Our vision: To challenge paradigms by developing effective innovations that treat disease and optimize health, and that prove their value in methodologically sound scientific research.
Our R&D projects cover a range of medical, psychological and technological topics. What they have in common is close collaboration between world-leading scientists and GAIA in-house experts.
Universities and research centres in Pisa, Turin (Italy), Madrid (Spain), Lisbon (Portugal), Stockholm (Karolinska Institute, Sweden), and Essex (United Kingdom)
This project is supported by the European Commission under the Horizon2020 scheme and aims to utilize sensor-technology in order to improve the detection and treatment of depression among patients with certain medical conditions (e.g., cardiovascular disease, kidney failure). Using artificial intelligence algorithms, sensor technology is used to estimate patients’ depression risk, based on routinely collected physiological data, and to initiate appropriate interventions accordingly. This project is consistent with GAIA’s vision to harness sophisticated software and technology in order to transform diagnostic and treatment procedures and thereby improve patient outcomes as well as quality of life.
Universities and medical centres in Hamburg, Lübeck, Berlin (Charité), Trier, Bielefeld, Tübingen, Bern (Switzerland), and Linköping (Sweden)
This multicenter randomized controlled trial was sponsored by the German Ministry of Health and investigated how deprexis, our evidence-based depression intervention, can help improve the standard of treatment for people with mild to moderate depressive symptoms. More than 1,000 adults with depressive symptoms were randomized to either deprexis or a control group, and the results showed significant and clinically meaningful effects in favour of deprexis. This was the largest trial of its kind, and apart from the main results, the EVIDENT trial continues to yield many scientific publications, providing detailed insights into how effective software can help reduce the global burden of depression. Many follow-up studies are now being conducted to further investigate how deprexis can best be implemented to help patients around the globe.
Major anxiety disorders
University of Texas (Austin, US) and VA Palo Alto (US), Sheffield Hallam University and City, University of London (UK)
Anxiety disorders are among the most common mental disorders across the globe, are associated with immense suffering, psychosocial impairment, and economic costs, but only a small proportion of those affected receive adequate treatment. We have developed an effective software intervention for the three major anxiety disorders: Panic disorder, generalized anxiety disorder, and social phobia. This intervention—velibra—has demonstrated efficacy in a recently published RCT (Berger et al., 2017, Psychological Medicine). Along with our international collaborating partners, we are now finalizing an English version of velibra and will soon be launching research in the US, UK and potentially other English-speaking regions. Our vision is to make a meaningful contribution to alleviating the global burden of anxiety and thereby improve the lives of millions who are struggling to overcome anxiety.
University medical centres in Hamburg and Berlin (Charité), King’s College/Guy’s Hospital (London, UK) and universities and medical centres in the USA (Los Angeles, Pennsylvania, Missouri)
Following encouraging results from a first study (Fischer et al., 2015, Lancet Psychiatry), which showed that our software (deprexis) can be used to treat depression in multiple sclerosis (MS), we are continuing to pursue this important clinical challenge. Symptoms such as fatigue and depression are exceedingly common in MS but few evidence-based treatments are available to most patients. We have developed a software-based intervention (ELEVIDA) specifically for MS-fatigue, and our novel depression intervention (MS-deprexis) is currently examined in a large, international, multicenter RCT, sponsored by the National MS Society (USA; Principal Investigator: Professor S. Gold, Berlin). Our vision is to bring effective software-based treatments to people living with MS, anywhere on the globe, easily accessible whenever they need it.
Research on or about GAIA’s innovations is published regularly in peer-reviewed scientific journals. Here is a selection of recent articles.
Twomey, C., et al. (2017).
Psychiatry Research, 256, 371-377.
Computerised cognitive behavioural therapy (cCBT) programmes differ widely but have rarely been evaluated separately through meta-analysis. Through a meta-analysis of randomised controlled trials, we investigated the effectiveness of ‘Deprexis’, an unconventional and individually-tailored cCBT programme for depression. Comparisons from eight studies (N = 2402) demonstrated the effectiveness of Deprexis for depressive symptoms at post-intervention, with a medium effect size (g = 0.54, 95% CI: 0.39–0.69). Analogous results arose when study quality, screening, and randomisation procedure were taken into account. The level of guidance provided alongside Deprexis had a statistically non-significant impact upon the effect size. There was no significant difference in the performance of Deprexis in developer-led trials compared with non-developer trials, and no publication bias was detected. The weighted-average dropout rate for participants allocated to Deprexis treatment arms in included studies was 26.5%. Based primarily on trials in naturalistic community settings, the findings support the effectiveness of Deprexis for depressive symptoms. The positive findings add to the growing evidence-base for individually-tailored cCBT programmes and point to the need for further investigations of apparent systematic differences in the effectiveness of specific cCBT programmes.
