Michael Baigent

Fear of falling (FOF) is well documented among older adults but has received little attention in younger populations. This case report describes the assessment and treatment of Angela, a 37-year-old woman with obesity who developed a phobic FOF. Her fear resulted in panic symptoms and extensive avoidance, which led to impaired mobility including dependency on mobility aids and compromised her engagement in physiotherapy. Body size appeared to contribute to the content of the patient’s catastrophic fears, particularly concerns regarding her ability to recover independently following a fall. Treatment involved values-guided graded cue exposure with response prevention alongside physiotherapy targeting balance and mobility. Functional impairment and phobic avoidance decreased substantially, with gains maintained at 1-month follow-up and remaining evident 4 years later. Unlike many interventions for older adults with FOF, which often require cautious progression because of frailty and fall risk, treatment for Angela progressed relatively quickly through exposure and rehabilitation tasks. Her younger age and the absence of age-related physical decline may have allowed a more rapid approach to rehabilitation. This case describes the application of integrated CBT-based exposure and physiotherapy in a younger adult whose FOF appeared to be maintained primarily by fear-related avoidance and addresses a gap in a literature focused predominantly on older adults.

This is a well-written paper and a meaningful contribution to the field. As reflected in the write-up, the group under study and the intervention warrant investigation. Hope my comments below will help. Abstract Can it follow the latest CONSORT...

Background: Protecting doctors’ mental health has typically focused on individuals, rather than addressing organisational and structural-level factors in the work environment. Objectives: This study uses the socioecological model (SEM) to illuminate and explore how these broader factors inform the mental health of individual doctors. Design: Semi-structured interviews (20–25 hours) and ethnographic observations (90 hours) involving work shadowing doctors (n=14). Participants: Doctors representing various career stages, specialty areas, genders and cultural backgrounds. Setting: Three specialties in a public South Australian hospital. Thematic analysis revealed work-related risk factors for poor mental health. Results: The SEM framework was used to analyse the work environment’s impact on doctors’ mental health. The analysis identified how the layers interconnect to influence risk factors for individual doctors. Microsystem : lack of control over career advancement, disenfranchisement due to understaffing and concerns about handling complex cases relative to experience. Mesosystem : negative impacts of shift work and fragmented teams, leading doctors to absorb pressure despite exhaustion to maintain professional credibility. Exosystem : high patient loads with time constraints and geographical limitations hindering care delivery, compounded by administrative burdens. Macrosystem : the commercialisation of medicine emphasising corporatisation and bureaucratic processes, which devalues professional autonomy. Conclusions: This study highlights how doctors experience layers of interconnected factors that compromise their mental health but over which they have very little control. Interventions must therefore address these issues at organisational and systemic levels, for which starting points evident within our data are identified.

Betting on the various codes of football in Australia accounts for the majority of sports betting, with Australian rules football (AFL) by far the most popular sport in Australia. Several studies have revealed the heavy presence of gambling advertising during AFL broadcasts, and a frequently used advertising strategy involves the use of well-known AFL commentators outlining their tips and betting suggestions. To date, no research has examined the hypotheses that skill may help in predicting AFL matches and monetary outcomes from AFL betting. Rather than merely discounting such ideas, it is important to test them empirically. The aims of this study were therefore, to examine if (1) expert AFL tipsters made better predictions than random picks, (2) expert AFL tipsters gained greater monetary reward than random selection, and (3) expert tipsters’ prediction accuracy improved with betting experience. To this end, six seasons of AFL matches, odds data, and expert tipster data were analysed retrospectively, totalling 1141 matches. Random selections were calculated for each match using an inbuilt random number generator within Microsoft Excel and a $2 simulated wager was applied for each AFL match. The results of mixed-effects modelling showed that experts picked more correct outcomes than random selection; experts’ correct predictions were partially mediated by home-game selections; no difference in monetary outcome was observed for experts compared to random selection; experts’ predictions did not improve over time. The results of this study may be used to inform both psychological interventions that target gamblers’ illusions of control, and public health gambling harm prevention messaging.

Online video gaming is a popular activity among people of all ages. For some, however, gaming can become problematic. While evidence exists for the effectiveness of cognitive behavioural therapy for gaming disorder (GD), a major challenge is that adolescents and young adults, particularly males, are often reluctant to seek help and engage long term with a mental health practitioner. This report presents a case involving brief parent‐delivered contingency management for a 19‐year‐old male with GD who refused to engage with treatment services following a significant decline in functioning and a high‐lethality suicide attempt. This approach led to a substantial reduction in gaming time, as well as related gains in self‐care and independence. This case highlights the value and feasibility of developing a therapeutic alliance with a parent to manage excessive gaming behaviours among treatment‐refusing individuals with GD. Practical challenges and associated lessons from managing this case are discussed. Practitioner points: Brief parent‐delivered contingency management was implemented for a 19‐year‐old treatment‐refusing male with GD. This approach led to a substantial reduction in the young man's gaming time as well as related gains in areas of self‐care and independence at 6‐month follow‐up. This case highlights the value and feasibility of developing a therapeutic alliance with a parent to manage excessive gaming behaviours among treatment‐refusing individuals with GD.

