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Maree L Hackett - One of the best experts on this subject based on the ideXlab platform.

  • pharmacological Psychological and non invasive brain stimulation interventions for preventing depression after stroke
    Cochrane Database of Systematic Reviews, 2020
    Co-Authors: Sabine M Allida, Katherine Laura Cox, Chengfang Hsieh, Allan House, Maree L Hackett
    Abstract:

    Background Depression is an important consequence of stroke that influences recovery yet often is not detected, or is inadequately treated. This is an update and expansion of a Cochrane Review first published in 2004 and previously updated in 2008. Objectives The primary objective is to test the hypothesis that pharmacological, Psychological Therapy, non‐invasive brain stimulation, or combinations of these interventions reduce the incidence of diagnosable depression after stroke. Secondary objectives are to test the hypothesis that pharmacological, Psychological Therapy, non‐invasive brain stimulation or combinations of these interventions reduce levels of depressive symptoms and dependency, and improve physical functioning after stroke. We also aim to determine the safety of, and adherence to, the interventions. Search methods We searched the Specialised Register of Cochrane Stroke and the Cochrane Depression Anxiety and Neurosis (last searched August 2018). In addition, we searched the following databases; Cochrane Central Register of Controlled Trials, CENTRAL (the Cochrane Library, 2018, Issue 8), MEDLINE (1966 to August 2018), Embase (1980 to August 2018), PsycINFO (1967 to August 2018), CINAHL (1982 to August 2018) and three Web of Science indexes (2002 to August 2018). We also searched reference lists, clinical trial registers (World Health Organization International Clinical Trials Registry Platform (WHO ICTRP); to August 2018 and ClinicalTrials.gov; to August 2018), conference proceedings; we also contacted study authors. Selection criteria Randomised controlled trials (RCTs) comparing: 1) pharmacological interventions with placebo; 2) one of various forms of Psychological Therapy with usual care and/or attention control; 3) one of various forms of non‐invasive brain stimulation with sham stimulation or usual care; 4) a pharmacological intervention and one of various forms of Psychological Therapy with a pharmacological intervention and usual care and/or attention control; 5) non‐invasive brain stimulation and pharmacological intervention with a pharmacological intervention and sham stimulation or usual care; 6) pharmacological intervention and one of various forms of Psychological Therapy with placebo and Psychological Therapy; 7) pharmacological intervention and non‐invasive brain stimulation with placebo plus non‐invasive brain stimulation; 8) non‐invasive brain stimulation and one of various forms of Psychological Therapy versus non‐invasive brain stimulation plus usual care and/or attention control; and 9) non‐invasive brain stimulation and one of various forms of Psychological Therapy versus sham brain stimulation or usual care plus Psychological Therapy, with the intention of preventing depression after stroke. Data collection and analysis Review authors independently selected studies, assessed risk of bias, and extracted data from all included studies. We calculated mean difference (MD) or standardised mean difference (SMD) for continuous data and risk ratio (RR) for dichotomous data with 95% confidence intervals (CIs). We assessed heterogeneity using the I2 statistic and assessed the certainty of evidence using GRADE. Main results We included 19 RCTs (21 interventions), with 1771 participants in the review. Data were available for 12 pharmacological trials (14 interventions) and seven Psychological trials. There were no trials of non‐invasive brain stimulation compared with sham stimulation or usual care, a combination of pharmacological intervention and one of various forms of Psychological Therapy with placebo and Psychological Therapy, or a combination of non‐invasive brain stimulation and a pharmacological intervention with a pharmacological intervention and sham stimulation or usual care to prevent depression after stroke. Treatment effects were observed on the primary outcome of meeting the study criteria for depression at the end of treatment: there is very low‐certainty evidence from eight trials (nine interventions) that pharmacological interventions decrease the number of people meeting the study criteria for depression (RR 0.50, 95% CI 0.37 to 0.68; 734 participants) compared to placebo. There is very low‐certainty evidence from two trials that Psychological interventions reduce the proportion of people meeting the study criteria for depression (RR 0.68, 95% CI 0.49 to 0.94, 607 participants) compared to usual care and/or attention control. Eight trials (nine interventions) found no difference in death and other adverse events between pharmacological intervention and placebo groups (RR 1.25, 95% CI 0.32 to 4.91; 496 participants) based on very low‐certainty evidence. Five trials found no difference in Psychological intervention and usual care and/or attention control groups for death and other adverse events (RR 1.18, 95% CI 0.73 to 1.91; 975 participants) based on very low‐certainty evidence. Authors' conclusions The available evidence suggests that pharmacological interventions and Psychological Therapy may prevent depression and improve mood after stroke. However, there is very low certainty in these conclusions because of the very low‐certainty evidence. More trials are required before reliable recommendations can be made about the routine use of such treatments after stroke

