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Depressive disorders are associated with reduced life satisfaction and ability to work. The waiting time for psychotherapy in Germany is currently between three and six months. Accordingly, there is a need for alternative, evidence-based treatment options that are made accessible to patients at a low threshold. A large number of empirical studies prove the effectiveness of exercise in mild and moderate depression. For further conceptualization and quality assurance of exercise as a treatment option, it is necessary to understand the concrete mechanisms of action. In addition to physiological factors, psychological factors also play a role in the effect. As a meta-theory of human experience and behavior, Self-Determination Theory (SDT) provides a useful frame for understanding psychological mechanisms of action with concrete implications for treatment practice. The conceptual extension of SDT to include the frustration of basic psychological needs in addition to need satisfaction is proving useful in the study of mental illness. The first part of this dissertation consists of two publications that validate relevant measurement instruments in this context. The first questionnaire measures the extent of generally experienced satisfaction and frustration of the basic psychological needs for autonomy, competence, and relatedness. The second questionnaire measures the experienced satisfaction of needs by the instructor (here: exercise therapist). The second part of the dissertation includes two publications that examine and classify the satisfaction and frustration of basic psychological needs in depressive symptoms. Differences in the extent of need satisfaction and need frustration between a sample with depression and a sample without depressive symptoms are examined. Further, the relationship between need frustration and depressive symptoms is placed in the context of established pathological processes (emotional dysregulation, rumination). The main findings of this work show that by adding the dimension of need frustration to Basic Psychological Needs Theory, SDT now covers a broader spectrum on the health-disease continuum. In doing so, SDT focuses on the psychological impact of social environments. In addition to the nonfulfillment of basic psychological needs, it is primarily experienced need frustration that is a general vulnerability factor for the occurrence of psychological illness. Moreover, the unbalanced satisfaction of basic psychological needs possibly indicates a conflicting experience between the needs. For the treatment practice it can be deduced that an autonomy-supporting atmosphere, which enables the balanced satisfaction of all three needs, is central for the treatment success.
Objectives:
The prevalence rates for mental health (MH) problems in cancer patients is high, although reduced uptake of services may be influenced by mental health literacy (MHL). The objective of this study was to investigate the MHL for depression and panic disorder (PD), including treatment preferences in Australian adults who had been diagnosed and treated for cancer, and whether MHL and treatment preferences was influenced by sex, age, and individuals' lived MH experience.
Method:
A total of 421 cancer survivors (n = 378 females) completed a self-report survey. Participants were asked to specify whether they had a lived experience with anxiety and/or depression, and to indicate treatment preferences for managing cancer-related distress. Two vignettes were administered to assess MHL for depression and PD.
Results:
The MHL accuracy for depression was higher than PD. Accuracy rates were higher for females with a lived experience with anxiety and/or depression; although the accuracy rate for PD was significantly lower in males. A high proportion of individuals preferred exercise and in-person counselling to manage depression and PD. Internet-based therapies were not strongly preferred for managing MH problems.
Conclusions:
The MHL for depression and PD is moderate for adult cancer survivors, with higher levels indicated for individuals with a personal lived experience with anxiety and/or depression. Public health campaigns for enhancing MHL should broaden to include individuals experiencing comorbid physical health conditions. Health providers also need to take into account client preferences for evidence-based therapies.
Objective Depression after stroke and myocardial infarction (MI) is common but often assumed to be undertreated without reliable evidence being available. Thus, we aimed to determine treatment rates and investigate the application of guidelines in these conditions. Methods Databases MEDLINE, EMBASE, PsycInfo, Web of Science, CINAHL, and Scopus were systematically searched without language restriction from inception to June 30, 2017. Prospective observational studies with consecutive recruitment reporting any antidepressant treatment in adults with depression after stroke or MI were included. Random-effects models were used to calculate pooled estimates of treatment rates. Results Fifty-five studies reported 32 stroke cohorts (n = 8938; pooled frequency of depression = 34%, 95% confidence interval [CI] = 29%-38%) and 17 MI cohorts (n = 10,767; pooled frequency of depression = 24%, 95% CI = 20%-28%). In 29 stroke cohorts, 24% (95% CI = 20%-27%) of 2280 depressed people used antidepressant medication. In 15 MI cohorts, 14% (95% CI = 8%-19%) of 2381 depressed people used antidepressant medication indicating a lower treatment rate than in stroke. Two studies reported use of psychosocial interventions, indicating that less than 10% of participants were treated. Conclusions Despite the high frequency of depression after stroke and MI and the existence of efficacious treatment strategies, people often remain untreated. Innovative strategies are needed to increase the use of effective antidepressive interventions in patients with cardiovascular disease.