The current COVID-19 pandemic has highlighted the limitations of relying solely on in-person contact for diagnosis, monitoring and treatment of mental health conditions. Mobile health approaches can be used to monitor mental health patients remotely, but they are not properly integrated with existing models of healthcare service delivery. We present findings from a case study of a mobile app enabled cloud-based software program rolled out in a phone based psychological service to enable real-time/temporal monitoring. The program offered patients an app to record measures of symptoms in everyday contexts and provided clinicians with access to an accompanying dashboard to use information from the app to tailor treatments and monitor progress and ultimately facilitate earlier and personalised care decisions. Feedback related to implementation and utility was gathered from clinicians through a focus group conducted two months post-roll-out. Findings identified that the system is valuable and feasible, however implementation issues were identified. These are discussed in order to inform future work in this area to support the delivery of timely and responsive mental health care in the community.

Answering the Call, the Australian National Police and Emergency Services Mental Health and Wellbeing Study, surveyed 14,868 Australian ambulance, fire and rescue, police, and state emergency service employees. Emergency services personnel had lower rates of mental wellbeing and higher rates of psychological distress and probable PTSD than the general adult population. Overall 30% had low wellbeing, 21% had high and 9% had very high psychological distress, and 10% had probable PTSD. An estimated 5% had suicidal ideation and 2% had a suicide plan in the past 12 months, while 16% binge drink at least weekly. Only one in five of those with very high psychological distress or probable PTSD felt they received adequate support for their condition. These findings highlight the risk of mental health conditions associated with work in the emergency services sector.

Advances in technology and increased usage of electronic mobile devices over the past decade have changed the way gamblers engage with online gambling. The convenience of mobile electronic devices is understood to be a major contributor to the increase of online gambling, which in turn has been implicated in the growth of sports betting. Emerging evidence suggests several sources of differentiation between mobile and other online gambling, which have important psychological implications. Given the inherent differences, we cannot conclude that evidence for the effectiveness of treatment for non-smartphone problem gambling (PG) automatically translates to online smartphone sports betting PG. The aim of this study, therefore, was to describe the feasibility and preliminary effectiveness of cue exposure therapy (CET) to treat individuals presenting to a community-based PG therapy service with an online smartphone sports betting addiction, using a case series design. Six men (21–42 years old) received up to 10 weekly 60-min manualised CET sessions. Outcome measures were gambling harm, gambling urge, gambling cognitions, psychological distress, and functional impairment. All six participants completed a course of CET averaging 8.33 sessions (SD = 1.75) and reported improvement across each of the outcome measures. Psychological distress scores had reduced to the non-clinical range for all six participants and five participants scored below the cut offs for PG and functional impairment at 1 month follow up. The findings provide preliminary proof of concept evidence for the feasibility and efficacy of CET for online smartphone sports betting addiction.

Background: The United Kingdom IAPT (Improving Access to Psychological Therapies) approach of delivering low intensity therapies for symptoms of depression and anxiety was adapted for Australia and named NewAccess. Clinical outcomes of the service were evaluated in three sites between October 2013 and 2016. Aims: This paper describes the clinical outcomes in the Australian health setting. Methods: Prospective cohort study with repeated measures. Both intent-to-treat and per protocol analyses were conducted for primary outcomes measures Patient Health Questionnaire-9 (nine item), and Generalised Anxiety Disorder (seven item). Secondary measures were Phobia Scale and Work and Social Adjustment Scale. Results: Three thousand nine hundred and forty-six individuals were assessed, and 3269 attended at least two treatment sessions. Forty percent were males. There was a clinically meaningful reduction (improvement) shown by reliable recovery rates in both depression and anxiety symptoms at post-treatment assessment (68%; 95% CI: 66–70%) with large effect sizes (1.23 for depression and 1.25 for anxiety). Outcomes in PHQ-9 and GAD-7 were not influenced by age or sex, but recovery rates were significantly reduced by relationship status (single or separated). Unemployment reduced PHQ-9 outcomes but not GAD-7 outcomes. Conclusion: NewAccess demonstrated positive clinical outcomes in Australia, that compared favourably with international studies with the same methodology.