Publications by authors named "Michael Kyrios"

70 Publications

Contemporary treatment of anxiety in primary care: a systematic review and meta-analysis of outcomes in countries with universal healthcare.

BMC Fam Pract 2021 05 15;22(1):92. Epub 2021 May 15.

College of Education, Psychology and Social Work, Flinders University, Adelaide, Australia.

Background: Anxiety disorders are highly prevalent mental health conditions and are managed predominantly in primary care. We conducted a systematic review and meta-analysis of psychological and pharmacological treatments in countries with universal healthcare, and investigated the influence of treatment provider on the efficacy of psychological treatment.

Method: PubMed, Cochrane, PsycINFO, CINAHL, and Scopus were searched in April 2017 for controlled studies of evidence-based anxiety treatment in adults in primary care, published in English since 1997. Searches were repeated in April 2020. We synthesised results using a combination of meta-analysis and narrative methods. Meta-analysis was conducted using a random-effects multi-level model to account for intercorrelation between effects contributed different treatment arms of the same study. Moderator variables were explored using meta-regression analyses.

Results: In total, 19 articles (from an initial 2,247) reporting 18 studies were included. Meta-analysis including ten studies (n = 1,308) found a pooled effect size of g = 1.16 (95%CI = 0.63 - 1.69) for psychological treatment compared to waitlist control, and no significant effect compared to care as usual (p = .225). Substantial heterogeneity was present (I = 81.25). Specialist treatment produced large effects compared to both waitlist control (g = 1.46, 95%CI = 0.96 - 1.96) and care as usual (g = 0.76, 95%CI = 0.27 - 1.25). Treatment provided by non-specialists was only superior to waitlist control (g = 0.80, 95%CI = 0.31 - 1.28). We identified relatively few studies (n = 4) of medications, which reported small to moderate effects for SSRI/SNRI medications and hydroxyzine. The quality of included studies was variable and most studies had at least "unclear" risk of bias in one or more key domains.

Conclusions: Psychological treatments for anxiety are effective in primary care and are more effective when provided by a specialist (psychologist or clinical psychologist) than a non-specialist (GP, nurse, trainee). However, non-specialists provide effective treatment compared with no care at all. Limited research into the efficacy of pharmacological treatments in primary care needs to be considered carefully by prescribers TRIAL REGISTRATION: PROSPERO registration number CRD42018050659.
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http://dx.doi.org/10.1186/s12875-021-01445-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8126070PMC
May 2021

A systematic review and meta-analysis of psychological interventions to improve mental wellbeing.

Nat Hum Behav 2021 05 19;5(5):631-652. Epub 2021 Apr 19.

Wellbeing and Resilience Centre, Lifelong Health Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.

Our current understanding of the efficacy of psychological interventions in improving mental states of wellbeing is incomplete. This study aimed to overcome limitations of previous reviews by examining the efficacy of distinct types of psychological interventions, irrespective of their theoretical underpinning, and the impact of various moderators, in a unified systematic review and meta-analysis. Four-hundred-and-nineteen randomized controlled trials from clinical and non-clinical populations (n = 53,288) were identified for inclusion. Mindfulness-based and multi-component positive psychological interventions demonstrated the greatest efficacy in both clinical and non-clinical populations. Meta-analyses also found that singular positive psychological interventions, cognitive and behavioural therapy-based, acceptance and commitment therapy-based, and reminiscence interventions were impactful. Effect sizes were moderate at best, but differed according to target population and moderator, most notably intervention intensity. The evidence quality was generally low to moderate. While the evidence requires further advancement, the review provides insight into how psychological interventions can be designed to improve mental wellbeing.
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http://dx.doi.org/10.1038/s41562-021-01093-wDOI Listing
May 2021

Proposed diagnostic criteria for compulsive buying-shopping disorder: A Delphi expert consensus study.

J Behav Addict 2021 Apr 13. Epub 2021 Apr 13.

4College of Education, Psychology and Social Work, Flinders University, Adelaide, Australia.

Background And Aims: Consensus in acknowledging compulsive buying-shopping disorder (CBSD) as a distinct diagnosis has been lacking. Before research in this area can be advanced, it is necessary to establish diagnostic criteria in order to facilitate field trials.

Methods: The study consisted of the following phases: (1) operationalization of a broad range of potential diagnostic criteria for CBSD, (2) two iterative rounds of data collection using the Delphi method, where consensus of potential diagnostic criteria for CBSD was reached by an international expert panel, and (3) interpretation of findings taking into account the degree of certainty amongst experts regarding their responses.

Results: With respect to diagnostic criteria, there was clear expert consensus about inclusion of the persistent and recurrent experience of (a) intrusive and/or irresistible urges and/or impulses and/or cravings and/or preoccupations for buying/shopping; (b) diminished control over buying/shopping; (c) excessive purchasing of items without utilizing them for their intended purposes, (d) use of buying-shopping to regulate internal states; (e) negative consequences and impairment in important areas of functioning due to buying/shopping; (f) emotional and cognitive symptoms upon cessation of excessive buying/shopping; and (g) maintenance or escalation of dysfunctional buying/shopping behaviors despite negative consequences. Furthermore, support was found for a specifier related to the presence of excessive hoarding of purchased items.

Conclusions: The proposed diagnostic criteria can be used as the basis for the development of diagnostic interviews and measures of CBSD severity.
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http://dx.doi.org/10.1556/2006.2021.00013DOI Listing
April 2021

Object attachment in buying-shopping disorder.

Curr Opin Psychol 2021 06 7;39:115-120. Epub 2020 Sep 7.

College of Education, Psychology and Social Work, Flinders University, Adelaide, Australia; Órama Institute for Mental Health and Wellbeing, Flinders University, Adelaide, Australia.

Buying-shopping disorder (BSD) is considered a behavioral addiction that is characterized by poorly controlled spending of money for consumer goods in unnecessary quantities, beyond budget and without necessarily utilizing them for their intended purposes. Little is known about the role of emotional attachment to the purchased products in BSD. Given the relative lack of empirical data on object attachment in relation to BSD, this narrative review relies on patients' reports and studies concerning erroneous beliefs about possessions and the influence of materialism, identity problems and narcissistic deficits on symptom severity of BSD. The findings indicate that BSD is mainly driven by materialistic values endorsement and the desire to regulate negative feelings, poor self-esteem and identity confusion via purchasing material goods.
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http://dx.doi.org/10.1016/j.copsyc.2020.08.019DOI Listing
June 2021

Using Internet-Based Psychological Measurement to Capture the Deteriorating Community Mental Health Profile During COVID-19: Observational Study.

