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Introduction: People living with young-onset dementia and their care-partners are at risk of a range of adverse mental health outcomes and social isolation. There are few interventions aimed at supporting couples affected by young-onset dementia, which poses unique psychosocial challenges for younger people. Methodology: This pre-post interventional mixed methods pilot study aimed to assess the feasibility and acceptability of an online group program for people with young-onset dementia and their care-partners living at home in Australia. The Music And Psychology and Social connections (MAPS) program aimed to address: (1) the challenges and changes associated with young-onset dementia; and (2) coping and wellbeing. The program involved six weekly two-hour sessions co-facilitated by a psychologist and music therapist, and a private Facebook group. The primary outcomes of feasibility and acceptability were assessed through a post-program focus group, separate individual feedback sessions with each couple, and a program evaluation questionnaire. Thematic analysis was conducted on the focus group transcripts and field notes from couple feedback sessions. We also examined the preliminary utility of MAPS in improving mental health and social connectedness, using quantitative pre-post-measures. Results: Five couples completed the MAPS program. The most common dementia type was Alzheimer's Disease. Participant attendance was 87% across all sessions. Qualitative findings supported acceptability of the program with four emergent themes: being connected to others with shared experiences; reframing thoughts and feelings about dementia; music as a therapeutic tool; and benefits of MAPS. Conclusion: The high retention rate, qualitative findings and positive program evaluation suggest MAPS may be a promising, feasible and acceptable program for couples affected by young-onset dementia. [ABSTRACT FROM AUTHOR]

This repeated-measures study examined the effects of a hybrid of Trauma-Focused Cognitive Behavioural Therapy (TF-CBT) with other therapeutic approaches at a community-based clinic in Perth Western Australia among a sample of children and young people overwhelmingly experiencing multiple forms of maltreatment and with complex family situations (i.e., family and domestic violence, parental mental health, parental substance abuse). Drawing on 1713 individual client records from between 2017 and 2020, the researchers identified 113 children and young people with viable pre-post treatment assessments including 78 on the TSCC, 36 on the TSCYC, and 12 on the CBCL. Significant improvements on most clinical scales were identified on the TSCC and TSCYC. Sub-analysis of the TSCC results found no differences across gender, age, care status, therapy funding source, and the presence of sexual abuse in the rate of improvement on trauma symptoms. Overall, the study highlights that integrating different therapy approaches for populations with multiple and complex trauma symptoms accessing community-based services can be useful for supporting the delivery of TF-CBT for difficult to treat populations. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this assessor‐blinded, randomised controlled trial was to determine the effect of computerised cognitive training (CT) on executive function, processing speed and working memory in 61 people with mild‐to‐moderate dementia. Methods: The primary outcomes were forward Digit Span and Trail Making Tests (TMT) at the completion of the 6‐month intervention. Secondary outcomes included cognitive and physical performance, rate of falls, participant and caregiver's quality of life and usability and adherence to the CT program. The study was registered with the Australian and New Zealand Clinical Trials Registry (ACTRN12617000364370). Results: Intervention group (n = 31) participants averaged 81 min of CT per week, and system usability scores were acceptable (participants: 68.8 ± 22.1; caregivers: 79.4 ± 23.5). There were no statistically significant differences in cognitive or physical performance outcomes between the intervention and control groups at 6‐ or 12‐months (between‐group differences [95% CI] for primary outcomes at 6‐months: Forward Digit Span −0.3 [−0.8, 0.3]; TMT‐A 2.7 s [−14.1, 19.5]; TMT‐B −17.1 s [−79.3, 45.2]). At the 12‐month follow‐up reassessment, the intervention group reported significantly more depressive symptoms and had lower caregiver‐rated participant quality of life and higher caregiver quality of life compared to control. Conclusions: This study showed no benefit of the CT program on working memory, processing speed and executive function. Future studies are required to better understand how CT can be used to improve cognitive and physical functioning in older people with mild–moderate dementia. [ABSTRACT FROM AUTHOR]

This study aimed to assess differences in emotion and elaboration quality between clinical and community child cohorts in both past reminiscing and future worry conversations. We analyzed 54 Australian parents (46 mothers, 8 fathers) and their 8- to 12-year-old children (M = 9.63, SD = 1.29; 28 boys, 26 girls) in reminiscing interactions. Dyads were recruited from local schools (community cohort, n = 26) or a children's psychology clinic waitlist (clinical cohort, n = 28). Clinical cohort children engaged in less emotion exploration in both past and future conversations, as did parents for future conversations. Elaboration quality did not differ. Parent-son dyads differed in the clinical cohort, exhibiting significantly lower emotion resolution than the community cohort, or parent-daughter dyads when discussing past events. These findings suggest that discussing anticipated negative events may be a relevant point of family-based intervention for anxious children. Additionally, this study highlights the importance of parent-son emotional discussion. [ABSTRACT FROM AUTHOR]

The article offers information on evidence-based approaches for treating insomnia disorder. Topics include the characteristics and diagnostic criteria of insomnia disorder; the endorsement of cognitive-behavioral therapy for insomnia (CBT-I) as the first-line treatment by the Australasian Sleep Association (ASA); and the availability of evidence-based treatment manuals, tailored recommendations for specific populations, and digital programs for delivering CBT-I.

Indigenous Psychology within Australia reflects the traditional knowledges of Aboriginal and Torres Strait Islander Peoples and their understanding of the cultivation of relational social and emotional wellbeing (SEWB). However, these perspectives are poorly incorporated into dominant "Western" psychological theories and practice, such as Cognitive Behaviour Therapy (CBT). This represents a barrier to the cultural safety of current mental health practice and its decolonisation within Australia. This study brought together CBT Practitioners and Practitioners of an Aboriginal Wellbeing practice ("Wayapa") to engage in a series of yarns (guided focus groups) to share perspectives, insights, and stories on their own and each other's practices. Indigenous qualitative research approaches including Research Topic Yarning were engaged to decolonise the research environment and support dialogue at the cultural interface of the two practices. Through experiencing Wayapa, CBT practitioners reflected on gaps in their own practice, with an enthusiasm for the opportunities that Wayapa provided to decolonise their practice. Wayapa practitioners were able to celebrate the holistic nature of their practice and the possibility for it to inform dominant "Western" psychological theories and practice, such as CBT, and encourage a more connected and culturally safe way of working with First Nations peoples. Creating safe cultural interfaces between "Western" and Indigenous Psychologies, and building awareness of the value of Aboriginal grounded wellbeing models, can help to promote and expand culturally safe practices within Australian psychological practice. What is already known about this topic: The cultural safety and relevance of CBT for Aboriginal and/or Torres Strait Islander Peoples remains uncertain. There is limited knowledge of Aboriginal wellbeing practices and Indigenous Psychologies amongst non-Indigenous Australian mental health practitioners, including psychologists. Broadened understanding of Aboriginal wellbeing practices such as Wayapa Wurrrk, may contribute to decolonising psychology in Australia. What this topic adds: CBT and Wayapa share common and unique tools and concepts that can support the social emotional wellbeing of all Australians. Wayapa Wurrrk concepts such as earth mindfulness and the centring of Country as a foundation for wellness and social emotional wellbeing represent gaps in current CBT practice. Work at the cultural interface of "Western" and Indigenous Psychology offers a pathway to promote appreciation for, and active utilisation of, Indigenous psychologies including the social emotional wellbeing framework (SEWB). In this article, we recognise both Aboriginal and Torres Strait Islander Peoples as the First Nations of Australia. We acknowledge and pay respect to the knowledge that Aboriginal and Torres Strait Islander cultures are unique, all with their own languages, knowledge systems, beliefs, and histories. We recognise the collective terms they prefer also vary. With respectful consideration to these preferences, typically we will specify Aboriginal and/or Torres Strait Islander Peoples when referring to First Nations Peoples in this article. From time to time, we use the term Indigenous. However, we note that for many Aboriginal and Torres Strait Islander Peoples, this is not preferred. As such, we have only used this where we are referencing it's use from another source, or it is the established use of the term, such as its use in "Indigenous knowledges". Where referring to individual Aboriginal and/or Torres Strait Islander people, we have endeavoured to incorporate their preferences, including for example, reference to the Country they are connected to. [ABSTRACT FROM AUTHOR]

The article focuses on the impact of pain self-management programs (PSMP) on chronic pain in cancer survivors. Topics include improvements in pain interference, mood, and pain self-efficacy among participants, the effectiveness of cognitive behavioral therapy (CBT) techniques, and reductions in opioid use.

