Exploring the Effectiveness of the 'Back of the Net' Intervention on Indices of Physical and Psychological Measures
Condition: Self Concept; Body Fat Composition; Depression; Perceived Social Support
MeSH terms: Depression
Study type: Interventional

Summary: 
      To date very little research has focused on the mental health of young men. The main aim of
      the proposed research is to explore the effectiveness of a combined exercise and
      internet-based cognitive behavioral therapy (CBT) intervention (called "Back of the Net") on
      indices of suicide risk in young men. A second aim is to explore the relationship between
      physical self-concept, self esteem, body fat composition, body circumference and changes in
      depression as a result of an exercise intervention. It is hypothesised that the combined
      exercise and internet-delivered CBT intervention will have greater benefits for indices of
      suicide risk compared to an exercise-only intervention, an internet-delivered CBT-only
      intervention and a control condition.
    

Detailed description: 
      The increase in the number of young people, particularly males, taking their own lives in
      Ireland has become a major cause for concern. Five times more men than women end their own
      lives in Ireland today. Research shows that young people, particularly men under 30 years are
      far less likely to attend their GP than adults aged over 30 years. Thus, young men who are
      suffering from depression and who are vulnerable to suicidal behaviour are not actively
      seeking the help they require. Young men are the group least likely to approach mental health
      services (Russell, Gaffney, Bergin & Bedford, 2004), despite suicide and depression being so
      prevalent among young Irish males. It is clear that approaches to suicide prevention in Irish
      society need to bridge the gap between young at-risk men and mental health services.

      Research has shown that both psychotherapeutic interventions such as Cognitive Behavioural
      Therapy (CBT) and exercise interventions can be equally effective as pharmacotherapy in
      addressing some of the risk factors associated with suicide (Mead et al., 2008), including
      symptoms of depression. Cognitive-Behavioural Therapy (CBT) places emphasis on identifying
      and changing maladaptive beliefs and behaviours that contribute to emotional distress. CBT
      techniques aim to enhance self-control, rational problem-solving abilities and social skills;
      it is therefore unsurprising that CBT has proven to be beneficial in addressing indices of
      suicide risk such as depression and perceived social isolation (Barbe, Bridge, Birhamer,
      Kolko & Brent, 2004; Brown at al., 2005). In an attempt to make CBT more widely available and
      easily accessible to various populations, research groups are investigating the impact of
      internet delivered CBT programmes on indices of suicide risk, including depression. Internet
      delivered CBT programmes have been found to be as effective as face-to-face treatment
      (Anderson, 2009). Internet delivered CBT has been shown to significantly reduce levels of
      depression in young people living in Sweden (Anderson, Bergstrom, Hollandare et al., 2005).
      Research proposes that internet-based interventions represent a paradigm shift in treatment
      techniques and that internet delivered CBT should be pursued further as a treatment
      alternative for symptoms of depression (Anderson, 2009; Anderson et al., 2005).

      There is a large body of research that supports the role of exercise in treating depressive
      symptoms. Both depression and feelings of hopelessness, principal indices of suicide, are
      found to be lower in adults who regularly engage in exercise compared to those who remain
      sedentary (Chioqueta & Stiles, 2007). In a study involving university students, Chioqueta and
      Stiles (2007) demonstrate that active engagement in physical activity was significantly
      associated with improvements in indices of suicide. Involvement in physical activity has been
      shown to produce positive mood states and subjective well-being as well as reducing stress
      levels (Fox, 1999).

      Suicide prevention in Ireland requires an innovative approach, one that provides support and
      is easily accessible by young men and which promotes help-seeking behaviour and mental health
      awareness. It is possible that internet based CBT interventions present such an opportunity
      for delivering mental health promotion and encouraging help-seeking behaviour among young
      Irish men while reducing indices of suicide risk. Exercise interventions are similarly
      successful in reducing the risk factors associated with suicide in young men, such as
      severity of depressive symptoms. Thus the main aim of this study is to explore the
      effectiveness of a combined exercise and internet delivered CBT intervention in reducing
      indices of suicide in young men.

      In addition, it has been suggested that Physical Self-Concept mediates the relationship
      between exercise and self-esteem which is in turn related to depression (Dishman, Hales, Ward
      et al., 2006). However the relationship between these variables over time as a result of an
      intervention has not yet been studied. Therefore a secondary aim of this present study is to
      explore the relationship between physical self-concept, self-esteem and depression throughout
      the duration of the proposed intervention. We will also examine if changes in body-fat
      composition and body circumference mediate the relationship between these variables.
    

Intervention name(s): Exercise; Online Cognitive Behavioural Therapy
Intervention type(s): Other; Behavioral
Intervention description(s): Moderate intensity aerobic exercise on the bike/cross trainer/ rower/ treadmill and resistance exercise on the weights machines, twice per week for 10 weeks.; Participants will be asked to log-on to a website aimed at young men once per week. Participants will be asked to read a vignette or watch a specific video clip, which will be updated each week by the researcher. Participants will be asked to respond to the vignette/video clip on the website. This should take no longer than 10-15 minutes to complete. Different themes (such as those addressed by traditional cognitive behavioural therapy) will be introduced each week. Themes include: relaxation, identifying positive strengths, body image, goal-setting, problem-solving, resilience, self-care behaviour and sources of support.
Other intervention name(s): Aerobic exercise; 'Back of the Net' Intervention
Allocation: Randomized
Intervention model: Factorial Assignment
Masking: None (Open Label)
Keywords: Internet based Cognitive-Behavioural Intervention; Exercise Intervention; Depression; Perceived Social Support; Physical Self-Concept