Beevers, C. G., et al. (2017).
Journal of Consulting and Clinical Psychology, 85(4), 367-380.
OBJECTIVE: To examine the effectiveness of an Internet intervention for depression with a randomized, controlled trial in a large sample of adults recruited from the United States.
METHOD: The current study examines the effectiveness of Deprexis, an Internet treatment for depression that was provided with relatively minimal support. There were 376 treatment-seeking adults (mean age = 32 years; 74% female; 77% Caucasian, 7% Asian, 7% multiple races, 4% African American, and 11% Hispanic/Latino) with elevated depression (Quick Inventory of Depressive Symptoms-Self-Report [QIDS-SR] > = 10) who were randomized to receive an 8-week course of treatment immediately (n = 285) or after an 8-week delay (n = 91; i.e., waitlist control).
RESULTS: Intention-to-treat analyses indicated that treatment was associated with greater reduction in self-reported symptoms of depression (effect size d = .80) and 12 times greater likelihood of experiencing at least 50% symptom improvement compared with waitlist control. Similar effects were observed for several secondary outcomes, such as interviewer-rated depression symptoms, well-being, and depression-related disability. Treatment effects for symptoms of social anxiety, panic, and traumatic intrusions were relatively small.
CONCLUSION: Results suggest that Deprexis can produce symptomatic improvement among depressed adults recruited from the United States. Additional research is needed that examines whether improvements are maintained over time and who is particularly likely to respond to this form of treatment.
Berger, T., et al. (2017).
Psychological Medicine, 47(1), 67-80.
BACKGROUND: Internet-based cognitive-behavioural treatment (ICBT) for anxiety disorders has shown some promise, but no study has yet examined unguided ICBT in primary care. This randomized controlled trial (RCT) investigated whether a transdiagnostic, unguided ICBT programme for anxiety disorders is effective in primary care settings, after a face-to-face consultation with a physician (MD). We hypothesized that care as usual (CAU) plus unguided ICBT would be superior to CAU in reducing anxiety and related symptoms among patients with social anxiety disorder (SAD), panic disorder with or without agoraphobia (PDA) and/or generalized anxiety disorder (GAD).
METHOD: Adults (n = 139) with at least one of these anxiety disorders, as reported by their MD and confirmed by a structured diagnostic interview, were randomized. Unguided ICBT was provided by a novel transdiagnostic ICBT programme (‘velibra’). Primary outcomes were generic measures, such as anxiety and depression symptom severity, and diagnostic status at post-treatment (9 weeks). Secondary outcomes included anxiety disorder-specific measures, quality of life, treatment adherence, satisfaction, and general psychiatric symptomatology at follow-up (6 months after randomization).
RESULTS: CAU plus unguided ICBT was more effective than CAU at post-treatment, with small to medium between-group effect sizes on primary (Cohen’s d = 0.41-0.47) and secondary (Cohen’s d = 0.16-0.61) outcomes. Treatment gains were maintained at follow-up. In the treatment group, 28.2% of those with a SAD diagnosis, 38.3% with a PDA diagnosis, and 44.8% with a GAD diagnosis at pretreatment no longer fulfilled diagnostic criteria at post-treatment.
CONCLUSIONS: The unguided ICBT intervention examined is effective for anxiety disorders when delivered in primary care.
Karyotaki, E., et al. (2017).
JAMA Psychiatry, 74(4), 351-359.
IMPORTANCE: Self-guided internet-based cognitive behavioral therapy (iCBT) has the potential to increase access and availability of evidence-based therapy and reduce the cost of depression treatment.
OBJECTIVES: To estimate the effect of self-guided iCBT in treating adults with depressive symptoms compared with controls and evaluate the moderating effects of treatment outcome and response.
DATA SOURCES: A total of 13 384 abstracts were retrieved through a systematic literature search in PubMed, Embase, PsycINFO, and Cochrane Library from database inception to January 1, 2016.
STUDY SELECTION: Randomized clinical trials in which self-guided iCBT was compared with a control (usual care, waiting list, or attention control) in individuals with symptoms of depression.