Background: Practitioners' attitudes and beliefs towards chronic low back pain (CLBP) influence their clinical decision making, but few studies have investigated decision making outside the context of patient vignettes for a range of first‐ and second‐line treatment options for CLBP, or in accredited exercise physiologists (AEPs). Methods: Using an online survey, Australian AEPs and physiotherapists rated their use of different treatments for CLBP (exercise, education, manual therapy, cognitive behavioural therapy) and their confidence in these treatments for reducing pain and disability. Their biomedical and biopsychosocial beliefs were also assessed using the Pain and Attitudes Beliefs Scale for Physiotherapists. Differences between disciplines in treatment use and confidence were analysed using Mann–Whitney U tests and independent t‐tests, respectively. Multiple linear regression was used to explore factors associated with treatment choices. Results: Two‐hundred thirty‐three practitioners (n = 143 physiotherapists, n = 90 AEPs) completed the survey. Most practitioners were confident in treating CLBP, had a moderate—high level of confidence in the different treatments, and regularly used them in practice. Practitioners with higher biomedical beliefs had greater use of, and confidence in, specific exercise, manual therapy, and combined exercise and manual therapy. Practitioners with higher biopsychosocial beliefs were more confident in general exercise, cognitive behavioural therapy, pain education and combined exercise and pain education. Conclusion: Practitioner beliefs influence their use of, and confidence in different treatments for CLBP. These findings suggest a need for strategies to enhance biopsychosocial beliefs/reduce biomedical beliefs in Australian exercise‐based practitioners. [ABSTRACT FROM AUTHOR]

Suicide and self-harm have significant health, economic and social costs. Group-based interventions can be an effective and advantageous treatment approach; however, there is little evidence on the application of these groups in youth community mental health settings in Australia. Using the RE-AIM framework, we explore the feasibility and implementation of two group programmes in a youth-focussed community-based mental health service: dialectical behaviour therapy-adolescent (DBT-A) and cognitive behavioural Self and Strength (S&S). Data were collected from an Australian community mental health service that implemented two group therapy treatments over 12 months. RE-AIM implementation framework outcomes included programme reach (patient flow, group uptake, treatment completion), effectiveness (youth and care clinical outcomes), adoption (staff perception), implementation (barriers), and maintenance (service commitment and acceptability). Groups were considered for all eligible clients (61% of referrals), of these 36% accepted treatment and of those who commenced, 71% completed DBT-A and 82% completed S&S. DBT-A participants reported improved suicidality, emotion dysregulation, self-harm and quality of life (QoL). S&S participants reported improved QoL. Despite small sample size, treatment was acceptable to participants, with high retention and adherence across both groups. Clinicians involved in facilitation noted positive clinical impacts. Group-based interventions have the potential to reduce emotion dysregulation difficulties for youth. Understanding barriers to uptake of group programmes in community-based mental health settings is essential to improve the reach and implementation of group programmes. What is already known about this topic: Self-harm and suicide are major public health concerns for youth, with self-harm linked to suicide completion. High rates of self-harm and emotion dysregulation occur in youth presenting to community-based mental health services. Clinicians need to be able to offer evidence-based interventions to support these individuals. Group-based interventions for emotion dysregulation present an opportunity to improve health outcomes, facilitate skill development and encourage social help-seeking behaviour. What this topic adds: Group-based interventions for emotion dysregulation have positive clinical outcomes for young people who engage in these programmes and offer potentially cost-effective solutions to addressing youth mental health; however, reach was low. Staff facilitators and group participants reported high acceptability and provided positive feedback on the group programmes. Further investigation into the barriers for group therapy is required to develop and implement strategies to increase uptake of group therapy. [ABSTRACT FROM AUTHOR]

Dysfunctional mental imagery is integral to the maintenance of many psychological disorders and is typically associated with stronger affective and behavioural responses than verbal cognitions. This finding extends itself to the high prevalence of suicidal mental imagery in disorders such as depression and bipolar disorder. Imagery Rescripting is a therapy approach which has been found to effectively reduce dysfunctional mental images across various mental health conditions. Thus, Imagery Rescripting of suicidal mental imagery may be effective at reducing such cognitions and ultimately associated risk. However, this remains an unexplored area within the treatment literature. This paper puts out an urgent call for clinical research to evaluate the effectiveness of such a treatment intervention, and to assist, we propose and describe a clinical approach to this to stimulate further thought and research. There are also many research questions of clinical relevance that must be explored in this field of work, which we put forward and consider in this commentary piece. What is already known about this topic: Mental imagery is a form of cognition that generates stronger emotional responses compared to verbal-linguistic thinking and is integral to the maintenance of most psychological disorders. Cognitive Behavioural Therapy (CBT) approaches are typically more effective when mental imagery techniques – such as Imagery Rescripting (ImRs) – are incorporated to target intrusive, distressing mental imagery. Mental images of suicide (comprised of both flash-back and/or flash-forward mental images) are more distressing, realistic and promote suicidal behaviours more than verbal thoughts, and are common in disorders such as depression and bipolar disorder. What this topic adds: Urgent clinical research is needed to evaluate the effectiveness of ImRs at reducing intrusive suicidal mental images, and thus related risk, and this paper proposes and describes an approach for researchers to use as a framework. There are several clinical research considerations to be made when examining ImRs of suicidal mental images, including around the delivery and safety of the intervention. More research is needed to clarify the above clinical considerations, and to further understand change mechanisms, to learn the most safe and effective ImRs approach. If ImRs is found to be effective at reducing suicidal images in upcoming clinical trials, it is strongly recommended clinicians receive adequate training and ongoing clinical supervision from an experienced practitioner given the complexities around this approach. [ABSTRACT FROM AUTHOR]

Objective: Parent-only cognitive-behavioural therapy (CBT) interventions have promise for youth with anxiety disorders. Fear-Less Triple P (FLTP) is one such intervention that has been found comparable to child-focused CBT. Although traditionally administered in six sessions, a one-day workshop format of FLTP was developed to improve accessibility. The current study compared the effectiveness of the six-session and one-day workshop formats. Method: Seventy-three youth (mean age, 8.4 years; 74% male) were randomized to traditional FLTP (6-week group) or the one-day workshop format. Anxiety diagnostic status, self- and parent-reported anxiety symptoms scores, independent evaluator-rated improvement, treatment satisfaction, and measures of family functioning were included to assess treatment outcome. Data were collected prior to treatment, and 1-week, 6-months, and 12-months following treatment. Results: Both conditions resulted in significant improvement in child anxiety symptom scores per parent report (on both questionnaire and diagnostic interview measures). Furthermore, significant decreases in sibling anxiety were observed in both treatment conditions. There were no statistically significant differences between conditions on any outcome measure. Conclusions: Results of this study add to the growing evidence that brief, low-intensity, parent-only interventions can effectively target child psychopathology. These brief interventions are ideal for families for whom the resources and time required to commit to a standard multi-week intervention are prohibitive. Registration of Clinical Trials: This trial was registered with the Australian and New Zealand Clinical Trials Registry (ACTRN 12615001284550). [ABSTRACT FROM AUTHOR]

Background: Anxiety‐related functional impairment, as reflected by life interference, is a lesser explored but highly relevant treatment outcome, and it is crucial that it be included and examined in the evaluation of treatment outcomes of internet‐delivered Cognitive Behavioural Therapy (iCBT). Methods: This single group, pre‐post study examined changes in life interference and anxiety symptoms in a sample of children (n = 1198; mean age 9.66 years) and adolescents (n = 721; mean age 13.66 years) participating in the BRAVE Self‐Help program in Australia. Results: Results demonstrated that both children and adolescents showed improvements in anxiety symptoms, with effect sizes ranging from ηp2 =.194–.318. Reductions in life interference were evident for children (ηp2 =.008–.044), particularly later in the programme, but adolescents did not show such effects. Adolescents in the low completer group (completing 3–5 sessions) showed increases in at‐home interference (ηp2 =.038). Conclusions: Adolescents in particular may require more sessions before entrenched life interference, such as that resulting from avoidance behaviours, can be overcome. [ABSTRACT FROM AUTHOR]

