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Sun Y, Park S, Malik A, Atif N, Zaidi A, Rahman A, Surkan PJ. Pregnancy stressors and postpartum symptoms of depression and anxiety: the moderating role of a cognitive-behavioural therapy (CBT) intervention. Gen Psychiatr 2024; 37:e101136. [PMID: 38440406 PMCID: PMC10910396 DOI: 10.1136/gpsych-2023-101136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 01/10/2024] [Indexed: 03/06/2024] Open
Abstract
Background Little is known about the association between stressors (especially positive stressors) during pregnancy and postpartum depression and anxiety. Aims We investigated the association between positive and negative stress events during different stages of pregnancy and postpartum mental health outcomes among low-income pregnant women with symptoms of anxiety in Pakistan and evaluated whether an intervention based on cognitive-behavioural therapy (CBT) had a regulatory effect. Methods Participants were 621 pregnant Pakistani women with mild anxiety. Using the Pregnancy Experience Scale-Brief Version, six scores were created to assess positive and negative stressors. We performed a multivariate linear regression to examine whether these six scores, measured both at baseline and in the third trimester, were associated with postpartum anxiety and depressive symptoms. The effect of the intervention on this relationship was examined by adding an interaction term to the regression model. Results Hassles frequency measured in the third trimester was positively associated with depression (B=0.22, 95% confidence interval (CI): 0.09 to 0.36) and anxiety (B=0.19, 95% CI: 0.08to 0.30). At the same timepoint, uplifts intensity was negatively associated with symptoms of depression (B=-0.82, 95% CI: -1.46 to -0.18) and anxiety (B=-0.70, 95% CI: -1.25 to -0.15), whereas hassles intensity was positively related to symptoms of depression (B=1.02, 95% CI: 0.36 to 1.67) and anxiety (B=0.90, 95% CI: 0.34 to 1.47). The intensity ratio of hassles to uplifts reported in the third trimester was positively related to both depression (B=1.40, 95% CI: 0.59 to 2.20) and anxiety (B=1.26, 95% CI: 0.57 to 1.96). The intervention strengthened the overall positive effects of uplifts and the negative effects of hassles. Pregnancy experiences at baseline during early pregnancy to mid-pregnancy were not associated with mental health outcomes. Conclusions Stressors in the third trimester but not earlier in pregnancy were associated with postpartum symptoms of anxiety and depression. The CBT intervention modified the association between pregnancy stressors and postpartum mental health outcomes. Programmes that promote positive experiences and reduce negative experiences, especially in late pregnancy, may mitigate postpartum mental health consequences. Trial registration number NCT03880032.
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Affiliation(s)
- Yunxiang Sun
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Soim Park
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Abid Malik
- Department of Public Mental Health, Health Services Academy, Islamabad, Pakistan
| | - Najia Atif
- Human Development Research Foundation, Rawalpindi, Pakistan
| | - Ahmed Zaidi
- Human Development Research Foundation, Rawalpindi, Pakistan
| | - Atif Rahman
- Department of Primary Care and Mental Health, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Pamela J Surkan
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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Choudhary N, Kumar A, Sharma V, Kaur K, Singh Kharbanda P, Baishya J, Kumar D, Sharma A, Chakravarty K. Effectiveness of CBT for reducing depression and anxiety in people with epilepsy: A systematic review and meta-analysis of randomized controlled trials. Epilepsy Behav 2024; 151:109608. [PMID: 38183927 DOI: 10.1016/j.yebeh.2023.109608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 11/18/2023] [Accepted: 12/21/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUND Patients with epilepsy suffer from depression and anxiety that reduces quality of life. Cognitive behavioral therapy (CBT) among various non pharmacological treatment recommended for depression and anxiety. Since there are several articles reporting CBT treatment for depression in patients with epilepsy, we conduct a meta-analysis to evaluate the effectiveness of CBT for adult patients with epilepsy. METHODS Four electronic databases PubMed, Scopus, Embase, and the Cochrane library searched for relevant studies. A detailed "RISK of bias" assessment has been done for included studies. Funnel plot was used for assessing publication Bias. R Software- RStudio 2022 was used to calculate standard mean difference (SMD). The study has been registered in PROSPERO (CRD42023447655). RESULTS Eventually, a Total 13 studies involving 1222 patients met the eligibility criteria. There was decline in the Patient Health Questionnaire (PHQ) [SMD = -0.42, 95 % CI = -0.63 to -0.22], Neurologic Disorder Depression Inventory-Epilepsy (NDDI-E) [SMD = -0.53, 95 % CI = -0.75 to -0.31], Beck depression Inventory (BDI) [SMD = -0.69, 95 % CI = -1.08 to -0.30], Hospital Anxiety and Depression Scale-Depression (HADS-D) [SMD = -0.73 , 95 % CI = -0.94 to -0.52] and Hospital Anxiety and Depression Scale Anxiety subscale (HADS-A) [SMD = -0.66, 95 % CI = -0.87 to -0.45] score of the CBT group than that of the control group at post-intervention. The results showed that the improvement in QOLIE-31 score of the CBT group than that of the control group [SMD = 0.67, 95 % CI = 1.33] at post-intervention. CONCLUSION The result of our study showed that Cognitive behavioral therapy is a superior therapy for treating anxiety and depression in epilepsy patients. CBT was effective in improving Quality of life in patients with epilepsy. However, the sample size varied across the trials, additional high-quality studies are needed in the future.
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Affiliation(s)
- Neetu Choudhary
- Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashok Kumar
- National Institute of Nursing Education, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vaishali Sharma
- Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Kirandeep Kaur
- Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Jitupam Baishya
- Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Devender Kumar
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Akhilesh Sharma
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Kamalesh Chakravarty
- Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
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Praptomojati A, Icanervilia AV, Nauta MH, Bouman TK. A systematic review of Culturally Adapted Cognitive Behavioral Therapy (CA-CBT) for anxiety disorders in Southeast Asia. Asian J Psychiatr 2024; 92:103896. [PMID: 38199202 DOI: 10.1016/j.ajp.2023.103896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 12/19/2023] [Accepted: 12/23/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND Cognitive Behavioral Therapy (CBT) has been proven an effective treatment for anxiety disorders. However, CBT still dominantly uses concepts and constructs rooted in Western cultures, and most research focuses on Western populations. It is unsure how this translates to non-Western cultures like Southeast Asia. AIMS Our objective is to explore which types of cultural adaptations in CBT have been implemented for anxiety disorders in Southeast Asia and their effectiveness. METHODS We systematically searched PubMed, PsycINFO, Embase, CENTRAL, GARUDA, and Google Scholar for CA-CBT for anxiety disorders in local communities in Southeast Asian countries. Data were analyzed using a narrative approach distinguishing between peripheral and core component adaptations. PROSPERO database preregistration number was CRD42022336376. RESULTS Seven studies (one randomized controlled trial, three quasi-experimental studies, and three case reports) were selected. Two studies made cultural adaptations in multiple components. Two studies modified core treatment components by incorporating local values in the CBT restructuring process. Three studies conducted cultural adaptation on peripheral treatment components: adaptation to materials and semantics, cultural examples and themes, and session structure. Three studies did not provide detailed information. One RCT study showed better improvement for those who got CA-CBT than those in treatment as usual (TAU). CONCLUSION The findings suggest some components to consider when conducting cultural adaptation. We could not establish the degree of superiority of CA-CBT over non-CA-CBT nor identify components with the most influence due to the limited number of studies found. Employing standard documentation in reporting trials is also important to increase transparency.
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Affiliation(s)
- Ardian Praptomojati
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS Groningen, the Netherlands; Faculty of Psychology, Universitas Gadjah Mada, Jl. Sosio Humaniora Bulaksumur, 55281 Yogyakarta, Indonesia.
| | - Ajeng Viska Icanervilia
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands; Department of Radiology, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, RSUP. Dr. Sardjito, Jl. Kesehatan 1, Sekip, 55284 Yogyakarta, Indonesia; Clinical Epidemiology and Biostatistics Unit (CEBU), Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Gedung Litbang FK-KMK UGM Lantai 1, Jl. Medika, Senolowo, Mlati, Sleman, Yogyakarta, Indonesia
| | - Maaike H Nauta
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS Groningen, the Netherlands
| | - Theo K Bouman
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS Groningen, the Netherlands
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Brenner DM, Ladewski AM, Kinsinger SW. Development and Current State of Digital Therapeutics for Irritable Bowel Syndrome. Clin Gastroenterol Hepatol 2024; 22:222-234. [PMID: 37743035 DOI: 10.1016/j.cgh.2023.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 09/07/2023] [Accepted: 09/11/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND & AIMS Irritable bowel syndrome (IBS) is a common, debilitating disorder characterized by abdominal pain and disordered bowel habits. Current pharmacologic treatments often provide incomplete symptom relief and may be poorly tolerated. Furthermore, alleviation of gastrointestinal symptoms does not always translate into improved quality of life for IBS patients. Current treatment guidelines recommend brain-gut behavior therapy (BGBT) in conjunction with other IBS therapies, and, in randomized controlled trials, BGBT has been shown to improve symptoms, patient satisfaction, functioning, and quality of life. Access to BGBT is limited by lack of adequately trained gastrointestinal psychologists, patient time constraints, and cost. Furthermore, clinician knowledge that BGBT is specific, and different from psychotherapy approaches for common mental health disorders, may limit referrals even where available. This review provides an overview of the pathophysiology of IBS, disease burden, unmet therapeutic needs, evidence base of novel digital therapeutics for IBS, and guidance on the introduction and appropriateness of these interventions for patients. METHODS We searched the literature for available published data relating to the use of novel digital therapeutics to provide cognitive behavioral therapy and gut-directed hypnotherapy in the treatment of irritable bowel syndrome. RESULTS Clinical trial data support the development and utility of digital therapeutics designed to deliver self-guided cognitive behavioral therapy and hypnotherapy for the treatment of IBS. CONCLUSIONS BGBTs are effective, guideline-recommended treatments for IBS. Digital therapeutic devices offer accessible, cost-effective treatment options for delivery of adjunctive BGBT for the treatment of IBS. The decision to recommend digital BGBTs should be guided by careful patient assessment that includes mental health screening and risk assessment.
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Affiliation(s)
- Darren M Brenner
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
| | - Amy M Ladewski
- Department of Digestive Health, Digestive Health Center, Northwestern Memorial Hospital, Chicago, Illinois
| | - Sarah Wimberly Kinsinger
- Division of Gastroenterology and Nutrition, Department of Medicine, Loyola University Medical Center, Maywood, Illinois
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Suarez Luna JC, Bazan Marquez MA. Cognitive clinical intervention in a patient with schizoid personality disorder: Case report. Medwave 2023; 23:e2757-e2757. [PMID: 38147582 DOI: 10.5867/medwave.2023.11.2757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2023] Open
Abstract
The present case report describes a 19-year-old male patient whose main symptoms were emotional coldness, absence of close relationships, difficulty experiencing pleasure with other people, and lack of motivation to work or to continue his studies. A schizoid personality disorder was diagnosed as a product of early maladaptive patterns such as inhibition, emotional deprivation, social isolation, and inadequacy. Likewise, a rigid and fragmented family context was evidenced, with an affective absence of parents and a focus on strict behavioral rules. The study aimed to intervene, from a cognitive clinical approach, the early maladaptive patterns and symptoms that maintained the features of schizoid personality disorder in the patient. For this purpose, cognitive behavioral therapy was carried out, with techniques such as debates, images to reparentalize, assignment of tasks, use of humor, and social skills training, among others. In conclusion, it can be stated that the early maladaptive patterns maintained the schizoid personality symptomatology. Finally, it was demonstrated through clinical and psychometric criteria that cognitive behavioral therapy decreased schizoid personality behaviors in the patient.
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Affiliation(s)
- Julio Cesar Suarez Luna
- Universidad Autónoma de Ica, Dirección de Investigación y Producción Intelectual, Chincha Alta, Perú
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Yang L, Zhang L, Yang W, Tang F, Du Y, Liu J. Exploring the potential of the metaverse medical paradigm in drug addiction treatment: a preliminary discussion and future prospects. Gen Psychiatr 2023; 36:e101258. [PMID: 38116459 PMCID: PMC10728956 DOI: 10.1136/gpsych-2023-101258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 11/17/2023] [Indexed: 12/21/2023] Open
Affiliation(s)
- Longtao Yang
- Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Lijie Zhang
- Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Wenhan Yang
- Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Fei Tang
- Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yanyao Du
- Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jun Liu
- Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Clinical Research Center for Medical Imaging in Hunan Province, Changsha, Hunan, China
- Department of Radiology Quality Control Center in Hunan Province, Changsha, Hunan, China
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Tatta J, Pignataro RM, Bezner JR, George SZ, Rothschild CE. PRISM-Pain Recovery and Integrative Systems Model: A Process-Based Cognitive-Behavioral Approach for Physical Therapy. Phys Ther 2023; 103:pzad077. [PMID: 37369058 DOI: 10.1093/ptj/pzad077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 03/12/2023] [Accepted: 05/21/2023] [Indexed: 06/29/2023]
Abstract
The Academy of Orthopedic Physical Therapy Pain Education Manual supports the advancement of modern pain content, and the National Institutes of Health Federal Pain Research Strategy has called for new models for pain management. This Perspective proposes the Pain Recovery and Integrative Systems Model (PRISM) as a new model that addresses the multidimensional nature of pain. PRISM is a salutogenic, integrative, process-based cognitive-behavioral model designed for physical therapist education and practice. PRISM aligns with national and international initiatives to better understand and manage pain, thereby mitigating the global opioid crisis. PRISM aims to address the multidimensional nature of pain while building resilience, nurturing growth, and facilitating pain recovery. IMPACT PRISM is a salutogenic, integrative, process-based cognitive-behavioral model to guide physical therapists in managing the multidimensional nature of pain.
