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Preventing depression and anxiety disorders by targeting excessive worry and rumination in adolescents

Projectomschrijving

Depressie en angststoornissen komen vaak voor en zijn geassocieerd met een verminderde kwaliteit van leven en hoge kosten voor de samenleving. Het doel van het project was om een nieuwe preventieve interventie voor angststoornissen en depressie te ontwikkelen, welke zich richt op het aanpakken van overmatig repetitief negatief denken (piekeren en rumineren) in adolescenten en jong volwassenen. De studie vergeleek een groepsvariant en een online variant van de interventie tegen een wachtlijst controlegroep. De resultaten toonden dat beide interventies leidden tot een significante vermindering van repetitief negatief denken (piekeren, rumineren) en deze effecten bleven behouden gedurende de follow-up metingen. Bovendien bleken de deelnemers in de behandelcondities tot een jaar na de behandeling een significant verlaagd risico te lopen op het ontwikkelen van depressie of een angststoornis. Op geen van de uitkomsten werd een verschil gevonden tussen de beide vormen van de aangeboden interventie (groep vs. online). Kortom, de nieuw ontwikkelde interventie bleek zeer effectief te zijn. 

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Samenvatting van de aanvraag

Depression and anxiety disorders are highly prevalent and associated with reduced quality of life for patients and enormous economic costs for society. Although effective treatments are available, a substantial number of patients fail to respond, and the time between disorder onset and treatment is typically long. The development of prevention programs therefore appears promising. Past prevention programs for depression and/or anxiety disorders have only shown modest effects. It has recently been argued that in order to improve the efficacy of prevention, programs should be offered specifically to individuals scoring high on a given vulnerability factor and interventions should then directly target this variable. In line with this idea, the current project aims to prevent depression and anxiety disorders by targeting excessive levels of repetitive negative thinking (rumination, worry) in adolescents and young adults. Focussing on rumination/worry appears promising as repetitive negative thinking has been shown to be an important risk factor for emotional disorders. In addition, brief interventions informed by basic research have been shown to reduce excessive levels of rumination/worry. The main study (Study 1) consists of a randomized controlled trial comparing two versions of a new preventive training program targeting excessive rumination and worry versus a no-training control group. The study aims to test proof-of-principle for these novel approaches and to investigate their feasibility and acceptability to the relevant population. Participants will be adolescents and young adults who show heightened levels of rumination/worry and can therefore be expected to be at elevated risk for future depression and anxiety disorders. Eligible participants will be identified via screening at secondary schools and institutions of higher education. The main inclusion criterion will be scores above the 75% percentile on two validated questionnaire measures of worry and rumination (Penn State Worry Questionnaire; Response Style Questionnaire). Exclusion criteria will be clinically relevant levels of depression or anxiety. Participants will be randomly assigned to (1) a rumination-focused cognitive-behavioral training delivered in a group format; (2) a rumination-focused cognitive-behavioral training delivered via the internet and (3) a no-training control condition. The main outcome measures (rumination/worry and emotional problems) will be assessed pre-training, post-training and at 3 months and 1 year follow-up. The rumination-focused cognitive behavioral training delivered in a group setting will be a modified version of a protocol developed by Watkins and colleagues that has been shown to effectively reduce levels of worry/ rumination and prevent relapse in individuals with residual depression. The training is based on (1) experimental research showing that dysfunctional forms of rumination are characterized by an abstract and evaluative style of processing, whereas functional forms processing are more concrete and process-focused and (2) evidence showing that rumination/worry are forms of avoidance. The training uses psycho-education, functional analysis, group discussion, experiential/imagery exercises and behavioral experiments designed to both facilitate a shift from dysfunctional ruminative thinking into the more helpful concrete thinking style and to increase approach behaviors. The internet-based training will be based on the same principles as the group training and will consist of the same basic strategies and exercises. However, no direct contact with a trainer or other participants will take place. The modules of the internet-based training will guide participants in a step-by-step way through the psychoeducation and the exercises practised in the rumination-focused approach, as well as allow participants to set and monitor their own homework. The implementation of a targeted prevention program for adolescents and young adults with high trait levels of rumination/worry requires the easy identification of individuals in need for the intervention. Therefore, Study 2 aims to develop and evaluate a short 4-item screening measure for excessive rumination/worry that can be used to identify individuals at need of preventive interventions. The data collection will be embedded within the main randomized controlled trial and conducted in parallel with this main study. If successful, the prevention program will improve quality of life for a substantial number of individuals and reduce the economic costs caused by depression and anxiety disorders, which are two of the five disorders identified to be related to the highest burden of disease in the VTV 2006. In addition, reducing levels of rumination/worry can be expected to also have an impact on other emotional disorders (e.g. eating disorders, substance use disorders, somatization) and therefore result in a relatively large health benefit.

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Kenmerken

Projectnummer:
200210001
Looptijd: 100%
Looptijd: 100 %
2009
2014
Onderdeel van programma:
Projectleider en penvoerder:
Dr. T.W.A. Ehring, PHD
Verantwoordelijke organisatie:
Universiteit van Amsterdam