Introduction Tobacco smoking rates in high-income countries are greater in rural, regional, and remote (RRR) areas compared to cities. Yet, there is limited knowledge about interventions targeted to RRR smokers. This review describes the effectiveness of smoking cessation interventions for RRR smokers in supporting smoking abstinence. Aims and Methods Seven academic databases were searched (inception-June 2022) for smoking cessation intervention studies to include if they reported on RRR residents of Australia, Canada, or the United States, and short- (<6 months) or long-term (≥6 months) smoking abstinence outcomes. Two researchers assessed study quality, and narratively summarized findings. Results Included studies (n = 26) were primarily randomized control (12) or pre-post (7) designs, from the United States (16) or Australia (8). Five systems change interventions were included. Interventions included cessation education or brief advice, and few included nicotine monotherapies, cessation counseling, motivational interviewing, or cognitive behavioral therapy. Interventions had limited short-term effects on RRR smoking abstinence, decreasing markedly beyond 6 months. Short-term abstinence was best supported by contingency, incentive, and online cessation interventions, and long-term abstinence by pharmacotherapy. Conclusions Cessation interventions for RRR smokers should include pharmacotherapy and psychological cessation counseling to establish short-term abstinence, and identify effective means of maintaining abstinence beyond 6 months. Contingency designs are a suitable vehicle for psychological and pharmacotherapy support for RRR people who smoke, and intervention tailoring should be explicitly considered. Implications Smoking disproportionately harms RRR residents, who can encounter access barriers to smoking cessation support. High-quality intervention evidence and outcome standardization are still required to support long-term RRR smoking abstinence. [ABSTRACT FROM AUTHOR]

Mental health practitioners of cognitive and behaviour therapies (CBTs) have an ethical obligation to select evidence-based techniques. Little data are available on which techniques are used and whether technique use varies as a function of a therapist's theoretical orientation. The study explored the use of CBT techniques among a diverse sample of Australian mental health practitioners (MHPs). The focus was to assess the extent to which different CBT techniques are used in their practice. A mixed methods study was conducted with a large MHP sample who were taking part in a post-qualification CBT training course. Of the 2,086 MHPs, 41% (n = 864) reported using behaviourally focused techniques, and 49% (n = 1,032) reported using cognitively focused techniques. Self-described theoretical orientation could differentiate technique use. A diverse range of CBT techniques were reported by MHPs in the present study. The different ways MHPs used techniques put a spotlight on how different targets may be a focus of the same technique. What is already known about this topic: CBT remains the dominant training model of psychological therapies in Australian universities. The past few decades have witnessed an evolution in CBTs, regarding the diversification of techniques. It is unclear whether therapists use a broad array of CBT techniques in their everyday clinical practice and if that use varies as a function of theoretical orientation. What this topic adds: Australian Mental Health Professionals (MHPs) indicated that they use a diverse array of behaviourally focused and cognitively focused techniques in their practice. Self-identified theoretical orientation meaningfully differentiated from reported CBT technique use in practice. A range of emotional, behavioural and cognitive targets were reported by MHPs. [ABSTRACT FROM AUTHOR]

Background: The implementation science literature acknowledges a need for engagement of key stakeholders when designing, delivering and evaluating implementation work. To date, the literature reports minimal or focused stakeholder engagement, where stakeholders are engaged in either barrier identification and/or barrier prioritisation. This paper begins to answer calls from the literature for the development of tools and guidance to support comprehensive stakeholder engagement in implementation research and practice. The paper describes the systematic development of the Implementation‐STakeholder Engagement Model (I‐STEM) in the context of an international, large‐scale empirical implementation study (ImpleMentAll) aimed at evaluating the effectiveness of a tailored implementation toolkit. The I‐STEM is a sensitising tool that defines key considerations and activities for undertaking stakeholder engagement activities across an implementation process. Methods: In‐depth, semistructured interviews and observations were conducted with implementers who were tailoring implementation strategies to integrate and embed internet‐based cognitive behavioural therapy (iCBT) services in 12 routine mental health care organisations in nine countries in Europe and Australia. The analytical process was informed by principles of first‐ and third‐generation Grounded Theory, including constant comparative method. Results: We conducted 55 interviews and observed 19 implementation‐related activities (e.g., team meetings and technical support calls). The final outcome of our analysis is expressed in an initial version of the I‐STEM, consisting of five interrelated concepts: engagement objectives, stakeholder mapping, engagement approaches, engagement qualities and engagement outcomes. Engagement objectives are goals that implementers plan to achieve by working with stakeholders in the implementation process. Stakeholder mapping involves identifying a range of organisations, groups or people who may be instrumental in achieving the engagement objectives. Engagement approaches define the type of work that is undertaken with stakeholders to achieve the engagement objectives. Engagement qualities define the logistics of the engagement approach. Lastly, every engagement activity may result in a range of engagement outcomes. Conclusion: The I‐STEM represents potential avenues for substantial stakeholder engagement activity across key phases of an implementation process. It provides a conceptual model for the planning, delivery, evaluation and reporting of stakeholder engagement activities. The I‐STEM is nonprescriptive and highlights the importance of a flexible, iterative approach to stakeholder engagement. It is developmental and will require application and validation across a range of implementation activities. Patient or Public Contribution: Patient contribution to ImpleMentAll trial was facilitated by GAMIAN‐Europe at all stages—from grant development to dissemination. GAMIAN‐Europe brings together a wide variety of patient representation organisations (local, regional and national) from almost all European countries. GAMIAN‐Europe was involved in pilot testing the ItFits‐toolkit and provided their views on the various aspects, including stakeholder engagement. Patients were also represented in the external advisory board providing support and advice on the design, conduct and interpretation of the wider project, including the development of the ItFits‐toolkit. Trial registration: ClinicalTrials.gov NCT03652883. Retrospectively registered on 29 August 2018. [ABSTRACT FROM AUTHOR]

Background: Rates of depression are increasing among adolescents. A novel way to reduce depression is by improving sleep. We evaluated whether an app‐based intervention for insomnia improved sleep and depression, and whether changes in insomnia mediated changes in depression. Methods: We conducted a 2‐arm single‐blind randomised controlled trial at the Black Dog Institute in Australia. Adolescents 12–16 years experiencing insomnia symptoms were randomly allocated to receive Sleep Ninja, an app‐delivered cognitive behavioural therapy program for insomnia, or to an active control group involving weekly text message sleep tips. Assessments took place at baseline, 6 weeks (post‐intervention) and 14 weeks (post‐baseline). Co‐primary outcomes were symptoms of insomnia and depression at post‐intervention (primary endpoint). Intent‐to‐treat analyses were conducted. The trial is registered with the Australian and New Zealand Clinical Trials Registry, number ACTRN12619001462178. Results: Between October 25, 2019, and September 6, 2020, 264 participants were randomised to receive Sleep Ninja (n = 131) or to the control group (n = 133). Relative to the control group, those allocated to the intervention reported a greater reduction in insomnia symptoms at 6 weeks (95% CI: −2.96 to −0.41, d =.41) and 14 weeks (95% CI: −3.34 to −0.19, d =.39), and a greater reduction in depression symptoms at 6 weeks (95% CI: −3.46 to −0.56, d =.28) but not 14 weeks (p < 1). Change in insomnia mediated change in depression. No adverse events were reported. Conclusions: An app‐delivered program for insomnia could be a practical, non‐stigmatising and scalable way to reduce symptoms of insomnia and depression among adolescents experiencing difficulties getting enough good quality sleep. [ABSTRACT FROM AUTHOR]

Background. During the normal ageing process, a person's cognitive functions and memory gradually decline, which can affect their ability to perform everyday activities including cooking, cleaning, managing finances, and shopping. Semantic memory encoding strategies benefit older adults' cognitive and functional performance. Such strategies can be taught by an accessible, cost-effective, and flexible app-based programme. Currently, no studies examine such an app-based programme focussed on everyday activities. Objectives. To determine if an app-based programme constructed on the principles of semantic memory encoding strategies, targeted towards older adults, called Enhancing Memory in Daily Life (E-MinD Life) is (1) feasible by examining acceptance, engagement, and attendance and (2) acceptable by examining the perceived effectiveness, relevancy, clarity, and convenience. Methods. Eleven participants were recruited to a nine-week (18 sessions) programme using E-MinD Life. Feasibility was measured by collecting data on recruitment and retention rates, attendance, and duration of sessions. Acceptability was measured via a Likert scale questionnaire and free comments. Likert scale responses were analysed using descriptive statistics; open-ended responses were categorised qualitatively via constant comparative approach. Results. Nine participants completed the programme. Overall, most participants found the programme relevant, convenient, logical, and easy to understand and perceived it to be effective to address functional cognitive problems impacting performance of everyday activities. The results from the qualitative analysis showed that participants found the programme enjoyable and the interaction with the research team throughout the intervention beneficial. Conclusion. E-MinD Life shows promise as the focus of further research to determine the effectiveness of the programme and sematic-based cognitive strategies in maintaining cognition and performance in everyday activities among older adults with and without cognitive impairment. [ABSTRACT FROM AUTHOR]

