Guided Internet‐based vs. face‐to‐face cognitive behavior therapy for psychiatric and somatic disorders: a systematic review and meta‐analysis

Internet-delivered cognitive behavior therapy (ICBT) has been tested in many research trials, but to a lesser extent directly compared to face-to-face delivered cognitive behavior therapy (CBT). We conducted a systematic review and meta-analysis of trials in which guided ICBT was directly compared to face-to-face CBT. Studies on psychiatric and somatic conditions were included. Systematic searches resulted in 13 studies (total N=1053) that met all criteria and were included in the review. There were three studies on social anxiety disorder, three on panic disorder, two on depressive symptoms, two on body dissatisfaction, one on tinnitus, one on male sexual dysfunction, and one on spider phobia. Face-to-face CBT was either in the individual format (n=6) or in the group format (n=7). We also assessed quality and risk of bias. Results showed a pooled effect size (Hedges'' g) at post-treatment of −0.01 (95% CI: −0.13 to 0.12), indicating that guided ICBT and face-to-face treatment produce equivalent overall effects. Study quality did not affect outcomes. While the overall results indicate equivalence, there are still few studies for each psychiatric and somatic condition and many conditions for which guided ICBT has not been compared to face-to-face treatment. Thus, more research is needed to establish equivalence of the two treatment formats.     

Targets and outcomes of psychotherapies for mental disorders: an overview

It is not yet clear what mental disorders are and what are the causal pathways that lead to them. That makes it difficult to decide what the targets and outcomes of psychotherapies should be. In this paper, the main types of targets and outcomes of psychotherapies are described, and a brief overview is provided of some of the main results of research on these types. These include symptom reduction, personal targets and outcomes from the patient's perspective, improvement of quality of life, intermediate outcomes depending on the theoretical framework of the therapist, negative outcomes to be avoided, and economic outcomes. In line with the dominance of the DSM and ICD systems for diagnoses, most research has been focused on symptom reduction. This considerable body of research, with hundreds of randomized trials, has shown that for most mental disorders effective psychotherapies are available. There is also research showing that psychotherapies can result in improvement of quality of life in most mental disorders. However, relatively little research is available on patient‐defined outcomes, intermediate outcomes, negative outcomes and economic outcomes. Patients, relatives, therapists, employers, health care providers and society at large each have their own perspectives on targets and outcomes of psychotherapies. The perspective of patients should have more priority in research, and a standardization of outcome measures across trials is much needed.     

Advantages and limitations of Internet‐based interventions for common mental disorders

Several Internet interventions have been developed and tested for common mental disorders, and the evidence to date shows that these treatments often result in similar outcomes as in face‐to‐face psychotherapy and that they are cost‐effective. In this paper, we first review the pros and cons of how participants in Internet treatment trials have been recruited. We then comment on the assessment procedures often involved in Internet interventions and conclude that, while online questionnaires yield robust results, diagnoses cannot be determined without any contact with the patient. We then review the role of the therapist and conclude that, although treatments including guidance seem to lead to better outcomes than unguided treatments, this guidance can be mainly practical and supportive rather than explicitly therapeutic in orientation. Then we briefly describe the advantages and disadvantages of treatments for mood and anxiety disorders and comment on ways to handle comorbidity often associated with these disorders. Finally we discuss challenges when disseminating Internet interventions. In conclusion, there is now a large body of evidence suggesting that Internet interventions work. Several research questions remain open, including how Internet interventions can be blended with traditional forms of care.     

Synaptic plasticity in health and disease: introduction and overview

We summarize the reviews and research papers submitted by speakers at a discussion meeting on Synaptic Plasticity in Health and Disease held at the Royal Society, London on 2–3 December 2013, and a subsequent satellite meeting convened at the Royal Society/Kavli Centre at Chicheley Hall on 4–5 December 2013. Together, these contributions give an overview of current research and controversies in a vibrant branch of neuroscience with important implications for the understanding of many forms of learning and memory, and a wide spectrum of neurological and cognitive disorders.     

