep could be an important first step in tackling many psychological and emotional problems,” he concluded.

The results can be found published online in The Lancet Psychiatry.

Relaxnews   Friday, September 8, 2017
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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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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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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.

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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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For Anxiety Disorders, CBT May Restore Brain’s Structural Balance

New research finds that cognitive behavioral therapy (CBT) actually changes key brain structures that are involved in processing and regulating emotions.

The finding helps to explain the success of CBT for anxiety disorders. Remediation of social anxiety is an important accomplishment as anxiety in social situations is not a rare problem.

Experts say that around one in 10 people are affected by social anxiety disorder during their lifetime. Social anxiety disorder is diagnosed if fears and anxiety in social situations significantly impair everyday life and cause intense suffering. A relatively common anxiety provoking experience is talking in front of a larger group — a situation that can provoke fear and extreme stress.

In the new study, researchers from the University of Zurich, Zurich University Hospital and the University Hospital of Psychiatry Zurich discovered that the successful treatment of an anxiety disorder alters key brain structures linked to emotions.

In patients suffering from social anxiety disorder, regulation of excessive anxiety by frontal and lateral brain areas is impaired. Strategies aimed at regulating emotions should restore the balance between cortical and subcortical brain areas.

key-brain-structures-involved-in-processing-and-regulating-emotions

These strategies are practiced in CBT, a central therapy for social anxiety disorder. In cognitive behavioral group therapy, patients learn and apply new strategies aimed at dealing with social anxiety disorder.

Based on specific examples, the group discusses explanatory models and identifies starting points for changes. Through self-observation, role plays, or video recordings, alternative viewpoints can be developed.

related: ‘Positive Activity’ as Effective as ‘Positive Thinking’ in Treating Depression

In the study, published online in the journal Molecular Psychiatry, researchers investigated structural brain changes in patients suffering from social anxiety disorder after a specific 10-week course of CBT. Using magnetic resonance imaging, the participants’ brains were examined before and after CBT.

“We were able to show that structural changes occur in brain areas linked to self-control and emotion regulation,” said Dr. Annette Brühl, head physician at the Center for Depression, Anxiety Disorders and Psychotherapy at the University Hospital of Psychiatry Zurich (PUK).

The more successful the treatment, the stronger the brain changes. The research group was also able to demonstrate that brain areas involved in processing emotions were more interconnected after the treatment.

“Psychotherapy normalizes brain changes associated with social anxiety disorder,” Brühl said.

By Rick Nauert PhD