Alternatives to talking based interventions for anxiety and depression Flashcards
What is the government guidance on anxiety for the UK?
List 3 points
- Step dependent
- Low intensity therapy
- CBT/applied relaxation or drug treatment
- Step dependent
- Low intensity therapy
- CBT/applied relaxation or drug treatment
These are the government guidance on ____ for the UK
a. Bipolar disorder
b. Anxiety
c. Depression
d. Multiple personality disorder
b. Anxiety
State the 4 steps to the UK stepped care model for anxiety
- Identification and assessment; education about GAD and treatment options; active monitoring
- Low-intensity psychological interventions (i.e., self help and psychoeducation)
- High Intensity Intervention OR Drug treatment (SSRI, or SNRI)
- Complex drug/psychological treatment; multiagency teams
List these 4 steps in order of the UK stepped care model for anxiety
Low-intensity psychological interventions (i.e., self help and psychoeducation)
Complex drug/psychological treatment; multiagency teams
Identification and assessment; education about GAD and treatment options; active monitoring
High Intensity Intervention OR Drug treatment (SSRI, or SNRI)
- Identification and assessment; education about GAD and treatment options; active monitoring
- Low-intensity psychological interventions (i.e., self help and psychoeducation)
- High Intensity Intervention OR Drug treatment (SSRI, or SNRI)
- Complex drug/psychological treatment; multiagency teams
How does the UK stepped care model identify and assess anxiety?
List 2 ways
- Education about GAD and treatment options
- Active monitoring
Give 2 examples of low-intensity psychological interventions based on the UK stepped care model for anxiety
- Self help
- Psychoeducation
What is the government guidance on depression for the UK?
List 3 points
- Severity dependent (PHQ-9 score)
- Less severe PHQ<16:CBT, behavioural activation, exercise, anti depressant
- More severe PHQ > 16: CBT, behavioural activation, anti depressant, group exercise
What PHQ-9 score is considered to be associated with severe depression?
PHQ > 16
What PHQ-9 score is considered to be associated with less severe depression?
PHQ < 16
What treatment does the UK government recommend for people with less severe PHQ < 16?
List 4
- CBT
- Behavioural activation
- Exercise
- Anti depressant
What treatment does the UK government recommend for people with more severe PHQ > 16?
List 4
- CBT
- Behavioural activation
- Anti depressant
- Group exercise
What are the top 5 first-line treatments for less severe depression?
- Guided self- help
- Group CBT
- Group behavioural activation
- Individual CBT
- Individual behavioural activation
What are the bottom 6 first-line treatments for less severe depression?
- Group exercise
- Group mindfulness and meditation
- Interpersonal psychotherapy
- SSRI antidepressants
- Counselling
- Short-term psychodynamic psychotherapy
Treatment options for depression are listed in what order?
Order of recommended use, based on the committee’s interpretation of their clinical and cost effectiveness and consideration of implementation factors
What are the top 5 first-line treatments for more severe depression?
- Individual CBT + Anti depressants
- Individual CBT
- Individual behavioural activation
- Antidepressant medication
- Individual problem solving
What are the bottom 5 first-line treatments for more severe depression?
- Counselling
- Short-term psychodynamic psychotherapy
- Interpersonal psychotherapy
- Guided self-help
- Group exercise
What is the government guidance on anxiety for Canada?
List 4 points
Recommended first-line therapy
- Cognitive Behaviour Therapy
- SSRI
- SNRI
- Antidepressant pregabalin
Which countries take a severity approach to mitigating depression?
UK and Canada
What is the government guidance on depression for Canada?
List 5 points
For mild severity depression:
- Psychoeducation
- Self-help
- Psychological therapy (behavioural activation, CBT, interpersonal therapy)
- Exercise
- Pharmacological treatment (SSRI, SNRI)
What is the government guidance on anxiety for the US?
Clinical guidelines for anxiety not published
APA guidelines are provided for PTSD instead
American Psychiatric Association has guidelines for PTSD and panic and OCD
What is the government guidance on depression for the US?
Recommended treatments:
1. CBT, interpersonal psychotherapy (IPT), mindfulness-based cognitive therapy, psychodynamic therapy
- Antidepressant medications
- Combined treatment: CBT or IPT plus ADM
- Exercise (if above not effective)
What is evidence for pharmacotherapy (the use of pharmacological interventions) for anxiety?
Systematic Reviews/Meta-Analyses
Found Pharmacotherapies (SSRI - escitalopram; SNRI -duloxetine, venlaflaxine; Pregabalin) appear to effective at reducing symptoms of anxiety, however the size of the effects are mixed
Systematic Reviews/Meta-Analyses
Found Pharmacotherapies (SSRI - escitalopram; SNRI -duloxetine, venlaflaxine; Pregabalin) appear to effective at reducing symptoms of anxiety, however the size of the effects are mixed
What are the effect sizes reported by Carl et al. (2020)?
g = 0.38
Systematic Reviews/Meta-Analyses
Found Pharmacotherapies (SSRI - escitalopram; SNRI -duloxetine, venlaflaxine; Pregabalin) appear to effective at reducing symptoms of anxiety, however the size of the effects are mixed
What are the effect sizes reported by Leichsenring et al (2022)?
