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What you need to know before choosing online therapy

Become an informed consumer of telepsychology services—learn factors to take into account when considering online therapy and explore additional resources.

With the click of a mouse or the tap of an app, you can have instant and inexpensive access to a therapist, or so make the claims of many new tools and technologies that want to take psychotherapy out of the therapist’s office and into whatever location you are connected to the Internet. Using the Web can be convenient for the many people who are comfortable using the Internet and looking for help.

But before you sign up, log in, and start chatting, there are points to consider about telepsychology.

Psychologists commonly refer to any therapy delivered by telecommunication tools or devices as telepsychology. You may hear it called Web therapy, phone therapy, text therapy or online therapy. Anytime you’re interacting with a psychologist using a website, a phone or a mobile app, you could be taking part in telepsychology services.

Technology can contribute to an evolution in how people receive psychotherapy or work with a psychologist. Researchers are taking great interest in telepsychology and telehealth, evaluating how well it works, especially compared to in-person, in-office psychotherapy sessions. But much like the technology, the research is still new, and there is a lot science doesn’t yet know.

There are a few points to consider before signing up for any services that are offered exclusively online or by telephone.

Why people like Web therapy
Web therapy has a lot of promise and offers benefits compared to in-person psychotherapy.

It can be convenient. Online therapy can take less time away from the office or your workday or worry about traffic. No need to travel miles to meet up with your psychologist. Dial a number or log in to a site, and the session can happen wherever you are comfortable.Compared to traditional in-person therapy, it can sometimes appear less expensive. Some apps will advertise pricing that provides unlimited use for a weekly or monthly fee. Or the online session may seem significantly lower than in-office visits. If you’re not interested in using health insurance for psychotherapy, this can be a benefit. More about insurance and online therapy is discussed in the next section.Online communication is very comfortable for many people, especially younger adults or those who use technology often. More people are using email, webinars and text messaging to communicate, and it can seem more comfortable or easier than talking to someone in person, especially when revealing personal or private information.It can provide access to those who can’t get to an office. In some rural communities, the nearest psychologist office may be an hour or two drive away. Some people with chronic illnesses or disabilities may not be able to drive or easily able to leave their home. In these situations, Web- or telephone-based therapy may be their only option for help.
What you need to think carefully about regarding Web-based therapy
Despite the potential benefits, psychologists caution that Web-therapy may not be the best option for everyone or every situation in need of professional support. Here are a few points to consider or ask before signing up:

Is this the right tool to help me? The research hasn’t yet shown that stand-alone therapy online or via texting is effective for everyone in every situation. Some sites advertise that they offer therapy, but those claims may be misleading or false. For example, the people behind the apps may not be licensed or qualified to provide therapy.Is the therapist licensed? Licensing protects you. Therapist and psychotherapist are not legally protected words in most states, meaning anyone can claim to be a therapist and offer services that may appear as therapy. It may not always be easy to know that you are receiving evidenced-based psychotherapy.

All psychologists and other professional health providers must be licensed by the state in which they practice. Licensure laws protect you by ensuring only those who are trained and qualified to practice receive a license. It also ensures that you have recourse if there are problems with your treatment. Before you sign up for any Web services, find out who you are working with, if he or she has a license, where that license is held and the license number. Most states offer an online, searchable directory of professionals licensed in their state.Is the psychologist licensed in the state you live? Licenses are granted by each state with their own laws and rules, much like each state determines what residents must know to earn a driver’s license. But unlike driver’s licenses, which allow you to legally operate a car in all states, a health care provider is limited to providing services in the state in which they are licensed. The provider must be licensed in the jurisdiction where you are located, and making that determination may be difficult to do if you don’t know where he or she is physically located.Is the site or app secure? Will the information I provide remain confidential? Psychotherapy works in part because psychologists ensure that clients have a safe, private space to share deeply personal and sometimes difficult stories, thoughts or emotions. What happens and is said in a therapy office stays there, with the exception of a few situations. The site or app you use should, at a minimum, be HIPAA-compliant and have the ability to verify your identity and your therapist’s identity.How will you pay for the service? Many insurance companies cover the treatment of mental health and substance abuse disorders—treatment that includes in-person psychotherapy. If you work with a psychologist in her office, your insurance could cover most or all of the fee, depending on whether you need to meet a deductible or have a co-pay. Psychologists will often provide an invoice that you can submit to your insurance company for reimbursement. But online therapy or web therapy services are often not covered or reimbursable by most insurance providers. If you plan to be reimbursed, check with your insurance company first. Otherwise, prepare to pay for the full cost yourself.
More psychologists are exploring online sites and apps just as more patients are interested in using them. Research does show that some technological tools can help when used in conjunction with in-office therapy.

Many psychologists and patients are finding text messages helpful for quick check-ins or reminders. Some apps can help track and log moods or thoughts. Web-conferencing and streaming in real time can offer continuity when a patient is on vacation or not able to make a regular session.

There are cases in which Web-conferencing or therapy via telephone does seem to be a viable option on its own for some people. But for now, with the current research and with the current technology, mobile apps and text messaging are best used as complementary to in-person psychotherapy.

reference: APA
Link:https://www.apa.org/topics/telehealth/online-therapy
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Traumas in children and adolescents can be treated effectively

Psychotherapeutic treatment based on trauma-focused therapy is highly effective for children and adolescents who have experienced repeated traumatic events such as sexual, physical or emotional abuse.

Around 25 percent of children and adolescents exposed to traumatic events develop post-traumatic stress disorder (PTSD). Repeated physical, sexual and emotional traumatization in childhood in particular carries a high risk of PTSD. The cases of sexual abuse in the Catholic church and the Russian war against Ukraine are two current examples that illustrate the scope of mass trauma events.