  • pharmacological Psychological and non invasive brain stimulation interventions for treating depression after stroke
    Stroke, 2020
    Co-Authors: Sabine M Allida, Katherine Laura Cox, Chengfang Hsieh, Helen Lang, Allan House, Maree L Hackett
    Abstract:

    Background Depression is an important morbidity associated with stroke that impacts on recovery yet often undetected or inadequately treated. This is an update and expansion of a Cochrane Review first published in 2004 and updated in 2008. Objectives Primary objective • To determine whether pharmacological Therapy, non‐invasive brain stimulation, Psychological Therapy, or combinations of these interventions reduce the prevalence of diagnosable depression after stroke Secondary objectives • To determine whether pharmacological Therapy, non‐invasive brain stimulation, Psychological Therapy, or combinations of these interventions reduce levels of depressive symptoms, improve physical and neurological function and health‐related quality of life, and reduce dependency after stroke • To assess the safety of and adherence to such treatments Search methods We searched the Specialised Registers of Cochrane Stroke and Cochrane Depression Anxiety and Neurosis (last searched August 2018), the Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 1), in the Cochrane Library, MEDLINE (1966 to August 2018), Embase (1980 to August 2018), the Cumulative Index to Nursing and Alllied Health Literature (CINAHL) (1982 to August 2018), PsycINFO (1967 to August 2018), and Web of Science (2002 to August 2018). We also searched reference lists, clinical trial registers (World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) to August 2018; ClinicalTrials.gov to August 2018), and conference proceedings, and we contacted study authors. Selection criteria Randomised controlled trials comparing (1) pharmacological interventions with placebo; (2) one of various forms of non‐invasive brain stimulation with sham stimulation or usual care; (3) one of various forms of Psychological Therapy with usual care and/or attention control; (4) pharmacological intervention and various forms of Psychological Therapy with pharmacological intervention and usual care and/or attention control; (5) non‐invasive brain stimulation and pharmacological intervention with pharmacological intervention and sham stimulation or usual care; (6) pharmacological intervention and one of various forms of Psychological Therapy with placebo and Psychological Therapy; (7) pharmacological intervention and non‐invasive brain stimulation with placebo plus non‐invasive brain stimulation; (8) non‐invasive brain stimulation and one of various forms of Psychological Therapy versus non‐invasive brain stimulation plus usual care and/or attention control; and (9) non‐invasive brain stimulation and one of various forms of Psychological Therapy versus sham brain stimulation or usual care plus Psychological Therapy, with the intention of treating depression after stroke. Data collection and analysis Two review authors independently selected studies, assessed risk of bias, and extracted data from all included studies. We calculated mean difference (MD) or standardised mean difference (SMD) for continuous data, and risk ratio (RR) for dichotomous data, with 95% confidence intervals (CIs). We assessed heterogeneity using the I² statistic and certainty of the evidence according to GRADE. Main results We included 49 trials (56 comparisons) with 3342 participants. Data were available for: (1) pharmacological interventions with placebo (with 20 pharmacological comparisons); (2) one of various forms of non‐invasive brain stimulation with sham stimulation or usual care (with eight non‐invasive brain stimulation comparisons); (3) one of various forms of Psychological Therapy with usual care and/or attention control (with 16 Psychological Therapy comparisons); (4) pharmacological intervention and various forms of Psychological Therapy with pharmacological