Review. The neurobiology of pathological gambling and drug addiction: an overview and new findings

Gambling is a prevalent recreational behaviour. Approximately 5% of adults have been estimated to experience problems with gambling. The most severe form of gambling, pathological gambling (PG), is recognized as a mental health condition. Two alternate non-mutually exclusive conceptualizations of PG have considered it as an obsessive-compulsive spectrum disorder and a 'behavioural' addiction. The most appropriate conceptualization of PG has important theoretical and practical implications. Data suggest a closer relationship between PG and substance use disorders than exists between PG and obsessive-compulsive disorder. This paper will review data on the neurobiology of PG, consider its conceptualization as a behavioural addiction, discuss impulsivity as an underlying construct, and present new brain imaging findings investigating the neural correlates of craving states in PG as compared to those in cocaine dependence. Implications for prevention and treatment strategies will be discussed.     

Adenosine signaling in striatal circuits and alcohol use disorders

Adenosine signaling has been implicated in the pathophysiology of alcohol use disorders and other psychiatric disorders such as anxiety and depression. Numerous studies have indicated a role for A1 receptors (A1R) in acute ethanol-induced motor incoordination, while A2A receptors (A2AR) mainly regulate the rewarding effect of ethanol in mice. Recent findings have demonstrated that dampened A2AR-mediated signaling in the dorsomedial striatum (DMS) promotes ethanol-seeking behaviors. Moreover, decreased A2AR function is associated with decreased CREB activity in the DMS, which enhances goal-oriented behaviors and contributes to excessive ethanol drinking in mice. Interestingly, caffeine, the most commonly used psychoactive substance, is known to inhibit both the A1R and A2AR. This dampened adenosine receptor function may mask some of the acute intoxicating effects of ethanol. Furthermore, based on the fact that A2AR activity plays a role in goal-directed behavior, caffeine may also promote ethanol-seeking behavior. The A2AR is enriched in the striatum and exclusively expressed in striatopallidal neurons, which may be responsible for the regulation of inhibitory behavioral control over drug rewarding processes through the indirect pathway of the basal ganglia circuit. Furthermore, the antagonistic interactions between adenosine and dopamine receptors in the striatum also play an integral role in alcoholism and addiction-related disorders. This review focuses on regulation of adenosine signaling in striatal circuits and the possible implication of caffeine in goal-directed behaviors and addiction.     

Internet‐delivered psychological treatments: from innovation to implementation

Internet interventions, and in particular Internet‐delivered cognitive behaviour therapy (ICBT), have existed for at least 20 years. Here we review the treatment approach and the evidence base, arguing that ICBT can be viewed as a vehicle for innovation. ICBT has been developed and tested for several psychiatric and somatic conditions, and direct comparative studies suggest that therapist‐guided ICBT is more effective than a waiting list for anxiety disorders and depression, and tends to be as effective as face‐to‐face CBT. Studies on the possible harmful effects of ICBT are also reviewed: a significant minority of people do experience negative effects, although rates of deterioration appear similar to those reported for face‐to‐face treatments and lower than for control conditions. We further review studies on change mechanisms and conclude that few, if any, consistent moderators and mediators of change have been identified. A recent trend to focus on knowledge acquisition is considered, and a discussion on the possibilities and hurdles of implementing ICBT is presented. The latter includes findings suggesting that attitudes toward ICBT may not be as positive as when using modern information technology as an adjunct to face‐to‐face therapy (i.e., blended treatment). Finally, we discuss future directions, including the role played by technology and machine learning, blended treatment, adaptation of treatment for minorities and non‐Western settings, other therapeutic approaches than ICBT (including Internet‐delivered psychodynamic and interpersonal psychotherapy as well as acceptance and commitment therapy), emerging regulations, and the importance of reporting failed trials.     

Efficacy of imagery rehearsal treatment related to specialized populations: A case study and brief report.