"PTDS is a serious, usually chronic, illness which creates severe functional impairment in everyday life of those affected," says Thole Hoppen who is the lead author of the study in collaboration with psychologists at the University of East Anglia (UK) and the University of Oslo (Norway).

There had previously been strong reservations in clinical practice as regards using trauma-focused psychotherapy to treat children and adolescents suffering PTSD from multiple traumas. This form of therapy aims at changing patients' patterns of thought and behavior that have arisen as a result of the trauma. The aim is to enable patients to confront the trauma they have experienced, under the supervision of a therapist, and thereby process the memories and their consequences.

"The widespread argument is that this therapy demands too much of patients, and that it is not very promising, inappropriate, or even dangerous," Hoppen comments. "Our analysis has enabled us to prove the opposite."

In a so-called meta-analysis, the researchers evaluated the results of all randomized controlled psychotherapy trials published so far relating to PTSD in children and adolescents. For the first time in a meta-analysis, the authors distinguished between individual and multiple trauma exposures in children and adolescents.

"Psychotherapy is highly effective for children and adolescents with PTSD—and not only after a single traumatisation," says Hoppen. "The evidence base shows that this is also the case for multiple traumas."

The results of the study are important not only for outpatient psychotherapy but also for inpatient treatment in psychiatric wards, as well as for the training of psychotherapists. The results provide hope and guidance for people affected, for their families and for those treating them.

link: https://medicalxpress.com/news/2023-03-traumas-children-adolescents-effectively.html
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The effect of psychotherapy on functional medical disorders

You may need medication, physical therapy, surgery, and so on. Psychotherapy can be a vital part of holistic treatment for all patients with medical conditions.

Functional somatic disorders are common and costly, thereby driving the need for the development of effective brief treatment options. many studies showed that  psychotherapy is a valid treatment option for diverse functional somatic disorders conditions resulting in somatic symptom reductions that persist over time. So psychotherapy should be included in functional somatic disorders treatment guidelines.
"The need for innovations in mental health to improve access and quality of care is urgent," said lead author Dr. Paul Kurdyak, Director of Health Outcomes and Performance Evaluation in the Institute for Mental Health Policy Research at CAMH and lead of the Mental Health and Addictions Research Program at ICES. "But increasing the number of specialists who provide psychotherapy alone will not solve the existing problem of poor access to psychotherapy in a publicly-funded system."
Psychotherapy is an evidence-based treatment for conditions like depression and anxiety, two of the most common psychiatric disorders. Treatment guidelines suggest that structured, evidence-based therapies like Cognitive Behavioural Therapy (CBT) should be a front-line treatment option for patients with mild to moderate depression or anxiety.
"Evidence-based psychotherapy should be available to all patients suffering from the most prevalent mental disorders," said Dr. Kurdyak.
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Geriatric Psychotherapy: A Growing Need

Therapists need to start focusing on elder mental health

Thanks to active lifestyles, healthier diets, exercise, and advances in medicine and healthcare, Americans are living longer. That trend, coupled with historically low birth rates, is transforming the United States into an older population. In fact, by 2030, it’s expected that every baby boomer will be at least 65 years old and that seniors will account for one out of every five US citizens.  
This growing population presents a great opportunity for those who practice geriatric psychotherapy to help an increasing number of seniors live their golden years to the fullest. Keep reading to learn more about the issues that affect the older generations, why therapists need to start focusing on elder mental health, and how geriatric psychotherapy can help your practice get to the next level. 
ELDER MENTAL HEALTH: WHAT ISSUES AFFECT OLDER FOLKS THE MOST? 
Just because they’ve been on the planet longer than most people doesn’t mean seniors have it all figured out. In fact, it’s not uncommon for mental health issues to manifest as individuals get older as they leave their jobs, their kids move away, and they find themselves with more time on their hands than they’re used to. With that in mind, let’s take a look at some of the common mental health issues that older folks struggle with. 
Insomnia 
Due to a confluence of factors — a lack of exercise, an uptick in medications, and a less-than-optimal diet, for example — many seniors have problems getting a good night’s sleep. In fact, research suggests that nearly half of the elder population experience insomnia at one point or another. Unfortunately, sleep issues can translate into a host of other problems — like irritability, exhaustion, and drug addiction. 
Drug addiction 
When you think of people addicted to drugs, the older population might not be the first group that pops into mind. Believe it or not, research suggests that 5.7 million seniors are suffering from drug addiction today. Moreover, 6 million seniors consume alcohol, 132,000 use marijuana, and 4,300 use cocaine on an average day. On top of this, there’s been an increase in opioid use among this age group in recent years. Add it all up, and drug addiction among seniors is a growing crisis. 
Depression 
As people age, it’s not uncommon for them to have more time to think about their lives and their place in this world. Someone might begin to dwell on a mistake they made two decades ago and ruminate on it obsessively because they have more time on their hands than they’re used to, for example. Another individual might wish they pursued a different career. Either situation is an example of someone worrying about something they have no control over. 
While some seniors have a natural propensity toward depression, others began developing the issue in the wake of the COVID-19 pandemic. The abrupt transformation of our lives — coupled with fear over the virus itself and profound social isolation — was particularly difficult for certain seniors to process, causing them to become depressed. 
Bereavement  
When you live long enough, you see a lot of people you care about die. Whether it’s an old colleague, a childhood friend, a family member, a spouse, or even a child, losing a loved one can be an incredibly difficult period for everyone, including our elders. Depending on how the individual experiences it, bereavement can ultimately turn into profound, almost crippling grief. 
Bereavement can also cause a slew of other thoughts and behaviors, including guilt, anger, and regret. For this reason, many seniors seek out professional help to process these feelings of loss and overcome bereavement-induced pain and sadness. 
Struggling with growing older 
As people age, many of them begin having problems with the process of aging itself. On one hand, an individual might develop mental health issues because they’re forced to deal with chronic pain and deteriorating health. On the other, someone might have self-esteem issues as they see themselves getting older and losing their place and influence in the world. Many of these folks choose to talk to therapists to improve their outlook and live happier lives. 
While this list is by no means exhaustive, it should give you a better idea of the variety of different mental health issues that impact seniors. 
WHY THERAPISTS NEED TO BE PREPARED TO CARE FOR ELDERS 
If you’re a therapist who hasn’t considered geriatric psychotherapy before, here are some reasons why you might want to rethink that and give it a try: 
•	The population isn’t getting any younger. With declining birth rates and an aging population, more and more Americans are skewing older. By preparing to treat this group of seniors, therapists can do their part to promote the health of older adults — much to the benefit of family, friends, communities, and the seniors themselves.
 
