Association of anxiety, neuroticism, and depression with dyspepsia of unknown cause. A case-control study. Treating Nonulcer Dyspepsia Considering Both Functional Disorders of the Digestive System and Psychiatric Conditions Long-term effect of a nurse-led psychosocial intervention on health-related quality of life in patients with head and neck cancer: a randomised controlled trial Cognitive behaviour therapy reduces dyspnoea ratings in patients with chronic obstructive pulmonary disease (COPD) Efficacy of a minimal home-based psychoeducative intervention versus usual care for managing anxiety and dyspnoea in patients with severe chronic obstructive pulmonary disease: a randomised controlled trial protocol Comparison of psychosocial outcomes in head and neck cancer patients receiving a coping strategies intervention and control subjects receiving no intervention. A prospective randomised trial of a “test and treat” policy versus endoscopy based management in youngHelicobacter pylori positive patients with ulcer-like dyspepsia, referred to a hospital clinic [Randomized controlled trial of modified banxia houpo decoction in treating functional dyspepsia patients with psychological factors]. A randomized controlled trial of psychotherapy in patients with chronic functional dyspepsia. Psychotherapy in functional dyspepsia. One-year effect of a nurse-led psychosocial intervention on depressive symptoms in patients with head and neck cancer: a randomized controlled trial. Pilot Study of a Brief Behavioral Intervention for Dyspnea in Patients With Advanced Lung Cancer. Improving distress in dialysis (iDiD): a feasibility two-arm parallel randomised controlled trial of an online cognitive behavioural therapy intervention with and without therapist-led telephone support for psychological distress in patients undergoing haemodialysis Teaching head and neck cancer patients coping strategies: results of a feasibility study. Evaluation of adjuvant psychological therapy in patients with testicular cancer: randomised controlled trial Clinical Presentation and Personality Factors Are Predictors of the Response to Treatment in Patients with Functional Dyspepsia: A Randomized, Double-Blind Placebo-Controlled Crossover Study Internet cognitive behavioural therapy for mixed anxiety and depression: a randomized controlled trial and evidence of effectiveness in primary care.
Non-ulcer dyspepsia , also termed " nervous dyspepsia , " is a heterogeneous syndrome : ulcerlike symptoms can occur with the irritable bowel syndrome , gastroesophageal reflux , and other disorders . In addition , there is a significant subgroup of non-ulcer dyspepsia sufferers who have no disorder associated with , and no known cause for , their dyspepsia , and the dyspepsia in this subgroup is given the provisional name of " essential dyspepsia . " The aim of this study was to assess if psychological factors are associated with patients who present with essential dyspepsia .  Psychometric testing  was carried out on 76 essential dyspepsia patients ( including 18 patients with gastroduodenitis ) , 76 r and omly selected dyspepsia-free community controls ( matched for age , sex , and social class ) , and 66 duodenal ulcer controls .  Essential dyspepsia patients were retested a mean of 3.6 mo later . Using stepwise regression analysis , the initial scores of essential dyspepsia and duodenal ulcer subjects showed them to be more neurotic , anxious , and depressed than community controls ; these abnormalities persisted in essential dyspepsia patients on retesting and were not affected by the symptom status . It is concluded that essential dyspepsia patients who present for investigation with symptoms are more likely to be persistently neurotic , anxious , and depressed than dyspepsia-free controls , and this is unrelated to the presence of symptoms , but the association may not be of major clinical significance , as the numerical differences observed between groups were small and the correlation coefficients were low Nonulcer dyspepsia ( NUD ) is a common syndrome , but the optimal treatments have yet to be established . This study was performed to determine the most effectivetreatment for NUD . Subjects were recruited through the Department of General InternalMedicine at the Kyushu University Hospital because oftheir somatic symptoms . When no organic lesions werefound , the patients were directed to consult ourdepartment ( Psychosomatic Medicine ) ; 194 consecutive NUD patients were studied . All subjects were assessedpsychiatrically with the Structured Clinical Interviewfor DSM-III-R(SCID ) . Patients with serious NUD were hospitalized , and r and omly divided into control(N = 42 ) and experimental groups ( N = 86 ) . The controlswere treated with physical treatment alone . Theexperimental group received psychiatric treatment inaddition , based on the results of SCID . The experimentalgroup showed a significant improvement compared with thecontrols ( P < 0.0001 ) . The treatment for NUD takinginto consideration both the physical and psychiatric conditions is highly effective Background : Head and neck cancer ( HNC ) patients are prone to have a poor health-related quality of life after cancer treatment . This study investigated the effect of the nurse counselling and after intervention ( NUCAI ) on the health-related quality of life and depressive symptoms of HNC patients between 12 and 24 months after cancer treatment . Methods : Two hundred and five HNC patients were r and omly allocated to NUCAI ( N=103 ) or usual care ( N=102 ) . The 12-month nurse-led NUCAI is problem-focused and patient-driven and aims to help HNC patients manage with the physical , psychological and social consequences of their disease and its treatment . Health-related quality of life was evaluated with the EORTC QLQ-C30 and QLQ H&N35 . Depressive symptoms were evaluated with the CES-D. Results : At 12 months the intervention group showed a significant ( P<0.05 ) improvement in emotional and physical functioning , pain , swallowing , social contact , mouth opening and depressive symptoms . At 18 months , global quality of life , role and emotional functioning , pain , swallowing , mouth opening and depressive symptoms were significantly better in the intervention group than in the control group , and at 24 months emotional functioning and fatigue were significantly better in the intervention group . Conclusion : The NUCAI effectively improved several domains of health-related quality of life and depressive symptoms in HNC patients and would seem a promising intervention for implementation in daily clinical practice There is evidence that psychological factors contribute to the perception of increased difficulty of breathing in patients with chronic obstructive pulmonary disease ( COPD ) , and increase morbidity . We tested the hypothesis that cognitive behaviour therapy ( CBT ) decreases ratings of perceived dyspnoea in response to resistive loading in patients with COPD . From 31 patients with COPD , 18 were r and omised to four sessions of specifically targeted CBT and 13 to routine care . Prior to r and omisation , participants were tested with an inspiratory external resistive load protocol ( loads between 5 and 45cmH2O/L/s ) . Six months later , we re-measured perceived dyspnoea in response to the same inspiratory resistive loads and compared results to measurements prior to r and omisation . There was a significant 17 % reduction in dyspnoea ratings across the loads for the CBT group , and no reduction for the routine care group . The decrease in ratings of dyspnoea suggests that CBT to alleviate breathing discomfort may have a role in the routine treatment of people with COPD Introduction In its final stages , chronic obstructive pulmonary disease is a severely disabling condition that is characterised by dyspnoea , which causes substantial anxiety . Anxiety is associated with an impaired quality of life and increased hospital admissions . Untreated comorbid anxiety can have devastating consequences for both patients and their relatives . Non-pharmacological interventions , including cognitive – behavioural therapy , have been effective in managing anxiety and dyspnoea in patients with chronic obstructive pulmonary disease . However , the majority of existing interventions have tested the efficacy of relatively intensive comprehensive programmes and primarily targeted patients who have moderate pulmonary disease . We present the rationale and design for a trial that focused on addressing the challenges experienced by severe pulmonary disease population s. The trial investigates the efficacy of a minimal home-based psychoeducative intervention versus usual care for patients with severe chronic obstructive pulmonary disease . Methods and analysis The trial is a r and omised controlled trial with a 4-week and 3-month follow-up . 66 patients with severe chronic obstructive pulmonary disease and associated anxiety will be r and omised 1:1 to either an intervention or control group . The intervention consists of a single psychoeducative session in the patient 's home in combination with a telephone booster session . The intervention is based on a manual , with a theoretical foundation in cognitive – behavioural therapy and psychoeducation . The primary outcome is patient-reported anxiety as assessed by the Hospital and Anxiety and Depression Scale ( HADS ) . Ethics and dissemination This trial complies with the latest Declaration of Helsinki , and The Ethics Committee of the Capital Region of Denmark ( number H-1 - 2013 - 092 ) was queried for ethical approval . Trial results will be disseminated in peer- review ed publications and presented at scientific conferences . Trial registration number NCT02366390 This feasibility study aim ed at comparing psychosocial outcomes in head and neck cancer patients receiving the Nucare program  with a group of control subjects receiving no intervention .  