This brief report examines the impact of imagery rehearsal treatment (IRT) on a 10-year-old boy with mild mental retardation and psychiatric illness. There is relatively little published information on the use of IRT to treat nightmares in children. The results in this case are consistent with reports of positive results from IRT in other studies with different populations. The findings in this study suggest that the limitations of IRT may not yet be known, and controlled studies with various populations are needed. This article also examines other factors present in this particular case that did not seem to impact the outcome, hence providing IRT with a robust appearance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The promise of cognitive behavior therapy for treatment of severe mental disorders: a review of recent developments

Cognitive behavior therapy (CBT), as exemplified by the model of psychotherapy developed and refined over the past 40 years by A.T. Beck and colleagues, is one of the treatments of first choice for ambulatory depressive and anxiety disorders. Over the past several decades, there have been vigorous efforts to adapt CBT for treatment of more severe mental disorders, including schizophrenia and the more chronic and/or treatment refractory mood disorders. These efforts have primarily studied CBT as an adjunctive therapy, i.e., in combination with pharmacotherapy. Given the several limitations of state‐of‐the‐art pharmacotherapies for these severe mental disorders, demonstration of clinically meaningful additive effects for CBT would have important implications for improving public health. This paper reviews the key developments in this important area of therapeutics, providing a summary of the current state of the art and suggesting directions for future research.     

Estimating treatment coverage for people with substance use disorders: an analysis of data from the World Mental Health Surveys

Substance use is a major cause of disability globally. This has been recognized in the recent United Nations Sustainable Development Goals (SDGs), in which treatment coverage for substance use disorders is identified as one of the indicators. There have been no estimates of this treatment coverage cross‐nationally, making it difficult to know what is the baseline for that SDG target. Here we report data from the World Health Organization (WHO)'s World Mental Health Surveys (WMHS), based on representative community household surveys in 26 countries. We assessed the 12‐month prevalence of substance use disorders (alcohol or drug abuse/dependence); the proportion of people with these disorders who were aware that they needed treatment and who wished to receive care; the proportion of those seeking care who received it; and the proportion of such treatment that met minimal standards for treatment quality (“minimally adequate treatment”). Among the 70,880 participants, 2.6% met 12‐month criteria for substance use disorders; the prevalence was higher in upper‐middle income (3.3%) than in high‐income (2.6%) and low/lower‐middle income (2.0%) countries. Overall, 39.1% of those with 12‐month substance use disorders recognized a treatment need; this recognition was more common in high‐income (43.1%) than in upper‐middle (35.6%) and low/lower‐middle income (31.5%) countries. Among those who recognized treatment need, 61.3% made at least one visit to a service provider, and 29.5% of the latter received minimally adequate treatment exposure (35.3% in high, 20.3% in upper‐middle, and 8.6% in low/lower‐middle income countries). Overall, only 7.1% of those with past‐year substance use disorders received minimally adequate treatment: 10.3% in high income, 4.3% in upper‐middle income and 1.0% in low/lower‐middle income countries. These data suggest that only a small minority of people with substance use disorders receive even minimally adequate treatment. At least three barriers are involved: awareness/perceived treatment need, accessing treatment once a need is recognized, and compliance (on the part of both provider and client) to obtain adequate treatment. Various factors are likely to be involved in each of these three barriers, all of which need to be addressed to improve treatment coverage of substance use disorders. These data provide a baseline for the global monitoring of progress of treatment coverage for these disorders as an indicator within the SDGs.     

Mexican Blindcats Genus Prietella (Siluriformes: Ictaluridae): an overview of Recent Explorations