intervention and usual care and/or attention control (with two comparisons); and (5) non‐invasive brain stimulation and pharmacological intervention with pharmacological intervention and sham stimulation or usual care (with 10 comparisons). We found no trials for the following comparisons: (6) pharmacological intervention and various forms of Psychological Therapy interventions versus placebo and Psychological Therapy; (7) pharmacological intervention and non‐invasive brain stimulation versus placebo plus non‐invasive brain stimulation; (8) non‐invasive brain stimulation and one of various forms of Psychological Therapy versus non‐invasive brain stimulation plus usual care and/or attention control; and (9) non‐invasive brain stimulation and one of various forms of Psychological Therapy versus sham brain stimulation or usual care plus Psychological Therapy. Treatment effects observed: very low‐certainty evidence from eight trials suggests that pharmacological interventions decreased the number of people meeting study criteria for depression (RR 0.70, 95% CI 0.55 to 0.88; 1025 participants) at end of treatment, and very low‐certainty evidence from six trials suggests that pharmacological interventions decreased the number of people with less than 50% reduction in depression scale scores at end of treatment (RR 0.47, 95% CI 0.32 to 0.69; 511 participants) compared to placebo. No trials of non‐invasive brain stimulation reported on meeting study criteria for depression at end of treatment. Only one trial of non‐invasive brain stimulation reported on the outcome <50% reduction in depression scale scores; thus, we were unable to perform a meta‐analysis for this outcome. Very low‐certainty evidence from six trials suggests that Psychological Therapy decreased the number of people meeting the study criteria for depression at end of treatment (RR 0.77, 95% CI 0.62 to 0.95; 521 participants) compared to usual care/attention control. No trials of combination therapies reported on the number of people meeting the study criteria for depression at end of treatment. Only one trial of combination (non‐invasive brain stimulation and pharmacological intervention) Therapy reported <50% reduction in depression scale scores at end of treatment. Thus, we were unable to perform a meta‐analysis for this outcome. Five trials reported adverse events related to the central nervous system (CNS) and noted significant harm in the pharmacological interventions group (RR 1.55, 95% CI 1.12 to 2.15; 488 participants; very low‐certainty evidence). Four trials found significant gastrointestinal adverse events in the pharmacological interventions group (RR 1.62, 95% CI 1.19 to 2.19; 473 participants; very low‐certainty evidence) compared to the placebo group. No significant deaths or adverse events were found in the Psychological Therapy group compared to the usual care/attention control group. Non‐invasive brain stimulation interventions and combination therapies resulted in no deaths. Authors' conclusions Very low‐certainty evidence suggests that pharmacological or Psychological therapies can reduce the prevalence of depression. This very low‐certainty evidence suggests that pharmacological Therapy, Psychological Therapy, non‐invasive brain stimulation, and combined interventions can reduce depressive symptoms. Pharmacological intervention was associated with adverse events related to the CNS and the gastrointestinal tract. More research is required before recommendations can be made about the routine use of such treatments.

Daniel Freeman - One of the best experts on this subject based on the ideXlab platform.

  • automated Psychological Therapy using immersive virtual reality for treatment of fear of heights a single blind parallel group randomised controlled trial
    The Lancet Psychiatry, 2018
    Co-Authors: Daniel Freeman, Polly Haselton, Jason Freeman, Bernhard Spanlang, Sameer Kishore, Emily Albery, Megan Denne, Poppy Brown, Mel Slater
    Abstract:

    Summary Background Engaging, interactive, and automated virtual reality (VR) treatments might help solve the unmet needs of individuals with mental health disorders. We tested the efficacy of an automated cognitive intervention for fear of heights guided by an avatar virtual coach (animated using motion and voice capture of an actor) in VR and delivered with the latest consumer equipment. Methods We did a randomised trial of automated VR versus usual care. We recruited adults aged older than 18 years with a fear of heights by radio advertisements in Oxfordshire, UK. We diagnosed fear of heights if participants scored more than 29 on the Heights Interpretation Questionnaire (HIQ). We randomly allocated participants by computer in a 1:1 ratio to either automated VR delivered in roughly six 30-min sessions administered about two to three times a week over a 2-week period (intervention group) or to usual care (control group). Randomisation was stratified by severity of fear of heights. The research team, who were unaware of the random allocation, administered three fear-of-height assessments, at baseline (0 weeks), at the end of treatment (2 weeks), and at follow-up (4 weeks). The primary outcome measure was HIQ score (range 16–80, with higher scores indicating greater severity). This trial is registered with the ISRCTN registry, number ISRCTN11898283. Findings Between Nov 25, 2017, and Feb 27, 2018, 100 individuals were enrolled and underwent randomisation, of whom 49 were assigned to the VR treatment group and 51 to the control group. All participants completed the 4-week follow-up. The mean total treatment time in VR was 124·43 min (SD 34·23). Compared with participants in the control group, the VR treatment reduced fear of heights at the end of treatment (mean change score −24·5 [SD 13·1] in the VR group vs −1·2 [7·3] in the control group; adjusted difference −24·0, 95% CI −27·7 to −20·3; Cohen's d=2·0; p Interpretation Psychological Therapy delivered automatically by a VR coach can produce large clinical benefits. Evidence-based VR treatments have the potential to greatly increase treatment provision for mental health disorders. Funding Oxford VR, and the National Institute of Health Research Oxford Health Biomedical Research Centre.

  • automated Psychological Therapy using immersive virtual reality for treatment of fear of heights a single blind parallel group randomised controlled trial
    The Lancet Psychiatry, 2018
    Co-Authors: Daniel Freeman, Polly Haselton, Jason Freeman, Bernhard Spanlang, Sameer Kishore, Emily Albery, Megan Denne, Poppy Brown, Mel Slater
    Abstract:

    Summary Background Engaging, interactive, and automated virtual reality (VR) treatments might help solve the unmet needs of individuals with mental health disorders. We tested the efficacy of an automated cognitive intervention for fear of heights guided by an avatar virtual coach (animated using motion and voice capture of an actor) in VR and delivered with the latest consumer equipment. Methods We did a randomised trial of automated VR versus usual care. We recruited adults aged older than 18 years with a fear of heights by radio advertisements in Oxfordshire, UK. We diagnosed fear of heights if participants scored more than 29 on the Heights Interpretation Questionnaire (HIQ). We randomly allocated participants by computer in a 1:1 ratio to either automated VR delivered in roughly six 30-min sessions administered about two to three times a week over a 2-week period (intervention group) or to usual care (control group). Randomisation was stratified by severity of fear of heights. The research team, who were unaware of the random allocation, administered three fear-of-height assessments, at baseline (0 weeks), at the end of treatment (2 weeks), and at follow-up (4 weeks). The primary outcome measure was HIQ score (range 16–80, with higher scores indicating greater severity). This trial is registered with the ISRCTN registry, number ISRCTN11898283. Findings Between Nov 25, 2017, and Feb 27, 2018, 100 individuals were enrolled and underwent randomisation, of whom 49 were assigned to the VR treatment group and 51 to the control group. All participants completed the 4-week follow-up. The mean total treatment time in VR was 124·43 min (SD 34·23). Compared with participants in the control group, the VR treatment reduced fear of heights at the end of treatment (mean change score −24·5 [SD 13·1] in the VR group vs −1·2 [7·3] in the control group; adjusted difference −24·0, 95% CI −27·7 to −20·3; Cohen's d=2·0; p vs −1·5 [7·8] in the control group; adjusted difference −24·3, 95% CI −27·9 to −20·6; Cohen's d=2·0; p Interpretation Psychological Therapy delivered automatically by a VR coach can produce large clinical benefits. Evidence-based VR treatments have the potential to greatly increase treatment provision for mental health disorders. Funding Oxford VR, and the National Institute of Health Research Oxford Health Biomedical Research Centre.