•	The stigma around mental health is disappearing. While Americans have traditionally kept quiet about the importance of talking to therapists to work through mental health issues, that’s all changing. As the stigma around mental health continues to dissipate, it follows that more and more seniors will be willing to give geriatric psychotherapy a try if for no other reason than it’s socially acceptable.
 
•	There aren’t many therapists specializing in this area. There’s a reason that as many as 90 percent of seniors don’t get the treatment they need to live their best lives: There is a dearth of therapists that treat older folks. To some extent, this is due to the misconception that you can’t teach the proverbial dog new tricks. This ageist outlook is simply untrue.  
Now that you have a better idea of some of the reasons why you should start sharpening your geriatric psychotherapy skills, let’s turn our attention to the business part of the equation: how treating older patients impacts your practice. 
HOW GERIATRIC PSYCHOTHERAPY CAN BENEFIT YOUR PRACTICE 
At a very basic level, offering geriatric psychotherapy services can benefit your practice by enabling you to target an entirely new slate of clients — and grow your bottom line because of it. After all, this is a traditionally underserved population. If there aren’t many therapists in your area who treat seniors, you may be able to become the only show in town — which could be particularly lucrative. 
On top of this, seniors can also help you grow your practice via word-of-mouth referrals. If an elderly client really enjoys your services, you can bet that they’ll tell their friends and loved ones about you. At the same time, you might even be able to get some of their friends or family members as clients, too, as you all work together to navigate the complex issues that come with aging — and how they impact the entire family.  
Depending on how your experience goes, you might even find out that geriatric psychotherapy is your true calling. This could make your work more engaging while helping you reach your full potential as a therapist. 
If you’re a GoodTherapy member who sees geriatric clients or is planning to give it a shot after reading these words, be sure that you have “Elders” selected as one of the ages you treat in your profile. That way, older folks will be able to find you more easily when they begin their search for a therapist. 


Link:
https://www.goodtherapy.org/blog/Geriatric-Psychotherapy-Growing-Need
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Why kindness and connection are important to mental health

How can a psychotherapist help someone looking for connection?

One of the main reasons we’re all unfortunately hardwired to struggle as human beings is that two of our central needs often disconnect us from ourselves and others: our safety needs and our reward needs. Safety needs view everything and everyone with a problem-focus while reward needs can cause disconnecting comparisons, competitiveness and feelings of dissatisfaction and frustration. In fact, much of what people bring to therapy – including anxiety, depression, chronic anger, narcissism, addiction, procrastination and stress – can all be seen as both causing and caused by this disconnection. 

When we feel connected, on the other hand, we feel safe, rewarded, alive and fulfilled. Life has meaning and purpose. Whether it’s to ourselves, trusted others, pets, groups, communities, nature or the environment around us, establishing and maintaining connection - which includes the quality of kindness both as its cause and its result - is fundamental to maintaining good mental and physical health. 

 

How can a psychotherapist help someone looking for connection?
To add to our biological tendency to do so, many of us also often disconnect easily due to our childhood experiences in relationships. These can include adverse incidents that happened to us, as well as a lack of genuine love and connection during that time. Because it was relationships that led to these difficulties, if we’re going to be able to connect more later on, we have to experience the quality of relationship we initially needed. 

Good therapy holds the very real potential for such a reparative relationship. The experience of being truly heard and listened to, of trusting someone enough to be vulnerable and say the previously unsayable will help with connection in all areas of life.   

Connection often requires conscious and consistent effort before it becomes the norm and each of its facets can be looked at in therapy. We can focus on how to improve connection with ourselves - including our thoughts, values, beliefs, self-image, body, feelings and behaviours - and with others by exploring areas like boundaries, communication and how we express love and resolve conflict. Looking at the client/therapist relationship itself in real-time can also be valuable here. 

If you’re interested in exploring therapy, then visit our website for helpful advice for those looking for an accredited and registered therapist.

 

Don’t hold on to the wrong connections 
It’s important to remember that nurturing connection and kindness doesn’t mean having to remain connected with others to our detriment. For good reason, our safety needs will be sceptical about striving for connection and kindness with everyone at all times. We all know there are people who are better left untrusted. In fact, disconnecting from another might be the kindest thing we do for ourselves and therapy can be a great place to explore this too. 

Link: https://www.psychotherapy.org.uk/news/why-kindness-and-connection-are-important-to-mental-health/
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Timely treatment of depression could reduce the risk of dementia

the course of ineffectively treated depression carries significant medical risk.

