Evaluating an e-mental health program (“deprexis”) as adjunctive treatment tool in psychotherapy for depression: design of a pragmatic randomized controlled trial

Background Major depressive disorder (MDD) places a significant disease burden on individuals as well as on societies. Several web-based interventions for MDD have shown to be effective in reducing depressive symptoms. However, it is not known whether web-based interventions, when used as adjunctive treatment tools to regular psychotherapy, have an additional effect compared to regular psychotherapy for depression. Methods/design This study is a currently recruiting pragmatic randomized controlled trial (RCT) that compares regular psychotherapy plus a web-based depression program (¿deprexis¿) with a control condition exclusively receiving regular psychotherapy. Adults with a depressive disorder (N?=?800) will be recruited in routine secondary care from therapists over the course of their initial sessions and will then be randomized within therapists to one of the two conditions. The primary outcome is depressive symptoms measured with the Beck Depression Inventory (BDI-II) at three months post randomization. Secondary outcomes include changes on various indicators such as anxiety, somatic symptoms and quality of life. All outcomes are again assessed at the secondary endpoint six months post randomization. In addition, the working alliance and feasibility/acceptability of the treatment condition will be explored. Discussion This is the first randomized controlled trial to examine the feasibility/acceptability and the effectiveness of a combination of traditional face-to-face psychotherapy and web-based depression program compared to regular psychotherapeutic treatment in depressed outpatients in routine care.

Effect of Health Risk Assessment and Counselling on Health Behaviour and Survival in Older People: A Pragmatic Randomised Trial.

BACKGROUND Potentially avoidable risk factors continue to cause unnecessary disability and premature death in older people. Health risk assessment (HRA), a method successfully used in working-age populations, is a promising method for cost-effective health promotion and preventive care in older individuals, but the long-term effects of this approach are unknown. The objective of this study was to evaluate the effects of an innovative approach to HRA and counselling in older individuals for health behaviours, preventive care, and long-term survival. METHODS AND FINDINGS This study was a pragmatic, single-centre randomised controlled clinical trial in community-dwelling individuals aged 65 y or older registered with one of 19 primary care physician (PCP) practices in a mixed rural and urban area in Switzerland. From November 2000 to January 2002, 874 participants were randomly allocated to the intervention and 1,410 to usual care. The intervention consisted of HRA based on self-administered questionnaires and individualised computer-generated feedback reports, combined with nurse and PCP counselling over a 2-y period. Primary outcomes were health behaviours and preventive care use at 2 y and all-cause mortality at 8 y. At baseline, participants in the intervention group had a mean ± standard deviation of 6.9 ± 3.7 risk factors (including unfavourable health behaviours, health and functional impairments, and social risk factors) and 4.3 ± 1.8 deficits in recommended preventive care. At 2 y, favourable health behaviours and use of preventive care were more frequent in the intervention than in the control group (based on z-statistics from generalised estimating equation models). For example, 70% compared to 62% were physically active (odds ratio 1.43, 95% CI 1.16-1.77, p = 0.001), and 66% compared to 59% had influenza vaccinations in the past year (odds ratio 1.35, 95% CI 1.09-1.66, p = 0.005). At 8 y, based on an intention-to-treat analysis, the estimated proportion alive was 77.9% in the intervention and 72.8% in the control group, for an absolute mortality difference of 4.9% (95% CI 1.3%-8.5%, p = 0.009; based on z-test for risk difference). The hazard ratio of death comparing intervention with control was 0.79 (95% CI 0.66-0.94, p = 0.009; based on Wald test from Cox regression model), and the number needed to receive the intervention to prevent one death was 21 (95% CI 12-79). The main limitations of the study include the single-site study design, the use of a brief self-administered questionnaire for 2-y outcome data collection, the unavailability of other long-term outcome data (e.g., functional status, nursing home admissions), and the availability of long-term follow-up data on mortality for analysis only in 2014. CONCLUSIONS This is the first trial to our knowledge demonstrating that a collaborative care model of HRA in community-dwelling older people not only results in better health behaviours and increased use of recommended preventive care interventions, but also improves survival. The intervention tested in our study may serve as a model of how to implement a relatively low-cost but effective programme of disease prevention and health promotion in older individuals. TRIAL REGISTRATION International Standard Randomized Controlled Trial Number: ISRCTN 28458424.

