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General Mental Health

317: Acceptability and usability of web and mobile versions of a cognitive behavioral intervention based on problem solving for depressive complaints in Turkey

Burçin Ünlü İnce, Department of Medical Informatics, Informatics Institute, Middle East Technical University, Ankara, Turkey, Ruhuna İyi Bak, Online Counseling Centre, Istanbul, Turkey; Didem Gökçay, Ece Dinçer, Department of Medical Informatics, Informatics Institute, Middle East Technical University, Ankara, Turkey; Heleen Riper,Department of Clinical, Neuro and Developmental Psychology, Section of Clinical Psychology, VU University, Amsterdam, the Netherlands; EMGO+ Institute for Health and Care Research, VU Medical Centre, Amsterdam, the Netherlands ; Department of Psychiatry, VU Medical Centre/GGZ inGeest, Amsterdam, the Netherlands ;  Pim Cuijpers,  Department of Clinical, Neuro and Developmental Psychology, Section of Clinical Psychology, VU University, Amsterdam, the Netherlands, Department of Clinical, Neuro and Developmental Psychology, VU University, Amsterdam, the Netherlands

In Turkey, the prevalence of depression is approximately 4.4%, while mental health care has serious deficiencies. Innovative solutions which provide cognitive behavioural interventions using online services are needed to fill the gap between health burden and the treatment of depression. For instance, Her Şey Kontrol Altında (HŞKA) which is based on problem-solving therapy is a good alternative which increases self-awareness and reduces the stigma and inconvenience of office visits. In this study, a web version and a mobile application of HŞKA were developed to evaluate the usability and acceptability of online guided self-help among students and therapists. A total of 6 focus groups were organised where participants were asked to perform small tasks in the intervention. Assessment of usability is made through several sub-scales such as trust to the intervention, perceived usability, value to personalization and intention to use the intervention. Finally, the evaluation of acceptability is done through qualitative remarks. The first pilot study was conducted on the web version with four focus groups (22 students and 5 therapists). Perceived ubiquity and application mobility was significantly rated as higher among students than therapists (p=.049 and p=.03). The second pilot was performed on the mobile version with two focus groups (28 students). Trust to the intervention was moderate while value to personalization and intention to use the intervention were rated as high. In conclusion, acceptance and usability of both web and mobile applications have been evaluated as moderate to high but trust and privacy were factors of concern.

 

316: Does a two-days workshop on managing ruptures of alliance help psychotherapy trainees conceptualizing their difficulties with refractory patients?

Valentino Pomini, Institute of psychology, University of Lausanne, Switzerland; Diana Ortega, Division of Endocrinology, Diabetology and Metabolism, Lausanne University Hospital, Switzerland

CBT therapists traditionally are trained to attribute failures in the collaborative relationship either to patients’ problems (e.g. lack of motivation, distorted thoughts about the treatment, etc.) or to themselves (lack of competence, inadequate technique implementation, etc.). Safran & Muran propose to conceptualize problems in the therapeutic relationships, considering definition of therapeutic alliance as the result of a continuous intersubjective negotiation where therapist and patient aspire to mutual recognition. Breakdowns in this negotiation regularly appear during the therapy, and are signaled by various patients’ withdrawal or confrontation attitudes. If a therapist does not react adequately to them, the therapy may lead to impasses and a premature end.  Identifying and repairing ruptures of alliance can be learned in dedicated training courses or supervisions. To see if young CBT trainees can develop through a brief course the basic skills to repair ruptures of alliance, we evaluated the effects of a two-days seminar specifically focused on the Safran and Muran model. We led a randomized control study (N=34) assessing the competence in repairing alliance ruptures through standardized role-plays, followed by structured interviews were therapists commented their performances. The poster will focus on the qualitative analyses done on therapists' comments. They reveal that trained therapists changed the way they conceptualize the difficulties encountered in the therapeutic relationship from pretest to post-test assessments. Even if this change is correlated with improved objective performances in role-plays, the effects remain moderate on perceived self-efficacy. Results will be discussed in the light of the contents and duration of the training but also from a methodological point of view.

 

306: Rumination, worry, and symptom severity of OCD: A correlational study in individuals diagnosed with obsessive-compulsive disorder.