Depression has long been associated with an increased risk of dementia, and now a new study provides evidence that timely treatment of depression could lower the risk of dementia in specific groups of patients.

Over 55 million people worldwide live with dementia, a disabling neurocognitive condition that mainly affects older adults. No effective treatment for dementia exists but identifying ways to help minimize or prevent dementia would help to lessen the burden of the disease.

The study, led by Jin-Tai Yu, MD, PhD, Huashan Hospital, Shanghai Medical College, Fudan University, and Wei Cheng, PhD, Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China, appears in Biological Psychiatry, published by Elsevier.

Professor Yu and Professor Cheng used data collected by the UK Biobank, a population-based cohort of over 500,000 participants. The current study included more than 350,000 participants, including 46,280 participants with depression. During the course of the study, 725 of the depressed patients developed dementia.

Previous studies examining whether depression therapies such as pharmacotherapy and psychotherapy could lower the risk for dementia produced mixed results, leaving the question unresolved. "Older individuals appear to experience different depression patterns over time," said Professor Yu. "Therefore, intra-individual variability in symptoms might confer different risk of dementia as well as heterogeneity in effectiveness of depression treatment in relation to dementia prevention."

To address that heterogeneity, the researchers then categorized participants into one of four courses of depression: increasing course, in which mild initial symptoms steadily increase; decreasing course, starting with moderate- or high-severity symptoms but subsequently decreasing; chronically high course of ongoing severe depressive symptoms; and chronically low course, where mild or moderate depressive symptoms are consistently maintained.

As expected, the study found that depression elevated the risk of dementia – by a striking 51% compared to non-depressed participants. However, the degree of risk depended on the course of depression; those with increasing, chronically high, or chronically low course depression were more vulnerable to dementia, whereas those with decreasing course faced no greater risk than participants without depression.

The researchers most wanted to know whether the increased risk for dementia could be lowered by receiving depression treatment. Overall, depressed participants who received treatment had reduced risk of dementia compared to untreated participants by about 30%. When the researchers separated the participants by depression course, they saw that those with increasing and chronically low courses of depression saw lower risk of dementia with treatment, but those with a chronically high course saw no benefit of treatment in terms of dementia risk.
He notes that, "in this case, symptomatic depression increases dementia risk by 51%, whereas treatment was associated with a significant reduction in this risk."

"This indicates that timely treatment of depression is needed among those with late-life depression," added Professor Cheng. "Providing depression treatment for those with late-life depression might not only remit affective symptoms but also postpone the onset of dementia."

"The new findings shed some light on previous work as well," said Professor Cheng. "The differences of effectiveness across depression courses might explain the discrepancy between previous studies."
Journal reference:
Yang, L., et al. (2022) Depression, Depression Treatments, and Risk of Incident Dementia: A Prospective Cohort Study of 354,313 Participants. Biological Psychiatry. doi.org/10.1016/j.biopsych.2022.08.026.
Link:
https://www.news-medical.net/news/20221017/Timely-treatment-of-depression-could-reduce-the-risk-of-dementia.aspx
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Digital interventions can help relieve depressive symptoms

data from smartphones and wearable devices might be used to identify people with symptoms of depression and anxiety.

With a shortage of therapists, help with mental health problems is being sought from digital interventions, where elements of psychological treatment are offered via computer programs or mobile applications. According to a study, smart devices can help identify people with symptoms of depression and anxiety.

Every year, 400 million people worldwide are affected by depression or anxiety, and the coronavirus pandemic has only increased the prevalence of mental health problems. At the same time, there is a shortage of psychotherapists. Digital interventions, where elements of psychological treatment are offered via computer programs or mobile applications, have been proposed as a solution.

In his doctoral thesis in the field of psychology, researcher Isaac Moshe investigated the effectiveness of digital interventions in treating mental health problems, with depressive symptoms in particular focus.

Tracking depression and anxiety with smart devices
One sub-study in the doctoral thesis examined whether symptoms of depression or anxiety can be identified from data collected by smartphones or wearable devices. A total of 60 adults who used an iPhone or an Oura Ring took part in the sub-study.

Based on the study, smartphone GPS data was predicted the user's depressive symptoms. Subjects who visited the same locations repeatedly had more depressive symptoms than those whose location had more variability. The data collected by smart rings indicated that the longer the person slept or spent time in bed on average, the more depressive symptoms they had. The ring data also revealed that the more frequently people woke up at night, the more symptoms of anxiety they had.
Digital interventions alleviate depressive symptoms
The most extensive sub-study of the doctoral thesis was an international collaboration that assessed the effectiveness of digital interventions in treating depression by conducting a meta-analysis of all previous studies. Digital interventions typically include videos, interactive exercises or text to deliver the core components of psychotherapy, which are then packaged into an online program or smartphone app.

The dataset was composed of 83 randomized controlled trials conducted between 1990 and 2020 involving 15,530 participants.
The findings indicate that digital interventions brought relief from depressive symptoms when they were offered in public or private healthcare settings. Digital interventions alleviated symptoms in people of all ages, regardless of depression severity or physical comorbidity.

Moshe points out that there are important caveats: in children and adolescents, digital interventions were less effective than in adults. Having human support alongside the digital interventions was also critical to people completing the programs and therefore getting the maximum benefits. Furthermore, the researchers felt that it was unclear whether digital interventions were indeed as effective as face-to-face psychotherapy, as so few comparative studies on the topic have so far been conducted.

Moshe believes that, overall, digital interventions could provide a valuable way to help meet the growing global demand for mental healthcare.