A prospect i ve , nonr and omized study design was used . The Nucare program , a short-term psychoeducational coping strategies intervention , was the test intervention . Control subjects were matched to intervention subjects by cancer stage and time since cancer diagnosis . Outcomes were quality of life and depressive symptoms evaluated at baseline and 3 to 4 months later . One hundred thirty-eight subjects were recruited , and outcome data were available on 101 subjects . At outcome evaluation , compared with their baseline scores , the intervention group had improved physical and social functioning , global quality of life , fatigue , sleep disturbance , and depressive symptoms ; the control group showed no changes in quality of life or depressive symptoms . The results suggest that the Nucare program may improve quality of life and reduce depressive symptoms in head and neck cancer patients BACKGROUND Management of dyspepsia remains a controversial area . Although the EuropeanHelicobacter pylori study group has advised empirical eradication therapy without oesophagogastroduodenoscopy ( OGD ) in young H pylori positive dyspeptic patients who do not exhibit alarm symptoms , this strategy has not been subjected to clinical trial . AIMS To compare a “ test and treat ” eradication policy against management by OGD . PATIENTS Consecutive subjects were prospect ively recruited from open access OGD and outpatient referrals . METHODS H pylori status was assessed using the carbon-13 urea breath test .  H pylori positive patients were r and omised to either empirical eradication or OGD .  Symptoms and quality of life scores were assessed at baseline and subsequent review s over a 12 month period . RESULTS A total of 104H pylori positive patients aged under 45 years were recruited . Fifty two were r and omised to receive empirical eradication therapy and 52 to OGD . Results were analysed using an intention to treat policy . Dyspepsia scores significantly improved in both groups over 12 months compared with baseline ; however , dyspepsia scores were significantly better in the empirical eradication group . Quality of life showed significant improvements in both groups at 12 months ; however , physical role functioning was significantly improved in the empirical eradication group . Fourteen ( 27 % ) in the empirical eradication group subsequently proceeded to OGD because of no improvement in dyspepsia . CONCLUSIONS This r and omised study strongly supports the use of empirical H pylori eradication in patients referred to secondary practice ; it is estimated that 73 % of OGDs in this group would have been avoided with no detriment to clinical outcome OBJECTIVE To observe the therapeutic effect of Modified Banxia Houpo Decoction ( MBHD ) in treating patients with functional dyspepsia ( FD ) accompanied with psychological factors , and to compare it with Domperidone , Neurostan , and Domperidone + Neurostan . METHODS Recruited were 89 FD patients accompanied with anxiety and /or depression , who were r and omly assigned to four groups , i.e. , the  MBHD group ( 23 cases ) , the  Domperidone group ( 22 cases ) , the  Neurostan  group ( 22 cases ) , and the Domperidone + Neurostan group ( 22 cases ) . Corresponding medication lasted for4 weeks . The psychological scoring was performed using Hamilton Depression Scale ( HAMD ) and Hamilton Anxiety Scale ( HAMA ) . The improvement rate of FD symptoms , the ratios of FD symptoms scoring < 2 , and the improvement rate of FD symptoms > 50 % were calculated by the scoring of FD symptoms . The gastric emptying rates of patients in each group were compared using the examinations of gastric emptying . RESULTS There was no statistical difference in pre-treatment HAMD , HAMA , FD symptoms scoring , and the gastric emptying rate among the 4 groups ( P > 0.05 ) . The psychological scoring and FD symptoms scoring significantly decreased in the 4 groups except the Domperidone group after 4-week treatment ( P<0.01 , P < 0.05 ) . The psychological scoring and FD symptoms scoring were obviously lower in the MBHD group than in the Domperidone group ( P < 0.05 ) . The improvement rate of FD symptoms , the ratios of FD symptoms scoring < 2 , and the improvement rate of FD symptoms > 50 % were the highest in the Domperidone + Neurostan group , followed by the MBHD group , and then the Domperidone group . After treatment the gastric emptying rate obviously increased in each treatment group when compared with before treatment in the same group ( P < 0 . 