Background: Lifetime trajectories of mental ill-health are often established during adolescence. Effective interventions to prevent the emergence of mental health problems are needed. In the current study we assessed the efficacy of the cognitive behavioural therapy (CBT)-informed Climate Schools universal eHealth preventive mental health programme, relative to a control. We also explored whether the intervention had differential effects on students with varying degrees of social connectedness. Method: We evaluated the efficacy of the Climate Schools mental health programme (19 participating schools; average age at baseline was 13.6) v. a control group (18 participating schools; average age at baseline was 13.5) which formed part of a large cluster randomised controlled trial in Australian schools. Measures of internalising problems, depression and anxiety were collected at baseline, immediately following the intervention and at 6-, 12- and 18-months post intervention. Immediately following the intervention, 2539 students provided data on at least one outcome of interest (2065 students at 18 months post intervention). Results: Compared to controls, we found evidence that the standalone mental health intervention improved knowledge of mental health, however there was no evidence that the intervention improved other mental health outcomes, relative to a control. Student's social connectedness did not influence intervention outcomes. Conclusion: These results are consistent with recent findings that universal school-based, CBT-informed, preventive interventions for mental health have limited efficacy in improving symptoms of anxiety and depression when delivered alone. We highlight the potential for combined intervention approaches, and more targeted interventions, to better improve mental health outcomes. [ABSTRACT FROM AUTHOR]

The effectiveness of Cognitive Processing Therapy (CPT) for posttraumatic stress disorder (PTSD) in Australian community mental health settings is understudied as is its impact on other mental health service utilisation. Adults (N = 155) with PTSD were seen at a large public health service. PTSD severity was measured at pretreatment, during treatment, and at posttreatment. Additional mental health outcomes and therapeutic processes were indexed (e.g., depression and therapeutic alliance) as was mental health service utilisation by participants in the 12-months prior to and 12-months after receiving CPT. Significant improvements across all symptom measures and large effect sizes for PTSD outcomes were observed (Cohen's d = 1.03–1.66). Analysis of the whole sample (intent-to-treat) demonstrated 46.4% of the sample fell below the probable-PTSD cut-off, and 34.1% achieved remission. On average, participants' use of mental health services (e.g., inpatient hospitalisations and outpatient services) halved in the 12 months following CPT relative to the same period prior to treatment. No significant adverse outcomes were reported. CPT is a safe and effective therapy for PTSD which can be delivered in a routine public mental health setting. Further research should be undertaken to formally establish health cost savings from delivering CPT in the Australian health care system. [ABSTRACT FROM AUTHOR]

Recent advancements in the field of psychotherapy have included a diversification in Cognitive Behaviour Therapies (CBTs), often referred to as the "third wave", yet relatively little is known about their coverage in Australian postgraduate clinical psychology training. Data were gathered to study the relationships between training program theoretical orientation, therapies covered, and factors determining the coverage of therapies. Responses to a semi-structured interview of 28 Directors of Clinical Training (DCT) or equivalent of Australian Psychology Accreditation Council (APAC) approved clinical psychology training programs (representing 72% of all accredited programs) were examined. Behaviour and cognitive theories were identified as dominant in programs. Coverage of Beck's CBT was not correlated with other CBTs, and the number of therapies covered did not distinguish integrative (64.3%) from non-integrative programs. In an examination of the factors guiding the adoption of insight orientated therapies (i.e., Cognitive Analytic Therapy, Interpersonal Psychotherapy, Humanistic Therapy, Psychoanalytic Therapy, Process Experiential/Emotion-Focused Therapy, Gestalt Therapy, and Existential Therapy), the focus of clinical research, and student interest emerged as significant predictors (β = −.16, SE =.06, p <.05, 95% Boot CI [−.27, −.03]). Beck's CBT, and its undergirding theories emerged as dominant and was not associated with coverage of more recent CBTs, suggesting that there is opportunity to diversify therapies covered considering their evidence base. What is already known about this topic: Cognitive Behaviour Therapy (CBT) has evolved and now includes therapies focused on acceptance, dialectical thinking, and mindfulness. Australian clinical psychologists predominantly self-identify a CBT theoretical orientation. Previous surveys of clinical training programs indicate a primary focus on traditional CBT. What this topic adds: Data on the extent to which diverse theories are included in Australian clinical psychology programs. Data on the extent to which various therapies, including third wave CBTs are included in Australian clinical psychology programs. Data on the factors guiding the adoption of therapies in Australian clinical psychology programs. [ABSTRACT FROM AUTHOR]

Tinnitus is among the top three most frequently accepted service-related conditions for Australian veterans. Veterans have described the effects of tinnitus as causing physical, emotional and social problems. In addition, many veterans with tinnitus, especially those with troublesome tinnitus, have other health conditions, such as hearing loss, insomnia, anxiety and depression. Research suggests tinnitus develops due to maladaptive neural changes in auditory and non-auditory pathways. This is thought to be due to actual or potential physical or psychological trauma. Hence, treatments focusing on physical and psychological factors, including emotional, attentional, behavioural and social aspects, obtain the best outcomes in reducing tinnitus-related distress. The most promising therapy to address these factors is cognitive behavioural therapy, particularly in a multidisciplinary setting, for which robust evidence exists. [ABSTRACT FROM AUTHOR]

Speech-language pathology practice guidelines recommend competency in counselling to support psychological adjustment and well-being in people with communication disability. However, there is limited information about what counselling education speech-language pathology students need or receive to attain this competency. Speech-language pathologists report that they frequently use counselling to support psychological well-being in people with post-stroke aphasia, a patient group particularly vulnerable to mood disorders, but they also report low knowledge, skill, and confidence in this practice. We aimed to describe the content, methods, duration, and evaluation of counselling education currently offered to Australian speech-language pathology students, including education specifically aimed at supporting the psychological well-being of people with post-stroke aphasia. Directors of all accredited speech-language pathology programs (N = 21) across 15 eligible Australian Universities were invited to participate in an online survey. Responses from 12 of the 21 eligible (57%) programs were obtained. Ten programs (83%) reported offering counselling education with four programs (33%) offering this specifically for people affected by post-stroke aphasia. Most programs provided over 10 hours of counselling coursework but provided less than 3 hours of counselling observation and practicum. Teaching on a variety of counselling topics was reported, most commonly general principles of counselling, while specific approaches included motivational interviewing and cognitive behavioural therapy. Counselling was taught using a range of methods, most frequently problem-based learning and role-play. Student counselling knowledge, skills, and competence were evaluated by written assignment, review of video/written transcripts of role-play, oral presentation, and problem-based learning (case studies) group discussion. Academics had mixed opinions on graduate competency for counselling. While the majority of university programs reported providing counselling education, few offered education to support the psychological needs of people specifically affected by post-stroke aphasia. Some courses offered no counselling education. Minimum standards of counselling education for speech-language pathology students are required to ensure graduates are competent to provide counselling to support adjustment and well-being in people with communication disabilities. [ABSTRACT FROM AUTHOR]

Background: Insomnia is common, and difficulty with daytime functioning is a core symptom. Studies show cognitive behavioural therapy (CBT) improves functioning, but evidence is needed on its value for money. Quality-adjusted life years (QALYs), capturing length and quality of life, provide a standard metric by which to judge whether a treatment is worth its cost. Studies have found QALY gains with therapist-delivered and therapist-guided CBT, but most have not reached statistical significance. Estimates of QALY gains with fully automated digital CBT (dCBT) for insomnia are lacking. Aim: To assess whether dCBT (Sleepio) for insomnia is associated with gains in QALYs compared with a sleep hygiene education control. Design & setting: A secondary analysis of a large effectiveness trial of 1711 participants from the UK, US, and Australia. Method: EQ-5D scores, the National Institute for Health and Care Excellence's (NICE's) preferred measure of health-related quality of life (HRQoL), were predicted (mapped) from the 10-item Patient-Reported Outcomes Measurement Information System (PROMIS-10) Global Health scores and used to determine QALYs from baseline to 24 weeks (controlled), and to 48 weeks (uncontrolled). Results: At week 24, QALYs were significantly higher for the dCBT group, with mean QALYs 0.375 and 0.362 in the dCBT and control groups, respectively. The mean difference was 0.014 (95% confidence interval [CI] = 0.008 to 0.019), and this difference was maintained over the 48-week study period (0.026, 95% CI = 0.016 to 0.036). The difference of 0.026 QALYs is equivalent to 9.5 days in perfect health. Conclusion: Sleepio is associated with statistically significant gains in QALYs over time compared with control. Findings may be used to power future studies and inform cost-effectiveness analyses of automated dCBT for insomnia scaled to a population level. [ABSTRACT FROM AUTHOR]