"They lower the barrier to accessing treatment, enabling anyone with a computer an internet connection to benefit from psychotherapy at a time and place that is convenient to them. Digital interventions also require much less time from therapists than traditional therapy, making it possible to shorten waiting lists and treat more people."
Source:
Helsingin yliopisto (University of Helsinki)
Link:
https://www.news-medical.net/news/20221220/Digital-interventions-can-help-relieve-depressive-symptoms.aspx
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Performing acts of kindness may help people suffering from depression or anxiety

Social connection is one of the ingredients of life most strongly associated with well-being. Performing acts of kindness seems to be one of the best ways to promote those connections.”

People suffering from symptoms of depression or anxiety may help heal themselves by doing good deeds for others, new research shows.

The study found that performing acts of kindness led to improvements not seen in two other therapeutic techniques used to treat depression or anxiety.

Most importantly, the acts of kindness technique was the only intervention tested that helped people feel more connected to others, said study co-author David Cregg, who led the work as part of his PhD dissertation in psychology at The Ohio State University.
Cregg conducted the research with Jennifer Cheavens, professor of psychology at Ohio State. Their study was published recently in The Journal of Positive Psychology.

The research also revealed why performing acts of kindness worked so well: It helped people take their minds off their own depression and anxiety symptoms.

This finding suggests that one intuition many people have about people with depression may be wrong, Cheavens said.

"We often think that people with depression have enough to deal with, so we don't want to burden them by asking them to help others. But these results run counter to that," she said.

"Doing nice things for people and focusing on the needs of others may actually help people with depression and anxiety feel better about themselves."

The study involved 122 people in central Ohio who had moderate to severe symptoms of depression, anxiety, and stress.

After an introductory session, the participants were split into three groups. Two of the groups were assigned to techniques often used in cognitive behavioral therapy (CBT) for depression: planning social activities or cognitive reappraisal.

The social activities group was instructed to plan social activities for two days a week. Another group was instructed in one of the staples of CBT: cognitive reappraisal. These participants kept records for at least two days each week that helped them identify negative thought patterns and revise their thoughts in a way that could reduce depression and anxiety.
Members of the third group were instructed to perform three acts of kindness a day for two days out of the week. Acts of kindness were defined as "big or small acts that benefit others or make others happy, typically at some cost to you in terms of time or resources."

Some of the acts of kindness that participants later said they did included baking cookies for friends, offering to give a friend a ride, and leaving sticky notes for roommates with words of encouragement.

Participants followed their instructions for five weeks, after which they were evaluated again. The researchers then checked with the participants after another five weeks to see if the interventions were still effective.

The findings showed that participants in all three groups showed an increase in life satisfaction and a reduction of depression and anxiety symptoms after the 10 weeks of the study.

"These results are encouraging because they suggest that all three study interventions are effective at reducing distress and improving satisfaction," Cregg said.

"But acts of kindness still showed an advantage over both social activities and cognitive reappraisal by making people feel more connected to other people, which is an important part of well-being," he said.

In addition, the acts of kindness group showed greater improvements than the cognitive reappraisal group for life satisfaction and symptoms of depression and anxiety, results showed.

Cheavens noted that just participating in social activities did not improve feelings of social connection in this study.

"There's something specific about performing acts of kindness that makes people feel connected to others. It's not enough to just be around other people, participating in social activities," she said.

Cregg said that while this study used techniques of CBT, it is not the same experience as going through CBT. Those who undergo the full treatment may have better results than those in this study.

But the findings also show that even the limited CBT exposure given in this study can be helpful, Cheavens said.

"Not everyone who could benefit from psychotherapy has the opportunity to get that treatment," she said. "But we found that a relatively simple, one-time training had real effects on reducing depression and anxiety symptoms."

And beyond traditional CBT, acts of kindness may have additional benefits in creating social connections, Cregg said.

"Something as simple as helping other people can go above and beyond other treatments in helping heal people with depression and anxiety," he said.

Reference:
Ohio State University

Journal reference:
Cregg, D.R., et al. (2022) Healing through helping: an experimental investigation of kindness, social activities, and reappraisal as well-being interventions. The Journal of Positive Psychology. doi.org/10.1080/17439760.2022.2154695.
Link:
https://www.news-medical.net/news/20230110/Performing-acts-of-kindness-may-help-people-suffering-from-depression-or-anxiety.aspx
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Is Exercise as Effective as Medications or Talk Therapy?

A large meta-review suggests it is.

