Publications by authors named "Aliza Werner-Seidler"

60 Publications

The early course and treatment of posttraumatic stress disorder in very young children: diagnostic prevalence and predictors in hospital-attending children and a randomized controlled proof-of-concept trial of trauma-focused cognitive therapy, for 3- to 8-year-olds.

J Child Psychol Psychiatry 2021 Jun 14. Epub 2021 Jun 14.

Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK.

Background: The introduction of developmentally adapted criteria for posttraumatic stress disorder (PTSD) has improved the identification of ≤6-year-old children with clinical needs. Across two studies, we assess predictors of the development of PTSD in young children (PTSD-YC), including the adult-led acute stress disorder (ASD) diagnosis, and provide proof of principle for cognitive-focused therapy for this age range, with the aim of increasing treatment options for children diagnosed with PTSD-YC.

Method: Study 1 (N = 105) assessed ASD and PTSD-YC diagnosis in 3- to 8-year-old children within one month and at around three months following attendance at an emergency room. Study 2 (N = 37) was a preregistered (www.isrctn.com/ISRCTN35018680) randomized controlled early-phase trial comparing CBT-3M, a cognitive-focused intervention, to treatment-as-usual (TAU) delivered within the UK NHS to 3- to 8-year-olds diagnosed with PTSD-YC.

Results: In Study 1, the ASD diagnosis failed to identify any young children. In contrast, prevalence of acute PTSD-YC (minus the duration requirement) was 8.6% in the first month post-trauma and 10.1% at 3 months. Length of hospital stay, but no other demographic or trauma-related characteristics, predicted development of later PTSD-YC. Early (within one month) diagnosis of acute PTSD-YC had a positive predictive value of 50% for later PTSD-YC. In Study 2, most children lost their PTSD-YC diagnosis following completion of CBT-3M (84.6%) relative to TAU (6.7%) and CBT-3M was acceptable to recipient families. Effect sizes were also in favor of CBT-3M for secondary outcome measures.

Conclusions: The ASD diagnosis is not fit for purpose in this age-group. There was a strong and encouraging signal of putative efficacy for young children treated using a cognitive-focused treatment for PTSD, and a larger trial of CBT-3M is now warranted.
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http://dx.doi.org/10.1111/jcpp.13460DOI Listing
June 2021

The impact of COVID-19 on the lives and mental health of Australian adolescents.

Eur Child Adolesc Psychiatry 2021 Apr 28. Epub 2021 Apr 28.

Black Dog Institute, UNSW, Hospital Road, Randwick, Sydney, 2022, Australia.

There has been significant disruption to the lives and mental health of adolescents during the COVID-19 pandemic. The purpose of this study was to assess the psychological and lifestyle impact of the pandemic on Australian adolescents, using an online survey, administered during the outbreak. Self-report surveys were administered online to a sample of 760 Australian adolescents aged 12-18 years assessing impact on a range of domains including behaviour, education, relationships, lifestyle factors (exercise, technology use, and sleep), and mental health outcomes (psychological distress, loneliness, health anxiety and well-being). Results showed that three quarters of the sample experienced a worsening in mental health, since the pandemic began, with negative impacts reported on learning, friendships and family relationships. There were also high higher levels of sleep disturbance, psychological distress and health anxiety, relative to normative samples. Effects on mental health were worse among those who reported a previous diagnosis of depression and/or anxiety relative to those without no such history. Adolescents are already vulnerable to the onset of mental illness at this developmental stage, and the current research underscores the need to find rapid and accessible ways to support adolescent mental health during times of crisis.
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http://dx.doi.org/10.1007/s00787-021-01790-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8080862PMC
April 2021

School teachers: the forgotten frontline workers of Covid-19.

Australas Psychiatry 2021 Apr 13:10398562211006145. Epub 2021 Apr 13.

Black Dog Institute, University of New South Wales, Sydney, NSW, Australia.

Objective: Australian school teachers have been affected by the Covid-19 pandemic. Teachers have had to face relentless and challenging working conditions, take on new roles and responsibilities, and embrace new ways of working. We searched reports and the available research literature on teacher mental health between September 2020 and October 2020. In our perspective piece, we summarise this literature and draw attention to the struggles of Australian school teachers and how Covid-19 has impacted their mental health.

Conclusions: To date, there has been a lack of research focusing on teacher mental health both internationally and in Australia. That which is available indicates that teacher mental health is likely to have deteriorated substantially during the pandemic. We position teachers as the forgotten frontline of Covid-19 and make recommendations to facilitate improvements into the future.
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http://dx.doi.org/10.1177/10398562211006145DOI Listing
April 2021

The relationship between screen time and mental health in young people: A systematic review of longitudinal studies.

Clin Psychol Rev 2021 06 20;86:102021. Epub 2021 Mar 20.

Black Dog Institute, University of New South Wales, Sydney, NSW, Australia.

An increase in time spent on screen-based technologies has been suggested to underlie recent increases in mental health problems among young people. However, this hypothesis has primarily been based on the findings of cross-sectional studies. The aim of the current review was to provide a comprehensive overview of longitudinal studies examining the relationship between screen time and internalising mental health symptoms. PsycINFO, PubMed/Medline and EMBASE were systematically searched for articles published up to August 2020. Thirty-five studies, with sample sizes ranging from 126 to 12,866 participants, met inclusion criteria. The association between screen time and subsequent depressive symptoms was found to be small to very small in size. There was limited evidence of any reverse association between depressive symptoms and subsequent screen time. The association between screen time and depressive symptoms varied between different devices and uses. In contrast to depressive symptoms, evidence to support longitudinal associations between screen time and other internalising mental health symptoms, including anxiety, self-esteem, and general internalising problems, was lacking. Together, these results suggest that the impact of increased screen time on the prevalence of mental health problems among young people is likely to be negligible or small. Further longitudinal studies that examine screen content and motivations underlying screen use are required to better discern any relationship between screen time and internalising mental health symptoms.
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http://dx.doi.org/10.1016/j.cpr.2021.102021DOI Listing
June 2021

Gender Differences in Adolescent Sleep Disturbance and Treatment Response to Smartphone App-Delivered Cognitive Behavioral Therapy for Insomnia: Exploratory Study.

JMIR Form Res 2021 Mar 23;5(3):e22498. Epub 2021 Mar 23.

Black Dog Institute, University of New South Wales, Randwick, Australia.