Objective: Cognitive-behavioural therapy is recommended as the first-line treatment for children and adolescents with anxiety. Despite its efficacy, a recent United Kingdom study indicated that few children with anxiety disorders receive cognitive-behavioural therapy. The primary aim of this study was to examine the receipt of cognitive-behavioural therapy for children and adolescents with elevated anxiety symptoms in Australia. Second, this study also examined whether there was a difference in the type of treatment received based on socioeconomic status and geographical location. Method: Using self-reported questionnaires, parents of children aged 4–18 years and children aged 12–18 years (N = 784; elevated anxiety symptom sample n = 169) were recruited from four samples: community (n = 164), school (n = 177), clinic (n = 16) and online panel provider (n = 427). Participants reported on the child's anxiety symptoms and the type of treatment (if any) the child received for their anxiety symptoms. Results: Results indicated that 19.5% of children and adolescents with elevated anxiety symptoms received evidence-based treatment (e.g. cognitive-behavioural therapy). Of those families who did seek help for anxiety in Australia, the majority (66.3%) did not receive cognitive-behavioural therapy. In addition, neither socioeconomic status (which was based on the Australian Index of Community Socio-Educational Advantage [ICSEA]) nor location (metropolitan vs regional/remote) affected whether individuals received evidence-based care or non-evidence-based care. Conclusion: Overall, children and adolescents in this study seeking support for their anxiety symptoms were not receiving adequate evidence-based care, regardless of socioeconomic status and location. These findings indicate there is a need to increase the receipt of cognitive-behavioural therapy for children and adolescents with anxiety symptoms. The findings should tentatively be interpreted, given data were collected during the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Although clinical guidelines recommend Cognitive Behavioural Therapy for insomnia (CBTi) as the first-line treatment for insomnia, many people with insomnia do not have access to CBTi and are prescribed sedative-hypnotic medicines by medical health professionals. Psychologists have training in CBT and may be well placed to deliver behavioural therapy for insomnia. However, the current treatment of insomnia, amount of sleep-specific training and knowledge of CBTi among Australian psychologists remains unknown. This qualitative study conducted semi-structured interviews with Australian psychologists. Interviews included case study scenarios to provide an in-depth exploration of psychologists' knowledge and skills in the management of insomnia. Interview transcripts were analysed using thematic analysis to identify themes. Twenty-six psychologists participated in this study. Four themes were identified in the data: 1) Sleep is important but rarely a treatment priority; 2) Confusion about funding pathways discourages treatment of insomnia; 3) A variety of approaches are used in the management of insomnia; 4) Psychologists with experience in CBTi are rare. Most Australian psychologists are not well equipped to manage insomnia effectively with CBTi. Along with other primary health care professionals, psychologists need training in the delivery of evidence-based insomnia treatment. What is already known about this topic: The recommended treatment for insomnia is Cognitive Behavioural Therapy for insomnia (CBTi) but most people with insomnia do not receive this treatment The most common treatments for insomnia are sedative hypnotic medications and sleep hygiene education Most people with insomnia are not referred to a psychologist. What this topic adds: Most psychologists and other primary care professionals lack specific knowledge and training in insomnia and CBTi Insomnia is often regarded as a secondary problem and clients are not usually referred to psychologists for treatment of insomnia Psychologists use a range of treatments for insomnia, most common are sleep hygiene and relaxation. [ABSTRACT FROM AUTHOR]

Aim: Cancer and its treatment produce significant acute and long‐term adverse effects in cancer survivors, resulting in a range of supportive cancer care needs across the disease trajectory. To enhance supportive cancer care in Australia, this study sought to understand and describe conventional services offered nationwide, specific to their structure (ownership, setting, duration), process (participants, delivery mode, referral pathways), and outcomes (evaluation). Methods: A survey canvassing 13 conventional supportive cancer care interventions was electronically distributed to 265 cancer organizations in all Australian states and territories over 2019 and 2020. Cancer organizations were invited to participate if they provided at least one cancer‐directed treatment (ie, surgery, radiation therapy, or systemic therapies); or clinical cancer care to adults, adolescents, or children; or conventional supportive care interventions to cancer survivors. Results: A response rate of 46% (n = 123/265) was achieved, with 72% of cancer organizations (n = 88) delivering at least one intervention. Most were provided as outpatient or inpatient services, with few at home (<13%) or via telehealth (<10%). Psychological therapy (90%), self‐care (82%), exercise (77%), healthy eating (69%), and lymphedema (69%) services were most common. Fatigue management (51%) and pelvic health (32%) were less common. Services offering massage, return‐to‐work, cognitive therapy, sleep hygiene, and leisure were underrepresented (<31%). Conclusion: Provision of conventional supportive cancer care services continues to evolve in Australia. Multiple areas of care require development of dedicated services to address supportive cancer care intervention shortfalls across the country. Online resources and telemedicine are currently underutilized modalities that are available for further development. [ABSTRACT FROM AUTHOR]

Background: Cancer-related fatigue (CRF) is a commonly experienced and often debilitating side effect of cancer treatment that can persist for years after treatment completion. The benefits of cognitive behaviour therapy (CBT) for CRF are well established; however, these interventions are typically not included in standard clinical care. Traditional CBT is resource-intensive, limiting implementation in hospital settings. Stepped-care approaches can offer benefits to more people, using the same personnel as traditional models. Method/design: This is a single-arm feasibility study. Fifty people with a cancer diagnosis, at least 12 weeks post-treatment or on long-term maintenance treatment, with persistent CRF that is affecting daily activities, will enrol in a stepped-care CBT program. Intervention: The stepped-care program involves two steps. Step 1: All participants begin with a 5-week supported self-management CBT progam targeting fatigue. Step 2: If fatigue remains severe or has changed less than the minimal clinically important difference on the fatigue measure after step 1, participants will be offered four sessions of therapist-directed group CBT. Measures: Participants will complete questionnaires at baseline and 6 and 10 weeks. The primary outcome is feasibility of the REFRESH program. The implementation evaluation comprises acceptability, satisfaction, appropriateness, and feasibility of the study intervention, along with administrative data including cost, processes, procedures and implementation. Secondary outcomes are changes in fatigue, quality of life and self-efficacy. Conclusion: The REFRESH program will be the first stepped-care CBT intervention for persistent CRF in Australia. Assessing feasibility of REFRESH is an important first step to establishing future implementation and efficacy. [ABSTRACT FROM AUTHOR]

Post-traumatic stress disorder (PTSD) is characterised by a range of symptoms including acute stress, flashbacks and avoidance of situations that trigger trauma. Women from Arabic-speaking backgrounds have been shown to have a higher likelihood of developing PTSD due to life stressors experienced. This paper aimed to provide an overview of the experiences and social circumstances of Arab women experiencing PTSD in Australia. Family, gender roles, religion, mental health stigma, trauma, re-settlement challenges, acculturation and discrimination were some of the factors explored in this review. The paper also aimed to review evidence-based treatment for PTSD such as cognitive behavioural therapy, narrative exposure and eye movement desensitisation therapy and whether these westernised approaches can extend to women from Arab backgrounds. Directions for culturally appropriate interventions and how to adapt treatments to suit the needs of individuals from the Arab community experiencing PTSD are discussed as well as considerations for specifically supporting women from Arab backgrounds who need treatment. Future avenues for research are canvassed and discussed within. KEY POINTS What is already known about this topic: (1) Women from Arabic speaking backgrounds in Western countries have been shown to have a higher likelihood of developing PTSD due to the life stressors that they have experienced. (2) Particular life stressors include migration and acculturation stressors, marginalisation, financial concerns, family responsibilities and for some, family violence which can exacerbate distress and contribute to the expression of PTSD symptoms. (3) No effective PTSD treatments for Arab populations in general, let alone Arab women have been identified in research. What this topic adds: (1) Effective mental health treatment for Arab women must take into consideration certain cultural values such as family, women's role/status and stigmas around mental health. (2) Some of the main factors to consider include beliefs and values, communication and language, shame, strict gender roles and religious healing. (3) There is a significant need for immediate future research to be conducted for this community. [ABSTRACT FROM AUTHOR]