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Affiliation(s)
- Joe Tatta
- Integrative Pain Science Institute, New York, New York, USA
- Department of Physical Therapy, Arcadia University, Glenside, Pennsylvania, USA
| | - Rose M Pignataro
- Program in Physical Therapy, Marion, Emory and Henry College, Emory, Virginia, USA
| | - Janet R Bezner
- Department of Physical Therapy, Texas State University, Round Rock, Texas, USA
| | - Steven Z George
- Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
| | - Carey E Rothschild
- Program in Physical Therapy, University of Central Florida, Orlando, Florida, USA
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Thondala B, Pawar H, Chauhan G, Panjwani U. The effect of non-pharmacological interventions on sleep quality in people with sleep disturbances: A systematic review and a meta-analysis. Chronobiol Int 2023; 40:1333-1353. [PMID: 37853577 DOI: 10.1080/07420528.2023.2262567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 09/18/2023] [Indexed: 10/20/2023]
Abstract
Sleep is the elixir of life. Both healthy populations and patients with chronic diseases experience sleep disturbances in their lifetime. Pharmacological agents to induce sleep in individuals with sleep disturbances pose side effects like tolerance and dependence, warranting the development of alternative non-pharmacological interventions with less or no adverse effects. However, deciphering comprehensive evidence on the translational potential of these alternative therapies remains difficult. In the current paper, we systematically reviewed the recent literature on the effect of non-pharmacological interventions (NPIs) on improving sleep quality in both healthy and diseased populations experiencing sleep disturbances. We searched PubMed, Science Direct, Cochrane Controlled Trials, and Web of Science databases from inception to June 2022 for randomized controlled trials and cohort studies evaluating the sleep quality of individuals. We performed a meta-analysis using the random effects model with Pittsburgh Sleep Quality Index (PSQI) as an outcome measure to evaluate the effect of five distinct NPIs on sleep quality in normal and people with different medical conditions. Subgroup analyses and sensitivity analyses were done for heterogeneity analysis and to check the consistency of results, respectively. In 16 trials reporting on 1885 subjects, that all NPIs like Resistance Training (SMD -0.29, 95% CI -0.64 to 0.05; p = 0.09); Yoga (SMD -0.48, 95% CI -0.72 to -0.25; p < 0.0001); Cognitive Behavioral Therapy (SMD -1.69, 95% CI -2.70 to -0.68; p = 0.001); Music (SMD -1.42, 95% CI -1.99 to -0.85; p < 0.00001); Light (SMD -0.43, 95% CI -0.77 to -0.09; p = 0.01) have substantially decreased the global PSQI scores. The findings of the randomized studies and a cohort study included in qualitative synthesis demonstrated that the global PSQI scores improved significantly as compared to the placebo groups. Despite the limitations of clinical heterogeneity in subjects, our results demonstrate a positive impact of the studied NPIs on sleep quality in individuals experiencing sleep disturbances. However, comprehensive double-blinded controlled trials are indispensable in the future, emphasizing the objective sleep quality and inter-individual differences in response to the intervention.
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Affiliation(s)
- Bhanuteja Thondala
- Department of Soldier Performance, Defence Institute of Physiology and Allied Sciences, Defence Research and Development Organization, Delhi, India
| | - Harsh Pawar
- Department of Soldier Performance, Defence Institute of Physiology and Allied Sciences, Defence Research and Development Organization, Delhi, India
| | - Garima Chauhan
- Department of Soldier Performance, Defence Institute of Physiology and Allied Sciences, Defence Research and Development Organization, Delhi, India
| | - Usha Panjwani
- Department of Soldier Performance, Defence Institute of Physiology and Allied Sciences, Defence Research and Development Organization, Delhi, India
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Heyrat A, Nekoui B. The Effectiveness of Cognitive-Behavioral Approach in Alleviation of Depression, Anxiety and Stress Risks in Diabetic People. Iran J Psychiatry 2023; 18:388-395. [PMID: 37881426 PMCID: PMC10593993 DOI: 10.18502/ijps.v18i4.13626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 02/15/2023] [Accepted: 03/15/2023] [Indexed: 10/27/2023]
Abstract
Objective: Stress, anxiety, and depression affect the diabetic patient by causing symptomatic changes. Considering the destructive effects of psychological symptoms on the health status of diabetic people, our aim was to investigate the effectiveness of cognitive-behavioral therapy (CBT) in improving the psychological outcomes of diabetic patients. Method : This trial is a quasi-experimental type that uses a pretest-posttest design with a control group. A total of 62 people were selected based on the inclusion criteria and randomly divided into two experimental and control groups. All subjects in the intervention group underwent CBT training twice a week for eight sessions, while those in the control group did not receive this intervention. Before and following the intervention, the depression, anxiety and stress scale (DASS-42) was utilized to evaluate the psychological symptoms of all participants. The data were analyzed through analysis of covariance (ANCOVA) and SPSS-23 software. Results: There were no significant differences between the two groups in terms of age, gender, marital status, parenthood, and education level (P > 0.05, n = 30 in each group). Additionally, there was no significant difference between the mean DASS-42 scores before the intervention (P > 0.05). However, after the intervention, the experimental group exhibited reduced levels of depression, anxiety, and stress compared to the control group (P < 0.001). The values of Eta for depression, anxiety, and stress subscales were equal to 0.809, 0.669 and 0.776, respectively, which means that 80.9%, 66.9%, and 77.6% of the changes in these symptoms in the experimental group are related to the training received through the CBT approach. Conclusion: It can be concluded that diabetic patients who suffer from psychological symptoms can benefit from the CBT approach to reduce their stress, anxiety, and depression levels.
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Affiliation(s)
- Atefeh Heyrat
- Department of Ahl-Al-Bait Studies, Faculty of Theology and Ahl Al-Bait Studies, University of Isfahan, Isfahan, Iran
| | - Bahare Nekoui
- Department of Counseling, Faculty of Literature and Human Sciences, University of Isfahan, Isfahan, Iran
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Tay AK, Mohsin M, Foo CYS, Rees S, Silove D. Long-term efficacy of brief psychological treatments for common mental disorders in Myanmar refugees in Malaysia: 12-month follow-up of a randomized, active-controlled trial of integrative adapt therapy v. cognitive behavioral therapy. Psychol Med 2023; 53:6055-6067. [PMID: 36330832 DOI: 10.1017/s0033291722003245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Long-term efficacy of brief psychotherapies for refugees in low-resource settings is insufficiently understood. Integrative adapt therapy (IAT) is a scalable treatment addressing refugee-specific psychosocial challenges. METHODS We report 12-month post-treatment data from a single-blind, active-controlled trial (October 2017-August 2019) where 327 Myanmar refugees in Malaysia were assigned to either six sessions of IAT (n = 164) or cognitive behavioral treatment (CBT) (n = 163). Primary outcomes were posttraumatic stress disorder (PTSD), depression, anxiety, and persistent complex bereavement disorder (PCBD) symptom scores at treatment end and 12-month post-treatment. Secondary outcome was functional impairment. RESULTS 282 (86.2%) participants were retained at 12-month follow-up. For both groups, large treatment effects for common mental disorders (CMD) symptoms were maintained at 12-month post-treatment compared to baseline (d = 0.75-1.13). Although participants in IAT had greater symptom reductions and larger effect sizes than CBT participants for all CMDs at treatment end, there were no significant differences between treatment arms at 12-month post-treatment for PTSD [mean difference: -0.9, 95% CI (-2.5 to 0.6), p = 0.25], depression [mean difference: 0.1, 95% CI (-0.6 to 0.7), p = 0.89), anxiety [mean difference: -0.4, 95% CI (-1.4 to 0.6), p = 0.46], and PCBD [mean difference: -0.6, 95% CI (-3.1 to 1.9), p = 0.65]. CBT participants showed greater improvement in functioning than IAT participants at 12-month post-treatment [mean difference: -2.5, 95% CI (-4.7 to -0.3], p = 0.03]. No adverse effects were recorded for either therapy. CONCLUSIONS Both IAT and CBT showed sustained treatment gains for CMD symptoms amongst refugees over the 12-month period.
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Affiliation(s)
- Alvin Kuowei Tay
- The Discipline of Psychiatry and Mental Health, School of Clinical Medicine, UNSW Medicine, Sydney, Australia
| | - Mohammed Mohsin
- Mental Health Research Unit, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Cheryl Yunn Shee Foo
- Department of Counseling and Clinical Psychology, Teachers College, Columbia University, New York City, USA
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Susan Rees
- The Discipline of Psychiatry and Mental Health, School of Clinical Medicine, UNSW Medicine, Sydney, Australia
| | - Derrick Silove
- The Discipline of Psychiatry and Mental Health, School of Clinical Medicine, UNSW Medicine, Sydney, Australia
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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van Helmondt SJ, Lodder P, van Woezik R, de Vries J, van der Lee ML. CBT-based Online Self-help Training to Reduce Fear and Distress After Cancer (CAREST Randomized Trial): 24 Months Follow-up Using Latent Growth Models and Latent Class Analysis. Ann Behav Med 2023; 57:787-799. [PMID: 37078920 PMCID: PMC10441870 DOI: 10.1093/abm/kaac078] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND Psychological distress (PD) and fear of cancer recurrence (FCR) are common consequences of surviving cancer. Online self-help training could help many cancer survivors deal with PD and FCR at low costs. PURPOSE To evaluate the long-term effectiveness of the CAncer REcurrence Self-help Training (CAREST trial) to reduce PD and FCR. Moreover, to evaluate the relation between FCR and PD across time and identify subgroups representing different change trajectories in FCR over time and their predictors. METHODS This multicenter randomized controlled trial included 262 female breast cancer survivors, assigned to online self-help training or care as usual. Participants completed questionnaires at baseline and four times during the 24-month follow-up. The primary outcomes were PD and FCR (Fear of Cancer Recurrence Inventory). Latent growth curve modeling (LGCM) and repeated measures latent class analysis (RMLCA) were performed, both according to the intention-to-treat principle. RESULTS LGCM showed no differences between the average latent slope in both groups for both PD and FCR. The correlation between FCR and PD at baseline was moderate for the intervention group and strong for the CAU group and did not significantly decrease over time in both groups. RMLCA revealed five latent classes and several predictors of class membership. CONCLUSIONS We did not find a long-term effect of the CBT-based online self-help training in reducing PD or FCR, nor in their relation. Therefore, we recommend adding professional support to online interventions for FCR. Information about FCR classes and predictors may contribute to improvement of FCR interventions.
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Affiliation(s)
- Sanne Jasperine van Helmondt
- Department of Medical and Clinical Psychology, Tilburg University, PO Box 90153, 5000 LE Tilburg, The Netherlands
- Scientific Research Department, Helen Dowling Institute, Professor Bronkhorstlaan 20, 3723 MB Bilthoven, The Netherlands
| | - Paul Lodder
- Department of Medical and Clinical Psychology, Tilburg University, PO Box 90153, 5000 LE Tilburg, The Netherlands
- Department of Methodology and Statistics, Tilburg University, PO Box 90153, 5000 LE Tilburg, The Netherlands
| | - Rosalie van Woezik
- Scientific Research Department, Helen Dowling Institute, Professor Bronkhorstlaan 20, 3723 MB Bilthoven, The Netherlands
| | - Jolanda de Vries
- Department of Medical and Clinical Psychology, Tilburg University, PO Box 90153, 5000 LE Tilburg, The Netherlands
- Admiraal de Ruyter Hospital (Adrz), PO Box 15, 4460 AA Goes, The Netherlands
| | - Marije Liesbeth van der Lee
- Department of Medical and Clinical Psychology, Tilburg University, PO Box 90153, 5000 LE Tilburg, The Netherlands
- Scientific Research Department, Helen Dowling Institute, Professor Bronkhorstlaan 20, 3723 MB Bilthoven, The Netherlands
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12
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Norris LA, Rabner JC, Crane ME, Cervin M, Ney JS, Benito KG, Kendall PC, Frank HE. What caregivers like the most (and least) about cognitive behavioral therapy for youth anxiety: A mixed methods approach. J Anxiety Disord 2023; 98:102742. [PMID: 37343420 DOI: 10.1016/j.janxdis.2023.102742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 05/29/2023] [Accepted: 06/14/2023] [Indexed: 06/23/2023]
Abstract
Cognitive behavioral therapy (CBT) is an efficacious therapy for youth anxiety disorders. Caregivers are key stakeholders in youth therapy, and their feedback on treatment can help to inform intervention personalization. This mixed-methods study applied a systematic inductive thematic analysis to identify themes among most- and least-liked CBT features reported by caregivers using open-ended responses on the Client Satisfaction Questionnaire (CSQ-8). The sample included 139 caregivers of youth ages 7-17 (M = 12.21, SD = 3.05; 59% female; 79.1% Caucasian, 5.8% Black, 2.9% Asian, 2.2% Hispanic, 7.9% Multiracial, 2.2% Other) with principal anxiety diagnoses who completed 16-sessions of CBT. CSQ-8 quantitative satisfaction scores (M = 29.18, SD = 3.30; range: 16-32) and survey-based treatment response rates (responders n = 93, 67%) were high. Most-liked treatment features included: coping skills (i.e., exposure, understanding/identifying anxiety, rewards, homework), therapist factors (interpersonal style/skill, relationship, accessibility), caregiver involvement, one-on-one time with a therapist, structure, consistency, and personally tailored treatment. Least-liked treatment features included: questionnaires, logistical barriers, telehealth, need for more sessions, non-anxiety concerns not addressed, insufficient caregiver involvement, and aspects of exposure tasks. Proportional frequencies of most- and least-liked themes differed by treatment responder status (e.g., responders cited exposure and homework as most-liked more frequently).
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Affiliation(s)
- Lesley A Norris
- Department of Psychology, Temple University, Philadelphia, PA, USA; Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA.
| | | | - Margaret E Crane
- Department of Psychology, Temple University, Philadelphia, PA, USA; Department of Psychiatry, Weill Cornell Medicine, New York City, NY, USA
| | - Matti Cervin
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Julia S Ney
- Department of Psychology, Temple University, Philadelphia, PA, USA
| | - Kristen G Benito
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Philip C Kendall
- Department of Psychology, Temple University, Philadelphia, PA, USA
| | - Hannah E Frank
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
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13
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Maathz P, McCracken LM, Eriksson V, Säde F, Aneblom G, Rikner Å, Skalkidou A, Buhrman M. A feasibility trial of online Acceptance and Commitment Therapy for women with provoked vestibulodynia. Scand J Pain 2023; 23:476-482. [PMID: 37401654 DOI: 10.1515/sjpain-2022-0146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 05/26/2023] [Indexed: 07/05/2023]
Abstract
OBJECTIVES Acceptance and Commitment Therapy (ACT) is an established treatment for chronic pain. However, it is a form of treatment that have not yet been applied much in the treatment of persistent vulvar pain disorders. This study examines the feasibility and preliminary effects of online ACT for patients with provoked vestibulodynia. METHODS Women diagnosed with provoked vestibulodynia were assigned randomly either to online ACT or to a waitlist control group. Feasibility was assessed in terms of recruitment potential, treatment credibility, completions rates, retention in trial, and data quality. Participants completed measures of pain with sexual activity, sexual functioning, emotional and relational adjustment, and potential treatment processes before and after treatment. RESULTS Of the 111 women who were invited to participate in the study, 44 were included (39.6 % recruitment rate). Thirty seven participants (84.1 %) completed the pre-treatment assessment. Participants who received online ACT rated treatment credibility positively, and completed on average 4.31 (SD=1.60) of the six treatment modules. Of participants, 34 provided post treatment data, giving a trial retention rate of 77 %. Effects of online ACT, as compared to waitlist, were large for pain acceptance and quality of life, medium for anxiety and pain catastrophizing, and small for sexual satisfaction, pain with sexual activity, and relationship adjustment. CONCLUSIONS With some adjustments to recruitment procedures, a full scale randomized controlled trial of online ACT for provoked vestibulodynia appears feasible.