JMIR Ment Health 2020 Jun 11;7(6):e20696. Epub 2020 Jun 11.

College of Education, Psychology and Social Work, Flinders University, Adelaide, Australia.

Background: The coronavirus disease (COVID-19) is expected to have widespread and pervasive implications for mental health in terms of deteriorating outcomes and increased health service use, leading to calls for empirical research on mental health during the pandemic. Internet-based psychological measurement can play an important role in collecting imperative data, assisting to guide evidence-based decision making in practice and policy, and subsequently facilitating immediate reporting of measurement results to participants.

Objective: The aim of this study is to use an internet-based mental health measurement platform to compare the mental health profile of community members during COVID-19 with community members assessed before the pandemic.

Methods: This study uses an internet-based self-assessment tool to collect data on psychological distress, mental well-being, and resilience in community cohorts during (n=673) and prior to the pandemic (two cohorts, n=1264 and n=340).

Results: Our findings demonstrate significantly worse outcomes on all mental health measures for participants measured during COVID-19 compared to those measured before (P<.001 for all outcomes, effect sizes ranging between Cohen d=0.32 to Cohen d=0.81. Participants who demonstrated problematic scores for at least one of the mental health outcomes increased from 58% (n=197/340) before COVID-19 to 79% (n=532/673) during COVID-19, leading to only 21% (n=141) of measured participants displaying good mental health during the pandemic.

Conclusions: The results clearly demonstrate deterioration in mental health outcomes during COVID-19. Although further research is needed, our findings support the serious mental health implications of the pandemic and highlight the utility of internet-based data collection tools in providing evidence to innovate and strengthen practice and policy during and after the pandemic.
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http://dx.doi.org/10.2196/20696DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7294997PMC
June 2020

Cost-effectiveness of internet-based cognitive-behavioural therapy for obsessive-compulsive disorder.

Internet Interv 2019 Dec 3;18:100277. Epub 2019 Sep 3.

Centre for Mental Health, Swinburne University of Technology, PO Box 218, Hawthorn, VIC 3122, Australia.

Economic analyses of treatments for OCD have been limited. This study analysed the comparative economic benefits and costs of an internet-based CBT (iCBT) relative to internet-based progressive relaxation therapy (iPRT) control. These were benchmarked against current estimates for face-to-face CBT (ffCBT) sourced from literature. The benefits to society of providing increased access to treatment was assessed using a cost-benefit analysis based upon productivity gains arising from treatment. Identification of the most cost-effective treatment amongst the three treatments was assessed using a cost-effectiveness analysis based upon both effectiveness as measured by the Yale-Brown Obsessive Compulsive Scale (YBOCS) and percentage of responders. The cost-effectiveness analysis showed iCBT to be the most cost effective treatment of the three analysed, followed by ffCBT based upon percentage of responders and iPRT based upon overall effectiveness of treatment. The cost-benefit analyses showed all treatment options delivered substantial benefits to society. These benefits ranged from three to thirty-five times the cost of providing treatment, depending on the assumptions used and the treatment provided, with iCBT showing the greatest ratio of benefits to costs but the ffCBT providing the greatest absolute benefits. Overall, the findings provide support for increased access to CBT intervention, for all patients with OCD; with online therapist-assisted modes of delivery as a cost-effective alternative to existing face-to-face treatments. Further work to more accurately quantify the benefits and costs resulting from CBT treatment modalities is required to support these preliminary findings.
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http://dx.doi.org/10.1016/j.invent.2019.100277DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6926329PMC
December 2019

A novel multi-component online intervention to improve the mental health of university students: Randomised controlled trial of the Uni Virtual Clinic.

Internet Interv 2019 Dec 28;18:100276. Epub 2019 Aug 28.

Centre for Mental Health Research, The Australian National University, Australia.

Background: Of the millions of students enrolled in university, up to 50% will experience a mental disorder. Many of these students do not seek help, and for those who do, university-based services are often over-burdened. Anonymous, evidence-based, online interventions can improve students' access to mental health support. The Uni Virtual Clinic (UVC) is a transdiagnostic online mental health program designed specifically for university students. This paper reports on a randomised controlled trial examining the effectiveness of the UVC in a sample of Australian university students.

Methods: University students with elevated psychological distress (K10>15;  = 200) were randomised to the UVC intervention or a waitlist control condition for a period of 6 weeks. Baseline, post-intervention, and 3-month follow-up surveys assessed depression, anxiety, self-efficacy, quality of life, adherence, and satisfaction with the UVC intervention.

Results: Mixed models analysis demonstrated that use of the UVC was associated with small significant reductions in social anxiety and small improvements in academic self-efficacy. The program was not effective in reducing symptoms of depression, anxiety, or psychological distress compared to a control group. The majority of participants in the intervention condition who were retained at follow-up engaged with the program, and most of these participants reported satisfaction with the UVC.

Discussion: The results suggest that multi-component online interventions such as the UVC have utility in a university environment. Future trials of the UVC should examine the impact of guidance and/or tailoring on treatment efficacy, and the potential role of the UVC in a stepped care model incorporating on-campus services.
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http://dx.doi.org/10.1016/j.invent.2019.100276DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6926241PMC
December 2019

Predicting engagement with an online psychosocial intervention for psychosis: Exploring individual- and intervention-level predictors.

Internet Interv 2019 Dec 15;18:100266. Epub 2019 Aug 15.

Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia.

Background: Individuals with psychosis demonstrate positive attitudes towards utilising digital technology in mental health treatment. Although preliminary research suggests digital interventions are feasible and acceptable in this population, little is known about how to best promote engagement with these resources. Candidate predictors include therapist support, sources of motivation and recovery style. Understanding what factors predict engagement will aid more effective design and implementation of digital interventions to improve clinical benefits.

Objective: This study aimed to investigate demographic, psychological, and treatment variables that predict overall and type of engagement with a psychosocial, online intervention for individuals with psychosis.

Methods: Ninety-eight participants with a history of psychosis were given access to a web program containing modules on self-management and recovery, which they were asked to use flexibly at their own pace. Activity was automatically logged by the system. Baseline measures of demographics, recovery style and motivation were administered, and participants were randomised to receive either website access alone, or website access plus weekly, asynchronous emails from an online coach over 12 weeks. Log and baseline assessment data were used in negative binomial regressions to examine predictors of depth and breadth of use over the intervention period. A logistic regression was used to examine the impact of predictor variables on usage profiles (active or passive).

Results: Depth and breadth of engagement were positively predicted by receiving email support, low levels of externally controlled motivations for website use, older age, and having a tertiary education. There was a significant interaction between level of controlled motivation and condition (+/-email) on breadth and depth of engagement: receiving asynchronous emails was associated with increased engagement for individuals with low, but not high, levels of externally controlled motivations. Receiving email support and more autonomous motivations for treatment predicted more active use of the website.