The ictalurid genus Prietella was described from a single locality in northern México (Coahuila) in 1954, and until very recently went largely unstudied. Cave explorers have recently uncovered new localities and a second species much farther to the south (México: Tamaulipas). Our team visited over 50 sites, including all of the previously known sites possible, and explored many new sites, expanding the known range of Prietella and describing their habitat. We identified geological units and mapped caves, identified associated troglobitic invertebrates, estimated population sizes and measured water chemistry parameters. We also comment on laboratory diet, parasites, sensory biology, behavior (such as jaw locking and periods of inactivity), reproduction and systematics based on preliminary genetic data. Prietella phreatophila is listed as endangered, and due to the recent discovery of many more sites (formerly documented from three localities, now known from twelve sites, though some are hydrologically connected) we recommend threatened status, with careful attention to growing threats such as over pumping and contamination of the aquifer it lives in. Should these patterns continue unchecked, re-listing this species as endangered may be called for. Prietella lundbergi was also described from one site but is now known from two, though it is quite rare at both (only five specimens have ever been seen). P. lundbergi was described after the most recent revision of the Mexican endangered species list and should probably be considered as endangered.     

Tool use inCebus apella: A case study

The case of a captive Cebus apella,capable of utilizing detached objects as true hammering tools in cracking nuts open, is investigated. In the experimental task administered, the monkey was offered nuts of two different sizes, hazelnuts and walnuts, and a choice among three “hammers” of different percussional efficacy. Its performance was compared to that of one of its cagemates that did not use tools and to its own performance in the absence of tools. Results show that there was a consistent choice of the most efficient tool, that tool use greatly reduces the amount of time needed to crack a nut open (in comparison with either the action of the teeth or pounding the nut against a hard substrate), and that the efficacy of tool use is not conditioned by the relative hardness or size of the nut. In the light of these results, the role of tool use in the exploitation of food resouces is discussed.     

Baculovirus P35 protein: An overview of its applications across multiple therapeutic and biotechnological arenas

Baculovirus immediate early P35 protein is well known for its anti‐apoptotic as well as anti‐oxidant properties. Mechanism of action of P35 involves inhibition of a vast range of initiator to executioner class of caspases. In addition, P35's role in inhibiting oxidant‐induced mitochondrial damage, primarily in the apoptotic pathway, has also been extensively investigated. Elucidation of P35's functions during regulation of programmed cell death (PCD) has led to a renewed focus on exploiting this basic knowledge for clinical and other related applications. This review outlines specific biochemical and genetic pathways where P35 intervenes and regulates rate‐limiting steps in the apoptotic signaling cascade. Research efforts are underway to utilize P35 as an agent in regulating apoptosis and under certain circumstances, also explore the therapeutic potential of its anti‐oxidant features. One of the major outcomes of recent studies include significantly improved effectiveness of cytochrome P450 directed enzyme pro‐drug delivery tools when used in conjunction with P35, which may help in alleviating drug resistance in tumor cells and simultaneously prolonging the cytotoxic effects of anti‐cancer drugs. Moreover, applied research carried out recently in the fields of diabetes, ischemia‐induced neuronal cell death, experimental autoimmune encephalomyelitis (EAE), multiple sclerosis (MS), inflammatory arthritis, cardiovascular and ocular disorders illustrate P35's utilization across diverse therapeutic areas and will certainly make it an attractive biomolecule for the discovery research. © 2009 American Institute of Chemical Engineers Biotechnol. Prog., 2010     

Information use and resource competition: an integrative framework

Organisms may reduce uncertainty regarding how best to exploit their environment by collecting information about resource distribution. We develop a model to demonstrate how competition can facilitate or constrain an individual''s ability to use information when acquiring resources. As resource distribution underpins both selection on information use and the strength and nature of competition between individuals, we demonstrate interdependencies between the two that should be common in nature. Individuals in our model can search for resources either personally or by using social information. We explore selection on social information use across a comprehensive range of ecological conditions, generalizing the producer–scrounger framework to a wide diversity of taxa and resources. We show that resource ecology—defined by scarcity, depletion rate and monopolizability—determines patterns of individual differences in social information use. These differences suggest coevolutionary processes linking dominance systems and social information use, with implications for the evolutionary demography of populations.     