Background: There is increasing recognition of the substantial burden of mental health disorders at an individual and population level, including consequent demand on mental health services. Lifestyle-based mental healthcare offers an additional approach to existing services with potential to help alleviate system burden. Despite the latest Royal Australian New Zealand College of Psychiatrists guidelines recommending that lifestyle is a 'first-line', 'non-negotiable' treatment for mood disorders, few such programs exist within clinical practice. Additionally, there are limited data to determine whether lifestyle approaches are equivalent to established treatments. Using an individually randomised group treatment design, we aim to address this gap by evaluating an integrated lifestyle program (CALM) compared to an established therapy (psychotherapy), both delivered via telehealth. It is hypothesised that the CALM program will not be inferior to psychotherapy with respect to depressive symptoms at 8 weeks. Methods: The study is being conducted in partnership with Barwon Health's Mental Health, Drugs & Alcohol Service (Geelong, Victoria), from which 184 participants from its service and surrounding regions are being recruited. Eligible participants with elevated psychological distress are being randomised to CALM or psychotherapy. Each takes a trans-diagnostic approach, and comprises four weekly (weeks 1-4) and two fortnightly (weeks 6 and 8) 90-min, group-based sessions delivered via Zoom (digital video conferencing platform). CALM focuses on enhancing knowledge, behavioural skills and support for improving dietary and physical activity behaviours, delivered by an Accredited Exercise Physiologist and Accredited Practising Dietitian. Psychotherapy uses cognitive behavioural therapy (CBT) delivered by a Psychologist or Clinical Psychologist, and Provisional Psychologist. Data collection occurs at baseline and 8 weeks. The primary outcome is depressive symptoms (assessed via the Patient Health Questionnaire-9) at 8 weeks. Societal and healthcare costs will be estimated to determine the cost-effectiveness of the CALM program. A process evaluation will determine its reach, adoption, implementation and maintenance. Discussion: If the CALM program is non-inferior to psychotherapy, this study will provide the first evidence to support lifestyle-based mental healthcare as an additional care model to support individuals experiencing psychological distress. Trial registration: Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12621000387820, Registered 8 April 2021. [ABSTRACT FROM AUTHOR]

Background: The impacts of COVID-19 for people with obsessive-compulsive disorder (OCD) may be considerable. Online cognitive behavioural therapy (iCBT) programmes provide scalable access to psychological interventions, although the effectiveness of iCBT for OCD during COVID-19 has not been evaluated. Aim: This study investigated the uptake and effectiveness of iCBT for OCD (both self- and clinician-guided courses) during the first 8 months of the pandemic in Australia (March to October 2020) and compared outcomes with the previous year. Method: 1,343 adults (824/1343 (61.4%) female, mean age 33.54 years, SD = 12.00) commenced iCBT for OCD (1061 during the pandemic and 282 in the year before) and completed measures of OCD (Dimensional Obsessive-Compulsive Scale) and depression (Patient Health Questionaire-9) symptom severity, psychological distress (Kessler-10), and disability (WHO Disability Assessment Schedule) pre- and post-treatment. Results: During COVID-19, there was a 522% increase in monthly course registrations compared with the previous year, with peak uptake observed between April and June 2020 (a 1191% increase compared with April to June 2019). OCD and depression symptom severity were similar for the COVID and pre-COVID groups, although COVID-19 participants were more likely to enrol in self-guided courses (versus clinician-guided). In both pre- and during-COVID groups, the OCD iCBT course was associated with medium effect size reductions in OCD (g = 0.65–0.68) and depression symptom severity (g = 0.56–0.65), medium to large reductions in psychological distress (g = 0.77–0.83) and small reductions in disability (g = 0.35–.50). Conclusion: Results demonstrate the considerable uptake of online psychological services for those experiencing symptoms of OCD during COVID-19 and highlight the scalability of effective digital mental health services. [ABSTRACT FROM AUTHOR]

Cognitive behaviour therapy (CBT) has the strongest evidentiary support for the treatment of panic disorder. Specifically, interoceptive exposure (IE) has been found to be a critical component in the research literature. International studies have suggested that psychologists often avoid undertaking IE or do so in ways not consistent with evidence-based practice. This study investigated whether this was true within an Australian and New Zealand context. A sample of 164 participants was included in an analysis of treatment modalities employed, exposure therapy implementation practices, use of other arousal reduction strategies and psychometric measures, negative beliefs regarding exposure therapy, general risk orientation, and self-reported actual treatment outcomes. Results revealed a wide variety of treatment models and implementation of exposure therapy techniques, influenced by widespread negative beliefs about exposure therapy which were significantly positively correlated with lower success rates in treatment outcomes. The findings highlight the need for further research into the quality of current training methodologies, supervision practices, and ongoing professional development standards for exposure therapy techniques in the Australian and New Zealand contexts. [ABSTRACT FROM AUTHOR]

This study assessed the effectiveness of interventions intended to mitigate anticipatory traumatic reaction, a form of future-focused distress occurring in response to threat-related media reports and discussions. A stratified sample of 512 Australian adults (260 women and 252 men; mean age = 46.80, SD = 16.62) completed measures of anticipatory traumatic reaction, and positive and negative affect. Participants then viewed a stimulus video containing a series of terrorism and crime reports, and were randomly assigned to one of seven conditions. The conditions consisted of six brief online interventions, based on standard psychological treatments for anxiety and mood disorders, and one control condition. A cognitive intervention to address probability neglect (p <.001) and a mindfulness intervention (p =.036) both significantly attenuated momentary anticipatory traumatic reaction. This research provides information leading to better understanding the phenomenon of anticipatory traumatic reaction and pilot results related to reducing levels of distress for affected individuals. [ABSTRACT FROM AUTHOR]

Online cognitive behavioural therapy for insomnia (iCBT-I) provides scalable access to psychological interventions; however, the effectiveness of these courses during COVID-19 has not been examined. This study investigated the uptake and potential effectiveness of iCBT-I during the first 10 months of the pandemic in Australia (March- December 2020) and compared outcomes in the year prior. Two thousand six hundred and ninety-four adults commenced a four-lesson iCBT-I course (1,883 during the pandemic; 811 in the year before). Measures of insomnia and psychological distress were administered pre-, mid- and post-treatment. In the COVID-19 period, we observed a 140% increase in monthly course registrations compared to the year prior (with a peak increase of 257% from April-June 2020). Insomnia symptom severity was marginally lower for the during-COVID group compared to the pre-COVID group, although levels of psychological distress were similar. Before and during COVID-19, iCBT-I was associated with large effect size reductions in insomnia symptom severity (gs =.86–1.09) and small effect size improvements in psychological distress and wellbeing (gs = 0.34–0.41). iCBT-I uptake substantially increased during the pandemic; treatment outcomes were similar. The findings demonstrate the scalability and potential effectiveness of iCBT-I. Key Points What is already known about this topic: Insomnia is a significant public health issue. Internet delivered cognitive behaviour therapy (iCBT) is effective in reducing insomnia symptom severity. The COVID-19 pandemic has had a large impact on mental health with higher estimated rates of insomnia during the pandemic. What this topic adds: Uptake of an online insomnia course increased by >180% during COVID-19. The course was associated with large effect size reductions in insomnia symptoms. Results highlight the utility and scalability of digital mental health services. [ABSTRACT FROM AUTHOR]