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Affiliation(s)
- Pernilla Maathz
- Department of Psychology, Division of Clinical Psychology, Uppsala University, Uppsala, Sweden
| | - Lance M McCracken
- Department of Psychology, Division of Clinical Psychology, Uppsala University, Uppsala, Sweden
| | - Viktor Eriksson
- Department of Psychology, Division of Clinical Psychology, Uppsala University, Uppsala, Sweden
| | - Fredrika Säde
- Department of Psychology, Division of Clinical Psychology, Uppsala University, Uppsala, Sweden
| | - Gunilla Aneblom
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Åsa Rikner
- Women's Health, University Hospital, Uppsala, Sweden
| | - Alkistis Skalkidou
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Monica Buhrman
- Department of Psychology, Division of Clinical Psychology, Uppsala University, Uppsala, Sweden
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14
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MacLean RR, Buta E, Higgins DM, Driscoll MA, Edmond SN, LaChappelle KM, Ankawi B, Krein SL, Piette JD, Heapy AA. Using Daily Ratings to Examine Treatment Dose and Response in Cognitive Behavioral Therapy for Chronic Pain: A Secondary Analysis of the Co-Operative Pain Education and Self-Management Clinical Trial. Pain Med 2023; 24:846-854. [PMID: 36484691 PMCID: PMC10250557 DOI: 10.1093/pm/pnac192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 11/15/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Cognitive behavioral therapy for chronic pain (CBT-CP) has a strong evidence base, but little is known about when treatment benefits are achieved. The present study is a secondary analysis of individuals with chronic back pain recruited for a noninferiority trial comparing interactive voice response (IVR) CBT-CP with in-person CBT-CP. METHODS On the basis of data from daily IVR surveys, a clinically meaningful change was defined as a 30% reduction in pain intensity (n = 108) or a 45% increase in daily steps (n = 104) compared with the baseline week. We identified individuals who achieved a meaningful change at any point during treatment, and then we compared those who maintained a meaningful change in their final treatment week (i.e., responders) with those who did not or who achieved a meaningful change but lapsed (i.e., nonresponders). RESULTS During treatment, 46% of participants achieved a clinically meaningful decrease in pain intensity, and 66% achieved a clinically significant increase in number of steps per day. A total of 54% of patients were classified as responders in terms of decreases in pain intensity, and 70% were responders in terms of increases in step count. Survival analyses found that 50% of responders first achieved a clinically meaningful change by week 4 for pain intensity and week 2 for daily steps. Dropout and demographic variables were unrelated to responder status, and there was low agreement between the two measures of treatment response. CONCLUSIONS Collectively, results suggest that most responders improve within 4 weeks. Evaluating treatment response is highly specific to the outcome measure, with little correlation across outcomes.
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Affiliation(s)
- R. Ross MacLean
- VA Connecticut Healthcare System Pain Research, Informatics, Multimorbidities, and Education (PRIME) Health Services Research and Development Center of Innovation, West Haven, Connecticut, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Eugenia Buta
- Yale Center for Analytical Sciences, Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut, USA
| | - Diana M. Higgins
- VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Mary A. Driscoll
- VA Connecticut Healthcare System Pain Research, Informatics, Multimorbidities, and Education (PRIME) Health Services Research and Development Center of Innovation, West Haven, Connecticut, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Sara N. Edmond
- VA Connecticut Healthcare System Pain Research, Informatics, Multimorbidities, and Education (PRIME) Health Services Research and Development Center of Innovation, West Haven, Connecticut, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Kathryn M. LaChappelle
- VA Connecticut Healthcare System Pain Research, Informatics, Multimorbidities, and Education (PRIME) Health Services Research and Development Center of Innovation, West Haven, Connecticut, USA
| | - Brett Ankawi
- VA Connecticut Healthcare System Pain Research, Informatics, Multimorbidities, and Education (PRIME) Health Services Research and Development Center of Innovation, West Haven, Connecticut, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Sarah L. Krein
- VA Ann Arbor Center for Clinical Management Research, Ann Arbor, Michigan, USA
- Department of Internal Medicine, School of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - John D. Piette
- VA Ann Arbor Center for Clinical Management Research, Ann Arbor, Michigan, USA
- Department of Health Behavior Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Alicia A. Heapy
- VA Connecticut Healthcare System Pain Research, Informatics, Multimorbidities, and Education (PRIME) Health Services Research and Development Center of Innovation, West Haven, Connecticut, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
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15
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An S, Ko J, Yu KS, Kwon H, Kim S, Hong J, Kong HJ. Exploring the Category and Use Cases on Digital Therapeutic Methodologies. Healthc Inform Res 2023; 29:190-198. [PMID: 37591674 PMCID: PMC10440199 DOI: 10.4258/hir.2023.29.3.190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 06/07/2023] [Accepted: 07/16/2023] [Indexed: 08/19/2023] Open
Abstract
OBJECTIVES As the Fourth Industrial Revolution advances, there is a growing interest in digital technology. In particular, the use of digital therapeutics (DTx) in healthcare is anticipated to reduce medical expenses. However, analytical research on DTx is still insufficient to fuel momentum for future DTx development. The purpose of this article is to analyze representative cases of different types of DTx from around the world and to propose a classification system. METHODS In this exploratory study examining DTx interaction types and representative cases, we conducted a literature review and selected seven interaction types that were utilized in a large number of cases. Then, we evaluated the specific characteristics of each DTx mechanism by reviewing the relevant literature, analyzing their indications and treatment components. A representative case for each mechanism was provided. RESULTS Cognitive behavioral therapy, distraction therapy, graded exposure therapy, reminiscence therapy, art therapy, therapeutic exercise, and gamification are the seven categories of DTx interaction types. Illustrative examples of each variety are provided. CONCLUSIONS Efforts from both the government and private sector are crucial for success, as standardization can decrease both the expense and the time required for government-led DTx development. The private sector should partner with medical facilities to stimulate potential demand, carry out clinical research, and produce scholarly evidence.
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Affiliation(s)
- Sunhee An
- Department of Transdisciplinary Medicine, Institute of Convergence Medicine with Innovative Technology, Seoul National University Hospital, Seoul,
Korea
- Interdisciplinary Program of Medical Informatics, Seoul National University College of Medicine, Seoul,
Korea
| | - Jieun Ko
- Department of Transdisciplinary Medicine, Institute of Convergence Medicine with Innovative Technology, Seoul National University Hospital, Seoul,
Korea
| | - Kyung-Sang Yu
- Department of Clinical Pharmacology and Therapeutics, Seoul National University Hospital, Seoul National University College of Medicine, Seoul,
Korea
| | - Hyuktae Kwon
- Department of Family Medicine, Seoul National University Hospital, Seoul,
Korea
| | - Sungwan Kim
- Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul,
Korea
| | - Jeeyoung Hong
- Medical Big Data Research Center, Seoul National University Medical Research Center, Seoul,
Korea
| | - Hyoun-Joong Kong
- Department of Transdisciplinary Medicine, Institute of Convergence Medicine with Innovative Technology, Seoul National University Hospital, Seoul,
Korea
- Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul,
Korea
- Innovative Medical Technology Research Institute, Seoul National University Hospital, Seoul,
Korea
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16
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Abstract
Rates of major depressive disorder (MDD) are increasing globally, in part due to the coronavirus disease 2019 pandemic, contributing to disease burden. It has long been known that insomnia is intricately connected with depression as indicated by greater depression severity and lower treatment response. Furthermore, insomnia is a significant risk factor for new-onset depression. Treatment of insomnia is thus a logical target for prevention of incidents and recurrent MDD. This systematic review sought to evaluate the current evidence for the preventive effects of insomnia treatment on depression onset. A database search yielded 186 studies, six of which met criteria for inclusion in this review. All of the studies utilized cognitive behavioral treatment for insomnia (CBT-I) as the target intervention and most delivered treatment via a digital platform. Four of the studies found significantly lower rates of MDD onset in those who received CBT-I compared to a control condition. The two remaining studies failed to confirm these effects in primary analyses but secondary analyses suggested evidence of a preventive effect. There was significant methodologic heterogeneity across studies in terms of sample selection, outcomes, and follow-up periods, limiting the ability to draw firm conclusions. The evidence overall is in the direction of insomnia treatment reducing the risk for onset of MDD, but further research is warranted.
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Affiliation(s)
- Elaine M Boland
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Cpl. Michael J. Crescenz VA Medical Center, Mental Illness Research Education and Clinical Center, Philadelphia, PA, USA
| | - Jennifer R Goldschmied
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Philip R Gehrman
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Cpl. Michael J. Crescenz VA Medical Center, Mental Illness Research Education and Clinical Center, Philadelphia, PA, USA
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17
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Pester BD, Wilson JM, Yoon J, Lazaridou A, Schreiber KL, Cornelius M, Campbell CM, Smith MT, Haythornthwaite JA, Edwards RR, Meints SM. Brief Mindfulness-Based Cognitive Behavioral Therapy is Associated with Faster Recovery in Patients Undergoing Total Knee Arthroplasty: A Pilot Clinical Trial. Pain Med 2023; 24:576-585. [PMID: 36394250 PMCID: PMC10501468 DOI: 10.1093/pm/pnac183] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 10/04/2022] [Accepted: 11/10/2022] [Indexed: 09/16/2023]
Abstract
OBJECTIVE To assess whether brief mindfulness-based cognitive behavioral therapy (MBCBT) could enhance the benefits of total knee arthroplasty (TKA) in improving pain and pain-related disability. Specifically, to determine 1) whether patients who received MBCBT differed from matched controls who received treatment-as-usual with regard to postsurgical pain outcomes and 2) whether changes in pain catastrophizing, depression, or anxiety explained the potential effects of MBCBT on pain outcomes. DESIGN Pilot clinical trial. SETTING An academic teaching hospital serving a large urban and suburban catchment area surrounding the Boston, Massachusetts metropolitan region. SUBJECTS Sample of 44 patients undergoing TKA. Patients who completed a brief MBCBT intervention (n = 22) were compared with age-, race-, and sex-matched controls who received treatment-as-usual (n = 22). METHODS The MBCBT intervention included four 60-minute sessions delivered by a pain psychologist in person and via telephone during the perioperative period. Participants were assessed at baseline and at 6 weeks, 3 months, and 6 months after surgery. RESULTS Compared with matched controls, patients who received MBCBT had lower pain severity and pain interference at 6 weeks after surgery. Group differences in outcomes were mediated by changes in pain catastrophizing but not by changes in depression or anxiety. The MBCBT group had similar reductions in pain severity and interference as the control group did at 3 and 6 months after surgery. CONCLUSIONS This work offers evidence for a safe and flexibly delivered nonpharmacological treatment (MBCBT) to promote faster recovery from TKA and identifies change in pain catastrophizing as a mechanism by which this intervention could lead to enhanced pain-related outcomes.
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Affiliation(s)
- Bethany D Pester
- Department of Anesthesiology and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jenna M Wilson
- Department of Anesthesiology and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jihee Yoon
- Department of Anesthesiology and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Asimina Lazaridou
- Department of Anesthesiology and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kristin L Schreiber
- Department of Anesthesiology and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Marise Cornelius
- Department of Anesthesiology and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Claudia M Campbell
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michael T Smith
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jennifer A Haythornthwaite
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Robert R Edwards
- Department of Anesthesiology and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Samantha M Meints
- Department of Anesthesiology and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
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18
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Hanevik E, Røvik FMG, Bøe T, Knapstad M, Smith ORF. Client predictors of therapy dropout in a primary care setting: a prospective cohort study. BMC Psychiatry 2023; 23:358. [PMID: 37226210 DOI: 10.1186/s12888-023-04878-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 05/16/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND Therapy dropout poses a major challenge. Considerable research has been conducted on predictors of dropout, however none in the context of primary mental health services in Norway. The purpose of this study was to investigate which client characteristics can predict dropout from the service Prompt Mental Health Care (PMHC). METHODS We performed a secondary analysis of a Randomized Controlled Trial (RCT). Our sample consisted of 526 adult participants receiving PMHC-treatment in the municipalities of Sandnes and Kristiansand, between November 2015 to August 2017. Using logistic regression, we investigated the association between nine client characteristics and dropout. RESULTS The dropout rate was 25.3%. The adjusted analysis indicated that older clients had a lower odds ratio (OR) of dropping out compared to younger clients (OR = 0.43, [95% CI = 0.26, 0.71]). Moreover, clients with higher education had a lower odds ratio of dropping out compared to clients with lower levels of education (OR = 00.55, 95% CI [0.34, 0.88]), while clients who were unemployed were more likely to drop-out as compared the regularly employed (OR = 2.30, [95% CI = 1.18, 4.48]). Finally, clients experiencing poor social support had a higher odds ratio of dropping out compared to clients who reported good social support (OR = 1.81, [95% CI = 1.14, 2.87]). Sex, immigrant background, daily functioning, symptom severity and duration of problems did not predict dropout. CONCLUSION The predictors found in this prospective study might help PMHC-therapists identify clients at risk of dropout. Strategies for preventing dropout are discussed.