Conclusions: Asynchronous email support can promote engagement with online interventions for individuals with psychosis, potentially enabling self-management of illness and improving clinical outcomes. However, those using online interventions due to external motivating factors, may have low levels of engagement with the intervention, irrespective of coaching provided. These findings may guide design and implementation of future online interventions in this population.
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http://dx.doi.org/10.1016/j.invent.2019.100266DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6926321PMC
December 2019

Comorbid elevated symptoms of anxiety and depression in adults with type 1 or type 2 diabetes: Results from the International Diabetes MILES Study.

J Diabetes Complications 2019 08 28;33(8):523-529. Epub 2019 Apr 28.

Deakin University, School of Psychology, Geelong, Australia; Department of Psychology, University of Southern Denmark, Odense, Denmark; STENO Diabetes Center Odense.

Aims: We examined: (a) the prevalence of comorbid elevated symptoms of anxiety/depression; (b) its demographic/clinical correlates; (c) associations with self-care behaviors, by diabetes type.

Methods: Cross-sectional self-report data of 6590 adults with diabetes (42% type 1; 58% type 2) from the Australian and Dutch Diabetes MILES studies were used. Elevated symptoms of anxiety/depression were defined as GAD-7 ≥ 10/PHQ-9 ≥ 10.

Results: In both diabetes types, comorbid elevated symptoms of anxiety/depression were present in 9% and symptoms of anxiety alone in 2%; symptoms of depression alone were present in 8% of adults with type 1 diabetes and 11% with type 2 diabetes. Shorter diabetes duration (type 1 only) was the only characteristic that distinguished those with comorbid elevated symptoms of anxiety/depression but not those with symptoms of anxiety/depression alone from the reference group (no/minimal symptoms of anxiety/depression). Those with comorbid elevated symptoms of anxiety/depression had increased odds of sub-optimal diabetes self-care behaviors compared with the reference group, with higher odds than those with symptoms of anxiety or depression alone.

Conclusions: Comorbid elevated symptoms of anxiety/depression affected one in ten respondents, who also had increased odds of suboptimal diabetes self-care. Those with shorter type 1 diabetes duration may be at increased risk.
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http://dx.doi.org/10.1016/j.jdiacomp.2019.04.013DOI Listing
August 2019

Buying-shopping disorder-is there enough evidence to support its inclusion in ICD-11?

CNS Spectr 2019 08 3;24(4):374-379. Epub 2019 Jan 3.

College of Education,Psychology and Social Work,Flinders University,Adelaide,Australia.

The phenomenon of buying-shopping disorder (BSD) was described over 100 years ago. Definitions of BSD refer to extreme preoccupation with shopping and buying, to impulses to purchase that are experienced as irresistible, and to recurrent maladaptive buying excesses that lead to distress and impairments. Efforts to stop BSD episodes are unsuccessful, despite the awareness of repeated break-downs in self-regulation, experiences of post-purchase guilt and regret, comorbid psychiatric disorders, reduced quality of life, familial discord, work impairment, financial problems, and other negative consequences. A recent meta-analysis indicated an estimated point prevalence of BSD of 5%. In this narrative review, the authors offer a perspective to consider BSD as a mental health condition and to classify this disorder as a behavioral addiction, based on both research data and on long-standing clinical experience.
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http://dx.doi.org/10.1017/S1092852918001323DOI Listing
August 2019

Buying-shopping disorder-is there enough evidence to support its inclusion in ICD-11?

CNS Spectr 2019 08 3;24(4):374-379. Epub 2019 Jan 3.

College of Education,Psychology and Social Work,Flinders University,Adelaide,Australia.

The phenomenon of buying-shopping disorder (BSD) was described over 100 years ago. Definitions of BSD refer to extreme preoccupation with shopping and buying, to impulses to purchase that are experienced as irresistible, and to recurrent maladaptive buying excesses that lead to distress and impairments. Efforts to stop BSD episodes are unsuccessful, despite the awareness of repeated break-downs in self-regulation, experiences of post-purchase guilt and regret, comorbid psychiatric disorders, reduced quality of life, familial discord, work impairment, financial problems, and other negative consequences. A recent meta-analysis indicated an estimated point prevalence of BSD of 5%. In this narrative review, the authors offer a perspective to consider BSD as a mental health condition and to classify this disorder as a behavioral addiction, based on both research data and on long-standing clinical experience.
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http://dx.doi.org/10.1017/S1092852918001323DOI Listing
August 2019

"Blended" therapy: The development and pilot evaluation of an internet-facilitated cognitive behavioral intervention to supplement face-to-face therapy for hoarding disorder.

Internet Interv 2018 Jun 21;12:16-25. Epub 2018 Feb 21.

School of Psychology, Deakin University, Burwood, Australia.

Mixed findings regarding the long-term efficacy of cognitive behavior therapy (CBT) for the treatment of hoarding has led to the investigation of novel treatment approaches. "Blended" therapy, a combination of face-to-face (f2f) and online therapy, is a form of therapy that enables longer exposure to therapy in a cost-effective and accessible format. Blended therapy holds many benefits, including increased access to content, lower time commitment for clinicians, and lower costs. The aim of the present study was to develop and evaluate a "blended" treatment program for hoarding disorder (HoPE), involving 12-weeks of face-to-face group therapy, and an 8 week online therapist assisted program. A sample of 12 participants with hoarding symptomology were recruited from the Melbourne Metropolitan area, and were involved in one of two conditions; 12 weeks group therapy +8 weeks online therapy (bCBT) or 12 weeks group therapy +8 weeks waitlist +8 weeks online therapy. Questionnaires were completed at all time points. The 8-week online component consists of 8 CBT-based modules, addressing psychoeducation, goal setting, motivation, relapse prevention and other key components. No significant differences were found over time between the bCBT group and waitlist control group, however trends suggested continued improvement in overall hoarding scores for the bCBT group, when compared to the waitlist control group. There were significant differences in scores from pre-treatment to 28 weeks, suggesting that all participants who were involved in the online intervention showed continued improvement from pre-treatment to post-treatment. This study highlights the potential benefit of novel formats of treatment. Future research into the efficacy of blended therapy would prove beneficial.
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http://dx.doi.org/10.1016/j.invent.2018.02.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6096324PMC
June 2018

Therapist-Assisted Internet-Based Cognitive Behavioral Therapy Versus Progressive Relaxation in Obsessive-Compulsive Disorder: Randomized Controlled Trial.