Background: Insomnia and sleep disturbance are pervasive and debilitating conditions affecting up to 40% of adolescents. Women and girls are at greater risk of insomnia, yet differences in treatment responsiveness between genders have not been adequately investigated. Additionally, while women report greater symptom severity and burden of illness than men, this discrepancy requires further examination in adolescents.

Objective: The purpose of this study was to examine gender differences in sleep symptom profiles and treatment response in adolescents.

Methods: Digital cognitive behavioral therapy for insomnia (CBT-I) treatment responsiveness, as indexed by changes in Insomnia Severity Index (ISI) and Global Pittsburgh Sleep Quality Index (PSQI) scores, was compared in boys and girls (aged 12-16 years; N=49) who participated in a pilot evaluation of the Sleep Ninja smartphone app. Gender differences in self-reported baseline insomnia symptom severity (ISI), sleep quality (PSQI), and sleep characteristics derived from sleep diaries were also examined.

Results: Compared with boys, we found that girls reported greater symptom severity (P=.04) and nighttime wakefulness (P=.01 and P=.04) and reduced sleep duration (P=.02) and efficiency (P=.03), but not poorer sleep quality (P=.07), more nighttime awakenings (P=.16), or longer time to get to sleep (P=.21). However, gender differences in symptom severity and sleep duration were accounted for by boys being marginally younger in age. Treatment response to CBT-I was equivalent between boys and girls when comparing reductions in symptom severity (P=.32); there was a trend showing gender differences in improvements in sleep quality, but this was not statistically significant (P=.07).

Conclusions: These results demonstrate the presence of gender differences in insomnia symptoms and severity in adolescents and suggest further research is required to understand gender differences in insomnia symptom profiles to inform the development of gender-specific digital interventions delivered to adolescents.
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http://dx.doi.org/10.2196/22498DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8075040PMC
March 2021

A randomized, controlled proof-of-concept trial evaluating durable effects of memory flexibility training (MemFlex) on autobiographical memory distortions and on relapse of recurrent major depressive disorder over 12 months.

Behav Res Ther 2021 05 3;140:103835. Epub 2021 Mar 3.

Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, UK; Cambridgeshire and Peterborough NHS Foundation Trust, UK.

Low-intensity psychological interventions that target cognitive risk factors for depressive relapse may improve access to relapse prevention programs and thereby reduce subsequent risk. This study provides the first evaluation of an autobiographical memory-based intervention for relapse prevention, to establish whether memory-training programs that are efficacious for acute depression may also aid those currently in remission. We also provide the longest follow-up to-date of the effects of autobiographical memory training on autobiographical memory processes themselves. This pre-registered randomized-controlled proof-of-concept trial (N = 74) compared an autobiographical Memory Flexibility (MemFlex) intervention to Psychoeducation about cognitive-behavioral mechanisms which maintain depression. Both interventions were primarily self-guided, and delivered via paper workbooks completed over four weeks. The key cognitive outcome was ability to retrieve and alternate between specific and general autobiographical memories. Co-primary clinical outcomes were time until depressive relapse and depression-free days in the twelve-months following intervention. Results indicated a small-moderate effect size (d = 0.35) in favor of MemFlex for the cognitive outcome. A small Hazard Ratio (1.08) was observed for time until depressive relapse, along with a negligible effect size for depression-free days (d = 0.11). Although MemFlex produced long-term improvement in memory retrieval skills, there was little support for MemFlex as a relapse prevention program for depression.
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http://dx.doi.org/10.1016/j.brat.2021.103835DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8047774PMC
May 2021

Content and Themes of Repetitive Thinking in Postnatal First-Time Mothers.

Front Psychol 2021 2;12:586538. Epub 2021 Feb 2.

School of Psychology, The University of New South Wales, Sydney, NSW, Australia.

Repetitive thinking (RT) predicts and maintains depression and anxiety, yet the role of RT in the perinatal context has been under-researched. Further, the content and themes that emerge during RT in the perinatal period have been minimally investigated. We recruited an online community sample of women who had their first baby within the past 12 months ( = 236). Participants completed a battery of self-report questionnaires which included four open-ended questions about the content of their RT. Responses to the latter were analyzed using an inductive thematic analysis approach. Participants reported RT about a range of unexpected emotional responses to becoming a new mother, impact on their sleep and cognitive functioning, as well as the impact on their identity, sense of self, lifestyle, achievements, and ability to function. RT was commonly experienced in first-time mothers, and the themes that emerged conveyed an overall sense of discrepancy between expectations and reality, as well as adjustment to profound change. By providing insight into the content of RT in new mothers, the findings of our study have scope to inform the content of interventions that seek to prevent and treat postnatal mental health problems, particularly those which target key psychological processes such as RT.
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http://dx.doi.org/10.3389/fpsyg.2021.586538DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7884627PMC
February 2021

Content and Themes of Repetitive Thinking in Postnatal First-Time Mothers.

Front Psychol 2021 2;12:586538. Epub 2021 Feb 2.

School of Psychology, The University of New South Wales, Sydney, NSW, Australia.

Repetitive thinking (RT) predicts and maintains depression and anxiety, yet the role of RT in the perinatal context has been under-researched. Further, the content and themes that emerge during RT in the perinatal period have been minimally investigated. We recruited an online community sample of women who had their first baby within the past 12 months ( = 236). Participants completed a battery of self-report questionnaires which included four open-ended questions about the content of their RT. Responses to the latter were analyzed using an inductive thematic analysis approach. Participants reported RT about a range of unexpected emotional responses to becoming a new mother, impact on their sleep and cognitive functioning, as well as the impact on their identity, sense of self, lifestyle, achievements, and ability to function. RT was commonly experienced in first-time mothers, and the themes that emerged conveyed an overall sense of discrepancy between expectations and reality, as well as adjustment to profound change. By providing insight into the content of RT in new mothers, the findings of our study have scope to inform the content of interventions that seek to prevent and treat postnatal mental health problems, particularly those which target key psychological processes such as RT.
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http://dx.doi.org/10.3389/fpsyg.2021.586538DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7884627PMC
February 2021

Protocol for the process evaluation of a complex intervention delivered in schools to prevent adolescent depression: the Future Proofing Study.

BMJ Open 2021 01 12;11(1):e042133. Epub 2021 Jan 12.