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Affiliation(s)
- Elin Hanevik
- Søndre Oslo DPS, Helga Vaneks Vei 6, 1281, Oslo, Norway
| | - Frida M G Røvik
- Rask Psykisk Helsehjelp, Bydel Ullern, Hoffsveien 48, 0377, Oslo, Norway
| | - Tormod Bøe
- Department of Psychosocial Science, The University of Bergen, Christies Gate 12, 5015, Bergen, Norway
- RKBU Vest, NORCE Norwegian Research Centre, Bergen, Norway
| | - Marit Knapstad
- Department of Health Promotion, Norwegian Institute of Public Health, Zander Kaaes Gate 7, 5015, Bergen, Norway
| | - Otto R F Smith
- Department of Health Promotion, Norwegian Institute of Public Health, Zander Kaaes Gate 7, 5015, Bergen, Norway.
- Centre for Evaluation of Public Health Measures, Norwegian Institute of Public Health, Oslo, Norway.
- Department of Teacher Education, NLA University College, Pb 74 Sandviken, 5812, Bergen, Norway.
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Blay M, Cohen S, Jan M, Perroud N, Speranza M, Charbon P. [Towards a pragmatic cohabitation of theoretical and clinical models: The example of "Good Psychiatric Management" in the treatment of borderline personality disorder]. Encephale 2023:S0013-7006(23)00042-8. [PMID: 37088579 DOI: 10.1016/j.encep.2023.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 01/16/2023] [Accepted: 01/31/2023] [Indexed: 04/25/2023]
Abstract
Borderline personality disorder (BPD) is a common disorder in general and clinical populations and is related to potentially severe medical and socio-professional consequences. Treatment of BPD is based on evidence-based psychotherapies (such as Dialectical Behavioral Therapy, Mentalization-Based Therapy, Schema-Focused Therapy or Transference Focused Psychotherapy), which have been shown effective but are poorly available in France. Pharmacological treatments, which are more easily available, are not effective in treating symptoms of the disorder but can be useful in management of comorbidities. In this context, recently called "generalist" models have been developed, which every well-trained psychiatrist can implement in their daily practice, combining practical elements from evidence-based psychotherapies and elements of pharmacological management of symptoms and comorbidities. The purpose of this article is to present one of these models, the Good Psychiatric Management (GPM) and its basic principles and its applications, and to provide one of the first French-speaking resources about this model. In addition, beyond the practical elements proposed by the GPM, we discuss the deeper question that it raises, namely the question of a pragmatic integration of different theoretical and clinical models. Indeed, the treatment of BPD patients is at the junction of different conceptualizations of mental pathology (psychopathological, neurobiological) and different modalities of practice (psychotherapy, biological psychiatry). In a French context, that sometimes separates these two models, and in our opinion GPM constitutes an example of clinical collaboration which shows the interest of the combined role of psychiatrist-psychotherapist.
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Affiliation(s)
- Martin Blay
- ADDIPSY, Centre ambulatoire d'addictologie et de psychiatrie, Groupe santé basque développement, 164, avenue Jean-Jaurès, 69007 Lyon, France; Université Claude-Bernard Lyon 1, Lyon, France.
| | - Satchel Cohen
- Centre hospitalier de Versailles, Service universitaire de psychiatrie de l'enfant et de l'adolescent, Le Chesnay, France
| | - Marlène Jan
- Centre hospitalier de Versailles, Service universitaire de psychiatrie de l'enfant et de l'adolescent, Le Chesnay, France
| | - Nader Perroud
- Service des spécialités psychiatriques, Département de psychiatrie, Hôpitaux universitaires de Genève, Genève, Suisse; Département de psychiatrie, Université de Genève, Genève, Suisse
| | - Mario Speranza
- Centre hospitalier de Versailles, Service universitaire de psychiatrie de l'enfant et de l'adolescent, Le Chesnay, France; Université Paris-Saclay, UVSQ, Inserm, Centre de recherche en épidémiologie et santé des populations Team "DevPsy", 94807 Villejuif, France
| | - Patrick Charbon
- Service des spécialités psychiatriques, Département de psychiatrie, Hôpitaux universitaires de Genève, Genève, Suisse; Cabinet de groupe « D'un Monde à l'Autre », Lausanne, Suisse
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20
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Biagianti B, Foti G, Di Liberto A, Bressi C, Brambilla P. CBT-informed psychological interventions for adult patients with anxiety and depression symptoms: A narrative review of digital treatment options. J Affect Disord 2023; 325:682-694. [PMID: 36690081 DOI: 10.1016/j.jad.2023.01.057] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 01/03/2023] [Accepted: 01/13/2023] [Indexed: 01/21/2023]
Abstract
BACKGROUND Across a range of age, educational and clinical characteristics, adults experiencing depression and anxiety already use digital technology to manage their symptoms. Although several reviews and meta-analyses indicated feasibility and efficacy for adults with depression and anxiety, digital treatments are poorly accessed and disseminated. This review illustrates potentials and limitations of interventions that specifically leveraged unique features of digital technology and were grounded in the principles of Cognitive Behavioral Therapy (CBT). METHODS This systematic review followed the PRISMA guidelines. An electronic database search was conducted in October 2021. Peer-reviewed, English-language studies were included if i) they reported data from RCTs for adults aged 18+ who engaged with CBT-informed digital interventions targeting primarily depression and anxiety; ii) they used at least PHQ-9 or GAD-7 as standardized and validated assessment self-report measures for depression and anxiety. RESULTS Findings from 35 RCTs examining 33 interventions (25 internet-based, 6 mobile-based, a2 mobile/web) are discussed. The quality of the evidence differed widely as many small-scale RCTs reported only short-term feasibility and preliminary efficacy. Effects of CBT-informed digital interventions were substantially larger when compared to waitlist than active control conditions. Greater therapeutic benefits were observed for interventions that offered clinical assistance or were used in combination with other treatments. CONCLUSIONS CBT-informed digital interventions have accumulated enough scientific evidence to be positioned today as: i) a low-intensity tool for those with subclinical levels of symptoms; ii) a first step in a stepped-care approach to service delivery iii) a low-cost, easily accessible option for targeted preventive programs.
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Affiliation(s)
- Bruno Biagianti
- Department of Psychology, University of Milano-Bicocca, Milan, Italy.
| | | | | | - Cinzia Bressi
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
| | - Paolo Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
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21
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Sacks-Zimmerman A, Bergquist TF, Farr EM, Cornwell MA, Kanellopoulos D. Rehabilitation of Neuropsychiatric Symptoms in Patients With Long COVID: Position Statement. Arch Phys Med Rehabil 2023; 104:350-354. [PMID: 36272444 PMCID: PMC9581644 DOI: 10.1016/j.apmr.2022.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 09/12/2022] [Accepted: 10/03/2022] [Indexed: 02/07/2023]
Abstract
Long COVID, a term used to describe ongoing symptoms after COVID-19 infection, parallels the course of other postviral syndromes. Neuropsychiatric symptoms of long COVID can be persistent and interfere with quality of life and functioning. Within the biopsychosocial framework of chronic illness, rehabilitation professionals can address the neuropsychiatric sequelae of long COVID. However, current practice models are not designed to address concurrent psychiatric and cognitive symptoms in adults living with long COVID. Thus, we present a biopsychosocial framework for long COVID and provide treatment strategies based on evidence from current literature of postviral chronic illness. These recommendations will guide rehabilitation professionals in identifying common neuropsychiatric symptoms in long COVID that can be targeted for intervention and addressing these symptoms via integrative interventions taking into account the biopsychosocial presentation of long COVID symptoms.
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Affiliation(s)
- Amanda Sacks-Zimmerman
- Weill Cornell Medicine, Brain & Spine Center, Department of Neurological Surgery, New York, NY.
| | - Thomas F Bergquist
- Mayo Clinic, Department of Physical Medicine and Rehabilitation, Rochester, MN; Mayo Clinic, Department of Psychiatry and Psychology, Rochester, MN
| | - Ellen M Farr
- Mayo Clinic, Department of Physical Medicine and Rehabilitation, Rochester, MN
| | - Melinda A Cornwell
- Weill Cornell Medicine, Brain & Spine Center, Department of Neurological Surgery, New York, NY
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22
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Coteur K, Henrard G, Schoenmakers B, Laenen A, Van den Broeck K, De Sutter A, Anthierens S, Devroey D, Kacenelenbogen N, Offermans AM, Van Nuland M. Blended care to discontinue BZRA use in patients with chronic insomnia disorder: a pragmatic cluster randomized controlled trial in primary care. Sleep 2022; 46:6840128. [PMID: 36413221 PMCID: PMC10091092 DOI: 10.1093/sleep/zsac278] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 11/14/2022] [Indexed: 11/24/2022] Open
Abstract
STUDY OBJECTIVES International guidelines recommend using benzodiazepine receptor agonists (BZRA) for maximally four weeks. Nevertheless, long-term use for chronic insomnia disorder remains a common practice. This study aimed to test the effectiveness of blended care for discontinuing long-term BZRA use in general practice. METHODS A pragmatic cluster randomized controlled superiority trial compared blended care to usual care through urine toxicology screening. In the intervention, care by the general practitioner (GP) was complemented by an interactive e-learning program, based on cognitive behavioral therapy for insomnia. Adults using BZRA daily for minimally six months were eligible. Participants were clustered at the level of the GP surgery for allocation (1:1). Effectiveness was measured as the proportion of patients who had discontinued at one-year follow-up. Data analysis followed intention-to-treat principles. RESULTS In total, 916 patients in 86 clusters, represented by 99 GPs, were randomized. Primary outcome data was obtained from 727 patients (79%). At one-year follow-up, 82 patients (18%) in blended care, compared to 91 patients (20%) in usual care, had discontinued. There was no statistically significant effect for the intervention (OR: 0·924; 95% CI: 0·60, 1·43). No adverse events were reported to the research team. CONCLUSIONS The findings did not support the superiority of blended care over usual care. Both strategies showed clinical effectiveness, with an average of 19% of patients having discontinued at one-year follow-up. Further research is important to study the effect of structurally implementing digital interventions in general practice.
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Affiliation(s)
- Kristien Coteur
- Department of Public Health and Primary Care, Academic Centre for General Practice, KU Leuven, Leuven, Belgium
| | - Gilles Henrard
- Department of General Practice, Research Unit Primary Care & Health, Liège Université, Liège, Belgium
| | - Birgitte Schoenmakers
- Department of Public Health and Primary Care, Academic Centre for General Practice, KU Leuven, Leuven, Belgium
| | - Annouschka Laenen
- Leuven Biostatistics and Statistical Bioinformatics Centre (L-Biostat), KU Leuven, Leuven, Belgium
| | - Kris Van den Broeck
- Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium
| | - An De Sutter
- Department of Public Health and Primary Care, Centre for Family Medicine, Ghent University, Ghent, Belgium
| | - Sibyl Anthierens
- Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium
| | - Dirk Devroey
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel, Brussels, Belgium
| | | | - Anne-Marie Offermans
- Department of General Practice, Université libre de Bruxelles, Brussels, Belgium
| | - Marc Van Nuland
- Department of Public Health and Primary Care, Academic Centre for General Practice, KU Leuven, Leuven, Belgium
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23
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Pinto A, Teller J, Wheaton MG. Obsessive-Compulsive Personality Disorder: A Review of Symptomatology, Impact on Functioning, and Treatment. Focus (Am Psychiatr Publ) 2022; 20:389-396. [PMID: 37200888 PMCID: PMC10187387 DOI: 10.1176/appi.focus.20220058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Obsessive-compulsive personality disorder (OCPD) is a chronic condition that involves a maladaptive pattern of excessive perfectionism, preoccupation with orderliness and details, and the need for control over one's environment. It is one of the most common personality disorders in the general population, with an estimated prevalence ranging from 1.9% to 7.8%. Despite the fact that patients with OCPD often present for treatment, there is little empirical research on treatments for OCPD, and there is no definitive empirically supported treatment for the condition. This review provides an overview of OCPD, its core features, its common presentation style types, and its impact on functioning. We review the limited treatment research to date and focus on cognitive-behavioral approaches targeting core aspects of OCPD that directly affect functioning in these patients, emphasizing take-home points for clinicians. We also address questions and controversies related to OCPD and its treatment.
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Affiliation(s)
- Anthony Pinto
- Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York (Pinto); Northwell Health Obsessive Compulsive Disorder Center, The Zucker Hillside Hospital, Glen Oaks, New York (Pinto, Teller); Department of Psychology, Barnard College, New York, (Wheaton)
| | - Jonathan Teller
- Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York (Pinto); Northwell Health Obsessive Compulsive Disorder Center, The Zucker Hillside Hospital, Glen Oaks, New York (Pinto, Teller); Department of Psychology, Barnard College, New York, (Wheaton)
| | - Michael G Wheaton
- Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York (Pinto); Northwell Health Obsessive Compulsive Disorder Center, The Zucker Hillside Hospital, Glen Oaks, New York (Pinto, Teller); Department of Psychology, Barnard College, New York, (Wheaton)
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24
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Van Looveren E, Meeus M, Cagnie B, Ickmans K, Bilterys T, Malfliet A, Goubert D, Nijs J, Danneels L, Moens M, Mairesse O. Combining Cognitive Behavioral Therapy for Insomnia and Chronic Spinal Pain Within Physical Therapy: A Practical Guide for the Implementation of an Integrated Approach. Phys Ther 2022; 102:6604584. [PMID: 35689809 DOI: 10.1093/ptj/pzac075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 09/13/2021] [Accepted: 12/10/2021] [Indexed: 11/14/2022]
Abstract
Most people who have nonspecific chronic spinal pain (nCSP) report comorbid insomnia. However, in current treatment strategies for nCSP, insomnia is usually not addressed. Considering the bidirectional interaction between pain and sleep and its underlying psychophysiological mechanisms, insomnia may increase the risk of developing adverse physical and psychological health outcomes and should thus no longer be left untreated. As suggested by previous pilot studies, adding cognitive behavioral therapy for insomnia to the contemporary evidence-based biopsychosocial physical therapy approach may also improve pain outcomes in nCSP. This manuscript aims to provide practical guidelines on hybrid physical therapy, including the combination of the following components: (1) pain neuroscience education (eg, to reconceptualize pain) and cognition-targeted exercise therapy (eg, graded exposure to functional daily life movements), and (2) cognitive behavioral therapy for insomnia (sleep psychoeducation, behavioral and cognitive therapy, correction of sleep hygiene, and relaxation therapy) can be deployed for the management of patients who have chronic spinal pain. Impact. Due to the major impact sleep disturbances have on pain and disability, insomnia as a comorbidity should no longer be ignored when treating patients with chronic spinal pain.