01 ) , and there was no statistical difference among these groups after treatment . CONCLUSIONS MBHD had certain therapeutic effects on FD patients accompanied with psychological factors . Its effect was associated with gastric emptying . Besides , its improvement of the psychological state and symptoms was superior to that of Domperidone BACKGROUND & AIMS This study aim ed to determine whether brief psychodynamic-interpersonal ( PI ) psychotherapy is more efficacious than a psychological control for patients with chronic , intractable functional dyspepsia ( FD ) , and whether patients with abnormal gastric function respond differently than those with normal gastric function . METHODS Ninety-five consecutive patients with chronic symptoms of FD who had failed to respond to conventional pharmacologic treatments were approached . Thirty-seven received  PI psychotherapy , and 36 the control condition ( supportive therapy ) . Patients completed self-report question naires before and after treatment and 12 months later . The patients ' gastroenterologists , who were blind to the study groups , conducted independent ratings before and after treatment . Forty-nine patients also underwent a radioisotope gastric emptying study . An intention-to-treat analysis was used with baseline scores as covariates . RESULTS At the end of treatment , there were significant advantages for PI psychotherapy compared with controls for the gastroenterologists ' ( P = 0.002 ) and patients ' total symptom score ( P = 0.015 ) . One year after treatment , the symptomatic scores were similar . However , a sub analysis showed that PI therapy was superior to the control condition at 1 year , when patients with severe heartburn were excluded . There was no difference in outcome between patients with normal and abnormal gastric emptying . CONCLUSIONS PI therapy may have both short- and long-term effects in patients with dyspepsia , but further evaluation is required . Its cost-effectiveness needs to be determined Patients with functional dyspepsia were assigned at r and om to cognitive psychotherapy ( 10 sessions of 50 min duration , n = 50 ) or to a control group ( no treatment , n = 50 ) . Before treatment all patients were assessed on psychological , somatic and lifestyle factors . If allocated to the therapy group all patients were also asked to define the main problems they wanted to discuss in therapy ( ' target complaints ' ) . The patients were evaluated at the end of therapy ( after 4 months ) and at 1 yr follow-up . Outcome measures were dyspeptic symptoms , scores on ' target complaints ' and psychological parameters . Both groups showed improvement in dyspeptic and psychological parameters after 1 yr . The improvement in the control group was attributed to a non- specific effect of increased interest and attention . The therapy group showed greater reduction than the control group on dyspeptic symptoms [ days of epigastric pain ( p = 0.050 ) , nausea ( p = 0.024 ) , heartburn ( p = 0.021 ) , diarrhoea ( p = 0.002 ) and constipation ( p = 0.047 ) ] ; and on scores on ' target complaints ' ( p = 0.001 ) BACKGROUND Many patients with head and neck cancer ( HNC ) experience depressive symptoms after treatment . This r and omized controlled trial investigated the effects of a psychosocial nurse counseling and after intervention ( NUCAI ) versus usual care on the depressive and HNC-related physical symptoms of patients with HNC at 1 year after diagnosis . METHODS A total of 205 patients with HNC were r and omly assigned to either intervention ( n = 103 ) or usual care ( n = 102 ) , with stratification for gender and tumor stage . The NUCAI , which consisted of six bimonthly 45-minute counseling sessions , was a problem-focused intervention aim ed at helping patients to manage the physical , psychological , and social consequences of HNC and its treatment . It was nurse-led and offered in combination with regular medical follow-up visits at the University Medical Center Utrecht , the Netherl and s. Depressive symptoms at 1 year after diagnosis were the primary outcome . Analyses were performed on an intention-to-treat basis for the total sample and for a predefined subgroup of patients with raised levels of depressive symptoms ( Center for Epidemiologic Studies -Depression score ≥ 12 ; n = 91 ) at baseline using mixed-effect models . RESULTS One year after HNC treatment , levels of depressive symptoms were