Therapist-supported Internet-based cognitive behaviour therapy yields similar effects as face-to-face therapy for psychiatric and somatic disorders: an updated systematic review and meta-analysis

Providing therapist-guided cognitive behaviour therapy via the Internet (ICBT) has advantages, but a central research question is to what extent similar clinical effects can be obtained as with gold-standard face-to-face cognitive behaviour therapy (CBT). In a previous meta-analysis published in this journal, which was updated in 2018, we found evidence that the pooled effects for the two formats were equivalent in the treatment of psychiatric and somatic disorders, but the number of published randomized trials was relatively low (n=20). As this is a field that moves rapidly, the aim of the current study was to conduct an update of our systematic review and meta-analysis of the clinical effects of ICBT vs. face-to-face CBT for psychiatric and somatic disorders in adults. We searched the PubMed database for relevant studies published from 2016 to 2022. The main inclusion criteria were that studies had to compare ICBT to face-to-face CBT using a randomized controlled design and targeting adult populations. Quality assessment was made using the Cochrane risk of bias criteria (Version 1), and the main outcome estimate was the pooled standardized effect size (Hedges’ g) using a random effects model. We screened 5,601 records and included 11 new randomized trials, adding them to the 20 previously identified ones (total n=31). Sixteen different clinical conditions were targeted in the included studies. Half of the trials were in the fields of depression/depressive symptoms or some form of anxiety disorder. The pooled effect size across all disorders was g=0.02 (95% CI: –0.09 to 0.14) and the quality of the included studies was acceptable. This meta-analysis further supports the notion that therapist-supported ICBT yields similar effects as face-to-face CBT.     

Environmental controls on water use efficiency during severe drought in an Ozark Forest in Missouri,USA

To accurately predict ecosystem responses induced by climate warming at local‐to‐global scales, models are in need of more precise knowledge of response during periods of environmental stress such as drought. In this paper, we studied environmental control of canopy‐level water use efficiency (WUE) during drought at an eddy flux site in an oak‐hickory forest in central Missouri, USA. Two consecutive severe droughts in the summers of 2006 and 2007 afforded coverage of a broad range of environmental conditions. We stratified data to obtain subranges that minimized cross‐correlations among putative WUE‐controlling factors. Our results showed that WUE was subject to control by atmospheric saturation deficit (ASD), soil water potential (SWP) and the ratio of diffuse to total photosynthetically active radiation (I_f/I_t). Generally, WUE was found to scale with 1/(ASD)^0.5, consistent with predictions from stomatal optimization theory. In contrast, SWP and I_f/I_t were related to WUE in a linear fashion. ASD was better correlated with WUE than either of the other two factors. It was also observed that the relationship between WUE and any single controlling factor was subject to influence of the other two. One such example was an opposite response of WUE to SWP between low and high ASD values, suggesting a breakdown of stomatal optimality under severe environmental stresses and a shift from optimal stomatal regulation to nonstomatal regulation at leaf scale. We have demonstrated that different data handling (stratified vs. nonstratified) or selection (hourly vs. daily) could lead to different conclusions on the relationship between WUE and its controls. For this reason, we recommend modelers to be cautious when applying WUE‐response formulas at environmental conditions or at time scales different from those at which they are derived.     

Hydrology and history: land use changes and ecological responses in an urban wetland

The impacts of changing land use on hydrology and dominant plant species from 1850–1990 were investigated in a palustrine wetland in southern Wisconsin, USA. Aerial photographs, historic maps and water levels of the area were used to determine changes in land use, wetland vegetation, and groundwater and surface flows over time. Piezometers and water table wells were monitored weekly for two years. Vegetation was quantified in four one-square meter quadrats at each water level measurement site. Linear regression models and multivariate ordinations were used to relate wetland plant species to hydrologic, chemical and spatial variables. The current hydrologic budget of the wetland was dominated by precipitation and evapotranspiration, although overland flow into the wetland from the subwatershed has increased twenty-fold since 1850. Water level stabilization in the adjacent Yahara River, creek channelization, and groundwater pumping have decreased inputs of groundwater and spring-fed surface water, and increased retention of precipitation. Typha spp. and Phalaris arundinacea L. have increased in the wetland, while Carex spp. have decreased. Phalaris arundinacea was found most often in the driest sites, and the sites with the greatest range of water levels. Typha spp. dominated in several hydrologic settings, indicating that water depth was not the only factor controlling its distribution. The distributions of dominant plant species in the wetland were most closely correlated with site elevation and average water levels, with some weaker correlations with vertical groundwater inflows and specific conductance.     