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Affiliation(s)
- Eveline Van Looveren
- Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education, and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Mira Meeus
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Department of Rehabilitation Sciences and Physiotherapy (REVAKI), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Barbara Cagnie
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Kelly Ickmans
- Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education, and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium.,Research Foundation - Flanders (FWO), Brussels, Belgium
| | - Thomas Bilterys
- Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education, and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Anneleen Malfliet
- Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education, and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium.,Research Foundation - Flanders (FWO), Brussels, Belgium
| | - Dorien Goubert
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Jo Nijs
- Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education, and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium.,Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Lieven Danneels
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Maarten Moens
- Department of Neurosurgery and Radiology, University Hospital Brussels, Brussels, Belgium.,Center of Neurosciences (C4N), Vrije Universiteit Brussel, Brussels, Belgium
| | - Oliver Mairesse
- Department of Psychology - Brain, Body and Cognition (BBCO), Vrije Universiteit Brussel, Brussels, Belgium.,Brugmann University Hospital, Sleep Laboratory and Unit for Clinical Chronobiology, Brussels, Belgium
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25
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Nikjooy A, Khoshlahjeh Sedgh A, Mahjoubi B, Mirzaei R, Naziri M, Mirbehresi P. The Effects of Cognitive Behavioral Therapy with Biofeedback Therapy on the Quality of Life, Anxiety, Depression and Somatic Symptoms in Patients with Dyssynergic Defecation: A Randomized Controlled Trial. Med J Islam Repub Iran 2022; 36:74. [PMID: 36128319 PMCID: PMC9448504 DOI: 10.47176/mjiri.36.74] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Accepted: 07/05/2022] [Indexed: 11/06/2022] Open
Abstract
Background: Dyssynergic defecation (DD) is a major cause of chronic functional constipation. Patients with DD have greater psychological distress and impaired health-related quality of life compared with the general population. This study aimed to evaluate the effectiveness of cognitive-behavioral therapy (CBT) combined with biofeedback therapy (BFT) on the quality of life, anxiety, depression and physical symptoms in patients with DD.
Methods: This randomized controlled trial (IRCT20141115019957N2) was conducted on 45DD patients who were referred to the Rehabilitation Clinic of Iran University of Medical Sciences in 2017. The convenience sampling method was used to select the participants and then they were randomly allocated into three equal groups using RANDBETWEEN function in Excel. The first group received a combination of BFT&CBT and also standard-of-care therapy (SoCT). The second group was treated with BFT and SoCT, and the third group received only SoCT. The patients were assessed by digital rectal examination and the Short Form-36, Spielberger Anxiety, Beck Depression and Constipation Scoring System questionnaires before and after the treatment.The data were analyzed by SPSS-22, ANOVA, ANCOVA and Chi-Square tests.
Results: Patients who received both CBT&BFT had significant improvement in symptoms of constipation, depression, and anxiety.Furthermore, BFT and CBT&BFT groups are valued equivalent only on the mental component of SF36 and the total SF36 questionnaire. But the physical component was significantly different, favoring CBT&BFT (p< 0.001). In CBT&BFT group,67%of patients reached the relaxed stage. In contrast, no patient reached the relaxed neither in BFT nor in SoCT.
Conclusion: According to our study, patients with unfavorable responses to BFT may become better if CBT is added to their treatment plan.
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Affiliation(s)
- Afsaneh Nikjooy
- Department of Physical Therapy, Faculty of Rehabilitation Sciences, Colorectal Research Center (CRRC), Iran University of Medical Sciences, Tehran, Iran,Corresponding author: Dr Afsaneh Nikjooy,
| | | | - Bahar Mahjoubi
- Department of Colorectal Surgery, Colorectal Research Center (CRRC), Iran University of Medical Sciences, Tehran, Iran
| | - Rezvan Mirzaei
- Department of Colorectal Surgery, Iran University of Medical Sciences, Tehran, Iran
| | - Mahdyieh Naziri
- Student Research Committee, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Parnian Mirbehresi
- Department of Physical Therapy, Faculty of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
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26
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Merlo LJ, Dede BL, Smith KB. Introduction to Cognitive Restructuring for Medical Students. MedEdPORTAL 2022; 18:11235. [PMID: 35497677 PMCID: PMC8995405 DOI: 10.15766/mep_2374-8265.11235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 01/08/2022] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Medical students list stigma and lack of time as reasons to avoid seeking mental health care. Many patients do not receive appropriate mental health care due to a lack of knowledge regarding available treatments among their medical providers. We created this activity to enhance medical student knowledge and well-being by introducing cognitive restructuring principles and skills in a highly interactive module. METHODS We administered a 90-minute learning activity, which included a short videotaped lecture, clinical case vignette, small-group discussion, and application exercise. Immediately following the learning activity, students and faculty completed anonymous evaluations. RESULTS A total of 139 first-year medical students and 152 second-year medical students completed the activity. For the first-year cohort, upwards of 80% of students and 100% of faculty respondents rated the session either good or excellent. For the second-year cohort, over 80% of students and over 90% of faculty rated the session either good or excellent. Approximately 90% of first- and second-year medical students and 100% of faculty recommended offering the session to future students. Open-ended feedback from students was overwhelmingly positive. DISCUSSION The resources included in this module allow educators at any institution to implement this learning activity, as no specific content knowledge/expertise is required of faculty. As the activity was well received by students and faculty, the investment of curricular time appears to have been well spent.
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Affiliation(s)
- Lisa J. Merlo
- Associate Professor, Department of Psychiatry, University of Florida College of Medicine
| | - Beverly L. Dede
- Assistant Professor, Department of Community Health and Family Medicine, University of Florida College of Medicine
| | - Kristy B. Smith
- Associate Professor, Department of Community Health and Family Medicine, University of Florida College of Medicine
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27
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Klein JP, Dale R, Glanert S, Grave U, Surig S, Zurowski B, Borgwardt S, Schweiger U, Fassbinder E, Probst T. Does childhood emotional abuse moderate the effect of cognitive behavioral analysis system of psychotherapy versus meta-cognitive therapy in depression? A propensity score analysis on an observational study. J Affect Disord 2022; 300:71-5. [PMID: 34952120 DOI: 10.1016/j.jad.2021.12.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 11/20/2021] [Accepted: 12/19/2021] [Indexed: 10/19/2022]
Abstract
Background Cognitive Behavioral Analysis System of Psychotherapy (CBASP) and Metacognitive Therapy (MCT) are effective for depression. CBASP might offer most benefit in patients reporting childhood emotional abuse (CEA). This needs to be confirmed in real-world settings and in comparisons with depression-specific psychotherapies. This study examines the moderating influence of CEA on the effectiveness of CBASP versus MCT. Methods In this observational study, we recruited patients treated with either CBASP or MCT in an intensive day treatment program for depression. CEA was assessed using the Childhood Trauma Questionnaire (CTQ). Patients reported symptoms weekly using the Quick Inventory of Depressive Symptoms (QIDS-SR). Mixed model analysis was run on the Intention to Treat dataset (ITT) using propensity matching to overcome baseline imbalances. Results A total of 141 patients were included in the analysis (MCT n = 78, CBASP n = 63). CEA moderated the treatment effect (time x CEA x treatment: β = 0.03, SE = 0.01, p = 0.014). Post-hoc analyses revealed that CBASP was more effective than MCT in patients without CEA (time x treatment: β = -0.01, SE = 0.007, p = .045). The difference between CBASP and MCT was not statistically significant for patients with CEA (β = 0.015, SE = 0.008, p = .11). Limitations Because of non-random treatment allocation the differences between CBASP and MCT can be due to unobserved baseline imbalances. Conclusions Our findings suggest that in patients reporting CEA, CBASP might not offer additional benefits above other depression-specific psychotherapies. Public Health Significance Statements This study shows that, on average, individuals with depression benefit equally from CBASP and MCT under the conditions of routine practice. Yet, CBASP was more effective than MCT for those without childhood emotional abuse. If childhood emotional abuse was present, CBASP and MCT were equally effective.
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28
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Poku OB, Becker TD, Rampa S, Misra S, Ho-Foster AR, Entaile P, Tay C, Choe K, Arscott-Mills T, Blank MB, Opondo PR, Yang LH. Theory-Driven, Multi-Stage Process to Develop a Culturally-Informed Anti-Stigma Intervention for Pregnant Women Living with HIV in Botswana. Int J MCH AIDS 2022; 11:e569. [PMID: 36320928 PMCID: PMC9617017 DOI: 10.21106/ijma.569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Despite a well-established universal HIV diagnosis and treatment program, Botswana continues to face a high HIV prevalence, in large part due to persistent stigma, which particularly affects pregnant women and interferes with healthcare engagement. Tackling stigma as a fundamental cause of HIV disparities is an important but understudied aspect of current HIV interventions. Our multinational and multicultural team used a theory-driven, multi-stage iterative process to develop measures and interventions to first identify and then target the most culturally-salient aspects of stigma for mothers living with HIV in Botswana. This methodology report examines the stage-by-stage application of the "What Matters Most" (WMM) theory and lessons learned, sharing a replicable template for developing culturally-shaped anti-stigma interventions. METHODS First, we conducted initial qualitative work based on the WMM theory to identify key structural and cultural factors shaping stigma for women living with HIV in Botswana. Second, we developed a psychometrically validated scale measuring how "what matters most" contributes to and protects against stigma for this population. Third, we designed an anti-stigma intervention, "Mothers Moving towards Empowerment" (MME), centered on the local values identified using WMM theory that underly empowerment and motherhood by adapting a cognitive behavioral therapy (CBT)-informed, group-based, and peer-co-led anti-stigma intervention specifically for pregnant women living with HIV. Fourth, we conducted a pilot study of MME in which participants were allocated to two trial arms: intervention or treatment-as-usual control. RESULTS Our qualitative research identified that bearing and caring for children are capabilities essential to the concept of respected womanhood, which can be threatened by a real or perceived HIV diagnosis. These values informed the development and validation of a scale to measure these culturally-salient aspects of stigma for women living with HIV in Botswana. These findings further informed our intervention adaptation and pilot evaluation, in which the intervention group showed significant decreases in HIV stigma and depressive symptoms compared to the control group. Participants reported overcoming reluctance to disclose their HIV status to family, leading to improved social support. CONCLUSION AND GLOBAL HEALTH IMPLICATIONS Previous studies have not utilized culturally-based approaches to assess, resist, and intervene with HIV-related stigma. By applying WMM in each stage, we identified cultural and gendered differences that enabled participants to resist HIV stigma. Focusing on these capabilities that enable full personhood, we developed an effective culturally-tailored anti-stigma intervention for pregnant women living with HIV in Botswana. This theory-driven, multi-stage approach can be replicated to achieve stigma reduction for other outcomes, populations, and contexts.
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Affiliation(s)
- Ohemaa B Poku
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality, and Health Columbia University & the New York State Psychiatric Institute, New York, NY, United States
| | - Timothy D Becker
- Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | | | - Supriya Misra
- Department of Public Health, San Francisco State University, San Francisco, CA, United States
| | - Ari R Ho-Foster
- Faculty of Medicine, University of Botswana, Gaborone, Botswana; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | | | - Charisse Tay
- Teachers College, Columbia University, New York, NY, United States
| | - Karen Choe
- New York University, Teachers College, Columbia University, New York, NY, United States
| | - Tonya Arscott-Mills
- Department of Pediatrics, Levine Children's Hospital, Charlotte, NC, United States
| | | | | | - Lawrence H Yang
- New York University, New York, NY, United States, Columbia University Mailman, School of Public Health, New York, NY, United States
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29
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Serrat M, Sanabria-Mazo JP, Almirall M, Musté M, Feliu-Soler A, Méndez-Ulrich JL, Sanz A, Luciano JV. Effectiveness of a Multicomponent Treatment Based on Pain Neuroscience Education, Therapeutic Exercise, Cognitive Behavioral Therapy, and Mindfulness in Patients With Fibromyalgia (FIBROWALK Study): A Randomized Controlled Trial. Phys Ther 2021; 101:6362860. [PMID: 34499174 DOI: 10.1093/ptj/pzab200] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 04/27/2021] [Accepted: 05/28/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the effectiveness of a 12-week multicomponent treatment based on pain neuroscience education, therapeutic exercise, cognitive behavioral therapy, and mindfulness-in addition to treatment as usual-compared with treatment as usual only in patients with fibromyalgia. METHODS This randomized controlled trial involved a total of 272 patients who were randomly assigned to either multicomponent treatment (n = 135) or treatment as usual (n = 137). The multicomponent treatment (2-hour weekly sessions) was delivered in groups of 20 participants. Treatment as usual was mainly based on pharmacological treatment according to the predominant symptoms. Data on functional impairment using the Revised Fibromyalgia Impact Questionnaire as the primary outcome were collected as were data for pain, fatigue, kinesiophobia, physical function, anxiety, and depressive symptoms (secondary outcomes) at baseline, 12 weeks, and, for the multicomponent group only, 6 and 9 months. An intention-to-treat approach was used to analyze between-group differences. Baseline differences between responders (>20% Revised Fibromyalgia Impact Questionnaire reduction) and nonresponders also were analyzed, and the number needed to treat was computed. RESULTS At posttreatment, significant between-group differences with a large effect size (Cohen d > 0.80) in favor of the multicomponent treatment were found in functional impairment, pain, kinesiophobia, and physical function, whereas differences with a moderate size effect (Cohen d > 0.50 and <0.80) were found in fatigue, anxiety, and depressive symptoms. Nonresponders scored higher on depressive symptoms than responders at baseline. The number needed to treat was 2 (95% CI = 1.7-2.3). CONCLUSION Compared with usual care, there was evidence of short-term (up to 3 months) positive effects of the multicomponent treatment for fibromyalgia. Some methodological shortcomings (eg, absence of follow-up in the control group and monitoring of treatment adherence, potential research allegiance) preclude robust conclusions regarding the proposed multicomponent program. IMPACT Despite some methodological shortcomings in the design of this study, the multicomponent therapy FIBROWALK can be considered a novel and effective treatment for patients with fibromyalgia. Physical therapists should detect patients with clinically relevant depression levels prior to treatment because depression can buffer treatment effects. LAY SUMMARY Fibromyalgia is prevalent and can be expensive to treat. This multicomponent treatment could significantly improve the core symptoms of fibromyalgia compared with usual treatment.