J Med Internet Res 2018 08 8;20(8):e242. Epub 2018 Aug 8.

Department of Statistics Data Science and Epidemiology, School of Health Sciences, Swinburne University of Technology, Melbourne, Australia.

Background: Obsessive-compulsive disorder (OCD) is a highly disabling psychological disorder with a chronic course if left untreated. Cognitive behavioral therapy (CBT) has been shown to be an effective treatment, but access to face-to-face CBT is not always possible. Internet-based CBT (iCBT) has become an increasingly viable option. However, no study has compared iCBT to an analogous control condition using a randomized controlled trial (RCT).

Objective: A 2-armed RCT was used to compare a therapist-assisted 12-module iCBT to an analogous active attention control condition (therapist-assisted internet-based standard progressive relaxation training, iPRT) in adult OCD. This paper reports pre-post findings for OCD symptom severity.

Method: In total, 179 participants (117 females, 65.7%) were randomized (stratified by gender) into iCBT or iPRT. The iCBT intervention included psychoeducation, mood and behavioral management, exposure and response prevention (ERP), cognitive therapy, and relapse prevention; the iPRT intervention included psychoeducation and relaxation techniques as a way of managing OCD-related anxiety but did not incorporate ERP or other CBT elements. Both treatments included audiovisual content, case stories, demonstrations of techniques, downloadable audio content and worksheets, and expert commentary. All participants received 1 weekly email, with a maximum 15-minute preparation time per client from a remote therapist trained in e-therapy. Emails aimed to monitor progress, provide support and encouragement, and assist in individualizing the treatment. Participants were assessed for baseline and posttreatment OCD severity with the telephone-administered clinician-rated Yale-Brown Obsessive-Compulsive Scale and other measures by assessors who were blinded to treatment allocation.

Results: No pretreatment differences were found between the 2 conditions. Intention-to-treat analysis revealed significant pre-post improvements in OCD symptom severity for both conditions (P<.001). However, relative to iPRT, iCBT showed significantly greater symptom severity improvement (P=.001); Cohen d for iCBT was 1.05 (95% CI 0.72-1.37), whereas for iPRT it was 0.48 (95% CI 0.22-0.73). The iCBT condition was superior in regard to reliable improvement (25/51, 49% vs 16/55, 29%; P=.04) and clinically significant pre-post-treatment changes (17/51, 33% vs 6/55, 11%; P=.005). Those undertaking iCBT post completion of iPRT showed further significant symptom amelioration (P<.001), although the sequential treatment was no more efficacious than iCBT alone (P=.63).

Conclusion: This study is the first to compare a therapist-assisted iCBT program for OCD to an analogous active attention control condition using iPRT. Our findings demonstrate the large magnitude effect of iCBT for OCD; interestingly, iPRT was also moderately efficacious, albeit significantly less so than the iCBT intervention. The findings are compared to previous internet-based and face-to-face CBT treatment programs for OCD. Future directions for technology-enhanced programs for the treatment of OCD are outlined.

Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12611000321943; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=336704 (Archived by WebCite at http://www.webcitation.org/70ovUiOmd).
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http://dx.doi.org/10.2196/jmir.9566DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6105869PMC
August 2018

Web-based intervention to improve quality of life in late stage bipolar disorder (ORBIT): randomised controlled trial protocol.

BMC Psychiatry 2018 07 13;18(1):221. Epub 2018 Jul 13.

Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia.

Background: The primary objective of this randomised controlled trial (RCT) is to establish the effectiveness of a novel online quality of life (QoL) intervention tailored for people with late stage (≥ 10 episodes) bipolar disorder (BD) compared with psychoeducation. Relative to early stage individuals, this late stage group may not benefit as much from existing psychosocial treatments. The intervention is a guided self-help, mindfulness based intervention (MBI) developed in consultation with consumers, designed specifically for web-based delivery, with email coaching support.

Methods/design: This international RCT will involve a comparison of the effectiveness and cost-effectiveness of two 5-week adjunctive online self-management interventions: Mindfulness for Bipolar 2.0 and an active control (Psychoeducation for Bipolar). A total of 300 participants will be recruited primarily via social media channels. Main inclusion criteria are: a diagnosis of BD (confirmed via a phone-administered structured diagnostic interview), no current mood episode, history of 10 or more mood episodes, no current psychotic features or active suicidality, under the care of a medical practitioner. Block randomisation will be used for allocation to the interventions, and participants will retain access to the program for 6 months. Evaluations will be conducted at pre- and post- treatment, and at 3- and 6- months follow-up. The primary outcome measure will be the Brief Quality of Life in Bipolar Disorder Scale (Brief QoL.BD), collected immediately post-intervention at 5 weeks (T1). Secondary measures include BD-related symptoms (mania, depression, anxiety, stress), time to first relapse, functioning, sleep quality, social rhythm stability and resource use. Measurements will be collected online and via telephone assessments at baseline (T0), 5 weeks (T1), three months (T2) and six months (T3). Candidate moderators (diagnosis, anxiety or substance comorbidities, demographics and current treatments) will be investigated as will putative therapeutic mechanisms including mindfulness, emotion regulation and self-compassion. A cost-effectiveness analysis will be conducted. Acceptability and any unwanted events (including adverse treatment reactions) will be documented and explored.

Discussion: This definitive trial will test the effectiveness and cost-effectiveness of a novel QoL focused, mindfulness based, online guided self-help intervention for late stage BD, and investigate its putative mechanisms of therapeutic action.

Trial Registration: ClinicalTrials.gov : NCT03197974 . Registered 23 June 2017.
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http://dx.doi.org/10.1186/s12888-018-1805-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6044003PMC
July 2018

The cognitive-behavioural model of hoarding disorder: Evidence from clinical and non-clinical cohorts.

Clin Psychol Psychother 2018 Mar 20;25(2):311-321. Epub 2017 Dec 20.

Research School of Psychology, The Australian National University, Canberra, Australia.

