ObjectiveMeta-analyses of behavior change (BC) interventions typically find large heterogeneity in effectiveness and small effects. This study aimed to assess the effectiveness of active BC interventions designed to promote physical activity and healthy eating and investigate whether theoretically-specified BC techniques improve outcome. DesignInterventions, evaluated in experimental or quasi-experimental studies, using behavioral and/or cognitive techniques to increase physical activity and healthy eating in adults were systematically reviewed. Intervention content was reliably classified into 26 BC techniques and the effects of individual techniques, and of a theoretically-derived combination of self-regulation techniques, were assessed using meta-regression. Main Outcome MeasuresValid outcomes of physical activity and healthy eating. ResultsThe 122 evaluations (N = 44,747) produced an overall pooled effect size of 0.31 (95% CI 0.26 to 0.36) (I 2 = 69%). The technique, "self-monitoring", explained the greatest amount of among-study heterogeneity (13%). Interventions that combined self-monitoring with at least one other technique derived from control theory were significantly more effective than the other interventions (0.42 versus 0.26). ConclusionClassifying interventions according to component techniques and theoretically-derived technique combinations and conducting meta-regression enabled identification of effective components of interventions designed to increase physical activity and healthy eating.

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16Background: Digital health interventions (DHIs), including computer-assisted therapy, 17

Objective: To systematically investigate the extent and type of theory use in physical activity and dietary interventions, as well as associations between extent and type of theory use with intervention effectiveness.Methods: An in-depth analysis of studies included in two systematic reviews of physical activity and healthy eating interventions (k = 190). Extent and type of theory use was assessed using the Theory Coding Scheme (TCS) and intervention effectiveness was calculated using Hedges's g. Meta-regressions assessed the relationships between these measures.Results: Fifty-six percent of interventions reported a theory base. Of these, 90% did not report links between all of their behavior change techniques (BCTs) with specific theoretical constructs and 91% did not report links between all the specified constructs with BCTs. The associations between a composite score or specific items on the TCS and intervention effectiveness were inconsistent. Interventions based on Social Cognitive Theory or the Transtheoretical Model were similarly effective and no more effective than interventions not reporting a theory base. Conclusions:The coding of theory in these studies suggested that theory was not often used extensively in the development of interventions. Moreover, the relationships between type of theory used and the extent of theory use with effectiveness were generally weak. The findings suggest that attempts to apply the two theories commonly used in this review more extensively are unlikely to increase intervention effectiveness.

National Basic Research Program of China (973 Program).

BackgroundEarly intervention services for psychosis aim to detect emergent symptoms, reduce the duration of untreated psychosis, and improve access to effective treatments.AimsTo evaluate the effectiveness of early intervention services, cognitive–behavioural therapy (CBT) and family intervention in early psychosis.MethodSystematic review and meta-analysis of randomised controlled trials of early intervention services, CBT and family intervention for people with early psychosis.ResultsEarly intervention services reduced hospital admission, relapse rates and symptom severity, and improved access to and engagement with treatment. Used alone, family intervention reduced relapse and hospital admission rates, whereas CBT reduced the severity of symptoms with little impact on relapse or hospital admission.ConclusionsFor people with early psychosis, early intervention services appear to have clinically important benefits over standard care. Including CBT and family intervention within the service may contribute to improved outcomes in this critical period. The longer-term benefits of this approach and its component treatments for people with early and established psychosis need further research.

One quarter of children and young people (CYP) experience anxiety and/or depression before adulthood, but treatment is sometimes unavailable or inadequate. Self-help interventions may have a role in augmenting treatment and this work aimed to systematically review the evidence for computerised anxiety and depression interventions in CYP aged 5-25 years old. Databases were searched for randomised controlled trials and 27 studies were identified. For young people (12-25 years) with risk of diagnosed anxiety disorders or depression, computerised CBT (cCBT) had positive effects for symptoms of anxiety (SMD -0.77, 95% CI -1.45 to -0.09, k = 6, N = 220) and depression (SMD -0.62, 95% CI -1.13 to -0.11, k = 7, N = 279). In a general population study of young people, there were small positive effects for anxiety (SMD -0.15, 95% CI -0.26 to -0.03; N = 1273) and depression (SMD -0.15, 95% CI -0.26 to -0.03; N = 1280). There was uncertainty around the effectiveness of cCBT in children (5-11 years). Evidence for other computerised interventions was sparse and inconclusive. Computerised CBT has potential for treating and preventing anxiety and depression in clinical and general populations of young people. Further program development and research is required to extend its use and establish its benefit in children.