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Affiliation(s)
- Mayte Serrat
- Unitat d'Expertesa en Síndromes de Sensibilització Central, Hospital de la Vall d'Hebron, Barcelona, Spain.,Escoles Universitàries Gimbernat, Universitat Autònoma de Barcelona, Sant Cugat del Vallès, Spain
| | - Juan P Sanabria-Mazo
- Teaching, Research, and Innovation Unit - Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain.,Department of Basic, Developmental and Educational Psychology. Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
| | - Míriam Almirall
- Unitat d'Expertesa en Síndromes de Sensibilització Central, Hospital de la Vall d'Hebron, Barcelona, Spain
| | - Marta Musté
- Unitat d'Expertesa en Síndromes de Sensibilització Central, Hospital de la Vall d'Hebron, Barcelona, Spain
| | - Albert Feliu-Soler
- Departament of Clinical & Health Psychology, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
| | - Jorge L Méndez-Ulrich
- Department of Methods of Research and Diagnosis in Education, Universitat de Barcelona, Barcelona, Spain
| | - Antoni Sanz
- Department of Basic, Developmental and Educational Psychology. Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
| | - Juan V Luciano
- Teaching, Research, and Innovation Unit - Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain.,Departament of Clinical & Health Psychology, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
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30
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Geda YE, Krell-Roesch J, Fisseha Y, Tefera A, Beyero T, Rosenbaum D, Szabo TG, Araya M, Hayes SC. Acceptance and Commitment Therapy in a Low-Income Country in Sub-Saharan Africa: A Call for Further Research. Front Public Health 2021; 9:732800. [PMID: 34631649 PMCID: PMC8494766 DOI: 10.3389/fpubh.2021.732800] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 08/23/2021] [Indexed: 11/13/2022] Open
Abstract
A worsening trend of critical shortages in senior health care workers across low- and middle-income countries (LMICs) in sub-Saharan Africa has been documented for decades. This is especially the case in Ethiopia that has severe shortage of mental health professionals. Consistent with the WHO recommended approach of task sharing for mental health care in LMICs, Acceptance and Commitment Therapy (ACT), which is an empirically validated psychological intervention aimed at increasing psychological flexibility, may be delivered by trained laypersons who have a grassroots presence. In this paper, we discuss the need for and potential role of ACT to be delivered by health extension workers (HEWs) to address mental health care needs across Ethiopia. To this end, we also reviewed previous studies that have examined the effectiveness of ACT-based interventions in African countries including in Nigeria, Sierra Leone, Uganda, and South Africa. All studies revealed significant improvements of various mental health-related outcome measures such as decreased psychological distress and depressive symptoms, or increased subjective wellbeing and life satisfaction in the groups that received an ACT-based intervention. However, to date, there is no study that applied ACT in Ethiopia. Thus, more research is warranted to examine the effectiveness and, if proven successful, to scale up a task sharing approach of an ACT-based intervention being delivered by trained HEWs at a grassroots level, possibly paving the way for an innovative, sustainable mental health service in Ethiopia as well as other African LMICs.
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Affiliation(s)
- Yonas E Geda
- Department of Neurology, Barrow Neurological Institute, Phoenix, AZ, United States
| | - Janina Krell-Roesch
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, United States.,Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Yaphet Fisseha
- Clinical PsyD Department, The Chicago School of Professional Psychology, Washington, DC, United States
| | - Aida Tefera
- Department of Psychiatry, Eka Kotebe Hospital, Addis Ababa, Ethiopia
| | - Teferra Beyero
- Department of Psychiatry, Eka Kotebe Hospital, Addis Ababa, Ethiopia
| | | | - Thomas G Szabo
- School of Behavior Analysis, Florida Institute of Technology, Melbourne, FL, United States
| | - Mesfin Araya
- Department of Psychiatry, College of Health Sciences, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Steven C Hayes
- Department of Psychology, University of Nevada, Reno, NV, United States
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Schumann ME, Coombes BJ, Gascho KE, Geske JR, McDermott MC, Morrison EJ, Reynolds AL, Bernau JL, Gilliam WP. Pain Catastrophizing and Pain Self-Efficacy Mediate Interdisciplinary Pain Rehabilitation Program Outcomes at Posttreatment and Follow-Up. Pain Med 2021; 23:697-706. [PMID: 34519826 DOI: 10.1093/pm/pnab271] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 07/15/2021] [Accepted: 08/16/2021] [Indexed: 11/13/2022]
Abstract
BACKGROUND Decreasing pain catastrophizing and improving self-efficacy to self-manage chronic pain symptoms are important treatment targets in the context of interdisciplinary cognitive behavioral therapy for chronic pain. Greater pain catastrophizing has been shown to be associated with greater impact of pain symptoms on functioning, while conversely, greater pain self-efficacy has been associated with lower pain intensity and lower levels of disability. OBJECTIVE To prospectively evaluate interdisciplinary cognitive behavioral therapy for pain outcomes, as well as to the mediating effects of both pain catastrophizing and pain self-efficacy on outcome. METHODS Participants were 315 patients with chronic pain between April 2017 and April 2018 who completed a three-week interdisciplinary pain rehabilitation program. Pain severity, pain interference, pain catastrophizing, pain self-efficacy, quality of life, and depressive symptom questionnaires, and measures of physical performance were assessed at pre- and posttreatment. Follow-up questionnaires were returned by 163 participants. Effect size and reliable change analyses were conducted from pre- to posttreatment and pretreatment to 6-month follow-up. Mediation analyses were conducted to determine the mediating effect of pain catastrophizing and pain self-efficacy on pain outcome. RESULTS Significant improvements from pre- to posttreatment in pain outcomes were observed, and over 80% evidenced reliable change in at least one pain-relevant measure. Pain catastrophizing and pain self-efficacy mediated the relationship between changes in pain outcomes. CONCLUSIONS Interdisciplinary pain rehabilitation is an effective treatment and decreasing pain catastrophizing and increasing pain self-efficacy can influence maintenance of treatment gains.
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Affiliation(s)
- Matthew E Schumann
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Brandon J Coombes
- Department of Quantitative Health Sciences, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Keith E Gascho
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Jennifer R Geske
- Department of Quantitative Health Sciences, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Mary C McDermott
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Eleshia J Morrison
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Andrea L Reynolds
- Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Jessica L Bernau
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Wesley P Gilliam
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
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Cattivelli R, Guerrini Usubini A, Manzoni GM, Vailati Riboni F, Pietrabissa G, Musetti A, Franceschini C, Varallo G, Spatola CAM, Giusti E, Castelnuovo G, Molinari E. ACTonFood. Acceptance and Commitment Therapy-Based Group Treatment Compared to Cognitive Behavioral Therapy-Based Group Treatment for Weight Loss Maintenance: An Individually Randomized Group Treatment Trial. Int J Environ Res Public Health 2021; 18:ijerph18189558. [PMID: 34574482 PMCID: PMC8472644 DOI: 10.3390/ijerph18189558] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 09/05/2021] [Accepted: 09/06/2021] [Indexed: 11/16/2022]
Abstract
The purpose of this Individually Randomized Group Treatment Trial was to compare an Acceptance and Commitment Therapy-based (ACT) group intervention and a Cognitive Behavioral Therapy-based (CBT) group intervention for weight loss maintenance in a sample of adult patients with obesity seeking treatment for weight loss. One hundred and fifty-five adults (BMI: Kg/m2 = 43.8 [6.8]) attending a multidisciplinary rehabilitation program for weight loss were randomized into two conditions: ACT and CBT. Demographical, physical, and clinical data were assessed at the beginning of the program (t0), at discharge (t1), and at 6-month follow-up (t2). The following measures were administered: The Acceptance and Action Questionnaire-II (AAQ-II) and the Clinical Outcome in Routine Evaluation-Outcome Measure (CORE-OM). Generalized linear mixed models were performed to assess differences between groups. Moderation effects for gender and Eating Disorders (ED) have been considered. From baseline to discharge, no significant differences between interventions were found, with the only exception of an improvement in the CORE-OM total score and in the CORE-OM subjective wellbeing subscale for those in the CBT condition. From discharge to follow-up, ACT group participants showed significant results in terms of weight loss maintenance, CORE-OM total score, and CORE-OM and AAQ-II wellbeing, symptoms, and psychological problems subscales. Gender moderated the effects of time and intervention on the CORE-OM subscale reporting the risk for self-harm or harm of others. The presence of an eating disorder moderated the effect of time and intervention on the CORE-OM total score, on the CORE-OM symptoms and psychological problems subscales, and on the AAQ-II. Patients who received the ACT intervention were more likely to achieve a ≥5% weight loss from baseline to follow-up and to maintain the weight loss after discharge. The ACT intervention was thus effective in maintaining weight loss over time.
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Affiliation(s)
- Roberto Cattivelli
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, 20145 Milan, Italy; (R.C.); (A.G.U.); (G.M.M.); (G.P.); (G.V.); (G.C.); (E.M.)
- Department of Psychology, Catholic University of Milan, 20123 Milan, Italy; (F.V.R.); (C.A.M.S.)
| | - Anna Guerrini Usubini
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, 20145 Milan, Italy; (R.C.); (A.G.U.); (G.M.M.); (G.P.); (G.V.); (G.C.); (E.M.)
- Department of Psychology, Catholic University of Milan, 20123 Milan, Italy; (F.V.R.); (C.A.M.S.)
| | - Gian Mauro Manzoni
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, 20145 Milan, Italy; (R.C.); (A.G.U.); (G.M.M.); (G.P.); (G.V.); (G.C.); (E.M.)
- Faculty of Psychology, eCampus University, 22060 Novedrate, Italy
| | - Francesco Vailati Riboni
- Department of Psychology, Catholic University of Milan, 20123 Milan, Italy; (F.V.R.); (C.A.M.S.)
| | - Giada Pietrabissa
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, 20145 Milan, Italy; (R.C.); (A.G.U.); (G.M.M.); (G.P.); (G.V.); (G.C.); (E.M.)
- Department of Psychology, Catholic University of Milan, 20123 Milan, Italy; (F.V.R.); (C.A.M.S.)
| | - Alessandro Musetti
- Department of Humanities, Social Sciences and Cultural Industries, University of Parma, 43121 Parma, Italy;
| | | | - Giorgia Varallo
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, 20145 Milan, Italy; (R.C.); (A.G.U.); (G.M.M.); (G.P.); (G.V.); (G.C.); (E.M.)
- Department of Psychology, Catholic University of Milan, 20123 Milan, Italy; (F.V.R.); (C.A.M.S.)
| | - Chiara A. M. Spatola
- Department of Psychology, Catholic University of Milan, 20123 Milan, Italy; (F.V.R.); (C.A.M.S.)
| | - Emanuele Giusti
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, 20145 Milan, Italy; (R.C.); (A.G.U.); (G.M.M.); (G.P.); (G.V.); (G.C.); (E.M.)
- Department of Psychology, Catholic University of Milan, 20123 Milan, Italy; (F.V.R.); (C.A.M.S.)
- Correspondence: ; Tel.: +39-0323-514246
| | - Gianluca Castelnuovo
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, 20145 Milan, Italy; (R.C.); (A.G.U.); (G.M.M.); (G.P.); (G.V.); (G.C.); (E.M.)
- Department of Psychology, Catholic University of Milan, 20123 Milan, Italy; (F.V.R.); (C.A.M.S.)
| | - Enrico Molinari
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, 20145 Milan, Italy; (R.C.); (A.G.U.); (G.M.M.); (G.P.); (G.V.); (G.C.); (E.M.)
- Department of Psychology, Catholic University of Milan, 20123 Milan, Italy; (F.V.R.); (C.A.M.S.)
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Myers H, Keefe F, George SZ, Kennedy J, Lake AD, Martinez C, Cook C. The influence of a cognitive behavioural approach on changing patient expectations for conservative care in shoulder pain treatment: a protocol for a pragmatic randomized controlled trial. BMC Musculoskelet Disord 2021; 22:727. [PMID: 34429074 PMCID: PMC8386126 DOI: 10.1186/s12891-021-04588-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 08/04/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Despite similar outcomes for surgery and conservative care, the number of surgeries to treat rotator cuff related shoulder pain has increased. Interventions designed to enhance treatment expectations for conservative care have been shown to improve patient expectations, but no studies have yet explored whether such interventions influence patient decisions to pursue surgery. The purpose of this randomized clinical trial is to examine the effect of an intervention designed to improve expectations of conservative care on the decision to have surgery. METHODS We will test the effectiveness of the Patient Engagement, Education, and Restructuring of Cognitions (PEERC) intervention which is intended to change expectations regarding conservative care. The PEERC intervention will be evaluated in a randomized, pragmatic "add-on" trial, to better understand the effect the intervention has on outcomes. Ninety-four (94) participants with rotator cuff related shoulder pain referred for physical therapy will be randomized to receive either impairment-based care or impairment-based care plus PEERC. Both groups will receive impairment-based conservative treatment created by compiling the evidence associated with established, effective interventions. Participants assigned to the impairment-based care plus PEERC condition will also receive the PEERC intervention. This intervention, informed by principles of cognitive behavioral therapy, involves three components: (1) strategies to enhance engagement, (2) education and (3) cognitive restructuring and behavioral activation. Outcomes will be assessed at multiple points between enrolment and six months after discharge. The primary outcome is patient reported decision to have surgery and the secondary outcomes are pain, function, expectations and satisfaction with conservative care. DISCUSSION Rotator cuff related shoulder pain is highly prevalent, and because conservative and surgical treatments have similar outcomes, an intervention that changes expectations about conservative care could alter patient reports of their decision to have surgery and ultimately could lead to lower healthcare costs and decreased risk of surgical complications. TRIAL REGISTRATION This study is registered as NCT03353272 at ClincialTrials.gov.