In the United States, when someone is experiencing a chronic health condition or persistent negative mood states, medications or talk therapy tend to be first to the rescue. Exercise is sometimes relegated to the category of “complementary and alternative medicine” for those who have tried medications and therapy and found them to be “ineffective” based on either provider opinion or a patient’s experience of subjective relief. However, this is not the case everywhere. In countries like Australia, behavioral approaches coined “lifestyle management,” which include exercise, is considered a front-line approach.
A new meta-review by a group of behavioral scientists from the University of South Australia highlighted the equivalence of physical activity to medications and psychotherapy in the treatment of depression, anxiety, various chronic diseases, and maintenance of overall health. The current findings, published in the British Journal of Sports Medicine, showed that physical activity has a medium effect size on depression, anxiety, and chronic disease, which is larger than the typical small effect sizes found in behavioral health research. This association improved with increased intensity of movement compared to treatment as usual. Critically, the effect size for physical activity on depression (median effect size = -0.43) and on anxiety (median effect size = -0.42) was comparable, though slightly greater, than medication or therapy (median effect size ranges = -0.22 to -0.37).
Though there have been dozens of randomized controlled trials or meta-analytic studies exploring the positive health impacts of exercise, they are typically limited due to examining very narrow demographics at a time, which may not generalize well to the larger population. The authors of the newest study attempted to include as many forms of physical activity as possible without focusing on specific subgroups of any one population to see what patterns emerged from data, which included over 128,000 participants across 1,039 clinical trials.
Any adult 18 years or older who participated in a research trial that aimed to increase physical activity was included in the analysis. Physical activity was defined as “any bodily movement produced by the contraction of skeletal muscles that results in a substantial increase in caloric requirements over resting energy expenditure.” The physical activity intervention had to occur across time (versus a single physical activity event, like a one-time marathon). Studies which included confounding variables in their intervention such as dietary changes, medications, or psychotherapy were excluded to be able to highlight the impact of physical activity alone on health outcomes. Participants included in the study ranged from 29 to 86 years old, with a median age of 55 years old.
Results showed depression and depressive symptoms were significantly reduced with a medium effect size as a result of physical activity in over 62,000 participants across 875 randomized controlled trials (RCTs) from 72 meta-analyses. Anxiety symptoms were significantly reduced with a medium effect size as a result of physical activity in over 10,000 participants across 171 RCTs from 28 meta-analyses. Psychological distress significantly reduced with a medium effect size in more than 500 participants across six RCTs from one systematic review. Importantly, effect sizes varied highly by the assessment instrument used, highlighting the importance of measurement-based care, utilizing validated screening tools to assess symptomology in patients and research participants.
Perhaps even more promising than the massive number of participants for whom these impacts of physical activity on mood symptoms held true is the finding that all modes of exercise were effective in reducing depression and anxiety symptoms. Regardless of strength-based movement, mind-body practices like yoga and tai chi, aerobic exercise, or mixed-mode exercises which include both aerobic and resistance training, exercise was shown to be effective in improving negative emotions and health distress. Higher intensity exercises were found to be more effective in ameliorating depression symptoms than lower or moderate-intensity exercises, while both moderate and higher intensity physical activity was found to be effective for reducing anxiety symptoms.
As the overall physical activity treatment was extended beyond 12 weeks, the amount of reduction in mood symptoms paradoxically diminished. This highlights the importance of structuring physical activity interventions for discrete periods of time, consistent with how individuals set effective behavioral goals, compared to giving patients open-ended guidance on physical activity which is not time-bound. Limiting physical activity interventions to a “sweet spot” of roughly three months is also more effective for patients, medical systems, and payers alike, reducing the burden of healthcare costs while maximizing health outcomes.
Weekly physical activity close to or under 150 minutes each week is ideal, compared to exercise beyond 150 minutes weekly which showed diminishing health impacts. Exercising a moderate amount, of 4-5 times per week, was found to be more closely tied to better mood than exercising at higher frequency like daily or at lower frequency like only 1-2 times each week. For anyone wondering what the optimal length of an exercise session may be, the authors found 30-60 minute exercise sessions are most effective. Given the potential benefits of physical activity as an intervention and the minimal negative side effects, it stands to reason that exercise should be considered a front-line approach for mood and chronic health problems when possible. Or at least, exercise should be given equal consideration as medications and psychotherapy for improving health outcomes.

reference:
psychology today

link:
https://www.psychologytoday.com/intl/blog/greater-than-the-sum-of-its-parts/202303/is-exercise-as-effective-as-medications-or-talk
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Lifestyle interventions can help pediatricians meet the growing need for youth depression management

Psychological Intervention for Adolescent’s Depression

With rising prevalence of depression in adolescents, screening requirements are increasingly falling on pediatric primary care providers, who are encountering more at-risk patients. A new literature review in Harvard Review of Psychiatry underscores the evidence that non-traditional, so-called lifestyle interventions can help providers meet the growing need for youth depression management. The journal is published in the Lippincott portfolio by Wolters Kluwer.

The article reviews studies of lifestyle medicine interventions related to physical activity, sleep, nutrition, substance use, social connectedness, and stress management and provides clinical practice recommendations. "Having additional and more comprehensive details about such lifestyle recommendations could help clinicians integrate specific advice into anticipatory guidance, management, and treatment plans," suggest Talia S. Benheim, BA, and her colleagues at Massachusetts General Hospital, along with Michelle Dalal, MD, of the University of Massachusetts Chan Medical School and Daniel Hosker, MD, in the September/October issue of the Harvard Review of Psychiatry.

Lifestyle medicine interventions can mitigate lack of access to traditional mental health treatments
Adolescent depression is strongly associated with negative academic, employment, and health outcomes well into adulthood, and studies point to the importance of early and timely access to mental health interventions. Yet, inaccessibility of mental health services persists, especially among marginalized populations.

The utility, versatility, and cost-effectiveness of lifestyle interventions are well known. They can be used by both licensed and non-licensed providers; implemented in a standalone manner or as part of a larger treatment plan; administered in-person or virtually, with a single patient or in groups; and are often more cost-effective and accommodating to patients' unique cultural situations.

The article reviews evidence of lifestyle interventions in physical activity, sleep, nutrition, substance use, social connectedness, and stress, demonstrating efficacy or feasibility in reducing depressive symptoms in adolescents. Studies included clinical trials, quantitative studies, and qualitative studies, as well as the authors' own clinical experience.

Regardless of whether physical activity is considered light or rigorous, many studies demonstrate the efficacy of physical activity in reducing depression symptoms. For example, one revealed that a two-hour decrease in sedentary activity in patients between ages 12 and 16 reduced depression scores by 16%–22% by age 18.
Sleep problems in adolescents persist into adulthood and have been associated with lack of response to depressive treatment and are even a risk factor for suicide. Yet, one study demonstrated that simple and specific guidelines for healthy sleep habits improved depressive symptoms. Bedtime routines such as keeping a diary or maintaining wind-down activities, as well as cognitive-behavioral therapy for insomnia, are also important.