Background: There is evidence that depression can be prevented; however, traditional approaches face significant scalability issues. Digital technologies provide a potential solution, although this has not been adequately tested. The aim of this study was to evaluate the effectiveness of a new smartphone app designed to reduce depression symptoms and subsequent incident depression amongst a large group of Australian workers. Methods: A randomized controlled trial was conducted with follow-up assessments at 5 weeks and 3 and 12 months post-baseline. Participants were employed Australians reporting no clinically significant depression. The intervention group (N = 1128) was allocated to use HeadGear, a smartphone app which included a 30-day behavioural activation and mindfulness intervention. The attention-control group (N = 1143) used an app which included a 30-day mood monitoring component. The primary outcome was the level of depressive symptomatology (PHQ-9) at 3-month follow-up. Analyses were conducted within an intention-to-treat framework using mixed modelling. Results: Those assigned to the HeadGear arm had fewer depressive symptoms over the course of the trial compared to those assigned to the control (F3,734.7 = 2.98, p = 0.031). Prevalence of depression over the 12-month period was 8.0% and 3.5% for controls and HeadGear recipients, respectively, with odds of depression caseness amongst the intervention group of 0.43 (p = 0.001, 95% CI 0.26–0.70). Conclusions: This trial demonstrates that a smartphone app can reduce depression symptoms and potentially prevent incident depression caseness and such interventions may have a role in improving working population mental health. Some caution in interpretation is needed regarding the clinical significance due to small effect size and trial attrition. Trial Registration Australian and New Zealand Clinical Trials Registry (www.anzctr.org.au/) ACTRN12617000548336 [ABSTRACT FROM AUTHOR]

Background: Childhood anxiety and depression lead to great distress and impairment. Preventing them simultaneously in early life is critically important. We evaluated the long-term efficacy of an emotion regulation-based (ER) and a behavioural activation-based (BA) program. Both aimed to build resilience to prevent worry, a transdiagnostic feature across anxiety and depression.Methods: Participants were 316 students (52.2% female; 8-13 years) from six South Australian primary schools. Schools were randomised to the ER, BA or a control condition. Measures of resilience, worry, anxiety, and depression were taken at pre- and post- program, and at 6- and 12-month follow-up. In addition, levels of emotion regulation, behavioural activation and resilience were measured as potential mediators of changes in anxiety and depression.Results: No significant condition × time interactions were observed. However, the percentage of children who met the clinical cut-offs for generalised anxiety disorder and major depressive disorder decreased significantly in the BA condition at 12-month follow-up, as well as the percentage of children who met the clinical cut-off for obsessive compulsive disorder in the ER condition. Furthermore, emotion regulation mediated the relationship between condition and worry at post-program in the ER condition.Limitations: The sample size is relatively small. Reliance on child self-report may have resulted in inaccurate responses.Conclusion: The ER and BA transdiagnostic prevention programs for childhood anxiety and depression showed promising results for certain anxiety disorders not otherwise observed in universal school-based studies. Future research should consider evaluating the programs with a larger sample using alternative outcome measures. [ABSTRACT FROM AUTHOR]

Despite growing attention to the efficacy of culturally adapted cognitive-behavioral treatment (CBT) programs for children and adolescents, there is still little empirical and practical information available to therapists who adapt original treatment protocols to suit clients of a specific culture. The current study aimed to compare therapeutic interactions across CBT treatment delivered with two different cultural groups. We developed an observational coding system to examine behaviors exhibited by child, parent, and therapist during CBT sessions conducted in Australia and Japan for children with anxiety disorders. Our results demonstrated significant differences between the two countries with respect to the treatment readiness of children, the proportion of talking during the sessions by parents and children, therapists' laughter, length of silence during the first session, and parent indices of accommodation. In terms of transitions over time (i.e., first to last CBT session), parents in both countries tended to talk more during the last CBT session, whereas only Australian therapists talked less over time. The proportion of silence decreased over time during the Japanese sessions, and the amount of interruptions by parents increased over time for Australian sessions. Finally, our exploratory analyses demonstrated that a number of behavioral observations were correlated with anxiety treatment outcome at posttreatment. This study suggests that interactions between a child, parent, and therapist during CBT sessions may be affected by the culture in which the CBT session occurs, which could have implications for culturally adapted CBT programs. [ABSTRACT FROM AUTHOR]

Olfactory Reference syndrome (ORS) is characterized by patients falsely believing that they exude a foul body odor, which is embarrassing and disturbing to the patient. The increased anxiety due to this belief leads to compulsive behaviors, social anxiety, and functional impairment. ORS poses enormous challenges in its diagnosis and treatment. The disorder can be often treatment-resistant or recurrent. A case formulation followed by a classificatory diagnosis is an effective approach to distinguish it from other diagnoses with an overlapping spectrum of symptoms. Here, we present a case of a 42-year-old Australian woman with recurrence of ORS post major stressful triggers. She reported a trial of a series of expensive cosmetic and hydraulic treatments, however, her symptoms persisted, causing significant deterioration in her mood and social functioning, interpersonal relationships, and self-care. Patient was brought to the psychiatric inpatient unit with the complaint of feeling unsafe in her own house. She was started on Lurasidone, along with 12 weeks of intense cognitive behavioral sessions. The use of psychotherapy is underreported even though it significantly reduces ongoing distress. The patient remains asymptomatic along with improved social functioning on subsequent follow-ups. [ABSTRACT FROM AUTHOR]

Within the National Rugby League (NRL), the elite competition body across Australia & New Zealand, clubs are mandated to report concerns to the NRL Integrity Unit for possible misconduct, on or off the field. This includes returning a positive illicit drug test leading to players needing to attend counseling that promotes behavioral change; ranging from alcohol and other drugs usage, mental health issues, anger management and family work. This paper strives to understand the purpose of psychological support and interventions as a reflective case study across professional rugby league settings, whilst looking at the role of counseling theories and practices. [ABSTRACT FROM AUTHOR]

Background: Vulvodynia is a condition characterised by pain in the vulva lasting more than three months and for which no obvious aetiology can be found. It affects around 8% of women and has significant negative impacts on quality of life. There is a paucity of research on healthcare management pathways and the use of evidence‐based treatments in an Australian community setting. Aims: To explore which healthcare professionals Australian women with vulvodynia seek treatment from, and which treatments are recommended, provided, or prescribed by these healthcare professionals. Materials and Methods: A cross‐sectional online survey was conducted from May 2019 to August 2019. Women were eligible to participate if they had been diagnosed with vulvodynia by a healthcare professional, were currently living in Australia, and were over 18 years old. Results: Fifty respondents meet the inclusion criteria, with a mean age of 30.5 years. On average, respondents reported seeing four different types of healthcare professionals in the management of their vulvodynia, with general practitioners (GPs) (98%), medical specialists (96%), and physiotherapists (80%) being the three most commonly consulted. Most respondents reported seeing multiple GPs (>87%), multiple medical specialists (>77%), and multiple physiotherapists (50%). The most commonly prescribed interventions were pelvic floor down‐training exercises (76%), topical (70%) and oral (70%) medication, and vulvodynia information (56%). Conclusions: Australian women with vulvodynia seek help from several professionals and receive a variety of treatments for their pain. Of concern is many treatments that are being offered clinically have very little peer‐reviewed evidence of effectiveness in vulvodynia. [ABSTRACT FROM AUTHOR]

Insomnia is a chronic condition and major healthcare problem for Australians across the lifespan. Insomnia's high prevalence and disease burden render it an important target for treatment. Further, and importantly, there exist established bidirectional links between insomnia and a range of health conditions, with insomnia both contributing to risk, maintenance and relapse of comorbid conditions. Recent clinical research demonstrates that treating insomnia in its own right is important for resolution of insomnia and for optimising treatment outcomes for comorbid presenting problems. Due to its effectiveness and favourable side-effect profile, Cognitive Behaviour Therapy-Insomnia (CBT-I) is the recommended first-line treatment even when comorbid conditions are present. CBT-I is a brief treatment often delivered in four to eight consultations. Individual, group and online CBT-I have each demonstrated effectiveness. Outcomes for online CBT-I are often stronger when individualised clinician support is provided. Specifically assessing for and treating insomnia in clinical practice may provide an opportunity to optimise treatment outcome in many patients. [ABSTRACT FROM AUTHOR]