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Affiliation(s)
- Heather Myers
- Physical Therapist, Urbaniak Sports Sciences Institute, Duke University Health System, 3475 Erwin Rd, Durham, NC, 27705, USA.
| | - Francis Keefe
- Professor in Psychiatry and Behavioral Sciences, Psychology and Neuroscience, Medicine, and Anesthesiology, 2200 W Main St, Suite 340, Durham, NC, 27705, USA
| | - Steven Z George
- Laszlo Ormandy Distinguished Professor, Department of Orthopaedic Surgery, Duke Clinical Research Institute, 200 Morris Street, Durham, NC, 27701, USA
| | - June Kennedy
- Physical Therapist, Urbaniak Sports Sciences Institute, Duke University Health System, 3475 Erwin Rd, Durham, NC, 27705, USA
| | - Ashley Davis Lake
- Physical Therapist, Urbaniak Sports Sciences Institute, Duke University Health System, 3475 Erwin Rd, Durham, NC, 27705, USA
| | - Corina Martinez
- Physical Therapist, Urbaniak Sports Sciences Institute, Duke University Health System, 3475 Erwin Rd, Durham, NC, 27705, USA
| | - Chad Cook
- Professor, Director of Clinical Research Facilitation, Duke Doctor of Physical Therapy Division, Duke Clinical Research Institute, 311 Trent Drive, Durham, NC, 27705, USA
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Baumgartner C, Schaub MP, Wenger A, Malischnig D, Augsburger M, Lehr D, Blankers M, Ebert DD, Haug S. "Take Care of You" - Efficacy of integrated, minimal-guidance, internet-based self-help for reducing co-occurring alcohol misuse and depression symptoms in adults: Results of a three-arm randomized controlled trial. Drug Alcohol Depend 2021; 225:108806. [PMID: 34171823 DOI: 10.1016/j.drugalcdep.2021.108806] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 04/14/2021] [Accepted: 04/15/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Depression and harmful alcohol use are two of the top five leading causes of years of life lost to disability in high-income countries. Integrated treatment targeting both at the same time is often considered more complicated and difficult and, therefore, more expensive. Consequently, integrated internet-based interventions could be a valuable addition to traditional care. METHODS A three-arm randomized controlled trial was conducted comparing the effectiveness of (1) an integrated, minimal-guidance, adherence-focused self-help intervention designed to reduce both alcohol use and depression symptoms (AFGE-AD); (2) a similar intervention designed to reduce alcohol use only (AFGE-AO), and (3) internet access as usual (IAU) as a control condition, in at least moderately depressed alcohol misusers from February 2016-March 2020. We recruited 689 alcohol misusers (51.6 % males, mean age = 42.8 years) with at least moderate depression symptoms not otherwise in treatment from the general population. Six months after baseline, 288 subjects (41.8 %) were reachable for the final assessment. RESULTS All interventions yielded reduced alcohol-use after six months (AFGE-AD: -16.6; AFGE-AO: -19.8; IAU: -13.2). Those who undertook active-interventions reported significantly fewer standard drinks than controls (AFGE-AD: p = .048, d=0.10; AFGE-AO: p = .004, d=0.20). The two active-intervention groups also reported significantly less severe depression symptoms than controls (AFGE-AD: p = .006, d=0.41; AFGE-AO: p = .008, d=0.43). Testing revealed noninferiority between the two interventions. CONCLUSIONS This study documented sustained effectiveness of the first integrated, fully internet-based self-help intervention developed for the reduction of both alcohol use and depression symptoms in at least moderately depressed adult alcohol misusers recruited from the general population.
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Affiliation(s)
- Christian Baumgartner
- Swiss Research Institute for Public Health and Addiction, University of Zurich, Zurich, Switzerland.
| | - Michael P Schaub
- Swiss Research Institute for Public Health and Addiction, University of Zurich, Zurich, Switzerland
| | - Andreas Wenger
- Swiss Research Institute for Public Health and Addiction, University of Zurich, Zurich, Switzerland
| | - Doris Malischnig
- Institute for Addiction Prevention, Addiction and Drug Coordination Vienna, Vienna, Austria
| | - Mareike Augsburger
- Swiss Research Institute for Public Health and Addiction, University of Zurich, Zurich, Switzerland
| | - Dirk Lehr
- Division of Online Health Training, Leuphana University Lueneburg, Germany
| | - Matthijs Blankers
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, Netherlands
| | - David D Ebert
- Department for Sport and Health Sciences, Chair for Psychology and Digital Mental Health Care, Technical University Munich, Munich, Germany
| | - Severin Haug
- Swiss Research Institute for Public Health and Addiction, University of Zurich, Zurich, Switzerland
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Billings W, Mathur K, Craven HJ, Xu H, Shin A. Potential Benefit With Complementary and Alternative Medicine in Irritable Bowel Syndrome: A Systematic Review and Meta-analysis. Clin Gastroenterol Hepatol 2021; 19:1538-1553.e14. [PMID: 32961342 PMCID: PMC8112831 DOI: 10.1016/j.cgh.2020.09.035] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 09/15/2020] [Accepted: 09/16/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Patients with irritable bowel syndrome (IBS) may pursue complementary and alternative medicine (CAM). We conducted a comprehensive systematic review and meta-analysis examining efficacy of CAM vs. placebo or sham in adults with IBS. METHODS Publication databases were searched for randomized controlled trials of CAM therapies (herbal therapy, dietary supplements, mind-body based, body-based, and energy-healing) in adults with IBS. Data were extracted to obtain pooled estimates of mean improvement in abdominal pain (standardized mean difference [SMD]) and relative risk (RR) of overall response using random effects models. Sensitivity and subgroup analyses along with quality assessments were completed. RESULTS Among 2825 articles identified, 66 were included. Herbal therapy (SMD=0.47, 95% CI: 0.20 to 0.75, I2=82%) demonstrated significant benefit over placebo for abdominal pain (low confidence in estimates). Benefit with mind-body based therapy for abdominal pain was of borderline significance (SMD=0.29, 95% CI: -0.01 to 0.59, I2=78%). Herbal therapy (RR=1.57, 95% CI: 1.31 to 1.88, I2=77%), dietary supplements (RR=1.95, 95% CI: 1.02 to 3.73, I2=75%), and mind-body based therapy (RR=1.67, 95% CI: 1.13 to 2.49, I2=63%) showed benefit for overall response compared to placebo (low confidence in estimates). Body-based and energy healing therapies demonstrated no significant benefit over placebo or sham for abdominal pain or overall response. CONCLUSIONS CAM therapies such as herbal or dietary supplements and mind-body based approaches may be beneficial for abdominal pain and overall response in IBS. However, overall quality of evidence is low. Rigorous, high quality clinical trials are warranted to investigate CAM in IBS.
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Affiliation(s)
- Wade Billings
- Department of Medicine, Indiana University School of Medicine
| | - Karan Mathur
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Hannah J. Craven
- Ruth Lilly Medical Library, Indiana University School of Medicine
| | - Huiping Xu
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Andrea Shin
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana.
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Smith R, Wuthrich V, Johnco C, Belcher J. Effect of Group Cognitive Behavioural Therapy on Loneliness in a Community Sample of Older Adults: A Secondary Analysis of a Randomized Controlled Trial. Clin Gerontol 2021; 44:439-449. [PMID: 33100187 DOI: 10.1080/07317115.2020.1836105] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Research suggests a link between loneliness, depression, and anxiety. Multiple studies have examined treatment programs for loneliness; however, none have examined the efficacy of Cognitive Behavioral Therapy (CBT) for depression and anxiety in reducing loneliness. METHODS Change in loneliness in sixty-two older adults (≥60 yrs; 65% female) who took part in a previously reported randomized controlled trial for the treatment of comorbid depression and anxiety was examined. Older adults were randomized to a 12-week group CBT or waitlist control condition. Participants who took part in CBT were followed-up three months later. RESULTS Linear Mixed Model analyses indicated that after controlling for baseline cognition, depression, and anxiety, participants who completed CBT experienced a significant decrease in loneliness while the control group did not. This reduction was maintained at follow-up. CONCLUSIONS CBT programs for depression and anxiety are likely to be effective at reducing loneliness. This may be due to shared underlying cognitive and behavioral mechanisms between loneliness, depression, and anxiety such as sensitivity to perceived threat and social withdrawal. Further research is needed to understand if specific loneliness interventions are more effective. CLINICAL IMPLICATIONS CBT may be effective at reducing loneliness among older adults with depression and anxiety.
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Affiliation(s)
- Ronald Smith
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
| | - Viviana Wuthrich
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
| | - Carly Johnco
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
| | - Jessica Belcher
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
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Fuhr K, Meisner C, Broch A, Cyrny B, Hinkel J, Jaberg J, Petrasch M, Schweizer C, Stiegler A, Zeep C, Batra A. Efficacy of hypnotherapy compared to cognitive behavioral therapy for mild to moderate depression - Results of a randomized controlled rater-blind clinical trial. J Affect Disord 2021; 286:166-73. [PMID: 33725616 DOI: 10.1016/j.jad.2021.02.069] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 01/10/2021] [Accepted: 02/28/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Methodologically well-designed RCTs concerning the efficacy of Hypnotherapy in the treatment of Major Depression are lacking. The aim of this study was to determine whether Hypnotherapy (HT) is not inferior to Cognitive Behavioral Therapy (CBT), the gold-standard psychotherapy, in the percentage reduction of depressive symptoms, assessed in mild to moderate Major Depression (MD). METHODS This study reports the main results of a monocentric two-armed randomized-controlled rater-blind clinical trial. A total of 152 patients with MD were randomized to either CBT or HT receiving outpatient individual psychotherapy with 16 to 20 sessions for the duration of six months. The primary outcome was the mean percentage improvement in depressive symptoms assessed with the Montgomery-Asberg Depression Rating Scale (MADRS) before and after treatment. RESULTS The difference in the mean percentage symptom reduction between HT and CBT was 2.8 (95% CI=-9.85 to 15.44) in the Intention-to-treat sample and 4.0 (95% CI=-9.27 to 17.27) in the Per Protocol sample (N=134). Concerning the pre-specified non-inferiority margin of -16.4, both results confirm the non-inferiority of HT to CBT. The results for the follow-ups six and twelve months after the end of the treatment support the primary results. LIMITATIONS For ethical reasons the trial did not include a control group without treatment; therefore we can only indirectly conclude that both treatment conditions are effective. CONCLUSION This is the first study to demonstrate that HT was not inferior to CBT in MD, while employing rigorous methodological standards.
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Stirman SW, Gutner CA, Gamarra J, Suvak MK, Vogt D, Johnson C, Wachen JS, Dondanville KA, Yarvis JS, Mintz J, Peterson AL, Young-McCaughan S, Resick PA. A Novel Approach to the Assessment of Fidelity to a Cognitive Behavioral Therapy for PTSD Using Clinical Worksheets: A Proof of Concept With Cognitive Processing Therapy. Behav Ther 2021; 52:656-672. [PMID: 33990240 DOI: 10.1016/j.beth.2020.08.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 08/24/2020] [Accepted: 08/28/2020] [Indexed: 11/28/2022]
Abstract
Fidelity monitoring is a critical indicator of psychotherapy quality and is central to successful implementation. A major barrier to fidelity in routine care is the lack of feasible, scalable, and valid measurement strategies. A reliable, low-burden fidelity assessment would promote sustained implementation of cognitive behavioral therapies (CBTs). The current study examined fidelity measurement for cognitive processing therapy (CPT) for posttraumatic stress disorder (PTSD) using clinical worksheets. External raters evaluated patient worksheets done as a part of treatment, both guided by the therapist and completed independently as homework. Results demonstrated that fidelity ratings from CPT session worksheets were feasible and efficient. Notably, they were strongly correlated with observer ratings of the fidelity of CPT strategies that were present on the worksheets. Agreement among ratings conducted by individuals with a range of experience with CPT was acceptable to high. There was not a main effect of therapist-guided, in-session worksheet ratings on PTSD symptom change. However, patient competence in completing worksheets independently was associated with greater PTSD symptom decline and in-session, therapist-guided worksheet completion was associated with larger symptom decreases among patients with high levels of competence. With further research and refinement, rating of worksheets may be an efficient way to examine therapist and patient skill in key CPT elements, and their interactions, compared to the gold standard of observer ratings of therapy video-recordings. Additional research is needed to determine if worksheets are an accurate and scalable alternative to gold standard observer ratings in settings in which time and resources are limited.
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Affiliation(s)
- Shannon Wiltsey Stirman
- Dissemination and Training Division, National Center for PTSD, VA Palo Alto Healthcare System & Stanford University.
| | - Cassidy A Gutner
- Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System &; Boston University School of Medicine
| | | | | | - Dawne Vogt
- Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System &; Boston University School of Medicine
| | - Clara Johnson
- Dissemination and Training Division, National Center for PTSD
| | - Jennifer Schuster Wachen
- Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System &; Boston University School of Medicine
| | | | | | - Jim Mintz
- University of Texas Health Science Center at San Antonio
| | - Alan L Peterson
- University of Texas Health Science Center at San Antonio; South Texas Veterans Health Care System; University of Texas at San Antonio
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Bunnell BE, Nemeth LS, Lenert LA, Kazantzis N, Deblinger E, Higgins KA, Ruggiero KJ. Barriers Associated with the Implementation of Homework in Youth Mental Health Treatment and Potential Mobile Health Solutions. Cognit Ther Res 2021; 45:272-286. [PMID: 34108776 PMCID: PMC8183976 DOI: 10.1007/s10608-020-10090-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Homework, or between-session practice of skills learned during therapy, is integral to effective youth mental health TREATMENTS. However, homework is often under-utilized by providers and patients due to many barriers, which might be mitigated via mHealth solutions. METHODS Semi-structured qualitative interviews were conducted with nationally certified trainers in Trauma Focused Cognitive Behavioral Therapy (TF-CBT; n=21) and youth TF-CBT patients ages 8-17 (n=15) and their caregivers (n=12) to examine barriers to the successful implementation of homework in youth mental health treatment and potential mHealth solutions to those barriers. RESULTS The results indicated that many providers struggle to consistently develop, assign, and assess homework exercises with their patients. Patients are often difficult to engage and either avoid or have difficulty remembering to practice exercises, especially given their busy/chaotic home lives. Trainers and families had positive views and useful suggestions for mHealth solutions to these barriers in terms of functionality (e.g., reminders, tracking, pre-made homework exercises, rewards) and user interface (e.g., easy navigation, clear instructions, engaging activities). CONCLUSIONS This study adds to the literature on homework barriers and potential mHealth solutions to those barriers, which is largely based on recommendations from experts in the field. The results aligned well with this literature, providing additional support for existing recommendations, particularly as they relate to treatment with youth and caregivers.