Black Dog Institute, University of New South Wales, Sydney, New South Wales, Australia

Introduction: Process evaluations provide insight into how interventions are delivered across varying contexts and why interventions work in some contexts and not in others. This manuscript outlines the protocol for a process evaluation embedded in a cluster randomised trial of a digital depression prevention intervention delivered to secondary school students (the Future Proofing Study). The purpose is to describe the methods that will be used to capture process evaluation data within this trial.

Methods And Analysis: Using a hybrid type 1 design, a mixed-methods approach will be used with data collected in the intervention arm of the Future Proofing Study. Data collection methods will include semistructured interviews with school staff and study facilitators, automatically collected intervention usage data and participant questionnaires (completed by school staff, school counsellors, study facilitators and students). Information will be collected about: (1) how the intervention was implemented in schools, including fidelity; (2) school contextual factors and their association with intervention reach, uptake and acceptability; (3) how school staff, study facilitators and students responded to delivering or completing the intervention. How these factors relate to trial effectiveness outcomes will also be assessed. Overall synthesis of the data will provide school cluster-level and individual-level process outcomes.

Ethics And Dissemination: Ethics approval was obtained from the University of New South Wales (NSW) Human Research Ethics Committee (HC180836; 21st January 2019) and the NSW Government State Education Research Applications Process (SERAP 2019201; 19th August 2019). Results will be submitted for publication in peer-reviewed journals and discussed at conferences. Our process evaluation will contextualise the trial findings with respect to how the intervention may have worked in some schools but not in others. This evaluation will inform the development of a model for rolling out digital interventions for the prevention of mental illness in schools.

Trial Registration Number: ANZCTRN12619000855123; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377664&isReview=true.
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http://dx.doi.org/10.1136/bmjopen-2020-042133DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7805380PMC
January 2021

Protocol for the process evaluation of a complex intervention delivered in schools to prevent adolescent depression: the Future Proofing Study.

BMJ Open 2021 01 12;11(1):e042133. Epub 2021 Jan 12.

Black Dog Institute, University of New South Wales, Sydney, New South Wales, Australia

Introduction: Process evaluations provide insight into how interventions are delivered across varying contexts and why interventions work in some contexts and not in others. This manuscript outlines the protocol for a process evaluation embedded in a cluster randomised trial of a digital depression prevention intervention delivered to secondary school students (the Future Proofing Study). The purpose is to describe the methods that will be used to capture process evaluation data within this trial.

Methods And Analysis: Using a hybrid type 1 design, a mixed-methods approach will be used with data collected in the intervention arm of the Future Proofing Study. Data collection methods will include semistructured interviews with school staff and study facilitators, automatically collected intervention usage data and participant questionnaires (completed by school staff, school counsellors, study facilitators and students). Information will be collected about: (1) how the intervention was implemented in schools, including fidelity; (2) school contextual factors and their association with intervention reach, uptake and acceptability; (3) how school staff, study facilitators and students responded to delivering or completing the intervention. How these factors relate to trial effectiveness outcomes will also be assessed. Overall synthesis of the data will provide school cluster-level and individual-level process outcomes.

Ethics And Dissemination: Ethics approval was obtained from the University of New South Wales (NSW) Human Research Ethics Committee (HC180836; 21st January 2019) and the NSW Government State Education Research Applications Process (SERAP 2019201; 19th August 2019). Results will be submitted for publication in peer-reviewed journals and discussed at conferences. Our process evaluation will contextualise the trial findings with respect to how the intervention may have worked in some schools but not in others. This evaluation will inform the development of a model for rolling out digital interventions for the prevention of mental illness in schools.

Trial Registration Number: ANZCTRN12619000855123; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377664&isReview=true.
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http://dx.doi.org/10.1136/bmjopen-2020-042133DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7805380PMC
January 2021

Protocol for the process evaluation of a complex intervention delivered in schools to prevent adolescent depression: the Future Proofing Study.

BMJ Open 2021 01 12;11(1):e042133. Epub 2021 Jan 12.

Black Dog Institute, University of New South Wales, Sydney, New South Wales, Australia

Introduction: Process evaluations provide insight into how interventions are delivered across varying contexts and why interventions work in some contexts and not in others. This manuscript outlines the protocol for a process evaluation embedded in a cluster randomised trial of a digital depression prevention intervention delivered to secondary school students (the Future Proofing Study). The purpose is to describe the methods that will be used to capture process evaluation data within this trial.

Methods And Analysis: Using a hybrid type 1 design, a mixed-methods approach will be used with data collected in the intervention arm of the Future Proofing Study. Data collection methods will include semistructured interviews with school staff and study facilitators, automatically collected intervention usage data and participant questionnaires (completed by school staff, school counsellors, study facilitators and students). Information will be collected about: (1) how the intervention was implemented in schools, including fidelity; (2) school contextual factors and their association with intervention reach, uptake and acceptability; (3) how school staff, study facilitators and students responded to delivering or completing the intervention. How these factors relate to trial effectiveness outcomes will also be assessed. Overall synthesis of the data will provide school cluster-level and individual-level process outcomes.

Ethics And Dissemination: Ethics approval was obtained from the University of New South Wales (NSW) Human Research Ethics Committee (HC180836; 21st January 2019) and the NSW Government State Education Research Applications Process (SERAP 2019201; 19th August 2019). Results will be submitted for publication in peer-reviewed journals and discussed at conferences. Our process evaluation will contextualise the trial findings with respect to how the intervention may have worked in some schools but not in others. This evaluation will inform the development of a model for rolling out digital interventions for the prevention of mental illness in schools.

Trial Registration Number: ANZCTRN12619000855123; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377664&isReview=true.
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http://dx.doi.org/10.1136/bmjopen-2020-042133DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7805380PMC
January 2021

Protocol for the process evaluation of a complex intervention delivered in schools to prevent adolescent depression: the Future Proofing Study.

BMJ Open 2021 01 12;11(1):e042133. Epub 2021 Jan 12.

Black Dog Institute, University of New South Wales, Sydney, New South Wales, Australia

Introduction: Process evaluations provide insight into how interventions are delivered across varying contexts and why interventions work in some contexts and not in others. This manuscript outlines the protocol for a process evaluation embedded in a cluster randomised trial of a digital depression prevention intervention delivered to secondary school students (the Future Proofing Study). The purpose is to describe the methods that will be used to capture process evaluation data within this trial.