significantly lower in the intervention group than in the control group in the total sample and in the subgroup of patients with raised levels of depressive symptoms . CONCLUSION The NUCAI was feasible and effective in reducing depressive symptoms in patients with HNC 1 year after HNC treatment , and especially in patients with raised levels of depressive symptoms . The results of this study need to be confirmed in future studies before the NUCAI can be used in daily clinical practice CONTEXT Dyspnea is a common symptom in patients with advanced cancer that interferes with functional ability and quality of life ( QOL ) . Although few evidence -based treatments for dyspnea exist , prior studies show support for nonpharmacological interventions that include elements of cognitive-behavioral therapy . OBJECTIVES To examine the feasibility and utility of delivering a brief behavioral intervention for dyspnea in patients with lung cancer . METHODS For this single-group pilot study , eligible patients included those with advanced lung cancer ( Stage III or IV non-small cell or extensive-stage small cell lung cancer ) receiving outpatient cancer treatment who reported at least moderate breathlessness . The manualized intervention consisted of two sessions in which nurse practitioners taught participants breathing and relaxation techniques within the infusion clinic and encouraged home practice . Participants completed measures of breathlessness ( Modified Medical Research Council Dyspnea Scale ) , QOL ( Functional Assessment of Cancer Therapy-Lung Trial Outcome Index ) , and anxiety and depression symptoms ( Hospital Anxiety and Depression Scale ) at baseline and within six weeks after enrollment . RESULTS Of the 32 patients enrolled in the study ( 56.3 % females ; mean age 63.34 [ SD ] = 7.96 years ) , 84.4 % ( N = 27 ) completed all study procedures . Comparing the baseline to post assessment s , we found significant improvements in Modified Medical Research Council Dyspnea Scale ( P < 0.001 ) , Functional Assessment of Cancer Therapy-Lung Trial Outcome Index ( P = 0.01 ) , and Hospital Anxiety and Depression Scale-depression subscale ( P < 0.001 ) scores . CONCLUSION In this sample of patients with advanced lung cancer and dyspnea , we observed a high completion rate for the two-session behavioral intervention . Patients also reported improvements in dyspnea , QOL , and mood . Follow-up r and omized controlled trials are needed to examine the efficacy of brief behavioral interventions for cancer-related dyspnea Introduction Psychological distress is common in end-stage kidney disease ( ESKD ) and is associated with poorer health outcomes . Cognitive behavioural therapy ( CBT ) is recommended in UK clinical guidelines for the management of depression in people with long-term conditions . Access to skilled therapists competent in managing the competing mental and physical health dem and s of ESKD is limited . Online CBT treatments tailored to the needs of the ESKD population offers a pragmatic solution for under-re source d services . This study examines the feasibility and acceptability of implementing a two-arm parallel r and omised controlled trial of online CBT with ( intervention arm ) and without ( control arm ) therapist support to improve psychological distress in patients undergoing haemodialysis . Methods Patients will be screened for depression and anxiety while attending for their haemodialysis treatments . We aim to recruit 60 adult patients undergoing haemodialysis who meet criteria for mild to moderately severe symptoms of depression and /or anxiety . Patients will be r and omised individually ( using a 1:1 computerised sequence ratio ) to either online CBT with therapist telephone support ( intervention arm ) , or online CBT with no therapist ( control arm ) . Outcomes include feasibility and acceptability descriptive data on rates of recruitment , r and omisation , retention and treatment adherence . Self-report outcomes include measures of depression ( Patient Health Question naire-9 ) , anxiety ( Generalised Anxiety Disorder-7 ) , quality of life ( Euro-QoL ) , service use ( client service receipt inventory ) and illness cognitions ( brief illness perception question naire ) . A qualitative process evaluation will also be conducted . The statistician will be blinded to treatment allocation . Ethics and dissemination A National Health Service ( NHS ) research ethics committee approved the study . Data from this study will provide essential information for the design and testing of further interventions to ameliorate distress in patients undergoing dialysis . Any amendments to the protocol will be su bmi tted to the NHS committee and study sponsor . Trial