The cognitive-behavioural model of hoarding disorder incorporates information processing difficulties, maladaptive attachment to possessions, erroneous beliefs about the nature of possessions, and mood problems as etiologically significant factors, although developmental experiences such as a compromised early family environment have also been proposed in an augmented model. This study examined the specificity and relevance of variables highlighted in the augmented cognitive-behavioural model. Various clinical participants (n = 89) and community controls (n = 20) were assessed with structured clinical interviews to verify diagnosis. Participants completed self-report measures of hoarding severity, cognitions, meta-memory, and early developmental experiences (e.g., memories of warmth and security in one's family). Hoarding cohorts (with and without obsessive-compulsive disorder) reported poor confidence in memory, but relative to other groups (obsessive-compulsive disorder without hoarding disorder, anxiety disorders, and healthy controls), hoarding-relevant cognitions, need to keep possessions in view, and concerns about the consequences of forgetting were significantly higher. Hoarding groups reported the lowest recollections of warmth in their family, although no differences were found between hoarding and non hoarding clinical cohorts for uncertainty about self and others. Nonetheless, clinical cohorts reported generally higher scores of uncertainty than healthy controls. When predicting hoarding severity, after controlling for age and mood, recollections of lack of warmth in one's family was a significant predictor of hoarding severity, with hoarding-related cognitions and fears about decision-making being additional unique predictors. The study supports the augmented cognitive-behavioural model of hoarding, inclusive of the importance of early developmental influences in hoarding.
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http://dx.doi.org/10.1002/cpp.2164DOI Listing
March 2018

Promoting Personal Recovery in People with Persisting Psychotic Disorders: Development and Pilot Study of a Novel Digital Intervention.

Front Psychiatry 2016 23;7:196. Epub 2016 Dec 23.

Centre for Mental Health, Swinburne University of Technology, Hawthorn, VIC, Australia; Research School of Psychology, Australian National University, Canberra, ACT, Australia.

Background: For people with persisting psychotic disorders, personal recovery has become an important target of mental health services worldwide. Strongly influenced by mental health service consumer perspectives, personal recovery refers to being able to live a satisfying and contributing life irrespective of ongoing symptoms and disability. Contact with peers with shared lived experience is often cited as facilitative of recovery. We aimed to develop and pilot a novel recovery-based digitally supported intervention for people with a psychotic illness.

Methods: We developed a website to be used on a tablet computer by mental health workers to structure therapeutic discussions about personal recovery. Central to the site was a series of video interviews of people with lived experience of psychosis discussing how they had navigated issues within their own recovery based on the Connectedness-Hope-Identity-Meaning-Empowerment model of recovery. We examined the feasibility and acceptability of an 8-session low intensity intervention using this site in 10 participants with persisting psychotic disorders and conducted a proof-of-concept analysis of outcomes.

Results: All 10 participants completed the full course of sessions, and it was possible to integrate use of the website into nearly all sessions. Participant feedback confirmed that use of the website was a feasible and acceptable way of working. All participants stated that they would recommend the intervention to others. Post-intervention, personal recovery measured by the Questionnaire for the Process of Recovery had improved by an average standardized effect of  = 0.46, 95% CI [0.07, 0.84], and 8 of the 10 participants reported that their mental health had improved since taking part in the intervention.

Conclusion: In-session use of digital resources featuring peer accounts of recovery is feasible and acceptable and shows promising outcomes. A randomized controlled trial is the next step in evaluating the efficacy of this low intensity intervention when delivered in conjunction with routine mental health care.
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http://dx.doi.org/10.3389/fpsyt.2016.00196DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5179552PMC
December 2016

What Role Can Avatars Play in e-Mental Health Interventions? Exploring New Models of Client-Therapist Interaction.

Front Psychiatry 2016 18;7:186. Epub 2016 Nov 18.

National eTherapy Centre, Centre for Mental Health, Swinburne University of Technology, Melbourne, VIC, Australia; Monash Alfred Psychiatry Research Centre, Monash University Central Clinical School and The Alfred, Melbourne, VIC, Australia.

In the burgeoning field of e-mental health interventions, avatars are increasingly being utilized to facilitate online communication between clients and therapists, and among peers. Avatars are digital self-representations, which enable individuals to interact with each other in computer-based virtual environments. In this narrative review, we examine the psychotherapeutic applications of avatars that have been investigated and trialed to date. Five key applications were identified (1) in the formation of online peer support communities; (2) replicating traditional modes of psychotherapy by using avatars as a vehicle to communicate within a wholly virtual environment; (3) using avatar technology to facilitate or augment face-to-face treatment; (4) as part of serious games; and (5) communication with an autonomous virtual therapist. Across these applications, avatars appeared to serve several functions conducive to treatment engagement by (1) facilitating the development of a virtual therapeutic alliance; (2) reducing communication barriers; (3) promoting treatment-seeking through anonymity; (4) promoting expression and exploration of client identity; and (5) enabling therapists to control and manipulate treatment stimuli. Further research into the feasibility and ethical implementation of avatar-based psychotherapies is required.
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http://dx.doi.org/10.3389/fpsyt.2016.00186DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5114267PMC
November 2016

Quantity and Quality of Homework Compliance: A Meta-Analysis of Relations With Outcome in Cognitive Behavior Therapy.

Behav Ther 2016 09 19;47(5):755-772. Epub 2016 May 19.

Boston University.

Homework assignments have been shown to produce both causal and correlational effects in prior meta-analytic reviews of cognitive behavior therapy (CBT), but this research area has been characterized by a focus on the amount of compliance (i.e., quantity), and little is known about the role of skill acquisition (i.e., quality). A landmark study by Neimeyer and Feixas (1990) showed stronger homework-outcome relations when quality was assessed, but previous reviews have not considered whether the same pattern is evident across studies. Seventeen studies of CBT (N = 2,312 clients) published following calls for research on homework quality were included in the current meta-analysis. In the present review, homework compliance relations were demonstrated when outcome was assessed at posttreatment (quality Hedges' g = 0.78, 95% Confidence Interval [CI] = 0.03 to 1.53, k = 3, n = 417; quantity g = 0.79, 95% CI = 0.57 to 1.02, k = 15, n = 1537) and at follow-up (quality g = 1.07, 95% CI = 0.06 to 2.08, k = 3, n = 417; quantity g = 0.51, 95% CI = 0.28 to 0.74, k = 7, n = 1291). All effect sizes were different from 0, ps < .05. Differences that were obtained in homework-outcome relations among sources of compliance data (client, therapist, objective) were tentative due to overlapping CIs, but suggest a potential moderating effect. If confirmed by further research, the present findings would suggest that trial methods capable of assessing both quantity and quality have been an important omission in research on homework-outcome relations in CBT.
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http://dx.doi.org/10.1016/j.beth.2016.05.002DOI Listing
September 2016

Randomised controlled trial of a digitally assisted low intensity intervention to promote personal recovery in persisting psychosis: SMART-Therapy study protocol.

BMC Psychiatry 2016 09 7;16(1):312. Epub 2016 Sep 7.

Centre for Mental Health, Swinburne University of Technology, PO Box 218, Hawthorn, VIC, 3122, Australia.