Methods And Analysis: Using a hybrid type 1 design, a mixed-methods approach will be used with data collected in the intervention arm of the Future Proofing Study. Data collection methods will include semistructured interviews with school staff and study facilitators, automatically collected intervention usage data and participant questionnaires (completed by school staff, school counsellors, study facilitators and students). Information will be collected about: (1) how the intervention was implemented in schools, including fidelity; (2) school contextual factors and their association with intervention reach, uptake and acceptability; (3) how school staff, study facilitators and students responded to delivering or completing the intervention. How these factors relate to trial effectiveness outcomes will also be assessed. Overall synthesis of the data will provide school cluster-level and individual-level process outcomes.

Ethics And Dissemination: Ethics approval was obtained from the University of New South Wales (NSW) Human Research Ethics Committee (HC180836; 21st January 2019) and the NSW Government State Education Research Applications Process (SERAP 2019201; 19th August 2019). Results will be submitted for publication in peer-reviewed journals and discussed at conferences. Our process evaluation will contextualise the trial findings with respect to how the intervention may have worked in some schools but not in others. This evaluation will inform the development of a model for rolling out digital interventions for the prevention of mental illness in schools.

Trial Registration Number: ANZCTRN12619000855123; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377664&isReview=true.
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http://dx.doi.org/10.1136/bmjopen-2020-042133DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7805380PMC
January 2021

Protocol for the process evaluation of a complex intervention delivered in schools to prevent adolescent depression: the Future Proofing Study.

BMJ Open 2021 01 12;11(1):e042133. Epub 2021 Jan 12.

Black Dog Institute, University of New South Wales, Sydney, New South Wales, Australia

Introduction: Process evaluations provide insight into how interventions are delivered across varying contexts and why interventions work in some contexts and not in others. This manuscript outlines the protocol for a process evaluation embedded in a cluster randomised trial of a digital depression prevention intervention delivered to secondary school students (the Future Proofing Study). The purpose is to describe the methods that will be used to capture process evaluation data within this trial.

Methods And Analysis: Using a hybrid type 1 design, a mixed-methods approach will be used with data collected in the intervention arm of the Future Proofing Study. Data collection methods will include semistructured interviews with school staff and study facilitators, automatically collected intervention usage data and participant questionnaires (completed by school staff, school counsellors, study facilitators and students). Information will be collected about: (1) how the intervention was implemented in schools, including fidelity; (2) school contextual factors and their association with intervention reach, uptake and acceptability; (3) how school staff, study facilitators and students responded to delivering or completing the intervention. How these factors relate to trial effectiveness outcomes will also be assessed. Overall synthesis of the data will provide school cluster-level and individual-level process outcomes.

Ethics And Dissemination: Ethics approval was obtained from the University of New South Wales (NSW) Human Research Ethics Committee (HC180836; 21st January 2019) and the NSW Government State Education Research Applications Process (SERAP 2019201; 19th August 2019). Results will be submitted for publication in peer-reviewed journals and discussed at conferences. Our process evaluation will contextualise the trial findings with respect to how the intervention may have worked in some schools but not in others. This evaluation will inform the development of a model for rolling out digital interventions for the prevention of mental illness in schools.

Trial Registration Number: ANZCTRN12619000855123; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377664&isReview=true.
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http://dx.doi.org/10.1136/bmjopen-2020-042133DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7805380PMC
January 2021

Protocol for the process evaluation of a complex intervention delivered in schools to prevent adolescent depression: the Future Proofing Study.

BMJ Open 2021 01 12;11(1):e042133. Epub 2021 Jan 12.

Black Dog Institute, University of New South Wales, Sydney, New South Wales, Australia

Introduction: Process evaluations provide insight into how interventions are delivered across varying contexts and why interventions work in some contexts and not in others. This manuscript outlines the protocol for a process evaluation embedded in a cluster randomised trial of a digital depression prevention intervention delivered to secondary school students (the Future Proofing Study). The purpose is to describe the methods that will be used to capture process evaluation data within this trial.

Methods And Analysis: Using a hybrid type 1 design, a mixed-methods approach will be used with data collected in the intervention arm of the Future Proofing Study. Data collection methods will include semistructured interviews with school staff and study facilitators, automatically collected intervention usage data and participant questionnaires (completed by school staff, school counsellors, study facilitators and students). Information will be collected about: (1) how the intervention was implemented in schools, including fidelity; (2) school contextual factors and their association with intervention reach, uptake and acceptability; (3) how school staff, study facilitators and students responded to delivering or completing the intervention. How these factors relate to trial effectiveness outcomes will also be assessed. Overall synthesis of the data will provide school cluster-level and individual-level process outcomes.

Ethics And Dissemination: Ethics approval was obtained from the University of New South Wales (NSW) Human Research Ethics Committee (HC180836; 21st January 2019) and the NSW Government State Education Research Applications Process (SERAP 2019201; 19th August 2019). Results will be submitted for publication in peer-reviewed journals and discussed at conferences. Our process evaluation will contextualise the trial findings with respect to how the intervention may have worked in some schools but not in others. This evaluation will inform the development of a model for rolling out digital interventions for the prevention of mental illness in schools.

Trial Registration Number: ANZCTRN12619000855123; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377664&isReview=true.
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http://dx.doi.org/10.1136/bmjopen-2020-042133DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7805380PMC
January 2021

The psychometric properties of the cognitive emotion regulation questionnaire (CERQ) in a clinical sample of adults with recurrent depression.

J Affect Disord 2020 11 15;276:212-219. Epub 2020 Jul 15.

University of Cambridge, Department of Psychology, Cambridge, United Kingdom; School of Psychology, University of New South Wales, Sydney, Australia.

Background: Affective dysregulation is central to depression. However, emotion regulation (ER) tendencies in depression remain poorly understood. It is critical, therefore, to validate measures of habitual ER in clinical populations. The current study aimed to validate the Cognitive Emotion Regulation Questionnaire (CERQ) in a sample of individuals with a history of recurrent depression who are currently in remission.

Method: The CERQ measures ER tendencies with 36 self-report items that are divided into nine subscales. Each subscale is purported to assess one of five adaptive and four maladaptive ER strategies. The CERQ was administered to 476 adults (mean age = 46.76 years; 75% female) that were currently in remission with a history of recurrent depression, who were recruited from primary care settings. We first investigated the CERQ's nine factor structure, internal consistency, convergent and criterion validity.

Results: The nine-factor structure did not fit the CERQ structure in a sample of individuals with recurrent depression and convergent validity was poor. Instead, a five-factor structure fit the data best and showed acceptable convergent and criterion validity.