Carlotta V. Heinzel;  Martin Mazanec;  Marcel Miché; Roselind Lieb, Karina Wahl, University of Basel, Faculty of Psychology, Clinical Psychology and Epidemiology

Rumination and worry are involved in the development and maintenance of multiple psychological disorders. The precise role of these two constructs in obsessive-compulsive disorder (OCD), however, is still largely unclear. Previous correlational studies using non-clinical as well as clinical samples have found associations between rumination, worry, and various obsessive-compulsive (OC) symptoms. However, to our knowledge these associations have so far not been investigated in large samples of individuals with OCD. The present study investigates the relationships between rumination, worry, and OC symptoms in N = 149 individuals with OCD using a correlational design. Participants reported ruminative tendencies (RRS), worry (PSWQ), OC symptoms (OCI-R), depressive symptoms (BDI) and anxiety symptoms (BAI). Ruminative tendencies showed moderate to large positive zero-order correlations with the OC symptom dimensions ordering, obsessions, hoarding as well as checking. The associations with ordering and obsessions remained significant even after controlling for depressive and anxiety symptoms. Similarly, worry showed moderate positive zero-order correlations with ordering, obsessions, and checking. However, only the relationship with ordering remained significant after controlling for depressive and anxiety symptoms. These results further support the idea that OC symptom severity is related to rumination and worry, and that these associations are unlikely to be accounted for by depressive or anxiety symptoms. Additionally, content analyses of typical episodes of repetitive negative thought are presented for a subsample of n = 38 individuals with OCD. The results are interpreted with regard to the possible overlap of rumination and worry with OC symptoms and clinical implications are considered.

 

302:What happens if one ruminates on unwanted intrusive thoughts? A replication and extension of previous findings

Martin Mazanec; Carlotta V. Heinzel;  Patrizia Hofer; Roselind Lieb;  Karina Wahl, University of Basel, Department of Psychology, Division of Clinical Psychology and Epidemiology, Missionsstr. 62a, 4055 Basel, Switzerland

Introduction. Rumination is a common cognitive thinking style involved in the onset and maintenance of many mental disorders. However, to date, there is only little research into its impact on obsessive-compulsive symptoms. In our previous experimental study, we found an effect of rumination about unwanted intrusive thoughts (UITs) on the urge to neutralize. The aim of the present study was to replicate the results of our previous study and to extend them by including assessment of behavioral neutralizing. Methods. A UIT was activated by asking non-clinical participants (N = 105) to write down the following sentence: „I wish that [beloved Person] would die today in a horrible car accident.“ Participants were then asked to monitor their distress, urge to neutralize, frequency of UITs, and depressed mood before and after an experimental manipulation. During the experimental manipulation, they were instructed either to ruminate on their UIT, to ruminate on negative mood, or to distract themselves (random allocation). At the end, behavioral neutralizing was assessed. Results. As in the previous study, there was no effect of rumination about UIT on the frequency. However, in contrast to the previous study both rumination instructions led to an attenuated decrease of the distress, urge to neutralize, and negative mood compared to distraction. Unexpectedly, rumination about UIT did not affect the behavioral neutralizing. Discussion. Present findings support the view that rumination might play a role in the maintenance of UITs. Effects on vividness and appraisals of UITs as well as clinical implications for obsessions are discussed.

287: Application of Short-Term Cognitive Behavior Therapy in Tbilisi Adult Crisis Intervention Centre

Natia Badrishvili, Georgian Association of Cognitive-Behavioral Therapy

We investigated the efficiency of brief individual Cognitive Behavior Therapy for the patients with depression and anxiety disorders in crisis intervention centre in Tbilisi, Georgia. The objective of the study was to explore effectiveness of short-term cognitive-behavior therapy in the context of crisis theory. The study consists to conduct individual CBT session for the patients with depression (n = 8) and anxiety disorders such as panic disorder (n=12) and obsessive-compulsive disorder (n=8) during 6-8 week. We were conducted an average 8-9 Cognitive-Behavior Therapy session with 28 patients’ (14 male and 14 female) from 16 to 65 year. Before and after therapy the patient’s mental state were evaluated by the following tests: Beck’s Depression Inventory (BDI), Hamilton Anxiety Rating Scale (HAM-A), Sheehan Panic Disorder Scale (SPS) and Yale-Brown Obsessive Compulsive Scale (Y-BOCS).   From the pre and post-assessment patient reported significant improvement of mood (BDI, t (27) =14, 789, p < .0001), decrees of anxiety (HAM-A, (t (27) = 15,000, p< .0001); (SPS, t (27) = 4,116, p< .0001) and OCD symptoms (Y-BOCS, t (27) = 3,800, p < .001). In summary, short-term individual CBT was effective treatment to improve mental status of persons with anxiety disorders and depressive patients in crisis intervention setting. Additional follow-up research needs to be continued.

