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Introduction: Myriad treatment barriers prevent birthing parents with postpartum depression (PPD) from receiving timely treatment. We aimed to determine whether a peer-delivered online 1-day cognitive behavioral therapy (CBT)-based workshop added to treatment as usual (TAU) improves PPD and its comorbidities and is more cost-effective than TAU alone. Methods: This parallel-group, randomized controlled trial took place in Ontario, Canada (June 7, 2021, to February 18, 2022). Participants were ≥18 years old, had an infant ≤12 months old, and an Edinburgh Postnatal Depression Scale (EPDS) score ≥10. Participants were allocated to receive the workshop plus TAU (n = 202) or TAU and waitlisted to complete the workshop 12 weeks later (n = 203). The primary outcome was change in PPD (EPDS score) from enrollment to 12 weeks later. The secondary outcome was cost-effectiveness and tertiary outcomes included anxiety, social support, partner relationship quality, the mother-infant relationship, parenting stress, and infant temperament. Results: Participants had a mean age of 32.3 years (SD = 4.30) and 65% were White. The workshop led to a significant reduction in EPDS scores (15.95–11.37; d = 0.92, p < 0. 01) and was associated with higher odds of exhibiting a clinically significant decrease in EPDS scores (OR = 2.03; 95% CI: 1.26–3.29). The workshop plus TAU was more cost-effective than TAU alone. It also led to improvements in postpartum anxiety, infant-focused anxiety, parenting stress, and infant temperament. Conclusions: Peer-delivered 1-day CBT-based workshops can improve PPD and are a potentially scalable low-intensity treatment that could help increase treatment access. [ABSTRACT FROM AUTHOR]

Objective: We modeled design factors influencing the intent to use a university mental health service. Participants: Between November 2012 and October 2014, 909 undergraduates participated. Method: Using a discrete choice experiment, participants chose between hypothetical campus mental health services. Results: Latent class analysis identified three segments. A Psychological/Psychiatric Service segment (45.5%) was most likely to contact campus health services delivered by psychologists or psychiatrists. An Alternative Service segment (39.3%) preferred to talk to peer-counselors who had experienced mental health problems. A Hesitant segment (15.2%) reported greater distress but seemed less intent on seeking help. They preferred services delivered by psychologists or psychiatrists. Simulations predicted that, rather than waiting for standard counseling, the Alternative Service segment would prefer immediate access to E-Mental health. The Usual Care and Hesitant segments would wait 6 months for standard counseling. Conclusions: E-Mental Health options could engage students who may not wait for standard services.

Objective: To examine whether metacognitive psychological skills, acquired in mindfulness-based cognitive therapy (MBCT), are also present in patients receiving medication treatments for prevention of depressive relapse and whether these skills mediate MBCT's effectiveness. Method: This study, embedded within a randomized efficacy trial of MBCT, was the first to examine changes in mindfulness and decentering during 6-8 months of antidepressant treatment and then during an 18-month maintenance phase in which patients discontinued medication and received MBCT, continued on antidepressants, or were switched to a placebo. In total, 84 patients (mean age = 44 years, 58% female) were randomized to 1 of these 3 prevention conditions. In addition to symptom variables, changes in mindfulness, rumination, and decentering were assessed during the phases of the study. Results: Pharmacological treatment of acute depression was associated with reductions in scores for rumination and increased wider experiences. During the maintenance phase, only patients receiving MBCT showed significant increases in the ability to monitor and observe thoughts and feelings as measured by the Wider Experiences (p less than 0.01) and Decentering (p less than 0.01) subscales of the Experiences Questionnaire and by the Toronto Mindfulness Scale. In addition, changes in Wider Experiences (p less than 0.05) and Curiosity (p less than 0.01) predicted lower Hamilton Rating Scale for Depression scores at 6-month follow-up. Conclusions: An increased capacity for decentering and curiosity may be fostered during MBCT and may underlie its effectiveness. With practice, patients can learn to counter habitual avoidance tendencies and to regulate dysphoric affect in ways that support recovery. (Contains 5 tables, 2 figures and 6 footnotes.)

