Thomas Richardson

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.

Clinicians' Attitudes Towards the Use of Computerized Cognitive Behaviour Therapy (cCBT) with Children and Adolescents

BACKGROUNDnResearch has begun to examine the effectiveness of computerized cognitive behaviour therapy (cCBT) with children and adolescents. Although cCBT appears promising, the attitudes of clinicians towards this type of intervention with children and young people have not been assessed, yet these are important in determining when and if cCBT will be offered.nnnAIMSnTo survey clinicians attitudes towards cCBT with children and adolescents.nnnMETHODnA self-report questionnaire was completed by 43 mental health professionals attending a conference.nnnRESULTSnClinicians were cautious but generally positive about the use of cCBT with children and adolescents, particularly for the delivery of prevention programmes and in the treatment of mild/moderate problems. Few felt that cCBT should be available freely online without any professional support. Indeed, the lack of a therapeutic relationship and professional support were identified as the biggest problems, whilst the potential to use cCBT at home was the greatest advantage identified.nnnCONCLUSIONSnThis survey suggests that clinicians are generally positive about the use of cCBT with children and adolescents for the prevention and treatment of mild/moderate problems. Further research is required to address clinicians concerns about the effectiveness of cCBT for more substantial problems and the level of therapeutic support required.

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

BACKGROUNDnResearch 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.nnnAIMSnTo describe the development of a cCBT intervention (Think, Feel, Do) for young people, and preliminary outcomes and feedback from a pilot randomized controlled trial.nnnMETHODnTwenty 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.nnnRESULTSnA 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.nnnCONCLUSIONSnThis study provides encouraging preliminary results for the effectiveness and acceptability of cCBT with this age group.

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

BACKGROUNDnChronic 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.nnnMETHODSnThree databases, Pubmed (including Medline), Embase and PsychInfo, were searched and papers were identified using specific inclusion criteria.nnnRESULTSnFour 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.nnnCONCLUSIONnThis 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.

Correlates of substance use disorder in bipolar disorder: a systematic review and meta-analysis

Substance use disorders (SUDs) are common in those with bipolar disorder (BD) and are linked to a number of negative outcomes. The aim of the present study was to systematically review and perform a meta-analysis on correlates of SUDs in those with BD. A systematic review was performed on the online database PsychINFO, with specific keywords and inclusion criteria employed. A total of 1794 papers were produced and 49 were accepted. A meta-analysis was performed on all available data. Correlates of SUD reported by individual studies included various socio-demographic, clinical history, developmental, personality and family history variables. A series of meta-analyses found that lower current age and lower age ofsymptom onset, male gender, being unmarried, having BD type I, having a co-morbid anxiety disorder and a history of suicide attempts all predicted co-morbid SUD. Variables such as years spent in education, number of lifetime psychiatric hospitalisations and ethnic minority status did not reach signi...

Comment on Hides et al. — Cannabis use and psychotic-like experiences

The research paper by Hides et al. (2009) in Julys issue of Schizophrenia Research examined the relationship between cannabis use and psychotic-like experiences (PLEs) in adolescents, finding a relationship between lifetime use and PLEs such as perceptual abnormalities. The authors report an unexpected yet interesting finding that frequent use was not related to PLEs. Specifically, using cannabis on a weekly basis at some point was not related to PLEs, and infrequent use in the past year was more strongly related to PLEs than frequent use in the past year. The authors provide three potential explanations for this result. Firstly, that those who experience psychotic symptoms with frequent use stop using cannabis. Secondly, those who use cannabis and do not consequently experience PLEs are more likely to go on to use cannabis on a regular basis. Finally, the authors suggest that genetic differences in the frequent users may moderate sensitivity to the effects of cannabis use and possible PLEs. These are all possible explanations for this finding; however wewould like to suggest two additional potential explanations. Firstly, this finding may represent a statistical issue. The authors state that the number of participants who were frequent users of cannabis was “adequate for the statistical purposes of this study”. However, just 19 participants had used cannabis weekly at some point in their lives, and only 14 had used cannabis on a monthly basis within the past year. Though it would have been possible to compute statistics using general linear modelling on a sample of this size, there may have been reduced statistical power. Therefore it may be possible that the lack of statistical relationship between frequent use and PLEs may be a function of sample size. Previous research with larger samples suggests that frequent/heavy users of cannabis have higher levels of psychotic symptoms, indicating a dose– response relationship (Henquet et al., 2005;VanOs et al., 2002). A second possible explanation relates to the effects of cannabis intoxication and tolerance on subsequent experience of PLEs. It is possible that the PLEs which the adolescents were reporting may represent the acute effects of cannabis intoxication; DSouza et al. (2004) found that healthy participants experienced a number of psychotic-like experiences while under the influence of cannabis. It is possible that many of the cannabis users experienced PLEs whilst intoxicated, and thus reported these in the study, but that these experiences havenot

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

BACKGROUNDnChronic 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.nnnMETHODSnThree databases, Pubmed (including Medline), Embase and PsychInfo, were searched and papers were identified using specific inclusion criteria.nnnRESULTSnFour 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.nnnCONCLUSIONnThis 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

BACKGROUNDnChronic 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.nnnMETHODSnThree databases, Pubmed (including Medline), Embase and PsychInfo, were searched and papers were identified using specific inclusion criteria.nnnRESULTSnFour 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.nnnCONCLUSIONnThis 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.