Limitations: The generalisability of the findings may be limited due to relative lack of diversity in terms of gender and ethnicity of the sample.

Conclusion: These results suggest that the taxonomic structure of the CERQ does not fit emotion regulation patterns in adults with a history of depression. These findings highlight the importance of validating measures in clinical samples.
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http://dx.doi.org/10.1016/j.jad.2020.06.061DOI Listing
November 2020

A randomised controlled trial of a relationship-focussed mobile phone application for improving adolescents' mental health.

J Child Psychol Psychiatry 2020 08 19;61(8):899-913. Epub 2020 Jul 19.

Black Dog Institute, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.

Background: This study evaluated the acceptability and effectiveness of a relationship-focussed mobile phone application (WeClick) for improving depressive symptoms and other mental health outcomes in adolescents.

Methods: A randomised controlled trial involving 193 youth (M age: 14.82, SD: 0.94, 86.5% female) from Australia was conducted. Youth were recruited via the Internet and randomly allocated to the intervention or a 4-week wait list control condition, stratified for age and gender. The primary outcome was change in depressive symptom scores measured using the Patient Health Questionnaire for Adolescents (PHQ-A) at baseline, 4-week post-test and 12-week follow-up. Secondary outcomes included anxiety, psychological distress, wellbeing, help-seeking intentions for mental health, social self-efficacy and social support. Participants in the intervention condition received access to the intervention for four weeks. Thematic analysis was utilised to identify and examine acceptability.

Results: The change in PHQ-A scores from baseline to 4-week post-test did not differ significantly (d = 0.26, p = .138) between the intervention (Mchange = -2.9, SD = 5.3) and wait list control conditions (Mchange = -1.7, SD = 4.3). However, significant between-group improvements were observed in wellbeing (d = 0.37, p = .023), help-seeking intentions (d = 0.36, p = .016) and professional help-seeking intentions for mental health problems (d = 0.36, p = .008). Increases in help-seeking intentions were sustained at follow-up in the intervention condition. No differential effects were found for generalised anxiety, separation anxiety, social self-efficacy or for any social support outcomes. Over 90% of participants indicated the app was enjoyable, interesting and easy to use. The app provided 'advice and direction' (n = 42; 46.15%), an 'opportunity for self-reflection' (n = 33; 36.3%) and 'normalised experiences' (n = 21; 23.1%).

Conclusions: The WeClick app was found to be effective for improving wellbeing and help-seeking intentions for mental health in adolescents. A larger, adequately powered trial is now required to establish differential effects on depressive symptoms. This trial was registered with the Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12618001982202.
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http://dx.doi.org/10.1111/jcpp.13294DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7496128PMC
August 2020

Practitioner review: Co-design of digital mental health technologies with children and young people.

J Child Psychol Psychiatry 2020 08 22;61(8):928-940. Epub 2020 Jun 22.

Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.

Background: There is increasing interest in digital technologies to help improve children and young people's mental health, and the evidence for the effectiveness for these approaches is rising. However, there is concern regarding levels of user engagement, uptake and adherence. Key guidance regarding digital health interventions stress the importance of early user input in the development, evaluation and implementation of technologies to help ensure they are engaging, feasible, acceptable and potentially effective. Co-design is a process of active involvement of stakeholders, requiring a change from the traditional approaches to intervention development. However, there is a lack of literature to inform the co-design of digital technologies to help child and adolescent mental health.

Methods: We reviewed the literature and practice in the co-design of digital mental health technologies with children and young people. We searched Medline, PsycInfo and Web of Science databases, guidelines, reviews and reference lists, contacted key authors for relevant studies, and extracted key themes on aspects of co-design relevant to practice. We supplemented this with case studies and methods reported by researchers working in the field.

Results: We identified 25 original articles and 30 digital mental health technologies that were designed/developed with children and young people. The themes identified were as follows: principles of co-design (including potential stakeholders and stages of involvement), methods of involving and engaging the range of users, co-designing the prototype and the challenges of co-design.

Conclusions: Co-design involves all relevant stakeholders throughout the life and research cycle of the programme. This review helps to inform practitioners and researchers interested in the development of digital health technologies for children and young people. Future work in this field will need to consider the changing face of technology, methods of engaging with the diversity in the user group, and the evaluation of the co-design process and its impact on the technology.
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http://dx.doi.org/10.1111/jcpp.13258DOI Listing
August 2020

Emotional complexity across the life story: Elevated negative emodiversity and diminished positive emodiversity in sufferers of recurrent depression.

J Affect Disord 2020 08 11;273:106-112. Epub 2020 May 11.

Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, UK; Cambridgeshire and Peterborough NHS Foundation Trust, UK. Electronic address:

Background: Greater diversity in the experience of negative and positive emotions - emodiversity - is associated with better mental health outcomes in the general population (Quoidbach et al. 2014). However, conceptual accounts of depression suggest this might differ in clinical depression. In this study, the diversity of negative and positive emotion experiences as remembered by a recurrently depressed sample and a never-depressed control group were compared.

Methods: Emodiversity was assessed using a life structure card sort task which allowed for the assessment of memory for emotional experience over the life course. Depressed (n=34) and non-depressed (n=34) participants completed the card sort task, from which emodiversity metrics were calculated for negative and positive emotion experience.

Results: Depressed individuals showed recollections of enhanced emodiversity across negative emotion but reduced emodiversity across positive emotion, relative to never-depressed individuals.

Limitations: This study involved a relatively small sample size.

Discussion: This study indicates that greater diversity of negative emotion experience, which has been interpreted as a protective factor against depressed mood in community samples (Quoidbach et al., 2014), instead characterises the remembered experience of recurrent clinical depression. The finding that positive emodiversity is adaptive in depression suggests that therapeutic outcomes may be improved by facilitating exposure to a diverse range of positive emotions. These findings indicate that the relationship between emotion diversity and mental health is more complex than hitherto assumed.
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http://dx.doi.org/10.1016/j.jad.2020.04.060DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7116332PMC
August 2020

Emotional complexity across the life story: Elevated negative emodiversity and diminished positive emodiversity in sufferers of recurrent depression.

J Affect Disord 2020 08 11;273:106-112. Epub 2020 May 11.

Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, UK; Cambridgeshire and Peterborough NHS Foundation Trust, UK. Electronic address:

Background: Greater diversity in the experience of negative and positive emotions - emodiversity - is associated with better mental health outcomes in the general population (Quoidbach et al. 2014). However, conceptual accounts of depression suggest this might differ in clinical depression. In this study, the diversity of negative and positive emotion experiences as remembered by a recurrently depressed sample and a never-depressed control group were compared.