Background older people coping with the impacts of living with multimorbidity are at increased risk of developing a depressive disorder. Objective this article reports the 24-month results of a randomised controlled trial of an internet-delivered cognitive behaviour therapy, which aimed to test whether depressive disorders could be prevented in this population. Participants community-based participants aged 65 years and over, who had two or more chronic physical health conditions and were assessed as having no current depressive disorder. Methods in total, 302 participants were randomised to an 8-week, five-lesson, internet-delivered intervention program (n  = 150) or treatment as usual (TAU, n  = 152). The primary outcomes were cases of depressive disorder, assessed post-intervention and at 3-month intervals throughout the trial, and depressive symptoms, assessed at pre-intervention, post-intervention, 6, 12 and 24 months following the intervention. Results there were significantly fewer cases of depressive disorder in the intervention group (n  = 23, 15%) compared with the TAU group (n  = 41, 27%) during the 24 months after the intervention (χ2(1, N  = 302) = 6.13, P  = 0.013, odds ratio = 0.490 [95% confidence interval: 0.277, 0.867]), representing a 44% reduction in cases of depressive disorder. No differences were found on depressive symptoms at 24-month follow-up. Internet-delivered cognitive behaviour therapy had high engagement and acceptability. Conclusions the results provide support that depressive disorders can be prevented in older people with multimorbidity through participation in internet-delivered cognitive behaviour therapy. With access to internet-delivered interventions in clinical care settings increasing, this has implications for older patient care where multimorbidity is extremely common. [ABSTRACT FROM AUTHOR]

Background: Despite the availability of effective treatments for bulimia nervosa (BN), a number of barriers to accessibility exist. Examples include access to trained clinicians, the expense of treatment, geographical limitations, and personal limitations such as stigma regarding help seeking. Self-help interventions, delivered via a digital platform, have the potential to overcome treatment gaps by providing patients with standardised, evidence-based treatments that are easily accessible, cost-effective, and require minimal clinician support. Equally, it is important to examine the shortcomings of digital interventions when compared to traditional to face-to-face delivery (e.g., high dropout rates) in order to maximise the therapeutic effectiveness of online, self-help interventions. Methods: A three-arm, multisite randomised controlled trial will be conducted in Australia examining the effectiveness and cost-effectiveness of a newly developed online self-help intervention, Binge Eating eTherapy (BEeT), in a sample of patients with full or sub-threshold BN. The BEeT program consists of 10, multimedia sessions delivering the core components of cognitive behaviour therapy. Eligible participants will be randomised to one of three groups: independent completion of BEeT as a purely self-help program, completion of BEeT alongside clinician support (in the form of weekly telemedicine sessions), or waitlist control. Assessments will take place at baseline, weekly, post-intervention, and three-month follow up. The primary outcome is frequency of objective binge episodes. Secondary outcomes include frequency of other core eating disorder behavioural symptoms and beliefs, psychological distress, and quality of life. Statistical analyses will examine treatment effectiveness, feasibility, acceptability and cost effectiveness. Discussion: There is limited capacity within the mental health workforce in Australia to meet the demand of people seeking treatment for eating disorders. This imbalance has only worsened following outbreak of the COVID-19 pandemic. Further research is required into innovative digital modes of treatment delivery with the capacity to service mental health needs in an accessible and affordable manner. Self-help programs may also appeal to individuals who are more reluctant to engage in traditional face-to-face treatment formats. This study will provide rigorous evidence on how to diversify treatment options for individuals with BN, ensuring more people with the illness can access evidence-based treatment. The study has been registered with the Australia New Zealand Clinical Trials Registry (ANZCTR Registration Number: ACTRN12619000123145p). Registered 22 January 2019, https://www.australianclinicaltrials.gov.au/anzctr/trial/ACTRN12619000123145. [ABSTRACT FROM AUTHOR]

Objective: MindStep™ is an Australian low-intensity cognitive behaviour therapy (LICBT) program for individuals with mild-to-moderate symptoms of anxiety and depression. UK-produced LICBT guided self-help (GSH) materials were originally used in the MindStep™ program. In 2017, Australian LICBT GSH materials were developed to better suit Australian users. This study explored whether the Australian-produced materials continued to achieve the benchmark recovery rates established in the UK and maintained in recent Australian studies. Methods: Binomial logistic regression was conducted using retrospective client data, including the Patient Health Questionnaire-9 and the Generalised Anxiety Disorder 7-item scale, between 2016 and 2019. Results: During time periods in which the Australian-produced materials were used, equivalent rates of reliable recovery and improvement were achieved compared with time periods in which the UK-produced materials were used. Australian-trained LICBT coaches, using Australian-produced LICBT GSH materials, achieve client recovery rates of up to 60%, reliable improvement rates of 58% and reliable recovery rates of 46% (with the probability of recovery increasing with client age). Conclusions: These findings are particularly pertinent with COVID-19 changing the landscape of mental health service delivery, requiring greater flexibility in the use of teleservices to ensure access to effective mental health care for populations that may already experience problems with isolation, access and service engagement. What is known about the topic?: LICBT is an acceptable, feasible and effective treatment approach for people experiencing mild-to-moderate anxiety and depression in Australia. LICBT GSH materials used with clients in Australia originated from the UK. However, according to guidelines, LICBT GSH materials should be contextualised to suit the audience they are being used with. What does this paper add?: This paper demonstrates that LICBT GSH materials tailored to an Australian context can be used in place of UK-produced materials because they yield equivalent and consistent therapeutic outcomes. Although contextualising the LICBT GSH materials for health services users was important, it is likely that the evidence-based cognitive behaviour therapy techniques sitting 'under the hood' of these materials are most important to ensure successful therapeutic outcomes. What are the implications for practitioners?: As we face unprecedented challenges following 2020, the physical, social, psychological and economic impacts of life-changing events must not inhibit access to treatments for common mental health conditions. It is anticipated that more non-traditional, alternative providers of mental health services will be needed to scale-up and respond to increasing demand. This paper shows that the provision of telephone-based LICBT in Australia, by trained coaches using Australian-produced GSH materials, is an evidenced-based support pathway that can reduce the access gap to treatments. [ABSTRACT FROM AUTHOR]

Background: Obsessive-compulsive disorder (OCD) is a debilitating neuropsychiatric anxiety disorder (DSM-5) characterised by emotionally disturbing, unwanted cognitions (obsessions) and repetitive compulsions (1). OCD typically presents in adolescence, causing circadian rhythm sleep disorders and severe debilitation (2). The recommended treatments for OCD are cognitive-- behavioural therapy using exposure and response prevention and/or pharmacotherapy. Increasing treatment effectivity using a multimodal approach reduces long term pharmacological use and provides support in treatment resistant OCD. Early intervention using nutritional and environmental medicine approaches may be effective in the treatment of OCD (3). Objectives: This case report discusses the environmental impact of OCD, integrative therapies, and clinical implications for OCD. It discusses conventional treatment options such as psychotropic medication treatment and cognitive behavioural therapy and the potential for adjunct nutraceutical treatment to support key drivers including inflammation, immune modulation, digestive health, and serotonin synthesis. Identification of the therapeutic benefit of dietary guidelines for patients with OCD is included. Conclusions: Early childhood neural development is complex and influenced by environmental and nutritional factors (4). Neurodevelopmental processes including neural circuit formation are influenced by hyperactivity of systemic immune pathways. Reducing neuroinflammation with immune-modulatory dietary and lifestyle interventions and reducing environmental influences may be beneficial in the treatment of OCD. Expanding assessment to include personalised biomarker assessments including internal and external environmental factors such as environmental exposure, toxic load and microbiota will assist health and well-being outcomes (5). [ABSTRACT FROM AUTHOR]

Background: The mental health impacts of COVID-19 have been considerable with many individuals experiencing significant anxiety and depression. Online cognitive behavioural therapy (iCBT) programs provide scalable access to psychological interventions, however the effectiveness of these programs during the pandemic has not been investigated. This study examined the uptake and effectiveness of iCBT for symptoms of anxiety and depression during the first eight months of the pandemic in Australia (March- October 2020) and compared outcomes to the 12 months prior to COVID-19.Methods: 6,132 adults commenced iCBT (5,074 during the pandemic and 1,058 in the year before) and completed measures of anxiety and depression symptom severity, and psychological distress pre- and post-treatment.Results: In the COVID-19 period, we observed a 504% increase in the number of monthly course registrations compared to the year prior (with a peak increase of 1,138% between April and June 2020). Baseline anxiety and depression symptom severity were similar for the COVID and pre-COVID groups. Prior to and during the pandemic, the iCBT course was associated with large effect size reductions in anxiety (g = 0.94-1.18) and depression (g = 0.92-1.12) symptom severity, as well as psychological distress (g = 1.08-1.35).Limitations: lack of control group and long-term follow-up, as well as lack of detailed information about course users (e.g., health status and life context).Conclusion: Results indicate the considerable increase in demand for psychological support during the COVID-19 pandemic in Australia and demonstrate the effectiveness and scalability of iCBT for symptoms of anxiety and depression. [ABSTRACT FROM AUTHOR]