Background: Individuals with aphasia after stroke (IWA) often present with working memory (WM) deficits. Research investigating the relationship between WM and language abilities has led to the promising hypothesis that treatments of WM could lead to improvements in language, a phenomenon known as transfer. Although recent treatment protocols have been successful in improving WM, the evidence to date is scarce and the extent to which improvements in trained tasks of WM transfer to untrained memory tasks, spoken sentence comprehension, and functional communication is yet poorly understood.
Aims: We aimed at (a) investigating whether WM can be improved through an adaptive n-back training in IWA (Study 1–3); (b) testing whether WM training leads to near transfer to unpracticed WM tasks (Study 1–3), and far transfer to spoken sentence comprehension (Study 1–3), functional communication (Study 2–3), and memory in daily life in IWA (Study 2–3); and (c) evaluating the methodological quality of existing WM treatments in IWA (Study 3). To address these goals, we conducted two empirical studies – a case-controls study with Hungarian speaking IWA (Study 1) and a multiple baseline study with German speaking IWA (Study 2) – and a systematic review (Study 3).
Methods: In Study 1 and 2 participants with chronic, post-stroke aphasia performed an adaptive, computerized n-back training. ‘Adaptivity’ was implemented by adjusting the tasks’ difficulty level according to the participants’ performance, ensuring that they always practiced at an optimal level of difficulty. To assess the specificity of transfer effects and to better understand the underlying mechanisms of transfer on spoken sentence comprehension, we included an outcome measure testing specific syntactic structures that have been proposed to involve WM processes (e.g., non-canonical structures with varying complexity).
Results: We detected a mixed pattern of training and transfer effects across individuals: five participants out of six significantly improved in the n-back training. Our most important finding is that all six participants improved significantly in spoken sentence comprehension (i.e., far transfer effects). In addition, we also found far transfer to functional communication (in two participants out of three in Study 2) and everyday memory functioning (in all three participants in Study 2), and near transfer to unpracticed n-back tasks (in four participants out of six). Pooled data analysis of Study 1 and 2 showed a significant negative relationship between initial spoken sentence comprehension and the amount of improvement in this ability, suggesting that the more severe the participants’ spoken sentence comprehension deficit was at the beginning of training, the more they improved after training. Taken together, we detected both near far and transfer effects in our studies, but the effects varied across participants. The systematic review evaluating the methodological quality of existing WM treatments in stroke IWA (Study 3) showed poor internal and external validity across the included 17 studies. Poor internal validity was mainly due to use of inappropriate design, lack of randomization of study phases, lack of blinding of participants and/or assessors, and insufficient sampling. Low external validity was mainly related to incomplete information on the setting, lack of use of appropriate analysis or justification for the suitability of the analysis procedure used, and lack of replication across participants and/or behaviors. Results in terms of WM, spoken sentence comprehension, and reading are promising, but further studies with more rigorous methodology and stronger experimental control are needed to determine the beneficial effects of WM intervention.
Conclusions: Results of the empirical studies suggest that WM can be improved with a computerized and adaptive WM training, and improvements can lead to transfer effects to spoken sentence comprehension and functional communication in some individuals with chronic post-stroke aphasia. The fact that improvements were not specific to certain syntactic structures (i.e., non-canonical complex sentences) in spoken sentence comprehension suggest that WM is not involved in the online, automatic processing of syntactic information (i.e., parsing and interpretation), but plays a more general role in the later stage of spoken sentence comprehension (i.e., post-interpretive comprehension). The individual differences in treatment outcomes call for future research to clarify how far these results are generalizable to the population level of IWA. Future studies are needed to identify a few mechanisms that may generalize to at least a subpopulation of IWA as well as to investigate baseline non-linguistic cognitive and language abilities that may play a role in transfer effects and the maintenance of such effects. These may require larger yet homogenous samples.