0.01-0.56
Systematic Reviews/Meta-Analyses
Found Pharmacotherapies (SSRI - escitalopram; SNRI -duloxetine, venlaflaxine; Pregabalin) appear to effective at reducing symptoms of anxiety, however the size of the effects are mixed
What was the limitation of the acceptability across active comparisons of these studies, according to Slee et al (2019)?
Acceptability across active comparisons largely involved drugs with acceptability profiles worse than placebo
Simply = Even though pharmacotherapies seem to appear effective in reducing anxiety, patients using it often do not stick to these interventions (they end up choosing to stick to the placebos)
What is evidence for pharmacotherapy (the use of pharmacological interventions) for depression?
Systematic Reviews/Meta-Analyses
Cipriani et al (2018) meta-analysis (n = 522 RCTs; 116 477 patients)
Small effect (SMD = 0.30) favouring pharmacotherapy in comparison to placebo
All active drugs were associated with higher withdrawal rates than placebo with ORs ranging between 1·64 and 4·44,
What was the effect size reported by Cipriani et al (2018) of pharmacotherapy in comparison to placebo?
SMD = 0.30
According to Cipriani et al.’s (2018) meta-analysis, did patients prefer pharmacotherapy or the placebo?
Pharmacotherapy
According to Cipriani et al.’s (2018) meta-analysis, all active drugs were associated with _____ than placebo with ORs ranging between 1·64 and 4·44,
Higher withdrawal rates
According to Cipriani et al.’s (2018) meta-analysis, all active drugs were associated with higher withdrawal rates than placebo with ORs ranging between __ and __
1.64 and 4.44,
What are the 3 limitations of pharmacological therapies?
- Study design
- Bias
- Follow up periods
Why is study design a limitation for pharmacological therapies?
While results are effective meta- analyses predominantly compare results to placebo or non intervention controls.
Why is bias a limitation for pharmacological therapies?
Studies are often completed by pharmaceutical companies
Why is follow up periods a limitation for pharmacological therapies?
Slee et al (2019) noted that follow up period ranged from 4 to 26 weeks
Slee et al (2019) noted that follow up period for pharmacological studies ranged from ___ to ___
4 to 26 weeks
What is the follow up period for psychological interventions?
6-12 months
What is the issue of follow up periods for pharmacological interventions being 4-26 weeks?
It is not clear what the longer term impacts of pharmacological interventions beyond 26 weeks are
Clinical guidelines in the US, UK, Canada, and Australia recommend ____ as a treatment for depression
Exercise
Clinical guidelines in the __, ___, ___ and ___ recommend exercise as a treatment for depression
- US
- UK
- Canada
- Australia
What is the limitation of clinical guidelines in the US, UK, Canada and Australia recommending exercise as a treatment for depression?
Guidelines are unclear on dose or exercise modality
What are the UK guidelines for exercise interventions?
Group exercise/increase any form of physical activity (NICE, 2023)
What are the US guidelines for exercise interventions?
Any dose of aerobic exercise or resistance training (APA, 2010)
What are the Australian guidelines for exercise interventions?
Combination of strength and vigorous aerobic exercise at least 2-3 times a week (Malhi et al 2020)
What is the latest evidence for Exercise Interventions to reduce anxiety?
Evidence from Systematic Reviews & Meta Analyses (Anxiety)
While evidence suggests that exercise may be effective for reducing symptoms of anxiety, although effect sizes are small (g = 0.3-0.4) (Aylett et al., 2018; Gordon et al., 2017)
Evidence from Systematic Reviews & Meta Analyses (Anxiety)
While evidence suggests that exercise may be effective for reducing symptoms of anxiety, although effect sizes are small
What was the effect size reported by Aylett et al. (2018) and Gordon et al. (2017)
0.3-0.4
True or False?
There are very few studies. on exercise for depression, which means there is not enough evidence and guidelines
False
There are very few studies. on exercise for anxiety, which means there is not enough evidence and guidelines
What is the latest evidence for Exercise Interventions to reduce depression?
Evidence from systematic reviews and meta-analyses indicate that exercise is associated with a decrease in symptoms of depression and may be associated with large effects in patients with MDD (Heissel et al., 2023; Noetel et al., 2024; Schuch et al., 2016; Gordon et al., 2018).
Schuch et al (2016) and Noetel et al (2024) suggest that interventions with higher intensities may have greater effects.
Noetel et al (2024) network meta-analysis of RCTs of exercise interventions.
Evidence from systematic reviews and meta-analyses indicate that exercise is associated with a decrease in symptoms of depression and may be associated with large effects in patients with …?
MDD
Evidence from systematic reviews and meta-analyses indicate that exercise is associated with a decrease in symptoms of depression and may be associated with ___ effects in patients with MDD
a. large
b. moderate
c. small
d. no
a. large
According to Schuch et al (2016) and Noetel et al (2024), exercise interventions with higher intensities may have ____ effects
a. smaller
b. greater
b. greater
According to Schuch et al (2016) and Noetel et al (2024), exercise interventions with ____ intensities may have greater effects
a. higher
b. lower
a. higher
According to Schuch et al (2016) and Noetel et al (2024), exercise interventions with higher intensities may have greater effects
What does this suggest about recommending exercise?
Maybe there is a difference in the types of exercise we should be. recommending people with depression
Noetel et al (2024) conducted a network meta-analysis of ____ of exercise interventions
RCTs (randomised control trials)