Background: Psychosocial interventions have an important role in promoting recovery in people with persisting psychotic disorders such as schizophrenia. Readily available, digital technology provides a means of developing therapeutic resources for use together by practitioners and mental health service users. As part of the Self-Management and Recovery Technology (SMART) research program, we have developed an online resource providing materials on illness self-management and personal recovery based on the Connectedness-Hope-Identity-Meaning-Empowerment (CHIME) framework. Content is communicated using videos featuring persons with lived experience of psychosis discussing how they have navigated issues in their own recovery. This was developed to be suitable for use on a tablet computer during sessions with a mental health worker to promote discussion about recovery.

Methods/design: This is a rater-blinded randomised controlled trial comparing a low intensity recovery intervention of eight one-to-one face-to-face sessions with a mental health worker using the SMART website alongside routine care, versus an eight-session comparison condition, befriending. The recruitment target is 148 participants with a schizophrenia-related disorder or mood disorder with a history of psychosis, recruited from mental health services in Victoria, Australia. Following baseline assessment, participants are randomised to intervention, and complete follow up assessments at 3, 6 and 9 months post-baseline. The primary outcome is personal recovery measured using the Process of Recovery Questionnaire (QPR). Secondary outcomes include positive and negative symptoms assessed with the Positive and Negative Syndrome Scale, subjective experiences of psychosis, emotional symptoms, quality of life and resource use. Mechanisms of change via effects on self-stigma and self-efficacy will be examined.

Discussion: This protocol describes a novel intervention which tests new therapeutic methods including in-session tablet computer use and video-based peer modelling. It also informs a possible low intensity intervention model potentially viable for delivery across the mental health workforce.

Trial Registration: NCT02474524 , 24 May 2015, retrospectively registered during the recruitment phase.
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http://dx.doi.org/10.1186/s12888-016-1024-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5015321PMC
September 2016

Short-Term Cognitive-Behavioural Group Treatment for Hoarding Disorder: A Naturalistic Treatment Outcome Study.

Clin Psychol Psychother 2017 Jan 11;24(1):235-244. Epub 2016 Jan 11.

Department of Psychological Sciences, Swinburne University of Technology, Hawthorn, Australia.

The study aim was to test whether a 12-week publically rebated group programme, based upon Steketee and Frost's Cognitive Behavioural Therapy-based hoarding treatment, would be efficacious in a community-based setting. Over a 3-year period, 77 participants with clinically significant hoarding were recruited into 12 group programmes. All completed treatment; however, as this was a community-based naturalistic study, only 41 completed the post-treatment assessment. Treatment included psychoeducation about hoarding, skills training for organization and decision making, direct in-session exposure to sorting and discarding, and cognitive and behavioural techniques to support out-of-session sorting and discarding, and nonacquiring. Self-report measures used to assess treatment effect were the Savings Inventory-Revised (SI-R), Savings Cognition Inventory, and the Depression, Anxiety and Stress Scales. Pre-post analyses indicated that after 12 weeks of treatment, hoarding symptoms as measured on the SI-R had reduced significantly, with large effect sizes reported in total and across all subscales. Moderate effect sizes were also reported for hoarding-related beliefs (emotional attachment and responsibility) and depressive symptoms. Of the 41 participants who completed post-treatment questionnaires, 14 (34%) were conservatively calculated to have clinically significant change, which is considerable given the brevity of the programme judged against the typical length of the disorder. The main limitation of the study was the moderate assessment completion rate, given its naturalistic setting. This study demonstrated that a 12-week group treatment for hoarding disorders was effective in reducing hoarding and depressive symptoms in an Australian clinical cohort and provides evidence for use of this treatment approach in a community setting. Copyright © 2016 John Wiley & Sons, Ltd.

Key Practitioner Message: A 12-week group programme delivered in a community setting was effective for helping with hoarding symptoms with a large effect size. Hoarding beliefs (emotional attachment and responsibility) and depression were reduced, with moderate effect sizes. A third of all participants who completed post-treatment questionnaires experienced clinically significant change. Suggests that hoarding CBT treatment can be effectively translated into real-world settings and into a brief 12-session format, albeit the study had a moderate assessment completion rate.
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http://dx.doi.org/10.1002/cpp.2001DOI Listing
January 2017

Self-Ambivalence in the Cognitive-Behavioural Treatment of Obsessive-Compulsive Disorder.

Psychopathology 2015 23;48(5):349-56. Epub 2015 Sep 23.

Background/aims: Despite emerging interest in the role of self-concept in obsessive-compulsive disorder (OCD), current research has failed to consider the role of self-perceptions in the cognitive-behavioural treatment of OCD. This study examined the relationship between ambivalence about self-worth and treatment outcomes in patients diagnosed with OCD.

Methods: Sixty-two volunteers (59.7% female, mean age = 36.05 years, standard deviation, SD = 11.58) with a primary diagnosis of OCD were assigned to 16 sessions of face-to-face cognitive-behavioural treatment delivered in an individual format. Symptom severity, self-ambivalence, depressive symptoms and anxiety were measured using self-report measures at 5 time points: prewaitlist, pretreatment, midtreatment, posttreatment and 6- month follow-up.

Results: All variables improved significantly at the posttreatment compared to the earlier time points, inclusive of OCD severity and self-ambivalence, and improvements were maintained at follow-up. As revealed through a series of logistical and stepwise regression analyses, controlling for various pretreatment levels of symptom severity and/or changes in mood severity, pre-post changes in self-ambivalence were predictive of lower posttreatment OCD severity and recovery from OCD. Of particular note, participants who changed by 1 SD in self-ambivalence were 2.5-3.9 times more likely to be recovered in OCD symptoms at the posttreatment time point, depending on what factors were entered first in the regression analysis.

Conclusion: These results suggest that resolution of self-ambivalence predicts positive treatment outcomes in the cognitive-behavioural treatment of OCD. Assisting patients resolve self-ambivalence may be an important target in the psychological treatment of OCD.
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http://dx.doi.org/10.1159/000438676DOI Listing
April 2016

The Self in Psychopathology.

Psychopathology 2015 16;48(5):275-7. Epub 2015 Sep 16.

Research School of Psychology, The Australian National University, Canberra, A.C.T., Australia.

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http://dx.doi.org/10.1159/000438876DOI Listing
December 2015

Self-Based Concepts and Obsessive-Compulsive Phenomena.

Psychopathology 2015 15;48(5):287-92. Epub 2015 Sep 15.

Swinburne University of Technology, Deakin University, Melbourne, Vic., Australia.

Background/aims: Using a cognitive framework, this paper examined self-perceptions as a vulnerability to phenomena in obsessive-compulsive disorder. Specifically, Guidano and Liotti's model of self-ambivalence (from 1983) and the notion of self-worth contingent upon moral standards were investigated as possible mechanisms to explain how individuals come to notice their unwanted intrusions.