Methods: Emodiversity was assessed using a life structure card sort task which allowed for the assessment of memory for emotional experience over the life course. Depressed (n=34) and non-depressed (n=34) participants completed the card sort task, from which emodiversity metrics were calculated for negative and positive emotion experience.

Results: Depressed individuals showed recollections of enhanced emodiversity across negative emotion but reduced emodiversity across positive emotion, relative to never-depressed individuals.

Limitations: This study involved a relatively small sample size.

Discussion: This study indicates that greater diversity of negative emotion experience, which has been interpreted as a protective factor against depressed mood in community samples (Quoidbach et al., 2014), instead characterises the remembered experience of recurrent clinical depression. The finding that positive emodiversity is adaptive in depression suggests that therapeutic outcomes may be improved by facilitating exposure to a diverse range of positive emotions. These findings indicate that the relationship between emotion diversity and mental health is more complex than hitherto assumed.
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http://dx.doi.org/10.1016/j.jad.2020.04.060DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7116332PMC
August 2020

A trial protocol for the effectiveness of digital interventions for preventing depression in adolescents: The Future Proofing Study.

Trials 2020 Jan 2;21(1). Epub 2020 Jan 2.

Black Dog Institute, University of New South Wales, Sydney, NSW, Australia.

Background: Depression frequently first emerges during adolescence, and one in five young people will experience an episode of depression by the age of 18 years. Despite advances in treatment, there has been limited progress in addressing the burden at a population level. Accordingly, there has been growing interest in prevention approaches as an additional pathway to address depression. Depression can be prevented using evidence-based psychological programmes. However, barriers to implementing and accessing these programmes remain, typically reflecting a requirement for delivery by clinical experts and high associated delivery costs. Digital technologies, specifically smartphones, are now considered a key strategy to overcome the barriers inhibiting access to mental health programmes. The Future Proofing Study is a large-scale school-based trial investigating whether cognitive behaviour therapies (CBT) delivered by smartphone application can prevent depression.

Methods: A randomised controlled trial targeting up to 10,000 Year 8 Australian secondary school students will be conducted. In Stage I, schools will be randomised at the cluster level either to receive the CBT intervention app (SPARX) or to a non-active control group comparator. The primary outcome will be symptoms of depression, and secondary outcomes include psychological distress, anxiety and insomnia. At the 12-month follow-up, participants in the intervention arm with elevated depressive symptoms will participate in an individual-level randomised controlled trial (Stage II) and be randomised to receive a second CBT app which targets sleep difficulties (Sleep Ninja) or a control condition. Assessments will occur post intervention (both trial stages) and at 6, 12, 24, 36, 48 and 60 months post baseline. Primary analyses will use an intention-to-treat approach and compare changes in symptoms from baseline to follow-up relative to the control group using mixed-effect models.

Discussion: This is the first trial testing the effectiveness of smartphone apps delivered to school students to prevent depression at scale. Results from this trial will provide much-needed insight into the feasibility of this approach. They stand to inform policy and commission decisions concerning if and how such programmes should be deployed in school-based settings in Australia and beyond.

Trial Registration: Australian and New Zealand Clinical Trial Registry, ACTRN12619000855123. Registered on 31 May 2019. Clinical Trial Notification Scheme (CTN), CT-2019-CTN-02110-1-v1. Registered on 30 June 2019.
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http://dx.doi.org/10.1186/s13063-019-3901-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6941300PMC
January 2020

A trial protocol for the effectiveness of digital interventions for preventing depression in adolescents: The Future Proofing Study.

Trials 2020 Jan 2;21(1). Epub 2020 Jan 2.

Black Dog Institute, University of New South Wales, Sydney, NSW, Australia.

Background: Depression frequently first emerges during adolescence, and one in five young people will experience an episode of depression by the age of 18 years. Despite advances in treatment, there has been limited progress in addressing the burden at a population level. Accordingly, there has been growing interest in prevention approaches as an additional pathway to address depression. Depression can be prevented using evidence-based psychological programmes. However, barriers to implementing and accessing these programmes remain, typically reflecting a requirement for delivery by clinical experts and high associated delivery costs. Digital technologies, specifically smartphones, are now considered a key strategy to overcome the barriers inhibiting access to mental health programmes. The Future Proofing Study is a large-scale school-based trial investigating whether cognitive behaviour therapies (CBT) delivered by smartphone application can prevent depression.

Methods: A randomised controlled trial targeting up to 10,000 Year 8 Australian secondary school students will be conducted. In Stage I, schools will be randomised at the cluster level either to receive the CBT intervention app (SPARX) or to a non-active control group comparator. The primary outcome will be symptoms of depression, and secondary outcomes include psychological distress, anxiety and insomnia. At the 12-month follow-up, participants in the intervention arm with elevated depressive symptoms will participate in an individual-level randomised controlled trial (Stage II) and be randomised to receive a second CBT app which targets sleep difficulties (Sleep Ninja) or a control condition. Assessments will occur post intervention (both trial stages) and at 6, 12, 24, 36, 48 and 60 months post baseline. Primary analyses will use an intention-to-treat approach and compare changes in symptoms from baseline to follow-up relative to the control group using mixed-effect models.

Discussion: This is the first trial testing the effectiveness of smartphone apps delivered to school students to prevent depression at scale. Results from this trial will provide much-needed insight into the feasibility of this approach. They stand to inform policy and commission decisions concerning if and how such programmes should be deployed in school-based settings in Australia and beyond.

Trial Registration: Australian and New Zealand Clinical Trial Registry, ACTRN12619000855123. Registered on 31 May 2019. Clinical Trial Notification Scheme (CTN), CT-2019-CTN-02110-1-v1. Registered on 30 June 2019.
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http://dx.doi.org/10.1186/s13063-019-3901-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6941300PMC
January 2020

A trial protocol for the effectiveness of digital interventions for preventing depression in adolescents: The Future Proofing Study.

Trials 2020 Jan 2;21(1). Epub 2020 Jan 2.

Black Dog Institute, University of New South Wales, Sydney, NSW, Australia.