DATA EXTRACTION AND SYNTHESIS: Primary authors provided individual participant data from 3876 participants from 13 of 16 eligible studies. Missing data were handled using multiple imputations. Mixed-effects models with participants nested within studies were used to examine treatment outcomes and moderators.
MAIN OUTCOMES AND MEASURES: Outcomes included the Beck Depression Inventory, Center for Epidemiological Studies-Depression Scale, and 9-item Patient Health Questionnaire scores. Scales were standardized across the pool of the included studies.
RESULTS: Of the 3876 study participants, the mean (SD) age was 42.0 (11.7) years, 2531 (66.0%) of 3832 were female, 1368 (53.1%) of 2574 completed secondary education, and 2262 (71.9%) of 3146 were employed. Self-guided iCBT was significantly more effective than controls on depressive symptoms severity (β = -0.21; Hedges g = 0.27) and treatment response (β = 0.53; odds ratio, 1.95; 95% CI, 1.52-2.50; number needed to treat, 8). Adherence to treatment was associated with lower depressive symptoms (β = -0.19; P = .001) and greater response to treatment (β = 0.90; P < .001). None of the examined participant and study-level variables moderated treatment outcomes.
CONCLUSIONS AND RELEVANCE: Self-guided iCBT is effective in treating depressive symptoms. The use of meta-analyses of individual participant data provides substantial evidence for clinical and policy decision making because self-guided iCBT can be considered as an evidence-based first-step approach in treating symptoms of depression. Several limitations of the iCBT should be addressed before it can be disseminated into routine care.
Schröder, J., et al. (2017).
Cognitive Therapy and Research, 1-12.
Internet interventions may help bridging gaps in the treatment of depression but dissemination is slow in most countries. Attitudes towards these novel treatments options among health care professionals and potential users may be crucial for a successful implementation. We recruited 1004 adults with mild to moderate depression symptoms within a randomized-controlled trial (RCT) on the efficacy of an Internet intervention (EVIDENT trial), and 428 licensed psychotherapists. We used the Attitudes towards Psychological Online Interventions Questionnaire (APOI) and confirmed psychometric validity of an adapted version for health care professionals, in order to test if psychotherapists hold more negative attitudes towards such interventions compared to individuals with depression symptoms, and to explore variables that predict these attitudes. Individuals with depression symptoms reported more positive attitudes towards Internet interventions than psychotherapists (large group difference; ηp2 = 0.384). Recruitment in clinical settings was associated with more negative attitudes compared to recruitment via the media. Among therapists, endorsing a psychodynamic rather than another theoretical orientation was associated with more pronounced negative attitudes. Results elucidate possible reasons for the slow dissemination of Internet interventions and suggest pathways for appropriate implementation into healthcare services.
Meyer, B., et al. (2017).
BMC Psychiatry, 17(1), 55.
Background: Depression is common among persons with epilepsy (PwE), affecting roughly one in three individuals, and its presence is associated with personal suffering, impaired quality of life, and worse prognosis. Despite the availability of effective treatments, depression is often overlooked and treated inadequately in PwE, in part because of assumed concerns over drug interactions or proconvulsant effects of antidepressants. Internet-administered psychological interventions might complement antidepressant medication or psychotherapy, and preliminary evidence suggests that they can be effective. However, no trial has yet examined whether an Internet intervention designed to meet the needs of PwE can achieve sustained reductions in depression and related symptoms, such as anxiety, when offered as adjunct to treatment as usual.
Methods/Design: This randomized controlled trial will include 200 participants with epilepsy and a current depressive disorder, along with currently at least moderately elevated depression (Patient Health Questionnaire (PHQ-9) sum score of at least 10). Patients will be recruited via epilepsy treatment centers and other sources, including Internet forums, newspaper articles, flyers, posters, and media articles or advertisements, in German-speaking countries. Main inclusion criteria are: self-reported diagnosis of epilepsy and a depressive disorder, as assessed with a phone-administered structured diagnostic interview, none or stable antidepressant medication, no current psychotherapy, no other major psychiatric disorder, no acute suicidality. Participants will be randomly assigned to either (1) a care-as-usual/waitlist (CAU/WL) control group, in which they receive CAU and are given access to the Internet intervention after 3 months (that is, a CAU/WL control group), or (2) a treatment group that may also use CAU and in addition immediately receives six-month access to the novel, Internet-administered intervention. The primary outcome measure is the PHQ-9, collected at three months post-baseline; secondary measures include self-reported anxiety, work and social adjustment, epilepsy symptoms (including seizure frequency and severity), medication adherence, potential negative treatment effects and health-related quality of life. Measurements are collected online at pre-treatment (T0), three months (T1), six months (T2), and nine months (T3).