Gerome Breen - One of the best experts on this subject based on the ideXlab platform.

  • DNA methylation of FKBP5 and response to exposure-based Psychological Therapy
    American Journal of Medical Genetics Part B: Neuropsychiatric Genetics, 2018
    Co-Authors: Susanna Roberts, Robert Keers, Gerome Breen, Jonathan R. I. Coleman, Peter Jöhren, Agnieszka Kepa, Kathryn J. Lester, Jürgen Margraf, Silvia Scheider, Tobias Teismann
    Abstract:

    Differential DNA methylation of the hypothalamic-pituitary-adrenal axis related gene FKBP5 has recently been shown to be associated with varying response to environmental influences and may play a role in how well people respond to Psychological treatments. Participants (n = 111) received exposure-based cognitive behavioural Therapy (CBT) for agoraphobia with or without panic disorder, or specific phobias. Percentage DNA methylation levels were measured for the promoter region and intron 7 of FKBP5. The association between percentage reduction in clinical severity and change in DNA methylation was tested using linear mixed models. The effect of genotype (rs1360780) was tested by the inclusion of an interaction term. The association between change in DNA methylation and FKBP5 expression was examined. Change in percentage DNA methylation at one CpG site of intron 7 was associated with percentage reduction in severity (β = -4.26, p = 3.90 × 10-4 ), where a decrease in DNA methylation was associated with greater response to Therapy. An interaction was detected between rs1360780 and changes in DNA methylation in the promoter region of FKBP5 on treatment outcome (p = .045) but did not survive correction for multiple testing. Changes in DNA methylation were not associated with FKBP5 expression. Decreasing DNA methylation at one CpG site of intron 7 of FKBP5 was strongly associated with decreasing anxiety severity following exposure-based CBT. In addition, there was suggestive evidence that allele-specific methylation at the promoter region may also be associated with treatment response. The results of this study add to the growing literature demonstrating the role of biological processes such as DNA methylation in response to environmental influences.

  • non replication of the association between 5httlpr and response to Psychological Therapy for child anxiety disorders
    British Journal of Psychiatry, 2016
    Co-Authors: Kathryn J. Lester, Susanna Roberts, Robert Keers, Gerome Breen, Jonathan R. I. Coleman, Chloe C Y Wong, Kristian Arendt, Judith Blattermeunier, Susan M Bogels, Peter J Cooper
    Abstract:

    Abstract Background We previously reported an association between 5HTTLPR genotype and outcome following cognitive–behavioural Therapy (CBT) in child anxiety (Cohort 1). Children homozygous for the low-expression short-allele showed more positive outcomes. Other similar studies have produced mixed results, with most reporting no association between genotype and CBT outcome. Aims To replicate the association between 5HTTLPR and CBT outcome in child anxiety from the Genes for Treatment study (GxT Cohort 2, n = 829). Method Logistic and linear mixed effects models were used to examine the relationship between 5HTTLPR and CBT outcomes. Mega-analyses using both cohorts were performed. Results There was no significant effect of 5HTTLPR on CBT outcomes in Cohort 2. Mega-analyses identified a significant association between 5HTTLPR and remission from all anxiety disorders at follow-up (odds ratio 0.45, P = 0.014), but not primary anxiety disorder outcomes. Conclusions The association between 5HTTLPR genotype and CBT outcome did not replicate. Short-allele homozygotes showed more positive treatment outcomes, but with small, non-significant effects. Future studies would benefit from utilising whole genome approaches and large, homogenous samples. © The Royal College of Psychiatrists 2015. This is an open access article distributed under the terms of the Creative Commons Attribution (CC BY) licence.