Background: Depression frequently first emerges during adolescence, and one in five young people will experience an episode of depression by the age of 18 years. Despite advances in treatment, there has been limited progress in addressing the burden at a population level. Accordingly, there has been growing interest in prevention approaches as an additional pathway to address depression. Depression can be prevented using evidence-based psychological programmes. However, barriers to implementing and accessing these programmes remain, typically reflecting a requirement for delivery by clinical experts and high associated delivery costs. Digital technologies, specifically smartphones, are now considered a key strategy to overcome the barriers inhibiting access to mental health programmes. The Future Proofing Study is a large-scale school-based trial investigating whether cognitive behaviour therapies (CBT) delivered by smartphone application can prevent depression.

Methods: A randomised controlled trial targeting up to 10,000 Year 8 Australian secondary school students will be conducted. In Stage I, schools will be randomised at the cluster level either to receive the CBT intervention app (SPARX) or to a non-active control group comparator. The primary outcome will be symptoms of depression, and secondary outcomes include psychological distress, anxiety and insomnia. At the 12-month follow-up, participants in the intervention arm with elevated depressive symptoms will participate in an individual-level randomised controlled trial (Stage II) and be randomised to receive a second CBT app which targets sleep difficulties (Sleep Ninja) or a control condition. Assessments will occur post intervention (both trial stages) and at 6, 12, 24, 36, 48 and 60 months post baseline. Primary analyses will use an intention-to-treat approach and compare changes in symptoms from baseline to follow-up relative to the control group using mixed-effect models.

Discussion: This is the first trial testing the effectiveness of smartphone apps delivered to school students to prevent depression at scale. Results from this trial will provide much-needed insight into the feasibility of this approach. They stand to inform policy and commission decisions concerning if and how such programmes should be deployed in school-based settings in Australia and beyond.

Trial Registration: Australian and New Zealand Clinical Trial Registry, ACTRN12619000855123. Registered on 31 May 2019. Clinical Trial Notification Scheme (CTN), CT-2019-CTN-02110-1-v1. Registered on 30 June 2019.
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http://dx.doi.org/10.1186/s13063-019-3901-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6941300PMC
January 2020

Pilot evaluation of the Sleep Ninja: a smartphone application for adolescent insomnia symptoms.

BMJ Open 2019 05 27;9(5):e026502. Epub 2019 May 27.

Black Dog Institute, University of New South Wales, Sydney, NSW, Australia.

Objectives: The aim of this study was to test the feasibility, acceptability and preliminary effects of a recently developed smartphone application, Sleep Ninja, for adolescent sleep difficulties.

Setting: The study was conducted online with Australian individuals recruited through the community.

Participants: Participants were 50 young people aged 12-16 years with sleep difficulties.

Design: A single-arm pre-post design was used to evaluate feasibility, acceptability and sleep and mental health variables at baseline and postintervention.

Intervention: Cognitive-behavioural therapy for insomnia informed the development of the Sleep Ninja. The core strategies covered by the app are psychoeducation, stimulus control, sleep hygiene and sleep-related cognitive therapy. It includes six training sessions (lessons), a sleep tracking function, recommended bedtimes based on sleep guidelines, reminders to start a wind-down routine each night, a series of sleep tips and general information about sleep. Users progress through each training session and conclude the 6-week programme with a black belt in sleep.

Outcome Measures: Feasibility was evaluated based on consent rates, adherence and attrition, acceptability was assessed using questionnaires and a poststudy interview, and sleep, depression and anxiety variables were assessed at baseline and postintervention.

Results: Data indicated that the Sleep Ninja is a feasible intervention and is acceptable to young people. Findings showed that there were significant improvements on sleep variables including insomnia (within-group effect size d=-0.90), sleep quality (d0.46), depression (d=-0.36) and anxiety (d=-0.41).

Conclusions: The Sleep Ninja is a promising intervention that could assist adolescents who experience sleep difficulties. A follow-up randomised controlled trial is now warranted.

Trial Registration Number: ACTRN12617000141347.
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http://dx.doi.org/10.1136/bmjopen-2018-026502DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6537982PMC
May 2019

Personally salient, emotionally negative task contexts provoke goal neglect in depression.

Psychol Med 2020 04 6;50(5):874-880. Epub 2019 May 6.

Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, Cambridgeshire, UK.

Background: Goal neglect refers to a dissociation between intended and actual action. Although commonly associated with frontal brain damage, this phenomenon is also characteristic of clinical depression. To date, tests of goal neglect typically require individuals to switch between subtasks populated with neutral stimuli. This study examined the impact of affective and personally salient stimulus contexts on goal neglect in clinical depression.

Methods: Participants were randomly allocated to either positively or negatively-valenced versions of the Affective Six Elements Test (A-SET). We hypothesised that depressed individuals (n = 30) would exhibit an overall impairment in A-SET performance by neglecting entire subtasks and allocating suboptimal time to each task, relative to never-depressed peers (n = 30), with effects being strongest for the negatively-valenced version.

Results: Findings showed that depressed individuals exhibited specific deficits, relative to controls on these measures in the negative A-SET only, with a magnitude comparable to that found in brain injured patients.

Conclusions: Individuals with depression are impaired in their ability to monitor performance and implement strategies that are optimal for the purpose of pursuing an overarching goal when the task context is negatively-valenced. Potential mechanisms are discussed.
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http://dx.doi.org/10.1017/S0033291719000886DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7168650PMC
April 2020

The Social and Emotional Impact of Involving Individuals With Mental Illness in the Research Process.

Qual Health Res 2019 09 19;29(11):1634-1640. Epub 2019 Apr 19.

1 Black Dog Institute, The University of New South Wales, Randwick, New South Wales, Australia.

There is a need to involve individuals with a lived experience in health and medical research. Some organizations have developed mechanisms to seek the input of people with a lived experience. However, there are few examples of qualitative research into the impacts of participation. In this study, we investigate the social and emotional impact of participation on individuals, as well as the perceived impact on the organization, in an advisory panel at an Australian mental health research institute. In-depth qualitative interviews were conducted with 50% of the participants on the panel to understand how they conceptualized their involvement. Participants became invested in the organization and their role within it, and found it personally valuable to access diverse perspectives and discuss mental health outside a treatment context. These findings suggest that participating in the research process is beneficial to individuals with a lived experience of mental illness.
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http://dx.doi.org/10.1177/1049732319837232DOI Listing
September 2019

The Social and Emotional Impact of Involving Individuals With Mental Illness in the Research Process.

Qual Health Res 2019 09 19;29(11):1634-1640. Epub 2019 Apr 19.

