Major depression is a common mental health problem in the general population 1 and is associated with substantial reductions in quality of life.2,3 Cost-of-illness studies reveal that the economic burden of depression is considerable. 4 However, many people with depression attending primary care do not receive the care they need. There is little evidence about the effectiveness of pharmacotherapy in patients with mild to moderate depression 5 and psychological treatments in primary care are scarce and costly. Consequently, effective treatments like cognitive-behavioural therapy (CBT) 6,7 are not offered to all patients and many people with depression in primary care remain untreated. 8 An effective, acceptable and feasible solution for such individuals might be computerised CBT (CCBT). 9 The National Institute for Health and Clinical Excellence (NICE) recommended the use of two CCBT software programs for depression and anxiety, 10 and these programs are now in use in England, Wales and Northern Ireland. In the Netherlands, an online CCBT program is currently being used as part of an ongoing implementation study (www.kleurjeleven.nl/). However, evidence about the costeffectiveness of CCBT is still limited.9 To our knowledge, only one study conducted an economic evaluation of CCBT for depression and it showed that CCBT (delivered on a personal computer in the general practice) can be highly cost-effective compared with usual care by a general practitioner (GP) in the UK setting.11 In a recent study, we compared the clinical effectiveness of unsupported, online CCBT (i.e. Colour Your Life) with treatment as usual (TAU) by a GP and a combination of both CCBT and TAU for depression (CCBT plus TAU). 12 In the present study, we assess the cost-effectiveness of these interventions, focusing on the research question: for mild to moderate depression, is CCBT compared with TAU or CCBT plus TAU preferable in terms of cost-effectiveness from a societal perspective? The Medical and Ethical Committee approved the study protocol. The study is registered at the Netherlands Trial Register, part of the Dutch Cochrane Centre (ISRCTN47481236) Method Design and participantsIn a randomised trial, 303 participants were recruited from the general population by means of a large-scale internet-based screening in the South of the Netherlands. Inclusion criteria were: age 18-65; access to the internet at home (for optimal use of the CCBT program, a broad-band connection was required and not dial-up connection); at least mild to moderate depressive complaints (Beck Depression Inventory II (BDI-II) 13 score516); duration of depressive complaints 3 months or more; no current psychological treatment for depression; no continuous antidepressant treatment for at least 3 months prior to entry; fluent in Dutch language; no alcohol and/ or drug dependence; and no severe psychiatric comorbidity (e.g. psychotic disorders). During a 1-year follow-up period, participants were asked to fill in monthly internet questionnaires. 12,14 InterventionsComputeri...

Nightmares are one of the most troubling features of posttraumatic stress disorder (PTSD), yet imagery rehearsal training (IRT) is currently the only empirically supported treatment for posttraumatic nightmares. Although IRT is effective, it is unknown whether IRT or the exposure, which is inherent in this procedure, causes the decrease in nightmares. This study will attempt to clarify this issue by using exposure therapy alone to treat a patient with PTSD. The participant is a 39-year-old male who experienced a single traumatic event. Data were collected on his sleep habits, as well as on the frequency and intensity of the nightmares. Results indicate that exposure-based nightmare treatment for PTSD sufferers should be considered in conjunction with standard treatment packages.

Pre‐release training is becoming a standard practice in conservation breeding and translocation programs for mammals and birds, but is still relatively neglected for herpetofauna, likely stemming from widespread beliefs that amphibians are “hard‐wired” and are thus predicted to benefit little from experiential learning. However, experience during development can drive both morphological and behavioral modifications that could benefit post‐translocation survival. Here, we developed an anti‐predator training program for the endangered mountain yellow‐legged frog Rana muscosa and evaluated its impact on morphometrics, developmental rates, behavior, and post‐release outcomes. Using a controlled, balanced factorial experimental design, we exposed individuals at two developmental stages (tadpoles and post‐metamorphic) to visual and olfactory cues from one of its principal predators, the two‐striped garter snake Thamnophis hammondii. We found that exposure to predators during the tadpole stage impacted tadpole development, morphology, and behavior. However, we found no evidence that post‐metamorphic behavior or post‐release outcomes were influenced by tadpole predator exposure, either on its own or in interaction with post‐metamorphic training treatments. Training of post‐metamorphic frogs, however, yielded evidence of learning, with downstream effects on behavior and apparent survival after release into the wild. Our findings produce novel insights on the value of anti‐predator training in amphibian conservation translocation programs, bolster recent evidence re‐evaluating the importance of learning and developmental experience for amphibian species, and provide guidance for selecting optimal developmental windows for training.