Evaluations

• Prevention of anxiety disorders and depression by targeting excessive worry and rumination in adolescents and young adults: A randomized controlled trial

  Topper M, Emmelkamp P, Watkins E, Ehring T. 2017. Behaviour Research and Therapy. 90: 123-136. doi: 10.1016/j.brat.2016.12.015

  Summary: Researchers recruited students aged 15-22 years (n = 251) with elevated levels of worry and rumination to participate in a randomized controlled trial to evaluate the effectiveness of the digital MindReSolve intervention compared with in-person clinician delivery of the intervention and a waitlist control condition. Recruitment occurred through routine mental health screening procedures and study advertising at secondary schools in greater Amsterdam (n = 23) and through the social science departments of Amsterdam universities (n = 2). Individuals with a diagnosis of major depression or generalized anxiety disorder were not eligible to participate in the trial. Researchers randomized participants to a clinician-delivered group CBT-based intervention (n = 82), a MindReSolve CBT-based internet intervention (iCBT) (n = 84), or a waitlist control (n = 85). Participants completed 9 self-report questionnaires (measuring worry, rumination, depression, and anxiety symptoms) at baseline, 6 weeks (post-intervention), and 3- and 12-month post-intervention follow-ups. Both versions of the CBT-based intervention facilitated significant long-term reductions in symptoms of worry, rumination, depression, and anxiety, and these results were maintained at 12 months. At 12 months, 14.7% of MindReSolve participants and 15.3% of participants in the clinician-delivered CBT group met the criteria for depression (a 45% and 47% reduction, respectively, from baseline to 12-month follow-up), compared with 32.4% of individuals in the control who still met the criteria for depression. Only 16.0% of MindReSolve participants and 18.0% of participants in the CBT group met the criteria for generalized anxiety disorder at 12 months, while 42.2% of control participants continued to meet the criteria for generalized anxiety disorder.

  Take away: Preliminary results suggest MindReSolve offers long-term efficacy comparable to clinician-delivered group CBT in significantly reducing symptoms of anxiety and depression over 12 months.

• Reducing Stress and Preventing Depression (RESPOND): Randomized Controlled Trial of Web-Based Rumination-Focused Cognitive Behavioral Therapy for High-Ruminating University Students

  Cook L, Mostazir M, Watkins E. Journal of Medical Internet Research. 2019. 21(5): e11349. doi: 10.2196/11349

  Summary: Researchers recruited university students aged 18-24 years (n = 235) with elevated worry and rumination in the United Kingdom to participate in a phase III randomized controlled efficacy trial. The trial sought to (I) determine whether MindReSolve (a clinician-assisted, internet-based rumination-focused cognitive behavioral therapy intervention (i-RFCBT) would reduce the incidence of major depression episodes relative to usual care over 15 months, and (II) explore the feasibility of MindReSolve without clinician assistance (self-help MindReSolve). Recruitment occurred through advertisements online and on university campuses with links to a study website. Researchers randomized participants to the MindReSolve i-RFCBT (n = 82), the self-help MindReSolve i-RFCBT (n = 76), or usual care (n = 77). Usual care participants could access any form of treatment necessary during the study. Participants completed questionnaires on symptoms of depression, anxiety, worry, and rumination at baseline, 3 months (post-intervention) and 6- and 15-month follow-ups. Researchers also conducted structured diagnostic interviews with intervention participants by telephone at 3 months and at the 6- and 15-month follow-ups. Participants completed symptom questionnaires during the phone interview, by email, or by mail. MindReSolve reduced risk of experiencing a major depressive episode by 34% relative to usual care over the 15-month study period. Among intervention participants with higher baseline stress (moderate or above), MindReSolve significantly reduced risk of experiencing a major depressive episode by 57% compared with usual care. MindReSolve participants also demonstrated significant short-to-medium term improvements in rumination, worry, and depressive symptoms. At 3 months, rumination symptoms had decreased significantly in the MindReSolve group, relative to usual care. At 6 months, MindResolve participants reported significantly reduced worry and depression symptoms, compared with usual care. These improvements were not maintained at 15 months. The self-help MindReSolve intervention reduced risk of developing a major depressive episode by 36%, relative to usual care, but researchers did not conduct formal significance analyses for the self-help MindReSolve intervention. 

  Take away: MindReSolve appeared to reduce onset of major depressive episodes in at-risk young adults with elevated levels of worry and rumination. Future research could formally evaluate the efficacy of the self-help MindReSolve intervention in prevention of major depressive episodes. If the effect sizes in symptom reduction observed in this study are replicated in a formal trial, the self-help MindReSolve intervention may have potential as a preventative intervention for depression.