Sophie Velleman

Computerised Cognitive Behavioural Therapy for the Prevention and Treatment of Depression and Anxiety in Children and Adolescents: A Systematic Review

Research has shown that computerised cognitive behaviour therapy (cCBT) can be effective in the treatment of depression and anxiety in adults, although the outcomes with children and adolescents are unclear. The aim of the study is to systematically review the literature on the effectiveness of cCBT for the prevention and treatment of depression and anxiety in children and adolescents. EMBASE, PsychInfo and Pubmed were searched using specific terms and inclusion criteria for cCBT studies involving young people under the age of 18. A hand search was also conducted, and the authors were contacted to identify additional papers. Ten studies met the inclusion criteria. These included case series and randomised controlled trials concerned with both treatment and prevention. Six different software packages were described that varied in length and the nature and extent of professional contact and supervision. All studies reported reductions in clinical symptoms and also improvements in variables such as behaviour, self-esteem and cognitions. Satisfaction with treatment was moderate to high from both children and parents, though levels of drop out and non-completion were often high. Additional randomised controlled trials are required, as the literature is currently limited. However, preliminary evidence suggests that cCBT is an acceptable and effective intervention for this age group.

Psychological flexibility in adults with chronic pain: A study of acceptance, mindfulness, and values-based action in primary care.

&NA; There is an increasing number of studies of acceptance, mindfulness, and values‐based action in relation to chronic pain. Evidence from these studies suggests that these processes may be important for reducing the suffering and disability arising in these conditions. Taken together these processes entail an overarching process referred to as “psychological flexibility.” While these processes have been studied in people with chronic pain contacted in specialty treatment centers, they have not yet been investigated in primary care. Thus, participants in this study were 239 adults with chronic pain surveyed in primary care, through contact with their General Practitioners (GPs), in the UK. They completed measures of acceptance of chronic pain, mindfulness, psychological acceptance, values‐based action, health status, and GP visits related to pain. Correlation coefficients demonstrated significant relations between the components of psychological flexibility and the measures of health and GP visits. In regression analyses, including both pain intensity and psychological flexibility as potential predictors, psychological flexibility accounted for significant variance, &Dgr;R2 = .039–.40 (3.9–40.0%). In these regression equations pain intensity accounted for an average of 9.2% of variance while psychological flexibility accounted for 24.1%. These data suggest that psychological flexibility may reduce the impact of chronic pain in patients with low to moderately complex problems outside of specialty care. Due to a particularly conservative recruitment strategy the overall response rate in this study was low and the generality of these results remains to be established.

Computerized CBT (Think, Feel, Do) for Depression and Anxiety in Children and Adolescents: Outcomes and Feedback from a Pilot Randomized Controlled Trial

BACKGROUND Research has demonstrated the effectiveness of computerized cognitive behaviour therapy (cCBT) for depression and anxiety in adults, but there has been little work with children and adolescents. AIMS To describe the development of a cCBT intervention (Think, Feel, Do) for young people, and preliminary outcomes and feedback from a pilot randomized controlled trial. METHOD Twenty participants aged 11 to 16 with depression or anxiety were randomized to receive cCBT immediately or after a delay. Standardized measures were used to assess self-reported anxiety, depression, self-esteem and cognitions, as well as parent rated strengths and difficulties. A feedback form was also completed to assess young peoples views of the programme. RESULTS A total of 15 participants completed the pre and post assessments in the trial, and 17 provided feedback on the intervention. Paired samples t-tests demonstrated significant improvements on 3 subscales in the control condition, compared to 7 subscales in the cCBT condition. Feedback showed moderate to high satisfaction for participants. CONCLUSIONS This study provides encouraging preliminary results for the effectiveness and acceptability of cCBT with this age group.

Concerns about medication and medication adherence in patients with chronic pain recruited from general practice.

&NA; This study examines the concerns and beliefs about medication reported by patients with nonmalignant chronic pain encountered within general practice. Two hundred thirty‐nine patients with chronic pain took part in this research. Patients completed the Pain Medication Attitudes Questionnaire, a measure of patient concerns and beliefs relating to addiction, withdrawal, side effects, mistrust in doctors, perceived need of medication, scrutiny from others, and tolerance. The data revealed that patient concerns and beliefs predicted general medication nonadherence. In addition, concerns were related to the direction of nonadherence: overuse of medication was related to increased perceived need for medication and greater concern over side effects; underuse was related to decreased concerns over withdrawal and increased mistrust in the prescribing doctor. Analyses also indicated that patient attitudes and concerns about medication were more predictive of nonadherence than both level of pain and the reported frequency of experienced side effects. This research contributes to the increasing evidence that patient attitudes and beliefs about pain medication are associated with adherence behavior. Training general practitioners to identify and address these concerns may reduce concerns, improve adherence, and facilitate the doctor–patient relationship. Patient concerns about medication predicted nonadherence, including both over‐ or underuse. Concern appeared more predictive than both pain intensity and frequency of side effects experienced.

A review and meta-analysis of computerized cognitive behaviour therapy for the treatment of pain in children and adolescents.

BACKGROUND Chronic pain is relatively common in children and adolescents. Cognitive behaviour therapy (CBT) has been shown to be effective for treating pain in this age group. This paper aims to review the literature on the use of computerized cognitive behavioural therapy (cCBT) with children and adolescents with pain. METHODS Three databases, Pubmed (including Medline), Embase and PsychInfo, were searched and papers were identified using specific inclusion criteria. RESULTS Four studies met the inclusion criteria, all of which indicated beneficial results of using cCBT, with those who completed cCBT being more likely to experience at least a 50% post-treatment reduction in symptoms than those in a control group. A meta-analysis suggested a medium effect size of -0.41 for reduced pain intensity post treatment for cCBT compared with the control groups. A mean odds ratio of 6.03 was found for achieving a clinically significant reduction in pain in the cCBT group compared with the control groups. CONCLUSION This review tentatively suggests potential for using cCBT for pain in children and adolescents. However, there is only a small body of research exploring this relationship at present, and so further research is needed before any solid conclusions can be drawn.