Discussion: Results of this trial are expected to extend the body of knowledge with regard to effective and efficient treatment options for PwE who experience elevated depression and anxiety.
Klein, J.-P., et al. (2016).
Psychotherapy and Psychosomatics, 85(4), 218-228.
BACKGROUND: Mild to moderate depressive symptoms are common but often remain unrecognized and treated inadequately. We hypothesized that an Internet intervention in addition to usual care is superior to care as usual alone (CAU) in the treatment of mild to moderate depressive symptoms in adults.
METHODS: This trial was controlled, randomized and assessor-blinded. Participants with mild to moderate depressive symptoms (Patient Health Questionnaire, PHQ-9, score 5-14) were recruited from clinical and non-clinical settings and randomized to either CAU or a 12-week Internet intervention (Deprexis) adjunctive to usual care. Outcomes were assessed at baseline, 3 months (post-assessment) and 6 months (follow-up). The primary outcome measure was self-rated depression severity (PHQ-9). The main analysis was based on the intention-to-treat principle and used linear mixed models.
RESULTS: A total of 1,013 participants were randomized. Changes in PHQ-9 from baseline differed signixFB01;cantly between groups (t825 = 6.12, p < 0.001 for the main effect of group). The post-assessment between-group effect size in favour of the intervention was d = 0.39 (95% CI: 0.13-0.64). It was stable at follow-up, with d = 0.32 (95% CI: 0.06-0.69). The rate of participants experiencing at least minimally clinically important PHQ-9 change at the post-assessment was higher in the intervention group (35.6 vs. 20.2%) with a number needed to treat of 7 (95% CI: 5-10).
CONCLUSIONS: The Internet intervention examined in this trial was superior to CAU alone in reducing mild to moderate depressive symptoms. The magnitude of the effect is clinically important and has public health implications.
Krause, K., et al. (2016).
Zeitschrift für Psychiatrie, Psychologie und Psychotherapie, 64, 121-131.
Abstract. The aim of this study was to identify available evidence-based computer-based interventions to reduce depressive symptoms. Therefore we conducted a systematic literature research. We identified 37 interventions which are mostly (51,4 %) based on methods of cognitive behavioral therapy alone. For the English language area there is a broad spectrum of internet-, computer- and smartphone-based interventions for patients with depressive symptoms. In the German language area availability of such interventions is still scarce. Linguistic and cultural adaptations of the foreign-language intervention systems would facilitate a substantial expansion of the available choices. In order to fully utilize the potential of computer-based interventions, it is important to clarify how to best provide these interventions to those in need.
Zill, J., et al. (2016).
BMC Psychiatry, 16(1), 19.
BACKGROUND: Problem drinking is an important global health concern, causing premature mortality and morbidity. Only few problem drinkers seek professional care, unfortunately, because of multiple barriers such as insufficient change motivation, fear of stigmatization or limited access to care. The aim of this study will be to examine the effectiveness of a novel Internet intervention termed Vorvida, which was developed based on established cognitive-behavioral therapy techniques with the aim of reducing problematic alcohol consumption.
METHODS/DESIGN: A two-arm randomized control trial (RCT) will be conducted to determine whether using Vorvida results in greater reductions in self-reported problem drinking, compared with a care-as-usual/waitlist (CAU/WL) control group. There will be a baseline assessment (t0) and follow-up assessments after three (t1) and six months (t2). Inclusion criteria will be: minimum age of 18, an average consumption of alcohol >24⁄12 g (men/women) per day and an AUDIT-C score ≥ 3, as well as informed consent. Participants will be randomly assigned to the intervention or control condition at a ratio of 1:1. Recruitment, informed consent, randomization and assessment will be Internet-based. Primary outcome will be change in self-reported alcohol consumption between t0 and t1. Secondary outcomes will be self-reported drinking behavior, expectancies of effects of alcohol use, abstinence and relapse tendencies, self-efficacy and motivation to change.
DISCUSSION: This study is expected to establish the extent to which a novel Internet intervention could contribute to reducing problem drinking among adults with mild to severe alcohol use disorders who may or may not seek or access a traditional treatments. Potentially, this program could be an effective and efficient tool to help reduce problem drinking on a population level because a great number of users can be reached simultaneously without adding burden to treating clinicians.
Fischer, A., et al. (2015).