registration number NCT023528702 ; Pre- results To test the feasibility of providing a psycho-educational intervention for people with head and neck ( H&N ) cancer . A prospect i ve non-r and omized design was used . Subjects were patients with H&N cancer . They were offered the Nucare coping strategies program in one of three formats : small group and one-to-one formats with therapists ; and a home format , with material for home use , without a therapist . Outcomes measures ( quality of life ( QOL ) and anxiety and depression ) were collected at baseline and following the intervention . Analyses were performed using non-parametric statistics . Of 128 people invited to participate , 66 agreed , 59 completed the intervention and 50 had outcomes data . Following the intervention , there were significant improvements in physical and social functioning and global QOL , and reduced fatigue , sleep disturbance and depressive symptoms . These data suggest that the intervention may have some beneficial effects , although an appropriately design ed study is required to confirm this Abstract Objective : To determine the efficacy of adjuvant psychological therapy in patients with testicular cancer and to compare the characteristics and psychosocial outcomes of men who agreed to participate with those who declined to participate in a r and omised trial of psychological intervention  . Design : Newly diagnosed patients were asked to participate in a r and omised trial of psychological support compared with st and ard medical care . Participants and non- participants completed self assessment question naires at baseline and at 2 , 4 and 12 months . Setting : Testicular Tumour Unit of the Royal Marsden Hospital . Subjects : 73 of 184 ( 40 % ) eligible patients agreed to enter the r and omised trial ( participants ) and 81 ( 44 % ) declined to participate but agreed to complete further assessment s ( non- participants ) . 30 patients wanted no further contact with the research ers . Outcome measures : Hospital anxiety and depression scale , psychosocial adjustment to illness scale , Rotterdam symptom checklist , mental adjustment to cancer scale . Only scores on the hospital anxiety and depression scale are reported for evaluating treatment efficacy . Results : 111 of 184 ( 60 % ) eligible men declined to participate in the trial . Patients with stage I disease were most likely to refuse to participate . A patient was less likely to participate if he had low volume disease and was receiving no further treatment . Likelihood of participation was associated with stage of disease and with type of primary treatment ( P<0.001 for heterogeneity ) . Patients with early stage disease ( P<0.001 ) and fewer physical symptoms ( P<0.001 ) were less likely to participate . Psychosocial factors associated with participation included anxious preoccupation regarding disease ( P=0.01 ) . There were no differences in outcome between participants and non- participants during follow up . Patients seemed to gain little benefit from adjuvant psychological therapy . At 2 months change from baseline favoured the treated group in the anxiety subscale ( mean difference between groups −1.41 ( 95 % confidence interval −2.86 to 0.03 ) ) . This was not sustained when adjusted for factors related to the disease . By 12 months change from baseline seemed to favour the control group ( mean difference between groups 1.66 ( −0.18 to 3.50 ) ) . Conclusions : Patients with testicular cancer seem to have considerable coping abilities . Those who declined to participate in the trial differed from those who participated . Those who agreed to participate may comprise the clinical group who perceive a need for psychological support . No evidence was found to indicate a need for routinely offering adjuvant psychological therapy . Key messages Counselling for patients with cancer is widely advocated , although its effectiveness has not been fully evaluated No study of patients with cancer has evaluated a psychological intervention in young men or in a group of patients with a disease with an excellent prognosis Most patients with testicular cancer declined to participate in this r and omised trial of adjuvant psychological therapy , and those who participated had more psychosocial dysfunction No evidence of benefit was observed after treatment with adjuvant psychological therapy in this group of patients There were no consistently significant differences in psychosocial outcome over one year between those who agreed to participate and those who declined to The role of psychological factors or symptom pattern for the response to treatment in patients with unexplained ( functional ) dyspepsia is unknown . We hypothesized that