The Process-Outcome Mindfulness Effects in Trainees (PrOMET) study: protocol of a pragmatic randomized controlled trial

Background Mindfulness has its origins in an Eastern Buddhist tradition that is over 2500 years old and can be defined as a specific form of attention that is non-judgmental, purposeful, and focused on the present moment. It has been well established in cognitive-behavior therapy in the last decades, while it has been investigated in manualized group settings such as mindfulness-based stress reduction and mindfulness-based cognitive therapy. However, there is scarce research evidence on the effects of mindfulness as a treatment element in individual therapy. Consequently, the demand to investigate mindfulness under effectiveness conditions in trainee therapists has been highlighted. Methods/Design To fill in this research gap, we designed the PrOMET Study. In our study, we will investigate the effects of brief, audiotape-presented, session-introducing interventions with mindfulness elements conducted by trainee therapists and their patients at the beginning of individual therapy sessions in a prospective, randomized, controlled design under naturalistic conditions with a total of 30 trainee therapists and 150 patients with depression and anxiety disorders in a large outpatient training center. We hypothesize that the primary outcomes of the session-introducing intervention with mindfulness elements will be positive effects on therapeutic alliance (Working Alliance Inventory) and general clinical symptomatology (Brief Symptom Checklist) in contrast to the session-introducing progressive muscle relaxation and treatment-as-usual control conditions. Treatment duration is 25 therapy sessions. Therapeutic alliance will be assessed on a session-to-session basis. Clinical symptomatology will be assessed at baseline, session 5, 15 and 25. We will conduct multilevel modeling to address the nested data structure. The secondary outcome measures include depression, anxiety, interpersonal functioning, mindful awareness, and mindfulness during the sessions. Discussion The study results could provide important practical implications because they could inform ideas on how to improve the clinical training of psychotherapists that could be implemented very easily; this is because there is no need for complex infrastructures or additional time concerning these brief session-introducing interventions with mindfulness elements that are directly implemented in the treatment sessions.

Jüdischer Turn- und Sport-Verein Bar-Kochba München

Bar Kochba / Jüdischer Turn- und Sportverein / Vorstand / München

Jüdische Turn- und Sportzeitung : Organ des Deutschen Kreises der Jüdischen Turnerschaft

Online-Ressource

The increasing role of career guidance at the turn of the centuries

At the beginning this paper sketches trends of the rapid changes of nearly all life issues, especially in society, work behaviours, labour environment and demands for adjustment under new social values. As main factors which influence worldwide the economic development and the labour market are elaborated the globalization and liberalization process and the labour market aspects of feminization, ageing labour force, migration, unemployment as a global phenomenon and general changes in labour demand by occupations and skill level. A well-developed and highly qualified career guidance service is seen as one of the most effective instruments in solving these problems which are raised by the described developements. The personal and psychological effects of uncertainty and dislocation of people and the new requirements of the expected qualification standard make career guidance an important cornerstone to cope with these social aspects. Thus, the nature and structure of guidance and counselling are described under the new challenges. The international co-operation in the guidance sector has accompanied this process in delivering two important documents. The Mission Statement and the Ethical Standards of IAEVG, adopted by the General Assembly of IAEVG in 1995, show in what direction guidance services have to be developed.

The increasing role of career guidance at the turn of the centuries

At the beginning this paper sketches trends of the rapid changes of nearly all life issues, especially in society, work behaviours, labour environment and demands for adjustment under new social values. As main factors which influence worldwide the economic development and the labour market are elaborated the globalization and liberalization process and the labour market aspects of feminization, ageing labour force, migration, unemployment as a global phenomenon and general changes in labour demand by occupations and skill level. A well-developed and highly qualified career guidance service is seen as one of the most effective instruments in solving these problems which are raised by the described developements. The personal and psychological effects of uncertainty and dislocation of people and the new requirements of the expected qualification standard make career guidance an important cornerstone to cope with these social aspects. Thus, the nature and structure of guidance and counselling are described under the new challenges. The international co-operation in the guidance sector has accompanied this process in delivering two important documents. The Mission Statement and the Ethical Standards of IAEVG, adopted by the General Assembly of IAEVG in 1995, show in what direction guidance services have to be developed.

The increasing role of career guidance at the turn of the centuries

At the beginning this paper sketches trends of the rapid changes of nearly all life issues, especially in society, work behaviours, labour environment and demands for adjustment under new social values. As main factors which influence worldwide the economic development and the labour market are elaborated the globalization and liberalization process and the labour market aspects of feminization, ageing labour force, migration, unemployment as a global phenomenon and general changes in labour demand by occupations and skill level. A well-developed and highly qualified career guidance service is seen as one of the most effective instruments in solving these problems which are raised by the described developements. The personal and psychological effects of uncertainty and dislocation of people and the new requirements of the expected qualification standard make career guidance an important cornerstone to cope with these social aspects. Thus, the nature and structure of guidance and counselling are described under the new challenges. The international co-operation in the guidance sector has accompanied this process in delivering two important documents. The Mission Statement and the Ethical Standards of IAEVG, adopted by the General Assembly of IAEVG in 1995, show in what direction guidance services have to be developed.