Nutritional studies demonstrate that healthy plant- and whole food–based diets can alleviate or reduce depressive symptoms. The authors suggest a number of simple interventional approaches, such as tip sheets or recipes, engaging professional nutritionists, and guidance on so-called mindful or intuitive eating.

Cannabis, alcohol, and nicotine are also associated with depression in adolescents and can hinder effective treatment of both. Studies show prompt intervention is paramount. An online program in Australia has shown that increased knowledge of substances, depression, and anxiety reduced likelihood of drinking.

In adolescents, loneliness is correlated with depression, and lack of social connectedness is a predictor of suicidal ideation. One study revealed that increases in connectedness over time had corresponding reductions in adolescents' suicidal ideation. Numerous forms of connectedness-;for example, via extracurricular activities such as clubs and sports-;have proven to reduce depressive symptoms and can overlap with other lifestyle interventions.

Finally, interventions to support patients in coping with and managing stress can favorably influence the onset, maintenance, and severity of depression. Successful interventions include deep breathing, meditation, muscle relaxation techniques, and mindfulness-based cognitive therapy.

The authors caution that interventions involving significant behavioral changes can be difficult, especially without social, financial, or cultural support. Despite the scarcity of randomized controlled trials of psychological and health behavior (e.g., physical activity) promoting interventions, Benheim, Dalal, and colleagues believe these interventions can help meet the increasing need for mental health services and give teens and families opportunities to empower themselves with the knowledge, skills, and habits to combat depression.

reference:
Benheim, T.S., et al. (2022) Back to Basics: Lifestyle Interventions for Adolescent Depression. Harvard Review of Psychiatry. doi.org/10.1097/HRP.0000000000000343.

Link:
https://www.news-medical.net/news/20220915/Lifestyle-interventions-can-help-pediatricians-meet-the-growing-need-for-youth-depression-management.aspx
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Timely treatment of depression could reduce the risk of dementia

Importance of Continuous Psychotherapy: Once again, the course of ineffectively treated depression carries significant medical risk.”

Depression has long been associated with an increased risk of dementia, and now a new study provides evidence that timely treatment of depression could lower the risk of dementia in specific groups of patients.

Over 55 million people worldwide live with dementia, a disabling neurocognitive condition that mainly affects older adults. No effective treatment for dementia exists but identifying ways to help minimize or prevent dementia would help to lessen the burden of the disease.

The study, led by Jin-Tai Yu, MD, PhD, Huashan Hospital, Shanghai Medical College, Fudan University, and Wei Cheng, PhD, Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China, appears in Biological Psychiatry, published by Elsevier.

Professor Yu and Professor Cheng used data collected by the UK Biobank, a population-based cohort of over 500,000 participants. The current study included more than 350,000 participants, including 46,280 participants with depression. During the course of the study, 725 of the depressed patients developed dementia.

Previous studies examining whether depression therapies such as pharmacotherapy and psychotherapy could lower the risk for dementia produced mixed results, leaving the question unresolved. "Older individuals appear to experience different depression patterns over time," said Professor Yu. "Therefore, intra-individual variability in symptoms might confer different risk of dementia as well as heterogeneity in effectiveness of depression treatment in relation to dementia prevention."

To address that heterogeneity, the researchers then categorized participants into one of four courses of depression: increasing course, in which mild initial symptoms steadily increase; decreasing course, starting with moderate- or high-severity symptoms but subsequently decreasing; chronically high course of ongoing severe depressive symptoms; and chronically low course, where mild or moderate depressive symptoms are consistently maintained.
As expected, the study found that depression elevated the risk of dementia – by a striking 51% compared to non-depressed participants. However, the degree of risk depended on the course of depression; those with increasing, chronically high, or chronically low course depression were more vulnerable to dementia, whereas those with decreasing course faced no greater risk than participants without depression.

The researchers most wanted to know whether the increased risk for dementia could be lowered by receiving depression treatment. Overall, depressed participants who received treatment had reduced risk of dementia compared to untreated participants by about 30%. When the researchers separated the participants by depression course, they saw that those with increasing and chronically low courses of depression saw lower risk of dementia with treatment, but those with a chronically high course saw no benefit of treatment in terms of dementia risk.
He notes that, "in this case, symptomatic depression increases dementia risk by 51%, whereas treatment was associated with a significant reduction in this risk."

"This indicates that timely treatment of depression is needed among those with late-life depression," added Professor Cheng. "Providing depression treatment for those with late-life depression might not only remit affective symptoms but also postpone the onset of dementia."

"The new findings shed some light on previous work as well," said Professor Cheng. "The differences of effectiveness across depression courses might explain the discrepancy between previous studies."
reference:
Yang, L., et al. (2022) Depression, Depression Treatments, and Risk of Incident Dementia: A Prospective Cohort Study of 354,313 Participants. Biological Psychiatry. doi.org/10.1016/j.biopsych.2022.08.026.

Link:
https://www.news-medical.net/news/20221017/Timely-treatment-of-depression-could-reduce-the-risk-of-dementia.aspx
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Study finds higher mortality risk in patients with treatment resistant depression

Importance of Early Psycho therapeutic Interventions 

Patients with treatment-resistant depression have a 23 per cent higher risk of death than other depressed patients. They also have twice as much outpatient care and spend three times the number of days in inpatient care. These are findings of a new study published in JAMA Psychiatry by researchers from Karolinska Institutet and elsewhere, who conclude that it is important to identify patients at risk of developing treatment-resistant depression.   