1 Black Dog Institute, The University of New South Wales, Randwick, New South Wales, Australia.

There is a need to involve individuals with a lived experience in health and medical research. Some organizations have developed mechanisms to seek the input of people with a lived experience. However, there are few examples of qualitative research into the impacts of participation. In this study, we investigate the social and emotional impact of participation on individuals, as well as the perceived impact on the organization, in an advisory panel at an Australian mental health research institute. In-depth qualitative interviews were conducted with 50% of the participants on the panel to understand how they conceptualized their involvement. Participants became invested in the organization and their role within it, and found it personally valuable to access diverse perspectives and discuss mental health outside a treatment context. These findings suggest that participating in the research process is beneficial to individuals with a lived experience of mental illness.
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http://dx.doi.org/10.1177/1049732319837232DOI Listing
September 2019

A randomised controlled trial of memory flexibility training (MemFlex) to enhance memory flexibility and reduce depressive symptomatology in individuals with major depressive disorder.

Behav Res Ther 2018 11 29;110:22-30. Epub 2018 Aug 29.

Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, United Kingdom; Cambridgeshire and Peterborough NHS Foundation Trust, United Kingdom.

Successful navigation within the autobiographical memory store is integral to daily cognition. Impairment in the flexibility of memory retrieval can thereby have a detrimental impact on mental health. This randomised controlled phase II exploratory trial (N = 60) evaluated the potential of a novel intervention drawn from basic science - an autobiographical Memory Flexibility (MemFlex) training programme - which sought to ameliorate memory difficulties and improve symptoms of Major Depressive Disorder. MemFlex was compared to Psychoeducation (an evidence-based low-intensity intervention) to determine the likely range of effects on a primary cognitive target of memory flexibility at post-intervention, and co-primary clinical targets of self-reported depressive symptoms and diagnostic status at three-month follow-up. These effect sizes could subsequently be used to estimate sample size for a fully-powered trial. Results demonstrated small-moderate, though as expected statistically non-significant, effect sizes in favour of MemFlex for memory flexibility (d = 0.34, p = .20), and loss of diagnosis (OR = 0.65, p = .48), along with the secondary outcome of depression-free days (d = 0.36, p = .18). A smaller effect size was observed for between-group difference in self-reported depressive symptoms (d = 0.24, p = .35). Effect sizes in favour of MemFlex in this early-stage trial suggest that fully-powered evaluation of MemFlex may be warranted as an avenue to improving low-intensity treatment of depression.

Trial Registration: ClinicalTrials.gov, Identifier NCT02371291.
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http://dx.doi.org/10.1016/j.brat.2018.08.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6173798PMC
November 2018

Digitally-delivered cognitive-behavioural therapy for youth insomnia: A systematic review.

Internet Interv 2018 Mar 7;11:71-78. Epub 2018 Feb 7.

Black Dog Institute, University of New South Wales, Sydney, NSW, Australia.

Sleep disturbance is common among young people, with consequences for academic, emotional and behavioural development. Cognitive-behavioural therapy for insomnia (CBT-I) is efficacious, yet it is costly and not available to many who need it. Digitally-delivered CBT-I (eCBT-I) has the potential to overcome these barriers. The purpose of this systematic review was to identify studies which report on the efficacy or effectiveness of eCBT-I for young people with sleep disturbance. Electronic databases were systematically searched and three studies met inclusion criteria. Two studies used the same online intervention for adolescents with insomnia symptoms, while the other was conducted in a college sample of individuals who opted into a stress-management study. Results showed that eCBT-I improved sleep efficiency, sleep quality, sleep-onset latency and total sleep time with effect sizes ranging from 0.17-1.30 (Cohen's ). This suggests that eCBT-I is a promising intervention for young people, but more studies are needed to verify the conditions under which it is most effective.
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http://dx.doi.org/10.1016/j.invent.2018.01.007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6084877PMC
March 2018

Turning gold into lead: Dampening appraisals reduce happiness and pleasantness and increase sadness during anticipation and recall of pleasant activities in the laboratory.

Behav Res Ther 2018 08 25;107:19-33. Epub 2018 May 25.

Black Dog Institute, Sydney, Australia.

Two studies examined whether use of dampening appraisals (e.g., thinking "this is too good to last") or amplifying appraisals (e.g., thinking "I deserve this") modulated affective experience when remembering (Study One) and anticipating (Study Two) positive events. Both studies used a mixed within-between participants design, with participants completing an uninstructed positive recall/anticipation task before being randomized to either control, dampening, or amplifying instructions during a second positive recall/anticipation task. During memory recall (Study One), instructed dampening increased dampening appraisals and led to a reduction in happiness and pleasantness and an increase in sadness, significantly differing from the control and amplifying conditions. While the amplifying condition significantly increased amplifying appraisals, it did not alter affective experience (relative to the control condition). During anticipation (Study Two), identical findings emerged for the dampening manipulation. The amplifying manipulation did not significantly increase amplifying appraisals, precluding conclusions being drawn about the impact of amplifying in this study. These results suggest that dampening appraisals contribute to altered affective experience when imagining and recalling positive activities and may account for why attempts to do so can have paradoxically negative effects in clinical populations. Moreover, the studies preliminarily validate a novel scale measuring state appraisal of positive experiences.
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http://dx.doi.org/10.1016/j.brat.2018.05.003DOI Listing
August 2018

The Impact of Affective Context on Autobiographical Recollection in Depression.

Clin Psychol Sci 2018 May 16;6(3):315-324. Epub 2017 Nov 16.

Medical Research Council (MRC) Cognition and Brain Sciences Unit, Cambridge University.

Across two studies we investigated the influence of contextual cues on autobiographical memory recall. In Study 1, participants ( = 37) with major depressive disorder, in episode or in varying degrees of remission, were administered a Negative Autobiographical Memory Task (NAMT) that required them to retrieve valenced memories in response to cue words (a positive context). We reasoned that increased depression symptom severity would be associated with a reduced ability to override priming from this disadvantageous context. Consequently, we hypothesized that increased depressive severity would counterintuitively be associated with negativity ratings for retrieved personal memories to positive cues on the NAMT. This hypothesis was supported. Study 2, using a community sample ( = 63), demonstrated that a similar reduction in memory negativity was observed in individuals with lower working memory capacity-an index of executive control. Implications for autobiographical memory and executive training paradigms for depression are discussed.
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http://dx.doi.org/10.1177/2167702617740672DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5952300PMC
May 2018