Alternatives to talking based interventions for anxiety and depression Flashcards by D E

What is the government guidance on anxiety for the UK?

List 3 points

Step dependent
Low intensity therapy
CBT/applied relaxation or drug treatment

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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

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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

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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

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How does the UK stepped care model identify and assess anxiety?

List 2 ways

Education about GAD and treatment options
Active monitoring

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Give 2 examples of low-intensity psychological interventions based on the UK stepped care model for anxiety

Self help
Psychoeducation

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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

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What PHQ-9 score is considered to be associated with severe depression?

PHQ > 16

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What PHQ-9 score is considered to be associated with less severe depression?

PHQ < 16

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What treatment does the UK government recommend for people with less severe PHQ < 16?

List 4

CBT
Behavioural activation
Exercise
Anti depressant

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What treatment does the UK government recommend for people with more severe PHQ > 16?

List 4

CBT
Behavioural activation
Anti depressant
Group exercise

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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

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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

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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

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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

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What are the bottom 5 first-line treatments for more severe depression?

Counselling
Short-term psychodynamic psychotherapy
Interpersonal psychotherapy
Guided self-help
Group exercise

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What is the government guidance on anxiety for Canada?

List 4 points

Recommended first-line therapy

Cognitive Behaviour Therapy
SSRI
SNRI
Antidepressant pregabalin

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Which countries take a severity approach to mitigating depression?

UK and Canada

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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)

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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

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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)

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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

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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

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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

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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?

1. Study design 2. Bias 3. 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

1. US 2. UK 3. Canada 4. 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)

What are the 2 limitations of meta-analyses?

1. Can only compare two interventions at a time 2. Can only those evaluated directly in head-to-head trials (i.e., intervention vs control)

Who conducted a network meta-analysis of RCTs of exercise interventions?

Noetel et al (2024)

What are the 2 advantages of network meta-analyses?

1. Can compare three or more interventions 2. Combines both direct and indirect evidence across a network of studies

Is this a: Combines both direct and indirect evidence across a network of studies a. Meta analysis b. Network meta-analysis

b. Network meta-analysis

Is this a: Can only compare two interventions at a time a. Meta analysis b. Network meta-analysis

a. Meta analysis

Is this a: Can compare three or more interventions a. Meta analysis b. Network meta-analysis

b. Network meta-analysis

Is this a: Can only those evaluated directly in head-to-head trials (i.e., intervention vs control) a. Meta analysis b. Network meta-analysis

a. Meta analysis

Based on Noetel et al's (2024) network meta-analysis, what were the findings on exercise effect on depression?

Exercise had moderate effect on depression vs active control (both alone or in combination i.e., with CBT)

Exercise had ____ effect on depression vs active control (both alone or in combination i.e., with CBT) a. Large b. Small c. Moderate

c. Moderate

Exercise had moderate effect on depression compared to ____ (both alone or in combination i.e., with CBT)

Active control

What modes of exercise interventions are the most effective in reducing depression, based on Noetel et al's (2024) network meta-analysis? List 4 modalities

1. Walking/jogging 2. Yoga 3. Strength training 4. Dancing

What modes of exercise interventions are the most effective in reducing depression in both men and women?

Walking/jogging

What modes of exercise interventions are the most effective in reducing depression in only men?

Yoga

What modes of exercise interventions are the most effective in reducing depression in only women?

Strength training

Most effective modality of exercise to reduce depression in ___ is yoga a. Only women b. Only men c. Both men and women d. Neither men or women

b. Only men

Most effective modality of exercise to reduce depression in ___ is walking/jogging a. Only women b. Only men c. Both men and women d. Neither men or women

c. Both men and women

Most effective modality of exercise to reduce depression in ___ is strength training a. Only women b. Only men c. Both men and women d. Neither men or women

a. Only women

Based on Noetel et al's (2024) network meta-analysis, what were the findings on exercise intensity in reducing depression?

Benefits were proportional to exercise intensity Exercise with greater intensity were associated with greater benefit

Exercise with greater intensity were associated with ____ benefit towards reducing depression a. greater b. smaller

a. greater

What are the limitations of exercise interventions?

While exercise interventions may be effective at reducing symptoms of anxiety and depression, the mechanisms for how they do so is unclear and they are often not based on a psychological theory for reducing symptoms of depression or anxiety

May be effective at reducing symptoms of anxiety and depression, the mechanisms for how they do so is unclear and they are often not based on a psychological theory for reducing symptoms of depression or anxiety What intervention for anxiety and depression does this limitation apply to?

Exercise Interventions

What is a popular combined treatment to reduce anxiety and depression?

Pharmacological and Psychotherapy combined interventions

What were the findings on the effects of Pharmacological and Psychotherapy combined interventions on depression?

Cuijppers et al (2020) found that combined treatment had greater response rate (RR 1.27) and remission rate (RR 1.22) for reducing depression

What were the findings on the effects of Pharmacological and Psychotherapy combined interventions on anxiety?