Mindfulness-based interventions (e.g., MBSR; Kabat-Zinn, 1990; MBCT; Segal, Williams, & Teasdale, 2002) have demonstrated effectiveness in a number of distinct clinical populations. However, few studies have evaluated MBCT within a heterogeneous group of psychiatric adult outpatients. This study examined whether a wider variety of patients referred from a large, tertiary mood and anxiety outpatient clinic could benefit from such a program. Twenty-three psychiatric outpatients with mood and/or anxiety disorders (mean age = 53.65 years, SD = 10.73; 18 women) were included in this study. Each participant completed the Structured Clinical Interview for Diagnosis Axis I and measures of mood, life stress, and mindfulness skills, prior to the start of group and immediately following its completion. Paired t-test analyses were conducted and results revealed a significant improvement in mood and mindfulness skills in addition to a significant reduction in severity and total number of perceived life stressors. In summary, our results indicate that MBCT can effectively be administered to a group of patients whose diagnoses and difficulties may vary, who have significant comorbidity, and who are currently experiencing significant symptoms. This has important practical implications for offering this treatment within broader psychological and psychiatric service systems. (Contains 1 table.)

Negative cognitive structure (particularly for interpersonal content) has been shown in some research to persist past a current episode of depression and potentially to be a stable marker of vulnerability for depression (D. J. A. Dozois, 2007; D. J. A. Dozois & K. S. Dobson, 2001a). Given that cognitive therapy (CT) is highly effective for treating the acute phase of a depressive episode and that this treatment also reduces the risk of relapse and recurrence, it is possible that CT may alter these stable cognitive structures. In the current study, patients were randomly assigned to CT+ pharmacotherapy (n = 21) or to pharmacotherapy alone (n = 21). Both groups evidenced significant and similar reductions in level of depression (as measured with the Beck Depression Inventory-II and the Hamilton Rating Scale for Depression), as well as automatic thoughts and dysfunctional attitudes. However, group differences were found on cognitive organization in favor of individuals who received the combination of CT+ pharmacotherapy. The implications of these results for understanding mechanisms of change in therapy and the prophylactic nature of CT are discussed. (Contains 3 figures and 4 tables.)

Negative cognitive structure (particularly for interpersonal content) has been shown in some research to persist past a current episode of depression and potentially to be a stable marker of vulnerability for depression (D. J. A. Dozois, 2007: D. J. A. Dozois & K. S. Dobson, 2001a). Given that cognitive therapy (CT) is highly effective for treating the acute phase of a depressive episode and that this treatment also reduces the risk of relapse and recurrence, it is possible that CT may alter these stable cognitive structures. In the current study, patients were randomly assigned to CT+ pharmacotberapy (n = 21) or to pharmacotherapy alone (n = 21). Both groups evidenced significant and similar reductions in level of depression (as measured with the Beck Depression Inventory-II and the Hamilton Rating Scale for Depression), as well as automatic thoughts and dysfunctional attitudes. However, group differences were found on cognitive organization in favor of individuals who received the combination of CT+ pharmacotherapy. The implications of these results for understanding mechanisms of change in therapy and the prophylactic nature of CT are discussed. Keywords: cognitive therapy, depression, cognitive change, schema DOI: 10.1037/a0016886

