Although exercise is associated with depression relief, the effects of aerobic exercise (AE) interventions on clinically depressed adult patients have not been clearly supported. The purpose of this meta-analysis was to examine the antidepressant effects of AE versus nonexercise comparators exclusively for depressed adults (18-65 years) recruited through mental health services with a referral or clinical diagnosis of major depression. Eleven e-databases and bibliographies of 19 systematic reviews were searched for relevant randomized controlled clinical trials. A random effects meta-analysis (Hedges' g criterion) was employed for pooling postintervention scores of depression. Heterogeneity and publication bias were examined. Studies were coded considering characteristics of participants and interventions, outcomes and comparisons made, and study design; accordingly, sensitivity and subgroup analyses were calculated. Across 11 eligible trials (13 comparisons) involving 455 patients, AE was delivered on average for 45 min, at moderate intensity, three times/week, for 9.2 weeks and showed a significantly large overall antidepressant effect (g = -0.79, 95% confidence interval = -1.01, -0.57, P < 0.00) with low and nonstatistically significant heterogeneity (I 2 = 21%). No publication bias was found. Sensitivity analyses revealed large or moderate to large antidepressant effects for AE (I 2 ≤ 30%) among trials with lower risk of bias, trials with short-term interventions (up to 4 weeks), and trials involving individual preferences for exercise. Subgroup analyses revealed comparable effects for AE across various settings and delivery formats, and in both outpatients and inpatients regardless symptom severity. Notwithstanding the small number of trials reviewed, AE emerged as an effective antidepressant intervention. K E Y W O R D Sdepression, empirically supported treatments, exercise, mood disorders, treatment
The treatment group improved on psychological outcomes, demonstrating the effectiveness of a Web-based CBT for perfectionism in a university setting.
This study assessed the effectiveness of a web-based cognitive behavioral intervention (CBT) in reducing perfectionism and psychological distress in post-secondary students. Participants assessed as high in perfectionism (n=77) were randomized to one of three 10-week, web-based, intervention conditions (no treatment [NT], general stress management [GSM], or CBT). Results indicated the CBT condition was effective in reducing perfectionism, and supported a pattern of significantly greater improvement than observed in participants in the GSM or NT conditions. While both CBT and GSM demonstrated capacities to significantly reduce distress, for CBT participants changes in perfectionism were significantly correlated with changes in depression and anxiety. Results offer support for the effectiveness of web-based CBT in positively affecting perfectionist-related problems. Given the considerable proportion of individuals who suffer from perfectionism-related distress, the intervention's apparent effectiveness, cost-effectiveness and ease of dissemination warrant future replication studies.
Researchers in psychology reliably select traditional null hypothesis significance tests (e.g., Student's t test), regardless of whether the research hypothesis relates to whether the group means are equivalent or whether the group means are different. Tests of equivalence, which have been popular in biopharmaceutical studies for years, have recently been introduced and recommended to researchers in psychology for demonstrating the equivalence of two group means. However, very few recommendations exist for applying tests of equivalence. A Monte Carlo study was used to compare the test of equivalence proposed by Schuirmann with the traditional Student t test for deciding if two group means are equivalent. It was found that Schuirmann's test of equivalence is more effective than Student's t test at detecting population mean equivalence with large sample sizes; however, Schuirmann's test of equivalence performs poorly relative to Student's t test with small sample sizes and/or inflated variances.
The field of psychology, as with many other disciplines, has been increasingly interested in being able to measure the effectiveness of behavioral interventions. This trend has led to a number of different approaches for measuring clinical significance, each addressing a slightly different aspect of the clinical outcome. Recently, clinical psychologists (and clients) have supported the contention that one of the most important therapeutic questions is whether clients are functioning equivalently to normal controls following an intervention. To address this question, Kendall, Marrs-Garcia, Nath, and Sheldrick (1999) presented an approach to measuring clinical significance that utilizes tests of equivalence. The present study clarifies the nature of the hypotheses being conducted in measuring clinical significance with tests of equivalence and extends the approach by incorporating recent advances in equivalence testing. A revised approach for evaluating clinical significance via equivalence testing is proposed, and an empirical example demonstrating this approach is provided.
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