Currently there is a lack of sufficient evidence on the combination of psychotherapy and pharmacological therapy for GAD (Cuijpers et al 2014; Bandelow et al 2009)

What were the findings on the effects of Pharmacological and Psychotherapy combined interventions on panic and ocd?

Cuijpers et al (2014) meta analysis found combined treatment to be more effective than pharmacotherapy alone for OCD (g = 0.7) and panic (g = 0.54)

Cuijpers et al (2014) meta analysis found combined treatment to be more effective than pharmacotherapy alone for OCD and panic What was the effect size for combined treatment for OCD?

g = 0.7

Cuijpers et al (2014) meta analysis found combined treatment to be more effective than pharmacotherapy alone for OCD and panic What was the effect size for combined treatment for panic?

g = 0.54

Cuijppers et al (2020) found that combined treatment had greater response rate and remission rate for reducing depression What was the response rate for combined treatment for depression?

1.27

Cuijppers et al (2020) found that combined treatment had greater response rate and remission rate for reducing depression What was the remission rate for combined treatment for depression?

1.22

What is remission rate?

The rate of the complete disappearance or elimination of symptoms

What is the name of the combined intervention involving exercise and psychological intervention?

Cardiac Rehabilitation

When are patients offered Cardiac Rehabilitation (CR)?

After a cardiac event

After a cardiac event patients are offered what kind of intervention/treatment?

Cardiac Rehabilitation (CR)

What 3 interventions does Cardiac Rehabilitation (CR) include?

1. Exercise 2. Education 3. Stress management/relaxation

How many patients with cardio vascular disease have clinically significant anxiety and/or depression?

1 in 3 patients

1 in 3 patients with cardio vascular disease have clinically significant ...?

Anxiety and/or depression

What is increased anxiety/depression associated with? List 3 points

1. Increased morbidity 2. Mortality 3. Reduced quality of life

1. Increased morbidity 2. Mortality 3. Reduced quality of life What are these consequences associated with?

Anxiety/depression

Does Cardiac Rehabilitation (CR) reduce symptoms of anxiety and depression?

Yes

While Cardiac Rehabilitation (CR) reduces symptoms of anxiety and depression, what did Yohannes et al (2010) report about patient benefits?

Not all patients benefit from Cardiac Rehabilitation (CR), with 30% of patients experiencing elevated anxiety and depression

Not all patients benefit from Cardiac Rehabilitation (CR), with ____% of patients experiencing elevated anxiety and depression a. 40% b. 72% c. 28% d. 30%

d. 30%

Not all patients benefit from Cardiac Rehabilitation (CR), with 30% of patients experiencing ...?

Elevated anxiety and depression

Despite some services offering tailored support to patients in managing anxiety and depression most do not offer ...?

Support

How many studies were analysed in Richards et al.'s (2017) meta analysis on Cardiac Rehabilitation (CR)?

How many patients were in Richards et al.'s (2017) meta analysis on Cardiac Rehabilitation (CR)?

10 703 patients

How many studies used multifaceted interventions (i.e. multi therapy components) in Richards et al.'s (2017) meta analysis on Cardiac Rehabilitation (CR)?

23/35

How many studies used relaxation interventions/therapy components in Richards et al.'s (2017) meta analysis on Cardiac Rehabilitation (CR)?

How many studies used self awareness/self-monitoring interventions/therapy components in Richards et al.'s (2017) meta analysis on Cardiac Rehabilitation (CR)?

How many studies used emotional support/client led discussion interventions/therapy components in Richards et al.'s (2017) meta analysis on Cardiac Rehabilitation (CR)?

How many studies used cognitive challenging/restricting interventions/therapy components in Richards et al.'s (2017) meta analysis on Cardiac Rehabilitation (CR)?

How many studies used increased awareness of cardiac risk factors interventions/therapy components in Richards et al.'s (2017) meta analysis on Cardiac Rehabilitation (CR)?

How many studies used reducing risk factors interventions/therapy components in Richards et al.'s (2017) meta analysis on Cardiac Rehabilitation (CR)?

According to Richards et al.'s (2017) meta analysis on Cardiac Rehabilitation (CR), what was the effect size of CR on reducing anxiety?

0.24

According to Richards et al.'s (2017) meta analysis on Cardiac Rehabilitation (CR), what was the effect size of CR on reducing depression?