  • serotonin tranporter methylation and response to cognitive behaviour Therapy in children with anxiety disorders
    Translational Psychiatry, 2014
    Co-Authors: Susanna Roberts, Jonathan R. I. Coleman, Kathryn J. Lester, R M Rapee, Jennifer L Hudson, Cathy Creswell, Peter J Cooper, Kerstin Thirlwall, Gerome Breen
    Abstract:

    Anxiety disorders that are the most commonly occurring psychiatric disorders in childhood, are associated with a range of social and educational impairments and often continue into adulthood. Cognitive behaviour Therapy (CBT) is an effective treatment option for the majority of cases, although up to 35–45% of children do not achieve remission. Recent research suggests that some genetic variants may be associated with a more beneficial response to Psychological Therapy. Epigenetic mechanisms such as DNA methylation work at the interface between genetic and environmental influences. Furthermore, epigenetic alterations at the serotonin transporter (SERT) promoter region have been associated with environmental influences such as stressful life experiences. In this study, we measured DNA methylation upstream of SERT in 116 children with an anxiety disorder, before and after receiving CBT. Change during treatment in percentage DNA methylation was significantly different in treatment responders vs nonresponders. This effect was driven by one CpG site in particular, at which responders increased in methylation, whereas nonresponders showed a decrease in DNA methylation. This is the first study to demonstrate differences in SERT methylation change in association with response to a purely Psychological Therapy. These findings confirm that biological changes occur alongside changes in symptomatology following a Psychological Therapy such as CBT.

  • predicting outcome following Psychological Therapy in iapt prompt a naturalistic project protocol
    BMC Psychiatry, 2014
    Co-Authors: Nina Grant, Gerome Breen, Anthony J Cleare, Matthew Hotopf, Nick Grey, Nilay Hepgul, Sinead King, Paul Moran, Carmine M Pariante, Janet Wingrove
    Abstract:

    Depression and anxiety are highly prevalent and represent a significant and well described public health burden. Whilst first line Psychological treatments are effective for nearly half of attenders, there remain a substantial number of patients who do not benefit. The main objective of the present project is to establish an infrastructure platform for the identification of factors that predict lack of response to Psychological treatment for depression and anxiety, in order to better target treatments as well as to support translational and experimental medicine research in mood and anxiety disorders.

Susanna Roberts - One of the best experts on this subject based on the ideXlab platform.

  • DNA methylation of FKBP5 and response to exposure-based Psychological Therapy
    American Journal of Medical Genetics Part B: Neuropsychiatric Genetics, 2018
    Co-Authors: Susanna Roberts, Robert Keers, Gerome Breen, Jonathan R. I. Coleman, Peter Jöhren, Agnieszka Kepa, Kathryn J. Lester, Jürgen Margraf, Silvia Scheider, Tobias Teismann
    Abstract:

    Differential DNA methylation of the hypothalamic-pituitary-adrenal axis related gene FKBP5 has recently been shown to be associated with varying response to environmental influences and may play a role in how well people respond to Psychological treatments. Participants (n = 111) received exposure-based cognitive behavioural Therapy (CBT) for agoraphobia with or without panic disorder, or specific phobias. Percentage DNA methylation levels were measured for the promoter region and intron 7 of FKBP5. The association between percentage reduction in clinical severity and change in DNA methylation was tested using linear mixed models. The effect of genotype (rs1360780) was tested by the inclusion of an interaction term. The association between change in DNA methylation and FKBP5 expression was examined. Change in percentage DNA methylation at one CpG site of intron 7 was associated with percentage reduction in severity (β = -4.26, p = 3.90 × 10-4 ), where a decrease in DNA methylation was associated with greater response to Therapy. An interaction was detected between rs1360780 and changes in DNA methylation in the promoter region of FKBP5 on treatment outcome (p = .045) but did not survive correction for multiple testing. Changes in DNA methylation were not associated with FKBP5 expression. Decreasing DNA methylation at one CpG site of intron 7 of FKBP5 was strongly associated with decreasing anxiety severity following exposure-based CBT. In addition, there was suggestive evidence that allele-specific methylation at the promoter region may also be associated with treatment response. The results of this study add to the growing literature demonstrating the role of biological processes such as DNA methylation in response to environmental influences.