When to come out from a refuge: risk-sensitive and state-dependent decisions in an alpine lizard

Prey often respond to predator presence by increasing theiruse of refuges. However, unfavorable thermal conditions in refugesmight entail physiological costs for an ectothermic prey. Thus,the decision of when to come out from a refuge should be optimizedby considering the expected fitness effects of diminution ofpredation risk with time, but also by considering the cost of theloss of time spent at optimal body temperature maximizing physiological functions.The model of Ydenberg and Dill describes the trade-off betweenrisk and cost for a prey fleeing to a refuge. We present a specialcase of this model to predict how emergence time from the refugein lizards or other ectotherms should vary as a function ofrisk of predation and thermal costs of refuge use. The analysesof the variation in emergence time from a refuge of Lacertamonticola lizards in the field under two different predation risklevels supported the predictions of the model. As predicted,time spent in the refuge was longer when the threat of the initialattack had been higher, and therefore the subsequent diminutionof risk was slower, but only when lizards emerged at the sameplace where they hid. When initial body temperature was high,some lizards decreased emergence time by emerging from a differentplace. In addition, the effects of thermal costs were more relevant inthe high-risk situation. Time spent in the refuge under highrisk increased when thermal conditions of the refuge were moresimilar to thermal conditions outside (i.e., physiological costsof refuge use were lower). We conclude that optimization ofrefuge-use strategies might help lizards cope with changes in predationrisk without incurring excessive physiological costs.     

Space use as an indicator of enclosure appropriateness: A novel measure of captive animal welfare

Empirical measures of animal behavior and space use within the captive environment can provide critical information about animals’ requirements, preferences and internal states. The trend toward naturalistic environments has shown promise in terms of behavioral benefits for animals such as great apes, and there have been several studies of the effects of complex environments on captive apes. However, few recent investigations have objectively compared environmental preferences between two distinct enclosures. In this study, we assessed how ape space use varied within and across two very different environments: an indoor, hardscape enclosure and an indoor/outdoor, naturalistic enclosure. Within-facility tests were conducted by comparing data from behavioral observations of the apes’ position in the enclosures to measurements of the space and the availability of individual environmental elements. Between-facility comparisons utilized electivity index calculations to assess both the degree of use for specific features and the degree to which these selections strengthened or weakened in the new facility. Both gorillas and chimpanzees showed significant structural preferences in the older, hardscape environment: positioning themselves by mesh barriers (chimpanzees: P = 0.005; gorillas: P < 0.001) and corners (P = 0.005; gorillas: P < 0.001) more than would be expected by random spatial utilization, and avoiding open spaces (chimpanzees: P = 0.005; gorillas: P < 0.001) not adjacent to any physical structure. A new, naturalistic enclosure was constructed using preference data from the previous facility. In the new facility, both species of ape substantially altered the way in which they chose to position themselves in the enclosure. Chimpanzees used most of the environmental elements at rates more similar to the proportions they were available. While gorilla's preference corners was maintained in the new facility, preferences for doorways and mesh barriers disappeared. Comparing electivity indices facilitated an empirical comparison of space use preferences. Chimpanzees showed significant differences in how they used structural elements (P = 0.021), mesh barriers (P = 0.009) and corners (P = 0.016) in the new facility. Gorillas’ environmental selections were similarly altered in the new facility, as selections of areas adjacent to doorways (P = 0.003), glass barriers (P = 0.005), structural elements (P < 0.001), and mesh barriers (P = 0.012) were all significantly affected by the transfer. This approach is useful for understanding how captive animals utilize their enclosures and we advocate that electivity indices can be added to a growing list of tools to assess the effect of captive environments on animal welfare.