240:The Power of Digital CBT: Group Counselling in an Online Atmosphere of Anonymity and Identity Protection

Barbara J. Veder, Morneau Shepell

As technology-driven mental health solutions continue to develop, seemingly permanent barriers to information, products, and services are crumbling. We continue to experience giant leaps forward in digital CBT, and with leading-edge technology and a personalized, high-touch, people-centered approach, we are now able to engage individuals who would not otherwise access support, regardless of geography, schedules, or learning styles and preferences, in ways that were never before thought of as possible. Such is the case in the area of online CBT group counselling. Launched in 2016, Morneau Shepell’s Online Group Counselling for Anxiety program has run over 1000 group sessions and helped over 7000 participants. Through this innovative method of support, multiple participants struggling with mild to moderate anxiety discuss their similar issue(s) in a closed, structured, counsellor-moderated, and confidential group setting, based on the foundation that individuals benefit from shared experience. Group interactions allow participants to build relationships, receive feedback on how to meet goals and overcome challenges, and gain peer encouragement. When delivered digitally, users are able to anonymously access group sessions and adjunct support via their smartphone, tablet, or computer, from wherever they’d like. This poster will present the current structure of our online group-CBT counselling program and its effectiveness when delivered digitally. We will share best practice models, as well as examine client demographics, engagement, and direct user feedback to demonstrate the value of offering online therapeutic group solutions in supporting mental health and behavior change in a digital world.

 

231: Spouse Support and General Health In the Context of Marital Satisfaction In Grieving Couples: An Actor–Partner Interdependence Mediation Model

Samet Baş, Psychology Department of Dokuz Eylul University, Izmir, Turkey; Duygu Güngör Culha, Psychology Department of Dokuz Eylul University, Izmir, Turkey.

Introduction: It is known that bereaved individuals may experience mental or physical health problems after the death of a loved one. Despite the fact that men and women give different reactions to the loss, in the context of marriage, partner’s health conditions are mutually influencing each other. Method: In this study using dyadic analysis we examined whether marital satisfaction is an effective mediator in the relationship between spouse support and general health among grieving couples (N=296). The data obtained from couples who has a significant loss experience tested using the actor-partner interdependence model and path analysis. Results: The model revealed that actor effects between spouse support and general heath mediated by marital satisfaction. The higher spouse support was significantly associated with higher marital satisfaction, and marital satisfaction was significantly associated with better general health for grieving couples. However, the partner effects showed different associations for men and women. While women’s perceived spouse support had a significant effect on men’s marital satisfaction, perceived spouse support of men was not significantly associated with women’s marital satisfaction. Moreover, there was no significant partner effect in the relationship between marital satisfaction and general health. Conclusion: Such findings provide an important perspective on interactive nature of men and women during marriage and the role of actor-partner interdependence model. Recommendations for further researches and dyadic methods will be discussed.

157: Pilot review: Assessing the effectiveness of CBT for depression, anxiety and long-term conditions for adults over 65 years of age

Idyli Kamaterou, Dr Vandana Gupta, Soraya Aweys, Mind Matters

Long-term conditions are more prevalent in older adults. Patients with chronic conditions suffer from related psychosocial factors, anxiety and depression that have an impact on their quality of life. As an IAPT service we looked at innovative ways to improve access to Older People as there was very poor uptake locally but also at a  national level. An 18-month pilot was designed to assess the effectiveness of individual and group CBT in reducing depression and anxiety and improving the management of LTC. Every person referred to the pilot was offered a face-to-face assessment before a treatment plan involving individual or group CBT was developed. Psychometric tools were used to assess people's symptoms and track their progress. People who entered therapy (both individual and group) showed clinical recovery of both anxiety and depression symptoms. However, individual therapy was more effective in treating anxiety symptoms. People’s confidence in managing their long-term condition improved in both treatment types but marginally more in the group setting. An interesting finding was that a lot of participants refused having treatment. The main reasons were: feeling able to cope/ not feeling they need support, being busy with appointments for their physical health/ not able to find time for therapy and ill health.

76: Suicidal attempts among drug-addicted patients with suicidal ideation: Prevalence and clinical profile

José J. López-Goñi., Javier Fernández-Montalvo, Alfonso Arteaga, Begoña Haro, Departamento de Ciencias de la Salud. Universidad Pública de Navarra, Pamplona/Iruñea, Spain

Background and Objectives: Patients with addictions have a great risk of suicidal ideation and attempts. Suicidal behaviour is a continuum that begins with ideation and may continue with planning, attempts and suicide completion. Investigating the specific risk characteristics for suicidal attempts in patients with addiction problems who present with suicidal ideation is crucial for developing prevention strategies. In this paper, the prevalence rate of suicide attempts among patients with suicidal ideation receiving treatment for addiction was studied. Moreover, differential characteristics for suicidal ideators with and without suicidal attempts were analysed. Methods: A sample of 149 patients with suicidal ideation (110 men and 39 women) who sought treatment for addiction in a Spanish clinical centre was assessed. Information concerning socio-demographic characteristics, addiction severity, and psychopathological symptoms was obtained. Results: In total, 39.6% of the patients had attempted suicide. Patients with both suicidal ideation and suicide attempts showed a more severe addiction profile and more maladjustment to everyday life than patients with only suicidal ideation. Conclusions: In this study, a high prevalence rate of suicide attempts in addicted patients with suicidal ideation was observed. Although all patients with suicidal behaviours presented a high severity in their addiction, suicide attempters showed a worse clinical profile. Systematic screening of suicidal risk in patients seeking treatment for addiction problems is recommended.