The Lancet Psychiatry, 2(3), 217-223.
Background: With a lifetime risk for major depressive disorder of up to 50%, depression is a common comorbidity in multiple sclerosis but remains widely underdiagnosed and untreated. We investigated the potential of a fully automated, internet-based, cognitive behavioural therapy programme, Deprexis, to reduce depressive symptoms in patients with multiple sclerosis.
Methods: For this randomised controlled trial, we recruited patients from an outpatient clinic in Hamburg, Germany. Patients aged 18–65 years were eligible for inclusion if they had multiple sclerosis and self-reported depressive symptoms. By use of a computer-generated randomisation sequence, we allocated 90 patients (1:1; no blocking or stratification) to either the intervention group or a waitlist control group for 9 weeks. The primary endpoint was the Beck Depression Inventory (BDI), as assessed by an intention-to-treat analysis. This trial is registered with ClinicalTrials.gov, number NCT01663649.
Findings: 71 patients completed the trial: 35 patients in the intervention group and 36 patients in the control group. During the intervention, BDI scores decreased in the Deprexis group and increased in the control group, yielding a positive effect of Deprexis relative to the waitlist group (mean group difference −4·02 points [95% CI −7·26 to −0·79], p=0·015, effect size d=0·53). Worsening of depressive symptoms from below to above the clinical cutoff (BDI >13) occurred in three (7%) of 45 patients in the control group and no patients in the Deprexis group. We noted no adverse events with respect to new occurrence of suicidal ideation during the trial.
Interpretation: Psychological online-intervention programmes could be suitable for patients with multiple sclerosis who are unable to regularly attend therapeutic sessions because of mobility impairments.
Fassbinder, E., et al. (2015).
Journal of Clinical Psychology, 71(8), 764-777.
Borderline personality disorder (BPD) is a severe, highly prevalent mental disorder. Effective psychological treatments for BPD are available. However, most patients do not receive evidence-based treatments partly because of high treatment delivery costs and lack of specialized therapists. By integrating specialized e-health tools into BPD-specific treatments, treatment intensity can be increased, frequency of face-to-face sessions and burden for psychotherapists can be reduced, and implementation of new skills and experiences in the everyday life of these patients can be promoted. This bears great potential to increase the availability of evidenced-based psychotherapy for BPD patients and close the gap between demand and supply. In this article we present such an innovative e-health tool, priovi, which has been developed for schema therapy. The concept and application of priovi are described and illustrated with a case example.
Meyer, B., et al. (2015).
Internet Interventions, 2(1), 48-59.
Background: Studies have shown that certain Internet interventions can help alleviate depression. However, many such interventions contain personal support elements, making it difficult to ascertain whether the program or the support drives the effects. Studies are needed to investigate whether Internet interventions contribute to symptom reduction even when they are delivered without personal support, and even among severely depressed individuals who often receive other forms of treatment.
Objective: This randomized controlled trial aimed to examine the effect of an Internet intervention that was deployed without personal support (“Deprexis”) among adults with initially severe depression symptoms.
Methods: Adults recruited from a range of sources who had exceeded the threshold for severe depression (PHQ-9 ≥ 15) in a pre-screening assessment and met inclusion criteria were randomized (N = 163) to the intervention (3 months program access; n = 78) or care-as-usual/waitlist control (n = 85). A diagnostic screening interview was administered by telephone at baseline to all participants. Online assessments were administered at baseline, 3 months (post-treatment), and 6 months (follow-up). The main outcome was the Patient Health Questionnaire (PHQ-9) between baseline and post-treatment.
Results: Eighty-two percent of randomized participants were reached for the post-treatment assessment. Results for the intention-to-treat (ITT) sample showed significant intervention effects on depression reduction between baseline and post-treatment (linear mixed model [MM], F1,155.6 = 9.00, p < .01, for the time by condition interaction), with a medium between-group effect size, Cohen’s d = 0.57 (95% CI: 0.22–0.92). Group differences in depression severity at follow-up were marginally significant in the ITT sample, t (119) = 1.83, p = 0.07, and smaller than at post-treatment (PHQ-9, d = 0.33, 95% CI: −0.03–0.69). The number needed to treat (NNT) at post-treatment was 5, with 38% of participants in the intervention group achieving response (at least 50% PHQ-9 symptom change, plus post-treatment score <10), compared to 17% in the control group, p < 0.01. Effects on secondary outcomes, including anxiety, health-related quality of life, and somatic symptoms, were not significant, with the exception of significant effects on anxiety reduction in PP analyses. Early ratings of program helpfulness/alliance (after 3 weeks) predicted pre–post depression reduction, controlling for baseline severity and early symptom change.