patients with reflux- and ulcer-like symptoms would be more likely to respond to acid-lowering therapy , while psychological disturbances would be associated with a less favorable response to treatment . Seventy-eight patients with a diagnosis of functional dyspepsia were recruited and 75 completed the trial . Patients were treated for 4 weeks in a double-blind , placebo-controlled crossover trial starting in r and om order with either active drug ( ranitidine , 150 mg b.d . ) or placebo . Every 7 days , medication was switched from active drug to placebo , or vice versa . At entry , patient characteristics were assessed utilizing a semistructured st and ardized interview and st and ardized question naires , and weekly intensity of symptoms was assessed utilizing a visual analogue scale . Patients with a greater reduction of the symptom score during active treatment and an overall reduction of the global symptom score by more than 50 % at the end of the study period were categorized as responders . Logistic regression analysis was utilized to assess the influence of symptom type and presence of psychological disturbances on the treatment response . During treatment the symptom score decreased significantly , from 32.1 ± 1.44 ( SD ) to 21.3 ± 1.9 at the end of the trial ( P < 0.001 ) . Twenty of 75 were responders . High scores for somatization ( OR , 3.6 ; 95 % Cl , 1.2–11.4 ) , anxiety ( OR , 3.3 ; 95 % Cl , 0.9–11.8 ) , and reflux-like symptoms ( OR , 5.3 ; 95 % Cl , 1.7–16.7 ) were associated with response to treatment , while dysmotility-like symptoms were associated with an unfavorable response ( OR , 0.3 ; 95 % Cl , 0.1–0.9 ) . Symptom pattern and psychological disturbances are independent predictors of treatment response . Patients with reflux-like symptoms and greater psychological disturbances are more likely to respond to an acid-lowering compound BACKGROUND Major depressive disorder ( MDD ) and generalized anxiety disorder ( GAD ) have the highest co-morbidity rates within the internalizing disorders cluster , yet no Internet-based cognitive behavioural therapy ( iCBT ) programme exists for their combined treatment . METHOD We design ed a six-lesson therapist-assisted iCBT programme for mixed anxiety and depression . Study 1 was a r and omized controlled trial ( RCT ) comparing the iCBT programme ( n = 46 ) versus wait-list control ( WLC ; n = 53 ) for patients diagnosed by structured clinical interview with MDD , GAD or co-morbid GAD/MDD . Primary outcome measures were the Patient Health Question naire nine-item scale ( depression ) , Generalized Anxiety Disorder seven-item scale ( generalized anxiety ) , Kessler 10-item Psychological Distress scale ( distress ) and 12-item World Health Organization Disability Assessment Schedule II ( disability ) . The iCBT group was followed up at 3 months post-treatment . In study 2 , we investigated the adherence to , and efficacy of the same programme in a primary care setting , where patients ( n = 136 ) completed the programme under the supervision of primary care clinicians . RESULTS The RCT showed that the iCBT programme was more effective than WLC , with large within- and between-groups effect sizes found ( > 0.8 ) . Adherence was also high ( 89 % ) , and gains were maintained at 3-month follow-up . In study 2 in primary care , adherence to the iCBT programme was low ( 41 % ) , yet effect sizes were large ( > 0.8 ) . Of the non-completers , 30 % experienced benefit . CONCLUSIONS Together , the results show that iCBT is effective and adherence is high in research setting s , but there is a problem of adherence when translated into the ' real world ' . Future efforts need to be placed on developing improved adherence to iCBT in primary care setting
Unadjusted data was not statistically significant .
The other problems of psychological intervention included low recruitment and high drop out rate , which has been shown to be greater in patients receiving group therapy .
There is insufficient evidence from this review to confirm the efficacy of psychological intervention in NUD
BACKGROUND Studies have also shown that non-ulcer dyspepsia ( NUD ) patients have higher scores of anxiety , depression , neurotism , chronic tension , hostility , hypochondriasis and tendency to be more pessimistic when compared with the community controls .
However , the role of psychological interventions in NUD remains uncertain .
OBJECTIVES This review aims to determine the effectiveness of psychological interventions including psychotherapy , psychodrama , cognitive behavioural therapy , relaxation therapy and hypnosis in the improvement of either individual or global dyspepsia symptom scores and quality of life scores in patients with NUD .