  • non replication of the association between 5httlpr and response to Psychological Therapy for child anxiety disorders
    British Journal of Psychiatry, 2016
    Co-Authors: Kathryn J. Lester, Susanna Roberts, Robert Keers, Gerome Breen, Jonathan R. I. Coleman, Chloe C Y Wong, Kristian Arendt, Judith Blattermeunier, Susan M Bogels, Peter J Cooper
    Abstract:

    Abstract Background We previously reported an association between 5HTTLPR genotype and outcome following cognitive–behavioural Therapy (CBT) in child anxiety (Cohort 1). Children homozygous for the low-expression short-allele showed more positive outcomes. Other similar studies have produced mixed results, with most reporting no association between genotype and CBT outcome. Aims To replicate the association between 5HTTLPR and CBT outcome in child anxiety from the Genes for Treatment study (GxT Cohort 2, n = 829). Method Logistic and linear mixed effects models were used to examine the relationship between 5HTTLPR and CBT outcomes. Mega-analyses using both cohorts were performed. Results There was no significant effect of 5HTTLPR on CBT outcomes in Cohort 2. Mega-analyses identified a significant association between 5HTTLPR and remission from all anxiety disorders at follow-up (odds ratio 0.45, P = 0.014), but not primary anxiety disorder outcomes. Conclusions The association between 5HTTLPR genotype and CBT outcome did not replicate. Short-allele homozygotes showed more positive treatment outcomes, but with small, non-significant effects. Future studies would benefit from utilising whole genome approaches and large, homogenous samples. © The Royal College of Psychiatrists 2015. This is an open access article distributed under the terms of the Creative Commons Attribution (CC BY) licence.

  • serotonin tranporter methylation and response to cognitive behaviour Therapy in children with anxiety disorders
    Translational Psychiatry, 2014
    Co-Authors: Susanna Roberts, Jonathan R. I. Coleman, Kathryn J. Lester, R M Rapee, Jennifer L Hudson, Cathy Creswell, Peter J Cooper, Kerstin Thirlwall, Gerome Breen
    Abstract:

    Anxiety disorders that are the most commonly occurring psychiatric disorders in childhood, are associated with a range of social and educational impairments and often continue into adulthood. Cognitive behaviour Therapy (CBT) is an effective treatment option for the majority of cases, although up to 35–45% of children do not achieve remission. Recent research suggests that some genetic variants may be associated with a more beneficial response to Psychological Therapy. Epigenetic mechanisms such as DNA methylation work at the interface between genetic and environmental influences. Furthermore, epigenetic alterations at the serotonin transporter (SERT) promoter region have been associated with environmental influences such as stressful life experiences. In this study, we measured DNA methylation upstream of SERT in 116 children with an anxiety disorder, before and after receiving CBT. Change during treatment in percentage DNA methylation was significantly different in treatment responders vs nonresponders. This effect was driven by one CpG site in particular, at which responders increased in methylation, whereas nonresponders showed a decrease in DNA methylation. This is the first study to demonstrate differences in SERT methylation change in association with response to a purely Psychological Therapy. These findings confirm that biological changes occur alongside changes in symptomatology following a Psychological Therapy such as CBT.

Mel Slater - One of the best experts on this subject based on the ideXlab platform.

  • automated Psychological Therapy using immersive virtual reality for treatment of fear of heights a single blind parallel group randomised controlled trial
    The Lancet Psychiatry, 2018
    Co-Authors: Daniel Freeman, Polly Haselton, Jason Freeman, Bernhard Spanlang, Sameer Kishore, Emily Albery, Megan Denne, Poppy Brown, Mel Slater
    Abstract:

    Summary Background Engaging, interactive, and automated virtual reality (VR) treatments might help solve the unmet needs of individuals with mental health disorders. We tested the efficacy of an automated cognitive intervention for fear of heights guided by an avatar virtual coach (animated using motion and voice capture of an actor) in VR and delivered with the latest consumer equipment. Methods We did a randomised trial of automated VR versus usual care. We recruited adults aged older than 18 years with a fear of heights by radio advertisements in Oxfordshire, UK. We diagnosed fear of heights if participants scored more than 29 on the Heights Interpretation Questionnaire (HIQ). We randomly allocated participants by computer in a 1:1 ratio to either automated VR delivered in roughly six 30-min sessions administered about two to three times a week over a 2-week period (intervention group) or to usual care (control group). Randomisation was stratified by severity of fear of heights. The research team, who were unaware of the random allocation, administered three fear-of-height assessments, at baseline (0 weeks), at the end of treatment (2 weeks), and at follow-up (4 weeks). The primary outcome measure was HIQ score (range 16–80, with higher scores indicating greater severity). This trial is registered with the ISRCTN registry, number ISRCTN11898283. Findings Between Nov 25, 2017, and Feb 27, 2018, 100 individuals were enrolled and underwent randomisation, of whom 49 were assigned to the VR treatment group and 51 to the control group. All participants completed the 4-week follow-up. The mean total treatment time in VR was 124·43 min (SD 34·23). Compared with participants in the control group, the VR treatment reduced fear of heights at the end of treatment (mean change score −24·5 [SD 13·1] in the VR group vs −1·2 [7·3] in the control group; adjusted difference −24·0, 95% CI −27·7 to −20·3; Cohen's d=2·0; p Interpretation Psychological Therapy delivered automatically by a VR coach can produce large clinical benefits. Evidence-based VR treatments have the potential to greatly increase treatment provision for mental health disorders. Funding Oxford VR, and the National Institute of Health Research Oxford Health Biomedical Research Centre.

  • automated Psychological Therapy using immersive virtual reality for treatment of fear of heights a single blind parallel group randomised controlled trial
    The Lancet Psychiatry, 2018
    Co-Authors: Daniel Freeman, Polly Haselton, Jason Freeman, Bernhard Spanlang, Sameer Kishore, Emily Albery, Megan Denne, Poppy Brown, Mel Slater
    Abstract:

    Summary Background Engaging, interactive, and automated virtual reality (VR) treatments might help solve the unmet needs of individuals with mental health disorders. We tested the efficacy of an automated cognitive intervention for fear of heights guided by an avatar virtual coach (animated using motion and voice capture of an actor) in VR and delivered with the latest consumer equipment. Methods We did a randomised trial of automated VR versus usual care. We recruited adults aged older than 18 years with a fear of heights by radio advertisements in Oxfordshire, UK. We diagnosed fear of heights if participants scored more than 29 on the Heights Interpretation Questionnaire (HIQ). We randomly allocated participants by computer in a 1:1 ratio to either automated VR delivered in roughly six 30-min sessions administered about two to three times a week over a 2-week period (intervention group) or to usual care (control group). Randomisation was stratified by severity of fear of heights. The research team, who were unaware of the random allocation, administered three fear-of-height assessments, at baseline (0 weeks), at the end of treatment (2 weeks), and at follow-up (4 weeks). The primary outcome measure was HIQ score (range 16–80, with higher scores indicating greater severity). This trial is registered with the ISRCTN registry, number ISRCTN11898283. Findings Between Nov 25, 2017, and Feb 27, 2018, 100 individuals were enrolled and underwent randomisation, of whom 49 were assigned to the VR treatment group and 51 to the control group. All participants completed the 4-week follow-up. The mean total treatment time in VR was 124·43 min (SD 34·23). Compared with participants in the control group, the VR treatment reduced fear of heights at the end of treatment (mean change score −24·5 [SD 13·1] in the VR group vs −1·2 [7·3] in the control group; adjusted difference −24·0, 95% CI −27·7 to −20·3; Cohen's d=2·0; p vs −1·5 [7·8] in the control group; adjusted difference −24·3, 95% CI −27·9 to −20·6; Cohen's d=2·0; p Interpretation Psychological Therapy delivered automatically by a VR coach can produce large clinical benefits. Evidence-based VR treatments have the potential to greatly increase treatment provision for mental health disorders. Funding Oxford VR, and the National Institute of Health Research Oxford Health Biomedical Research Centre.