Method: Using an analogue framework, participants were first-year undergraduate psychology students (95 females, mean age = 22.49 years, SD = 7.96, and 25 males, mean age = 21.64 years, SD = 7.26) who were administered a battery of self-report questionnaires.

Results: Results indicated that self-ambivalence moderated the relationship between high moral standards and obsessive-compulsive (OC) phenomena; individuals who had high moral standards and high self-ambivalence showed increased OC vulnerability.

Conclusions: The findings suggest that ambivalence about moral self-worth may constitute a particular vulnerability to OC symptoms. Directions for future research are discussed and implications of the findings explored.
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http://dx.doi.org/10.1159/000437333DOI Listing
April 2016

Predictors of response to cognitive behaviour therapy for obsessive-compulsive disorder.

Int J Clin Health Psychol 2015 Sep-Dec;15(3):181-190. Epub 2015 Aug 10.

The Australian National University, Australia.

Response to psychological treatment for Obsessive-Compulsive Disorder (OCD) varies, and dropout and relapse rates remain troubling. However, while studies examining symptom reductions are favourable, outcomes are less encouraging when outcome is defined in terms of clinically significant change. Moreover, there is little understanding of what predicts treatment outcome. This study examined demographic, symptomatic and cognitive predictors of outcome in 79 participants undertaking individualised cognitive-behavioural therapy for OCD. After investigating differences between treatment completers and non-completers, we examined treatment response as defined by post-treatment symptom severity and clinically reliable change, as well as predictors of treatment response. Completers were less likely to present with co-morbidity. The treatment was highly efficacious irrespective of whether completer or intention-to-treat analysis was undertaken, with 58% of treatment completers considered "recovered" at post-treatment. Lower pre-treatment levels of OCD symptoms and greater perfectionism/intolerance of uncertainty were the best unique predictors of OCD severity outcomes at post-treatment. Changes in obsessional beliefs were associated with symptomatic change, although only perfectionism/intolerance of uncertainty was a significant unique predictor of post-treatment change. Recovery status was predicted only by pre-treatment OCD severity. In helping to identify those at risk for poorer outcomes, such research can lead to the development of more effective interventions.
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http://dx.doi.org/10.1016/j.ijchp.2015.07.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6225019PMC
August 2015

Exposure to unwanted intrusions, neutralizing and their effects on self-worth and obsessive-compulsive phenomena.

J Behav Ther Exp Psychiatry 2015 Dec 31;49(Pt B):216-222. Epub 2015 Jul 31.

Swinburne University of Technology, Brain and Psychological Sciences Research Centre (H99), Swinburne University of Technology, P.O Box 218, Hawthorn, VIC, 3122, Australia. Electronic address:

Background: Although there is a growing body of literature to support the importance of understanding self processes in the experience of obsessive-compulsive disorder (OCD), no experimental research has directly examined the relationship between self-construals and phenomena central to OCD. The current study examined the effect that unwanted intrusions and neutralizing responses have on self-worth, distress and urge to neutralize.

Methods: After listening to repeated audio recordings of idiosyncratic unwanted intrusions, a combined nonclinical and clinical OCD sample were asked to respond with either their chosen neutralizing strategy (experimental) or a refocus counting strategy (control). Each condition comprised of a 12-min responding period (respond) followed by an equivalent non-response period (listen). Participants completed each condition, and were randomly allocated into the condition completed first. Ratings of discomfort, urge to neutralize, and self-worth were measured throughout.

Results: Neutralizing and refocussing responses were both associated with decreases in discomfort and higher self-worth. The expected rebound effect for discomfort and urge to neutralize for the listen period after neutralizing was found.

Limitations: Methodological problems lead to missing data, although this was corrected with the use of Multi Level Modelling (MLM) analysis on a combined sample. The small clinical sample meant that comparison between the two populations was not possible.

Conclusions: Findings support cognitive accounts that neutralizing is involved in the development and maintenance of OCD, and suggest that neutralizing is a purposeful response aimed to help reinstate self-worth. Implications and directions for future research are discussed.
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http://dx.doi.org/10.1016/j.jbtep.2015.07.008DOI Listing
December 2015

Efficacy of cognitive-behavioral therapy for obsessive-compulsive disorder.

Psychiatry Res 2015 May;227(1):104-13

NIHR Specialist Biomedical Research Centre for Mental Health at the South London and Maudsley NHS Foundation Trust, UK; The Institute of Psychiatry, King׳s College London, UK.

Cognitive-behavioral therapy (CBT), which encompasses exposure with response prevention (ERP) and cognitive therapy (CT), has demonstrated efficacy in the treatment of obsessive-compulsive disorder (OCD). However, the samples studied (reflecting the heterogeneity of OCD), the interventions examined (reflecting the heterogeneity of CBT), and the definitions of treatment response vary considerably across studies. This review examined the meta-analyses conducted on ERP and cognitive therapy (CT) for OCD. Also examined was the available research on long-term outcome associated with ERP and CT. The available research indicates that ERP is the first line evidence based psychotherapeutic treatment for OCD and that concurrent administration of cognitive therapy that targets specific symptom-related difficulties characteristic of OCD may improve tolerance of distress, symptom-related dysfunctional beliefs, adherence to treatment, and reduce drop out. Recommendations are provided for treatment delivery for OCD in general practice and other service delivery settings. The literature suggests that ERP and CT may be delivered in a wide range of clinical settings. Although the data are not extensive, the available research suggests that treatment gains following ERP are durable. Suggestions for future research to refine therapeutic outcome are also considered.
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http://dx.doi.org/10.1016/j.psychres.2015.02.004DOI Listing
May 2015

Online mindfulness-based intervention for late-stage bipolar disorder: pilot evidence for feasibility and effectiveness.

J Affect Disord 2015 Jun 5;178:46-51. Epub 2015 Mar 5.

Australian National University, Canberra, Australia.

Objectives: People in the late stage of bipolar disorder (BD) experience elevated relapse rates and poorer quality of life (QoL) compared with those in the early stages. Existing psychological interventions also appear less effective in this group. To address this need, we developed a new online mindfulness-based intervention targeting quality of life (QoL) in late stage BD. Here, we report on an open pilot trial of ORBIT (online, recovery-focused, bipolar individual therapy).

Methods: Inclusion criteria were: self-reported primary diagnosis of BD, six or more episodes of BD, under the care of a medical practitioner, access to the internet, proficient in English, 18-65 years of age. Primary outcome was change (baseline - post-treatment) on the Brief QoL.BD (Michalak and Murray, 2010). Secondary outcomes were depression, anxiety, and stress measured on the DASS scales (Lovibond and Lovibond, 1993).