Depression is the leading cause of functional disability the world over. The most common treatments are antidepressants or psychotherapy. Many sufferers need care for months or years, but a significant share of patients never recover despite two well-implemented treatment attempts. They have what is commonly called treatment-resistant depression.   

Researchers at Karolinska Institutet and the Centre for Psychiatric Research have now examined the effects of treatment-resistant depression in Region Stockholm at both an individual and societal level, something that has not been studied to the same extent previously.  

In the population-based observation study, the researchers used data from several sources, including Region Stockholm's administrative healthcare database and the Swedish Social Insurance Agency. Over 145,000 patients with depression in the Stockholm region were included in the study.   

Having identified 158,000 depressive episodes in these patients between 2012 and 2017, of which in excess of 12,000 were of a treatment-resistant nature, the researchers were able to draw a number of conclusions about what characterizes patients with treatment-resistant depression.   
They also found increased comorbidity with other psychiatric conditions, such as anxiety syndrome, insomnia, substance abuse syndrome and self-harm in the group with treatment-resistant depression.  

The researchers discovered that the risk of developing treatment-resistant depression could be predicted already at the first depression diagnosis. By far the most important prognostic factor was self-rated severity of depression. 

"We would benefit from identifying patients at risk of developing treatment-resistant depression, since it causes a great deal of personal suffering and is a burden for the whole of society," says Professor Johan Lundberg. 

It took an average of one and a half years for the patients with treatment-resistant depression to undergo the two treatment attempts, which is several months longer than is recommended for assessing the efficacy of a treatment for depression. Professor Lundberg says that a more frequent replacement of ineffective treatments would probably be of great help for this patient group. 

"We're talking about a patient group with a substantial health care consumption that might be identified earlier than today by increasing the use of symptom severity rating scales. Going by the results of the study, their care and treatment could be improved if their physician replaced ineffective treatments more rapidly and more often used treatments recommended for treatment-resistant depression, such as lithium, than was the case in the study material," says Professor Lundberg.   

The study was initiated and financed by Region Stockholm and carried out in association with the pharmaceutical company Janssen-Cilag.  

Reference:
Lundberg, J., et al. (2022) Association of Treatment-Resistant Depression With Patient Outcomes and Health Care Resource Utilization in a Population-Wide Study. JAMA Psychiatry. doi.org/10.1001/jamapsychiatry.2022.3860.
Link:
https://www.news-medical.net/news/20221215/Study-finds-higher-mortality-risk-in-patients-with-treatment-resistant-depression.aspx
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Digital interventions can help relieve depressive symptoms

Psychotherapy with Electronic , Online Intervention

With a shortage of therapists, help with mental health problems is being sought from digital interventions, where elements of psychological treatment are offered via computer programs or mobile applications. According to a study, smart devices can help identify people with symptoms of depression and anxiety.

Every year, 400 million people worldwide are affected by depression or anxiety, and the coronavirus pandemic has only increased the prevalence of mental health problems. At the same time, there is a shortage of psychotherapists. Digital interventions, where elements of psychological treatment are offered via computer programs or mobile applications, have been proposed as a solution.

In his doctoral thesis in the field of psychology, researcher Isaac Moshe investigated the effectiveness of digital interventions in treating mental health problems, with depressive symptoms in particular focus.
Tracking depression and anxiety with smart devices

One sub-study in the doctoral thesis examined whether symptoms of depression or anxiety can be identified from data collected by smartphones or wearable devices. A total of 60 adults who used an iPhone or an Oura Ring took part in the sub-study.

Based on the study, smartphone GPS data was predicted the user's depressive symptoms. Subjects who visited the same locations repeatedly had more depressive symptoms than those whose location had more variability. The data collected by smart rings indicated that the longer the person slept or spent time in bed on average, the more depressive symptoms they had. The ring data also revealed that the more frequently people woke up at night, the more symptoms of anxiety they had.
Digital interventions alleviate depressive symptoms
The most extensive sub-study of the doctoral thesis was an international collaboration that assessed the effectiveness of digital interventions in treating depression by conducting a meta-analysis of all previous studies. Digital interventions typically include videos, interactive exercises or text to deliver the core components of psychotherapy, which are then packaged into an online program or smartphone app.

The dataset was composed of 83 randomized controlled trials conducted between 1990 and 2020 involving 15,530 participants.

The findings indicate that digital interventions brought relief from depressive symptoms when they were offered in public or private healthcare settings. Digital interventions alleviated symptoms in people of all ages, regardless of depression severity or physical comorbidity.

Moshe points out that there are important caveats: in children and adolescents, digital interventions were less effective than in adults. Having human support alongside the digital interventions was also critical to people completing the programs and therefore getting the maximum benefits. Furthermore, the researchers felt that it was unclear whether digital interventions were indeed as effective as face-to-face psychotherapy, as so few comparative studies on the topic have so far been conducted.

Moshe believes that, overall, digital interventions could provide a valuable way to help meet the growing global demand for mental healthcare.

"They lower the barrier to accessing treatment, enabling anyone with a computer an internet connection to benefit from psychotherapy at a time and place that is convenient to them. Digital interventions also require much less time from therapists than traditional therapy, making it possible to shorten waiting lists and treat more people."

Reference:
Helsingin yliopisto (University of Helsinki)
Link: 
https://www.news-medical.net/news/20221220/Digital-interventions-can-help-relieve-depressive-symptoms.aspx
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