0.27

Describe Wells et al.'s (2021) pathway trial study on Cardiac Rehabilitation (CR)

Wells et al (2021) compared cardiac rehabilitation alone vs cardiac rehabilitaiton plus group based metacognitive therapy

Describe the aim of Wells et al.'s (2021) pathway trial study on Cardiac Rehabilitation (CR)

Is MCT+CR more effective than CR-alone at reducing anxiety and depression in cardiac rehabilitation patients (n = 332)

True or False? It can be difficult to use CBT alone on patients with cardiovascular disease

True

Describe the findings of Wells et al.'s (2021) pathway trial study on Cardiac Rehabilitation (CR)

There was a significant decrease in anxiety and depression in group-MCT + CR vs CR alone

There was a significant ____ in anxiety and depression in group-MCT + CR vs CR alone a. decrease b. increase

a. decrease

There was a significant decrease in anxiety and depression in: a. Cardiac Rehabilitation (CR) alone b. Neither Cardiac Rehabilitation (CR) alone or Group-MCT plus Cardiac Rehabilitation (CR) c. Both Cardiac Rehabilitation (CR) alone and Group-MCT plus Cardiac Rehabilitation (CR) d. Group-MCT plus Cardiac Rehabilitation (CR)

d. Group-MCT plus Cardiac Rehabilitation (CR)

Which intervention is more reliable after a 4 month follow up? a. Cardiac Rehabilitation (CR) alone b. Neither Cardiac Rehabilitation (CR) alone or Group-MCT plus Cardiac Rehabilitation (CR) c. Both Cardiac Rehabilitation (CR) alone and Group-MCT plus Cardiac Rehabilitation (CR) d. Group-MCT plus Cardiac Rehabilitation (CR)

d. Group-MCT plus Cardiac Rehabilitation (CR)

Which intervention resulted in the improvement of anxiety and depression symptoms after a 4 month follow up? a. Cardiac Rehabilitation (CR) alone b. Neither Cardiac Rehabilitation (CR) alone or Group-MCT plus Cardiac Rehabilitation (CR) c. Both Cardiac Rehabilitation (CR) alone and Group-MCT plus Cardiac Rehabilitation (CR) d. Group-MCT plus Cardiac Rehabilitation (CR)

d. Group-MCT plus Cardiac Rehabilitation (CR)

Which intervention resulted in the deterioration of anxiety and depression symptoms after a 4 month follow up? a. Cardiac Rehabilitation (CR) alone b. Neither Cardiac Rehabilitation (CR) alone or Group-MCT plus Cardiac Rehabilitation (CR) c. Both Cardiac Rehabilitation (CR) alone and Group-MCT plus Cardiac Rehabilitation (CR) d. Group-MCT plus Cardiac Rehabilitation (CR)

a. Cardiac Rehabilitation (CR) alone

What are the 3 implications (results) of Group-MCT plus Cardiac Rehabilitation (CR)?

1. Improved Mental Health Outcomes 2. Improved Access to Psychological Therapies 3. Meets Patients Needs

How many patients experienced improvement in mental health outcomes through Group-MCT plus Cardiac Rehabilitation (CR)? And what was the deterioration rate?

1 in 3 patients Halved the deterioration rate

How does Group-MCT plus Cardiac Rehabilitation (CR) improve access to psychological therapies?

Group-MCT provided access to psychological support within Cardiac Rehabilitation (CR) where psychological support is minimal or unavailable

How does Group-MCT plus Cardiac Rehabilitation (CR) meets patients needs?

Patients described engaging in chronic worry and rumination, and how current Cardiac Rehabilitation (CR) techniques felt superficial and difficult to apply in real life MCT overcomes limitations with current psychological support in Cardiac Rehabilitation (CR)

What % of patients who underwent Cardiac Rehabilitation (CR) alone made a reliable change post treatment (after 4 months)?

20%

What % of patients who underwent Group-MCT plus Cardiac Rehabilitation (CR) made a reliable change post treatment (after 4 months)?

33%

What % of patients who underwent Cardiac Rehabilitation (CR) alone had gotten worse post treatment (after 4 months)?

15%

What % of patients who underwent Group-MCT plus Cardiac Rehabilitation (CR) had gotten worse post treatment (after 4 months)?

4-5%

Name one new frontier of interventions for heart conditions

CardioActive

What intervention is recommended for children and adolescents with heart conditions?

CardioActive

What is the study design of CardioActive?

Feasibility and acceptability trial

What is the study aim of CardioActive?

Evaluate the acceptability and feasibility of a cardiac rehabilitation programme for children and young people with heart conditions

What activities/therapies are included in CardioActive?

1. Exercise 2. Education 3. Based on psychological theory (Metacogntive Model)

How does CardioActive support adjusting to living with a heart condition in children and adolecents?

It is based on psychological theory (Metacogntive Model)

True or False? UK, Canada and USA have similar guidelines to treating anxiety and depression

True

Beyond talking based therapies there are a number of interventions that have demonstrated efficacy for treating anxiety and depression Name 3 of these interventions

1. Pharmacological interventions 2. Exercise 3. Combined interventions

Which is more beneficial for people with depression and/or anxietyt? Combined interventions (i.e., pharmacological and talking based therapies) or pharmacological interventions alone?

Combined interventions (i.e., pharmacological and talking based therapies)

Alternatives to talking based interventions for anxiety and depression Flashcards

(133 cards)