Conclusions: These results replicate and extend previous findings by showing that Deprexis can facilitate symptomatic improvement over 3 months and, perhaps to a lesser degree, up until 6 months among adults with initially severe depression.
Holmes, E. A., et al. (2015).
Submitted to Emerging Trends in the Social and Behavioral Sciences.
Mental imagery involves having an experience like perception but in the absence of a percept. We frequently have mental images such as when we remember an event or imagine the future. In psychological disorders, emotional mental images can flash to mind and be highly distressing, including traumatic memories or simulations of feared future events. However, emotional images have been neglected in research and therapy. This entry combines perspectives from cognitive science (mental imagery) and clinical psychology (psychological disorders). Cognitive science suggests that compared to verbal thoughts, mental imagery has a more powerful impact on emotion. Therefore, it is useful to ask about imagery in clinical assessment of emotional disorders. However, this approach has been largely restricted to PTSD (posttraumatic stress disorder). First, we illustrate that emotional mental imagery occurs across a wide variety of disorders. Second, by mapping the nature of imagery in disorders where it has been neglected (e.g., bipolar disorder), we may be able to import existing imagery therapy techniques (e.g., from PTSD) to improve treatment. Third, by drawing on cognitive science, we can capitalize on the properties inherent to mental imagery to suggest novel techniques. For example, maladaptive imagery may be reduced by cognitive tasks, which interfere with holding an image in mind. Also, adaptive imagery may be boosted by computerized training in generating positive imagery. Intriguingly, this opens the possibility of cognitively informed and computerized psychological treatments that may look rather different from traditional talking therapies.
Krieger, T., et al. (2014).
BMC Psychiatry, 14(1), 285.
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.
Hasler, G., et al. (2014).
Dialogues in Clinical Neuroscience, 16, 255-266.
Patient-reported outcome (PRO) refers to measures that emphasize the subjective view of patients about their health-related conditions and behaviors. Typically, PROs include self-report questionnaires and clinical interviews. Defining PROs for borderline personality disorder (BPD) is particularly challenging given the disorder’s high symptomatic heterogeneity, high comorbidity with other psychiatric conditions, highly fluctuating symptoms, weak correlations between symptoms and functional outcomes, and lack of valid and reliable experimental measures to complement self-report data. Here, we provide an overview of currently used BPD outcome measures and discuss them from clinical, psychometric, experimental, and patient perspectives. In addition, we review the most promising leads to improve BPD PROs, including the DSM-5 Section III, the Recovery Approach, Ecological Momentary Assessments, and novel experimental measures of social functioning that are associated with functional and social outcomes.
Bower, P., et al. (2013).
BMJ, 346, f540.
Objective: To assess how initial severity of depression affects the benefit derived from low intensity interventions for depression.
Design: Meta-analysis of individual patient data from 16 datasets comparing low intensity interventions with usual care.
Setting: Primary care and community settings.
Participants: 2470 patients with depression.
Interventions: Low intensity interventions for depression (such as guided self help by means of written materials and limited professional support, and internet delivered interventions).
Main outcome measures: Depression outcomes (measured with the Beck Depression Inventory or Center for Epidemiologic Studies Depression Scale), and the effect of initial depression severity on the effects of low intensity interventions.
Results: Although patients were referred for low intensity interventions, many had moderate to severe depression at baseline. We found a significant interaction between baseline severity and treatment effect (coefficient −0.1 (95% CI −0.19 to −0.002)), suggesting that patients who are more severely depressed at baseline demonstrate larger treatment effects than those who are less severely depressed. However, the magnitude of the interaction (equivalent to an additional drop of around one point on the Beck Depression Inventory for a one standard deviation increase in initial severity) was small and may not be clinically significant.
Conclusions: The data suggest that patients with more severe depression at baseline show at least as much clinical benefit from low intensity interventions as less severely depressed patients and could usefully be offered these interventions as part of a stepped care model.
Alexandra Widmer (2016)
Wie du der Erschöpfung entkommst und mutig neue Wege gehst
Gitta Jacob, Hannie van Genderen, Laura Seebauer (2015)
A Schema Therapy Self-Help and Support Book
Arnoud Arntz, Gitta Jacob (2012)
An Introductory Guide to the Schema Mode Approach