Background: Longitudinal neuroimaging investigations of antidepressant treatment offer the opportunity to identify potential baseline biomarkers associated with poor outcome. Methods: To explore the neural correlates of nonresponse to cognitive behavioural therapy (CBT) or venlafaxine (VEN), we compared pretreatment (18)F-fluoro-2-deoxy-D-glucose positron emission tomography scans of participants with major depressive disorder responding to either 16 weeks of CBT (n = 7) or VEN treatment (n = 9) with treatment nonresponders (n = 8). Results: Nonresponders to CBT or VEN, in contrast to responders, exhibited pretreatment hypermetabolism at the interface of the pregenual and subgenual cingulate cortices. Limitations: Limitations of our study include the small sample sizes and the absence of both arterial sampling to determine absolute glucose metabolism and high-resolution structural magnetic resonance imaging coregistration for region-of-interest analyses. Conclusion: Our current findings are consistent with those reported in previous studies of relative hyperactivity in the ventral anterior cingulate cortex in treatment-resistant populations. Contexte: Les etudes de neuro-imagerie longitudinales pendant le traitement antidepresseur offrent la possibilite de reperer certains biomarqueurs de base susceptibles d&apos;etre associes a une evolution moins favorable. Methodes: Pour explorer les correlats neuraux propres au phenomene de resistance a la therapie cognitivo-comportementale (TCC) ou au traitement par venlafaxine (VEN), nous avons compare les tomographies par emission de positrons au (18)F-fluoro-2-desoxy-D-glucose pretherapeutiques de participants atteints de troubles depressifs majeurs qui ont repondu soit a 16 semaines de TCC (n = 7), soit a un traitement par VEN (n = 9), a celles de participants n&apos;ayant pas repondu au traitement (n = 8). Resultats: Comparativement aux participants ayant repondu au traitement, ceux qui n&apos;ont repondu ni a la TCC ni a la VEN presentaient en pretraitement un hypermetabolisme au niveau de l&apos;interface du cortex cingulaire ventro-anterieur du genou du corps calleux. Limites: Les limites de notre etude sont notamment la petite taille des echantillons et l&apos;absence a la fois de prelevements arteriels pour determiner le metabolisme absolu du glucose et d&apos;enregistrements simultanes d&apos;imagerie par resonance magnetique structurelle de haute resolution a des fins d&apos;analyse des regions concernees. Conclusion: Nos resultats actuels concordent avec ceux d&apos;etudes anterieures sur l&apos;hyperactivite relative du cortex cingulaire ventro-anterieur dans le traitement des populations refractaires au traitement., Introduction The 2 most established acute treatment modalities for major depressive disorder (MDD) are pharmacotherapy and evidence-based psychotherapy, particularly cognitive behavioural therapy (CBT). Both have roughly comparable outcomes. (1,2) Nevertheless, [...]

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Cognitive-behavior therapy (CBT) for Social Phobia is effective in both group and individual formats. However, the impact of group processes on treatment efficacy remains relatively unexplored. In this study we examined group cohesion ratings made by individuals at the midpoint and endpoint of CBT groups for social phobia. Symptom measures were also completed at the beginning and end of treatment. We found that cohesion ratings significantly increased over the course of the group and were associated with improvement over rime in social anxiety symptoms, as well as improvement on measures of general anxiety, depression, and functional impairment. In conclusion, findings are consistent with the idea that changes in group cohesion are related to social anxiety symptom reduction and, therefore, speak to the importance of nonspecific therapeutic factors in treatment outcome. Keywords: Social phobia; Social anxiety disorder; Group cohesion; Cognitive-behavior therapy

Although the State-Trait Anxiety Inventory (STAI) is a popular measure of anxiety, some previous research suggests that the trait scale may assess depression, as well as anxiety. The factor structure of the trait items was initially examined using factor analytic procedures. Confirmatory factor analytic methods suggested that a hierarchical solution best fit the data, with one overall factor and two lower order factors. The lower order subscales created from this factor solution were examined in a sample of individuals diagnosed with an anxiety disorder. Overall, the results offered good support for the notion that the trait scale of the STAI assesses depression, as well as anxiety. One set of items appeared to assess anxiety and worry, whereas the other assessed sadness and self-deprecation. The two subscales correlated differentially with other measures of anxiety and depression in a manner that was consistent with their content. Finally, diagnostic groups and controls could be meaningfully distinguished on these subscales. Implications for the use of this measure are discussed.

Research was conducted to examine the reliability, factor structure and validity of the Depression Anxiety Stress Scales (DASS) in clinical groups and a community sample. Samples consisted of outpatients diagnosed with panic disorder with or without agoraphobia, major depressive disorder, social phobia and obsessive-compulsive disorder. Results indicate that the DASS is an excellent instrument for measuring features of hyperarousal, depression and tension in nonclinical and clinical groups.