Abstract Introduction: The factors influencing patients' motivation for undergoing electroconvulsive therapy (ECT) have not yet been subjected to a thorough study. Knowledge of these factors could improve the quality of care for patients with depression recommended to have ECT. Aim: To identify the factors that influence the motivation of patients diagnosed with depression to have ECT. Method: This qualitative study followed a grounded theory approach in which semistructured interviews were conducted with 18 patients from four different psychiatric hospitals to study their perspectives on factors influencing their motivation to have ECT. Results: The explanatory framework of factors influencing motivation for ECT comprises four main categories, starting with the most important category, psychological pain and distress, and continuing with the following categories: perceived need for treatment; perception of ECT as an effective treatment; environmental influences. Discussion: In this study, we found that the psychological pain and distress of depression, and their consequences in daily life, had been the primary experiences that motivated patients to start and continue ECT. Implications for Practice: This is the first study that has examined motivational factors for patients with severe depression to participate in ECT. Professionals appear to have a key role in motivating patients for ECT. They should explore factors that influence motivation for ECT, regularly assess their motivation and intervene on influential factors
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While there is increasing evidence for the effectiveness of psychosocial support programs for cancer patients, little attention has been paid to creativity or art as a way of addressing their psychological problems and improving quality of life. This review provides an overview of interventional studies that investigate the effects of art therapy interventions on anxiety, depression, and quality of life in adults with cancer.
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Depression is a highly prevalent and seriously impairing disorder. Evidence suggests that music therapy can decrease depression, though the music therapy that is offered is often not clearly described in studies. The purpose of this study was to develop an improvisational music therapy intervention based on insights from theory, evidence and clinical practice for young adults with depressive symptoms. The Intervention Mapping method was used and resulted in (1) a model to explain how emotion dysregulation may affect depressive symptoms using the Component Process Model (CPM) as a theoretical framework; (2) a model to clarify as to how improvisational music therapy may change depressive symptoms using synchronisation and emotional resonance; (3) a prototype Emotion-regulating Improvisational Music Therapy for Preventing Depressive symptoms (EIMT-PD); (4) a ten-session improvisational music therapy manual aimed at improving emotion regulation and reducing depressive symptoms; (5) a program implementation plan; and (6) a summary of a multiple baseline study protocol to evaluate the effectiveness and principles of EIMT-PD. EIMT-PD, using synchronisation and emotional resonance may be a promising music therapy to improve emotion regulation and, in line with our expectations, reduce depressive symptoms. More research is needed to assess its effectiveness and principles.
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The aim of this study was to assess the feasibility, acceptability and preliminary effectiveness of Mindfulness-Based Compassionate Living (MBCL) as a follow-up intervention to Mindfulness Based Cognitive Therapy in adults with recurrent depression. We conducted an uncontrolled study in 17 patients with recurrent depression, in two successive groups. The first group contained novices to compassion training (N = 14); in the second group, ten of these participated again, in addition to three new participants (N = 13). The overall group contained 15 females and 2 males, aged between 37 and 71. The MBCL program was qualitatively evaluated using post-intervention focus group interviews in both groups. In addition, self-report questionnaires assessing depressive symptoms, worry and both self-compassion and mindfulness skills were administered before and after MBCL. No patients dropped out of the intervention. Average attendance was 7.52 (SD 0.73) out of eight sessions. Helpful elements were theory on the emotion regulation systems, practicing self-compassion explicitly and embodiment of a compassionate attitude by the teachers. Unhelpful elements were the lack of a clear structure, lack of time to practice compassion for self and the occurrence of the so-called back draft effect. We adapted the program in accordance with the feedback of the participants. Preliminary results showed a reduction in depressive symptoms in the second group, but not in the first group, and an increase in self-compassion in both groups. Worry and overall mindfulness did not change. MBCL appears to be feasible and acceptable for patients suffering from recurrent depressive symptoms who previously participated in MBCT. Selection bias may have been a factor as only experienced and motivated participants were used; this, however, suited our intention to co-create MBCL in close collaboration with knowledgeable users. Examination of the effectiveness of MBCL in a sufficiently powered randomised controlled trial is needed.
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Introduction: Depression can be a serious problem in young adult students. There is a need to implement and monitor prevention interventions for these students. Emotion-regulating improvisational music therapy (EIMT) was developed to prevent depression. The purpose of this study was to evaluate the feasibility of EIMT for use in practice for young adult students with depressive symptoms in a university context. Method: A process evaluation was conducted embedded in a larger research project. Eleven students, three music therapists and five referrers were interviewed. The music therapists also completed evaluation forms. Data were collected concerning client attendance, treatment integrity, musical components used to synchronise, and experiences with EIMT and referral. Results: Client attendance (90%) and treatment integrity were evaluated to be sufficient (therapist adherence 83%; competence 84%). The music therapists used mostly rhythm to synchronise (38 of 99 times). The students and music therapists reported that EIMT and its elements evoked changes in all emotion regulation components. The students reported that synchronisation elicited meaningful experiences of expressing joy, feeling heard, feeling joy and bodily responses of relaxation. The music therapists found the manual useful for applying EIMT. The student counsellors experienced EIMT as an appropriate way to support students due to its preventive character. Discussion: EIMT appears to be a feasible means of evoking changes in emotion regulation components in young adult students with depressive symptoms in a university context. More studies are needed to create a more nuanced and evidence-based understanding of the feasibility of EIMT, processes of change and treatment integrity.