Results: Twenty-six people consented to participate (Age M=46.6 years, SD=12.9, and 75% female). Ten participants were lost to follow-up (38.5% attrition). Statistically significant improvement in QoL was found for the completers, t(15)=2.88, 95% CI:.89-5.98, p=.011, (Cohen׳s dz=.72, partial η(2)=.36), and the intent-to-treat sample t(25)=2.65, 95% CI:.47-3.76, (Cohen׳s dz=.52; partial η(2)=.22). A non-significant trend towards improvement was found on the DASS anxiety scale (p=.06) in both completer and intent-to-treat samples, but change on depression and stress did not approach significance.

Limitations: This was an open trial with no comparison group, so measured improvements may not be due to specific elements of the intervention. Structured diagnostic assessments were not conducted, and interpretation of effectiveness was limited by substantial attrition.

Conclusion: Online delivery of mindfulness-based psychological therapy for late stage BD appears feasible and effective, and ORBIT warrants full development. Modifications suggested by the pilot study include increasing the 3 weeks duration of the intervention, adding cautions about the impact of extended meditations, and addition of coaching support/monitoring to optimise engagement.
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http://dx.doi.org/10.1016/j.jad.2015.02.024DOI Listing
June 2015

Efficacy of cognitive-behavioral therapy for obsessive-compulsive disorder.

Psychiatry Res 2015 Feb 8;225(3):236-46. Epub 2014 Dec 8.

NIHR Specialist Biomedical Research Centre for Mental Health at the South London and Maudsley NHS Foundation Trust and The Institute of Psychiatry, King׳s College London, UK.

Cognitive-behavioral therapy (CBT), which encompasses exposure with response prevention (ERP) and cognitive therapy, has demonstrated efficacy in the treatment of obsessive-compulsive disorder (OCD). However, the samples studied (reflecting the heterogeneity of OCD), the interventions examined (reflecting the heterogeneity of CBT), and the definitions of treatment response vary considerably across studies. This review examined the meta-analyses conducted on ERP and cognitive therapy (CT) for OCD. Also examined was the available research on long-term outcome associated with ERP and CT. The available research indicates that ERP is the first line evidence based psychotherapeutic treatment for OCD and that concurrent administration of cognitive therapy that targets specific symptom-related difficulties characteristic of OCD may improve tolerance of distress, symptom-related dysfunctional beliefs, adherence to treatment, and reduce drop out. Recommendations are provided for treatment delivery for OCD in general practice and other service delivery settings. The literature suggests that ERP and CT may be delivered in a wide range of clinical settings. Although the data are not extensive, the available research suggests that treatment gains following ERP are durable. Suggestions for future research to refine therapeutic outcome are also considered.
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http://dx.doi.org/10.1016/j.psychres.2014.11.058DOI Listing
February 2015

Experimental evidence for the influence of cognitions on compulsive buying.

J Behav Ther Exp Psychiatry 2014 Dec 18;45(4):496-501. Epub 2014 Jul 18.

Swinburne University of Technology, Melbourne, Australia.

Background And Objectives: Compulsive buying is a disabling condition, where individuals are unable to resist or control their buying behavior, leading to substantial social and financial problems. Cognitive models implicate the role of beliefs as one factor in buying behavior, for example, "this item is unique and will help me improve my life".

Methods: This study experimentally examined the contribution of such beliefs to the disorder, in individuals who compulsively buy (N = 18) and in non-clinical controls (N = 17). Participants were presented with photographs of idiosyncratically appealing and unappealing items, in the context of imagined scenarios that either minimized or maximized aspects relevant to hypothesized "compulsive buying beliefs" (i.e., beliefs that acquisition can compensate for negative feelings, beliefs regarding uniqueness and lost opportunities, and emotional reasons for buying).

Results: It was found that individuals who compulsively buy demonstrated stronger urges to purchase than control participants, regardless of context, but the overall strength of these urges was responsive to manipulations of beliefs about consumer items said to be associated with compulsive buying.

Limitations: The main limitation of the study was a small sample size, potentially reducing power.

Conclusions: Nonetheless, these findings provide insights into the processes underlying compulsive phenomena, in particular supporting the role of cognitions in compulsive buying.
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http://dx.doi.org/10.1016/j.jbtep.2014.07.003DOI Listing
December 2014

Study protocol for a randomised controlled trial of internet-based cognitive-behavioural therapy for obsessive-compulsive disorder.

BMC Psychiatry 2014 Jul 25;14:209. Epub 2014 Jul 25.

Swinburne University of Technology, Melbourne, VIC, Australia.

Background: Obsessive-Compulsive Disorder (OCD) is a common chronic psychiatric disorder that constitutes a leading cause of disability. Although Cognitive-Behaviour Therapy (CBT) has been shown to be an effective treatment for OCD, this specialised treatment is unavailable to many due to access issues and the social stigma associated with seeing a mental health specialist. Internet-based psychological treatments have shown to provide effective, accessible and affordable treatment for a range of anxiety disorders, and two Randomised Controlled Trials (RCTs) have demonstrated the efficacy and acceptability of internet-based CBT (iCBT) for OCD, as compared to waitlist or supportive therapy. Although these initial findings are promising, they do not isolate the specific effect of iCBT. This paper details the study protocol for the first randomised control trial evaluating the efficacy of therapist-assisted iCBT for OCD, as compared to a matched control intervention; internet-based therapist-assisted progressive relaxation training (iPRT). It will aim to examine whether therapist-assisted iCBT is an acceptable and efficacious treatment, and to examine how effectiveness is influenced by patient characteristics.

Method/design: A randomised controlled trial using repeated measures with two arms (intervention and matched control) will be used to evaluate the efficacy and acceptability of iCBT for OCD. The RCT will randomise 212 Australian adults with a primary diagnosis of OCD into either the active intervention or control condition, for 12 weeks duration. Outcomes for participants in both study arms will be assessed at baseline and post-intervention. Participants in iCBT will be further assessed at six month follow-up, while participants in the control condition will be crossed over to receive the iCBT intervention and reassessed at post-intervention and six month follow-up. The primary outcome will be clinically significant change in obsessive-compulsive symptom scores.

Discussion: This will be the first known therapist assisted internet-based trial of a comprehensive CBT treatment for OCD as compared to a matched control intervention. Demonstrating the efficacy of an internet-based treatment for OCD will allow the development of models of care for broad-based access to an evidence-based but complex treatment.
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http://dx.doi.org/10.1186/1471-244X-14-209DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4222668PMC
July 2014
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