69: Suicidal ideation and attempts among drug-addicted patients with lifetime physical and/or sexual abuse

Begoña Haro,  Javier Fernández-Montalvo, Alfonso Arteaga;  José Javier López-Goñi, Health Sciences Department of Public University of Navarre, Spain

Background: Several studies indicate that lifetime abuse is a relevant risk factor for suicidal ideation and/or attempts. However, little is known about this phenomenon in drug-addicted patients seeking treatment. The prevalence rate of suicidal ideation and/or suicide attempts was explored among lifetime physically and/or sexually abused patients receiving treatment for drug addiction. The differential characteristics between these patients and those without suicidal behaviours were studied. Method: Three hundred and seventy-five patients were assessed. Socio-demographic characteristics, addiction severity, lifetime abuse, suicidal ideation and attempts, and psychopathological symptoms were explored. Results: Eighty-two patients (21.9%) presented with a history of lifetime abuse and were included in the study (37 men and 45 women). Sixty-two per cent of them presented with lifetime suicidal ideation (12.2% in the last month), and 30.5% with suicidal attempts (1.2% in the last month). Patients with suicidal ideation or attempts showed a more severe addiction profile (assessed by the EuropASI) and more psychopathological symptoms (assessed by the SCL-90-R). Conclusion: This study highlights the relationship between previous traumatic experiences and suicidal behaviours. According to these results, systematic screening of suicidal risk in addicted patients seeking treatment with histories of abuse is recommended.

67: Life Review Therapy for Holocaust Survivors 

Simon Forstmeier, University of Siegen, Germany;  Danny Brom, Hebrew University of Jerusalem, Israel; Martin Auerbach, Elisheva van der Hal, Amcha, Israel; Sarah Zimmermann, University of Siegen, Germany

The mental health of Holocaust survivors is in average still worse today than a comparison group, mainly with regard to PTSD symptoms, depression and anxiety (Barel, Van IJzendoorn, Sagi-Schwartz, & Bakermans-Kranenburg, 2010). Although Holocaust survivors exhibit incredible adaptive processes (deVries, Suedfeld, Krell, Blando, & Southard, 2005), aging poses new challenges for this adaptation process. Most PTSD treatment research has focused on children and young and middle-aged adults. The need for psychotherapy for the elderly, especially for those who suffer from PTSD, has till very recently not been subject to systematic study (Maercker, 2013). As aging is accompanied by reviewing one’s life (Butler, 1963), a narrative approach including life-review and narrative exposure (i.e. “life review therapy”) seems to meet the natural need of older people very well (Pinquart & Forstmeier, 2012). However, life review therapy (LRT) has not been evaluated with state-of-the-art methodology in traumatised older people, let alone in Holocaust survivors. Therefore, a randomized controlled trial that investigates the efficacy of LRT is urgently needed. In cooperation with the Hebrew University of Jerusalem and AMCHA, the “National Israeli Center for Psychosocial Support of Survivors of the Holocaust and the Second Generation”, we evaluate the effect of life-review therapy for Holocaust survivors on symptoms of PTSD and related mental health problems (depression, anxiety, prolonged grief), compared to a supportive control group (visiting “social clubs” at AMCHA) that receives no psychotherapeutic intervention. We further aim to identify groups of participants that especially seem to benefit from the intervention. The sample (N = 80) consists of Holocaust survivors, i.e., Israeli individuals that were born 1945 or earlier in Europe and experienced persecution, concentration camp, witnessing torture and death, or having to survive in hiding and/or other traumatic events by the Nazi regime during World War II. The participants will be recruited from 6 centres of AMCHA. Each patient is diagnosed with one or more of the following conditions: PTSD, complex PTSD, depressive disorder (major depression, minor depression, or dysthymia), anxiety disorder, prolonged grief disorder. The treatment includes 20 sessions. Before and after the treatment phase, participants in both conditions will be assessed. Follow-up will take place at 6 months post-treatment. We expect that life-review therapy reduces the symptoms of PTSD and related mental health problems with a large pre-post effect size and to a greater extent than the supportive control group at posttest and 6-months follow-up with a medium-to-large effect size.