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BACKGROUND: Depression in later life is a common mental disorder with a prevalence rate of between 3% and 35% for minor depression and approximately 2% for Major Depressive Disorder (MDD). The most common treatment modalities for MDD are antidepressant medication and psychological interventions. Recently, Behavioral Activation (BA) has gained renewed attention as an effective treatment modality in MDD. Although BA is considered an easy accessible intervention for both patients and health care workers (such as nurses), there is no research on the effectiveness of the intervention in inpatient depressed elderly.The aim of study, described in the present proposal, is to examine the effects of BA when executed by nurses in an inpatient population of elderly persons with MDD. METHODS/DESIGN: The study is designed as a multi-center cluster randomized controlled trial. BA, described as The Systematic Activation Method (SAM) will be compared with Treatment as Usual (TAU). We aim to include ten mental health care units in the Netherlands that will each participate as a control unit or an experimental unit. The patients will meet the following criteria: (1) a primary diagnosis of Major Depressive Disorder (MDD) according to the DSM-IV criteria; (2) 60 years or older; (3) able to read and write in Dutch; (4) have consented to participate via the informed consent procedure. Based on an effect size d = 0.7, we intend to include 51 participants per condition (n = 102). The SAM will be implemented within the experimental units as an adjunctive therapy to Treatment As Usual (TAU). All patients will be assessed at baseline, after eight weeks, and after six months. The primary outcome will be the level of depression measured by means of the Beck Depression Inventory (Dutch version). Other assessments will be activity level, mastery, costs, anxiety and quality of life. DISCUSSION: To our knowledge this is the first study to test the effect of Behavioral Activation as a nursing intervention in an inpatient elderly population. This research has been approved by the medical research ethics committee for health-care settings in the Netherlands (No. NL26878.029.09) and is listed in the Dutch Trial Register (NTR No.1809).
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Empirical studies in the creative arts therapies (CATs; i.e., art therapy, dance/movement therapy, drama therapy, music therapy, psychodrama, and poetry/bibliotherapy) have grown rapidly in the last 10 years, documenting their positive impact on a wide range of psychological and physiological outcomes (e.g., stress, trauma, depression, anxiety, and pain). However, it remains unclear how and why the CATs have positive effects, and which therapeutic factors account for these changes. Research that specifically focuses on the therapeutic factors and/or mechanisms of change in CATs is only beginning to emerge. To gain more insight into how and why the CATs influence outcomes, we conducted a scoping review (Nstudies = 67) to pinpoint therapeutic factors specific to each CATs discipline, joint factors of CATs, and more generic common factors across all psychotherapy approaches. This review therefore provides an overview of empirical CATs studies dealing with therapeutic factors and/or mechanisms of change, and a detailed analysis of these therapeutic factors which are grouped into domains. A framework of 19 domains of CATs therapeutic factors is proposed, of which the three domains are composed solely of factors unique to the CATs: “embodiment,” “concretization,” and “symbolism and metaphors.” The terminology used in change process research is clarified, and the implications for future research, clinical practice, and CATs education are discussed.
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Aim: To explore which factors are associated with psychological insulin resistance in insulin-naive patients with Type 2 diabetes in primary care.Methods: A sample of 101 insulin-naive patients with Type 2 diabetes completed self-administered questionnaires including demographic and clinical characteristics, the Insulin Treatment Appraisal Scale and the Center for Epidemiological Studies Depression scale. Psychological insulin resistance was denoted by negative appraisal of insulin (Insulin Treatment Appraisal Scale).Results: Thirty-nine per cent of the sample were unwilling to accept insulin therapy. Unwilling participants perceived taking insulin more often as a failure to control their diabetes with tablets or lifestyle compared with willing participants (59 vs. 33%), unwilling participants were more reluctant to accept the responsibilities of everyday management of insulin therapy (49 vs. 24%). Multiple linear regression analysis revealed that depression and objection to lifelong insulin therapy were independently associated with psychological insulin resistance.Conclusions: In this study in primary care, depression and objection to lifelong insulin therapy are associated with psychological insulin resistance. Analysis of the objection to the indefiniteness of insulin therapy showed a sense of limitation of daily life and loss of independence that should not be underestimated. Insulin should be offered as a means to improve health as this might facilitate the acceptance of insulin therapy.
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Light therapy for older persons with dementia is often administered with light boxes, even though indoor ambient light may more comfortably support the diverse lighting needs of this population. Our objective is to investigate the influence of indoor daylight and lighting on the health of older adults with dementia living in long-term care facilities. A systematic literature search was performed within PubMed, CINAHL, PsycINFO, Web of Science and Scopus databases. The included articles (n=37) were published from 1991 to 2020. These articles researched the influence of existing and changed indoor light conditions on health and resulted in seven categories of health outcomes. Although no conclusive evidence was found to support the ability of indoor light to decrease challenging behaviors or improve circadian rhythms, findings of two studies indicate that exposure to (very) cool light of moderate intensity diminished agitation. Promising effects of indoor light were to reduce depressive symptoms and facilitate spatial orientation. Furthermore, there were indications that indoor light improved one’s quality of life. Despite interventions with dynamic lighting having yielded little evidence of its efficacy, its potential has been insufficiently researched among this study population. This review provides a clear and comprehensive description of the impact of diverse indoor light conditions on the health of older adults with dementia living in long-term care facilities. Variation was seen in terms of research methods, (the description of) light conditions, and participants’ characteristics (types and severity of dementia), thus confounding the reliability of the findings. The authors recommend further research to corroborate the beneficial effects of indoor light on depression and to clarify its role in supporting everyday activities of this population. An implication for practice in long-term care facilities is raising the awareness of the increased lighting needs of aged residents. Original article at: https://doi.org/10.2147/CIA.S297865
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