Patterns of prescription and concern about opioid analgesics for chronic non-malignant pain in general practice

Aim The purpose of this study was to investigate the circumstances of opioid prescription among general practitioners (GPs) in the UK. Background Prescription of opioids for chronic pain, particularly non-malignant chronic pain, remains controversial. In the midst of this controversy, patterns of actual prescription and influences on these patterns are not well understood. Method A mail survey was posted to 1192 GPs and it was returned by 414 (35.0%). The survey addressed the frequency and reluctance in GP prescription of opioids for chronic pain. It also sampled their attitudes and concerns about opioids, including their views on appropriateness and effectiveness, adverse effects and potential social pressures presumed to impact on prescribing. Findings Overall, 57.9% of GPs reported they sometimes, frequently, or always, prescribe strong opioids for chronic pain, which was of significantly lower frequency than for prescribing of weak opioids, non-steroidal anti-inflammatory drugs (NSAIDs) or tricyclic antidepressant medications. Similarly, 69.1% reported a reluctance to prescribe strong opioids for chronic non-malignant pain, which was a significantly greater reluctance than for cancer pain, for example. GPs who were men, younger, had fewer years experience and worked full time (as opposed to part time), were more likely to prescribe opioids. Practice guideline use was unrelated to prescribing but those with specialty training were more likely to prescribe. Interestingly, a majority of GPs (83.0%) felt that opioids are effective for chronic non-malignant pain; however, they worry about long-term commitment (such as managing dosing and repeat prescriptions), addiction and other adverse events. Conclusions Based on multivariate analyses, both frequency of prescribing and reluctance were predicted by a combination of concerns about effects on patient behaviour, professional competency concerns and degree of belief in opioids as an effective option. These results may suggest a need for additional GP training in the management of analgesics for chronic non-malignant pain.

Psychological wellbeing and quality-of-life among siblings of paediatric CFS/ME patients: A mixed-methods study

Chronic fatigue syndrome or myalgic encephalomyelitis (CFS/ME) is a disabling condition known to have a negative impact on all aspects of a child’s life. However, little is understood about the impact of CFS/ME on siblings. A total of 34 siblings completed questionnaires measuring depression (Hospital Anxiety and Depression Scale (HADS)), anxiety (HADS and Spence Children’s Anxiety Scale (SCAS)) and European Quality-of-life-Youth (EQ-5D-Y). These scores were compared with scores from normative samples. Siblings had higher levels of anxiety on the SCAS than adolescents of the same age recruited from a normative sample; however, depression and quality-of-life were similar. Interviews were undertaken with nine siblings of children with CFS/ME who returned questionnaires. Interview data were analysed using a framework approach to thematic analysis. Siblings identified restrictions on family life, ‘not knowing’ and lack of communication as negative impacts on their family, and change of role/focus, emotional reactions and social stigma as negative impacts on themselves. They also described positive communication, social support and extra activities as protective factors. Paediatric services should be aware of the impact of CFS/ME on the siblings of children with CFS/ME, understand the importance of assessing paediatric CFS/ME patients within the context of their family and consider providing information for siblings about CFS/ME.

A review and meta-analysis of computerized cognitive behaviour therapy for the treatment of pain in children and adolescents: cCBT for pain in children

BACKGROUND Chronic pain is relatively common in children and adolescents. Cognitive behaviour therapy (CBT) has been shown to be effective for treating pain in this age group. This paper aims to review the literature on the use of computerized cognitive behavioural therapy (cCBT) with children and adolescents with pain. METHODS Three databases, Pubmed (including Medline), Embase and PsychInfo, were searched and papers were identified using specific inclusion criteria. RESULTS Four studies met the inclusion criteria, all of which indicated beneficial results of using cCBT, with those who completed cCBT being more likely to experience at least a 50% post-treatment reduction in symptoms than those in a control group. A meta-analysis suggested a medium effect size of -0.41 for reduced pain intensity post treatment for cCBT compared with the control groups. A mean odds ratio of 6.03 was found for achieving a clinically significant reduction in pain in the cCBT group compared with the control groups. CONCLUSION This review tentatively suggests potential for using cCBT for pain in children and adolescents. However, there is only a small body of research exploring this relationship at present, and so further research is needed before any solid conclusions can be drawn.

A review and meta-analysis of Computerized Cognitive Behaviour Therapy (cCBT) for the treatment of pain in children

BACKGROUND Chronic pain is relatively common in children and adolescents. Cognitive behaviour therapy (CBT) has been shown to be effective for treating pain in this age group. This paper aims to review the literature on the use of computerized cognitive behavioural therapy (cCBT) with children and adolescents with pain. METHODS Three databases, Pubmed (including Medline), Embase and PsychInfo, were searched and papers were identified using specific inclusion criteria. RESULTS Four studies met the inclusion criteria, all of which indicated beneficial results of using cCBT, with those who completed cCBT being more likely to experience at least a 50% post-treatment reduction in symptoms than those in a control group. A meta-analysis suggested a medium effect size of -0.41 for reduced pain intensity post treatment for cCBT compared with the control groups. A mean odds ratio of 6.03 was found for achieving a clinically significant reduction in pain in the cCBT group compared with the control groups. CONCLUSION This review tentatively suggests potential for using cCBT for pain in children and adolescents. However, there is only a small body of research exploring this relationship at present, and so further research is needed before any solid conclusions can be drawn.