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Affiliation(s)
- Brian E. Bunnell
- Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
- Biomedical Informatics Center, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Lynne S. Nemeth
- Department of Nursing, College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - Leslie A. Lenert
- Biomedical Informatics Center, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Nikolaos Kazantzis
- Cognitive Behavior Therapy Research Unit and School of Psychological Sciences, Monash University, Clayton, VIC, Australia
| | - Esther Deblinger
- Child Abuse Research Education & Service (CARES) Institute, Rowan University School of Osteopathic Medicine, Stratford, New Jersey, USA
| | - Kristen A. Higgins
- Biomedical Informatics Center, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Kenneth J. Ruggiero
- Technology Applications Center for Healthful Lifestyles, College of Nursing, Medical University of South Carolina, Charleston, SC, USA
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Burian H, Böge K, Burian R, Burns A, Nguyen MH, Ohse L, Ta TMT, Hahn E, Diefenbacher A. Acceptance and commitment-based therapy for patients with psychiatric and physical health conditions in routine general hospital care - Development, implementation and outcomes. J Psychosom Res 2021; 143:110374. [PMID: 33571859 DOI: 10.1016/j.jpsychores.2021.110374] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 01/16/2021] [Accepted: 01/24/2021] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Transdiagnostic approaches are needed to effectively treat patients with a broad range of diagnoses and comorbidities in routine general hospital care. Yet the evidence for the effectiveness of treatments beyond Cognitive Behavioral Therapy (CBT) is largely lacking. We describe the process of implementing an interdisciplinary multi-professional Acceptance and Commitment Therapy (ACT)-based treatment for patients with psychiatric and physical health conditions and present outcomes before and after implementation. METHOD The present investigation was a naturalistic comparative study comparing ACT-based (n = 126) vs. CBT-based (n = 127) treatments in a psychiatric day hospital in Berlin, Germany. Within- and between-group changes (pre- to post-treatment) in everyday functioning and health-related quality of life (primary outcomes; assessed by the Short Form 36 (SF-36)), as well as anxiety and depressive symptoms (secondary outcomes; assessed by the Hospital Anxiety and Depression Scale (HADS) and Beck Depression Inventory-II (BDI-II)), were analyzed with Generalized Linear Models, and Wilcoxon signed-rank tests and effect size r. RESULTS Data analysis showed statistically significant improvements from pre- to post-treatment (r ranging from 0.27 to 0.61, p < 0.001) for most SF-36 scales as well as for all HADS and BDI-II scores (r ranging from 0.38 to 0.60, p < 0.001) for both the ACT and CBT groups. ACT and CBT showed comparable effects in relation to clinical outcomes. CONCLUSION An interdisciplinary multi-professional ACT-based group treatment is a valuable approach for patients with psychiatric and physical health conditions in real-life hospital settings, with effects equivalent to CBT interventions.
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Affiliation(s)
- Hannah Burian
- Evangelic Hospital "Königin Elisabeth Herzberge", Department of Psychiatry, Psychotherapy and Psychosomatics, Herzbergstr. 79, 10365 Berlin, Germany; Charité-Universitätsmedizin Berlin, Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany.
| | - Kerem Böge
- Charité-Universitätsmedizin Berlin, Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany.
| | - Ronald Burian
- Evangelic Hospital "Königin Elisabeth Herzberge", Department of Psychiatry, Psychotherapy and Psychosomatics, Herzbergstr. 79, 10365 Berlin, Germany.
| | - Annette Burns
- Bamford Centre for Mental Health and Well Being, Ulster University, Coleraine, Ireland.
| | - Main Huong Nguyen
- Charité-Universitätsmedizin Berlin, Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany.
| | - Ludwig Ohse
- Evangelic Hospital "Königin Elisabeth Herzberge", Department of Psychiatry, Psychotherapy and Psychosomatics, Herzbergstr. 79, 10365 Berlin, Germany; Psychologische Hochschule Berlin, Am Köllnischen Park 2, 10179 Berlin, Germany.
| | - Thi Minh Tam Ta
- Charité-Universitätsmedizin Berlin, Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany.
| | - Eric Hahn
- Charité-Universitätsmedizin Berlin, Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany.
| | - Albert Diefenbacher
- Evangelic Hospital "Königin Elisabeth Herzberge", Department of Psychiatry, Psychotherapy and Psychosomatics, Herzbergstr. 79, 10365 Berlin, Germany; Charité-Universitätsmedizin Berlin, Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany.
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Aitken M, Andrade BF. Attention Problems and Restlessness as Transdiagnostic Markers of Severity and Treatment Response in Youth with Internalizing Problems. Res Child Adolesc Psychopathol 2021; 49:1069-1082. [PMID: 33755870 DOI: 10.1007/s10802-021-00797-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2021] [Indexed: 11/25/2022]
Abstract
Transdiagnostic models of psychopathology suggest that disorders may share common features that could influence their severity. Attention problems and psychomotor restlessness are included in the diagnostic criteria for several disorders, including disorders on the internalizing spectrum, but their transdiagnostic significance has received little attention. The present study identifies patterns of attention problems and restlessness among youth with internalizing problems, in order to understand their clinical significance in terms of internalizing symptom severity and response to cognitive behavioral therapy (CBT). Participants were 142 adolescents age 11-18 clinically referred for mood and/or anxiety problems. Latent class analysis was used to identify patterns of self-reported attention problems and psychomotor restlessness, and classes were compared on internalizing, depression, and anxiety severity. Differences in treatment response were examined in a subset of youth (n = 82; age 14-18) who participated in group CBT. Youth in the Attention Problems class (42% of sample) and youth in the Restless class (15% of sample) endorsed significantly more internalizing, depression, and anxiety problems than youth with Low Symptoms of attention problems or psychomotor restlessness (43% of sample). Youth in the Restless class responded significantly better to CBT than youth in the Low Symptoms of attention problems or psychomotor restlessness class in terms of decrease in overall internalizing problems. Attention problems and psychomotor restlessness appear to be important transdiagnostic markers of severity across the internalizing spectrum; however, they do not limit the effectiveness of CBT and, in the case of psychomotor restlessness, may forecast a good treatment response.
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Affiliation(s)
- Madison Aitken
- Department of Psychiatry, University of Toronto, Toronto, Canada. .,Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health, Toronto, Canada. .,Margaret and Wallace McCain Centre for Child and Youth Mental Health, Centre for Addiction and Mental Health, Toronto, Canada.
| | - Brendan F Andrade
- Department of Psychiatry, University of Toronto, Toronto, Canada.,Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health, Toronto, Canada.,Margaret and Wallace McCain Centre for Child and Youth Mental Health, Centre for Addiction and Mental Health, Toronto, Canada
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Nonahal S, Mohammadkhani S, Hasani J, Akbari M, Sadeghi-Bahmani D. Psychometric Properties of the Persian Version of the Weight Control Strategies Scale (WCSS). Iran J Psychiatry 2021; 16:146-153. [PMID: 34221040 PMCID: PMC8233555 DOI: 10.18502/ijps.v16i2.5815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Objective: The purpose of the present study was to examine the validity and reliability of the Persian version of the Weight Control Strategies Scale among individuals engaged in weight loss or weight maintenance. Method: This descriptive study conducted from October 2019 to February 2020 on social media networks. A total of 420 men and women were selected using consecutive sampling. They completed the Persian version of the Weight Control Strategies Scale and the Self-Compassion Scale. Data were analyzed using descriptive statistics, Cronbach’s α, confirmatory factor analysis, and Pearson product-moment correlations. Results: Internal consistency for the total score of the Persian version of Weight Control Strategies Scale was excellent and acceptable to good for all 4 subscales (in all cases over α = 0.70). Confirmatory factor analysis supported the factor structure of the original model of the scale, but, it was different from the model at the item level. Moreover, the Persian version of Weight Control Strategies Scale had good convergent validity. Conclusion: Psychometrically speaking, the Persian version of the Weight Control Strategies Scale is a valid and reliable tool to assess the psychological and behavioral profile of individuals engaging in losing or maintaining weight, both for clinical and research purposes.
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Affiliation(s)
- Saman Nonahal
- Department of Clinical Psychology, Faculty of Psychology and Education, Kharazmi University, Tehran, Iran
| | - Shahram Mohammadkhani
- Department of Clinical Psychology, Faculty of Psychology and Education, Kharazmi University, Tehran, Iran
| | - Jafar Hasani
- Department of Clinical Psychology, Faculty of Psychology and Education, Kharazmi University, Tehran, Iran
| | - Mehdi Akbari
- Department of Clinical Psychology, Faculty of Psychology and Education, Kharazmi University, Tehran, Iran
| | - Dena Sadeghi-Bahmani
- Departments of Physical Therapy, University of Alabama at Birmingham, Birmingham, Alabama, United States of America.,University of Basel, Psychiatric Clinics (UPK), Center of Affective, Stress and Sleep Disorders (ZASS), Basel, Switzerland.,Sleep Disorders Research Center, Kermanshah University of Medical Sciences (KUMS), Kermanshah, Iran
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Goldstein I, Komisaruk BR, Pukall CF, Kim NN, Goldstein AT, Goldstein SW, Hartzell-Cushanick R, Kellogg-Spadt S, Kim CW, Jackowich RA, Parish SJ, Patterson A, Peters KM, Pfaus JG. International Society for the Study of Women's Sexual Health (ISSWSH) Review of Epidemiology and Pathophysiology, and a Consensus Nomenclature and Process of Care for the Management of Persistent Genital Arousal Disorder/Genito-Pelvic Dysesthesia (PGAD/GPD). J Sex Med 2021; 18:665-97. [PMID: 33612417 DOI: 10.1016/j.jsxm.2021.01.172] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/24/2020] [Accepted: 01/06/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Persistent genital arousal disorder (PGAD), a condition of unwanted, unremitting sensations of genital arousal, is associated with a significant, negative psychosocial impact that may include emotional lability, catastrophization, and suicidal ideation. Despite being first reported in 2001, PGAD remains poorly understood. AIM To characterize this complex condition more accurately, review the epidemiology and pathophysiology, and provide new nomenclature and guidance for evidence-based management. METHODS A panel of experts reviewed pertinent literature, discussed research and clinical experience, and used a modified Delphi method to reach consensus concerning nomenclature, etiology, and associated factors. Levels of evidence and grades of recommendation were assigned for diagnosis and treatment. OUTCOMES The nomenclature of PGAD was broadened to include genito-pelvic dysesthesia (GPD), and a new biopsychosocial diagnostic and treatment algorithm for PGAD/GPD was developed. RESULTS The panel recognized that the term PGAD does not fully characterize the constellation of GPD symptoms experienced by patients. Therefore, the more inclusive term PGAD/GPD was adopted, which maintains the primacy of the distressing arousal symptoms and acknowledges associated bothersome GPD. While there are diverse biopsychosocial contributors, there is a common underlying neurologic basis attributable to spontaneous intense activity of the genito-pelvic region represented in the somatosensory cortex and its projections. A process of care diagnostic and treatment strategy was developed to guide the clinician, whenever possible, by localizing the symptoms as originating in any of five regions: (i) end organ, (ii) pelvis/perineum, (iii) cauda equina, (iv) spinal cord, and (v) brain. Psychological treatment strategies were considered critical and should be performed in conjunction with medical strategies. Pharmaceutical interventions may be used based on their site and mechanism of action to reduce patients' symptoms and the associated bother and distress. CLINICAL IMPLICATIONS The process of care for PGAD/GPD uses a personalized, biopsychosocial approach for diagnosis and treatment. STRENGTHS AND LIMITATIONS Strengths and Limitations: Strengths include characterization of the condition by consensus, analysis, and recommendation of a new nomenclature and a rational basis for diagnosis and treatment. Future investigations into etiology and treatment outcomes are recommended. The main limitations are the dearth of knowledge concerning this condition and that the current literature consists primarily of case reports and expert opinion. CONCLUSION We provide, for the first time, an expert consensus review of the epidemiology and pathophysiology and the development of a new nomenclature and rational algorithm for management of this extremely distressing sexual health condition that may be more prevalent than previously recognized. Goldstein I, Komisaruk BR, Pukall CF, et al. International Society for the Study of Women's Sexual Health (ISSWSH) Review of Epidemiology and Pathophysiology, and a Consensus Nomenclature and Process of Care for the Management of Persistent Genital Arousal Disorder/Genito-Pelvic Dysesthesia (PGAD/GPD). J Sex Med 2021;18:665-697.
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Masoumian S, Ashouri A, Ghomian S, Keshtkar M, Siahkamary E, Vahed N. Efficacy of Acceptance and Commitment Therapy Compared to Cognitive Behavioral Therapy on Anger and Interpersonal Relationships of Male Students. Iran J Psychiatry 2021; 16:21-29. [PMID: 34054979 PMCID: PMC8140295 DOI: 10.18502/ijps.v16i1.5374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Objective: The aim of the present study was to determine the efficacy of acceptance and commitment therapy (ACT) compared to cognitive-behavioral therapy (CBT) on anger and interpersonal relationships among male students. Method: In the present study, several universities were selected from the public universities in Tehran province, based on random cluster sampling. Then, 400 students from selected universities were selected randomly and Aggression Questionnaire (AGQ) was administered on them. After collecting information, among the participants who gained scores higher than the average, 30 were selected based on the lottery and randomly (sorting their names in alphabetical order and randomly selecting them) and then were placed randomly in ACT (n = 15) and CBT (n = 15) groups. Also, the Fundamental Interpersonal Relation Orientation- Behavior (FIRO-B) and Aggression Questionnaire (AGQ) was performed on both groups before and after intervention. Results: The results indicated that at the end of treatment, there was a significant decrease in the degree of anger among the participants and a significant improvement in all subscales of interpersonal relationships. Also, a significant difference was found between the 2 groups of ACT and CBT in terms of anger changes. Considering that the anger changes in the ACT group were higher, it can be concluded that the ACT group had more changes than the CBT group, but there was no significant difference between the 2 groups of ACT and CBT in terms of FIRO-B subscales. Conclusion: In some cases, such as anger, ACT has a better effect than CBT, and in others, such as interpersonal problems, it is as effective as CBT.
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Affiliation(s)
- Samira Masoumian
- Mental Health Research, Iran University of Medical Sciences, Tehran, Iran
| | - Ahmad Ashouri
- Mental Health Research, Iran University of Medical Sciences, Tehran, Iran
| | - Soheila Ghomian
- Clinical Psychology, University of Tehran Counseling Center, Tehran, Iran
| | - Mahbobeh Keshtkar
- Mental Health Research, Iran University of Medical Sciences, Tehran, Iran
| | | | - Neda Vahed
- Student Research Committee, Iran University of Medical Sciences, Tehran, Iran
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Kivity Y, Cohen L, Weiss M, Elizur J, Huppert JD. The role of expressive suppression and cognitive reappraisal in cognitive behavioral therapy for social anxiety disorder: A study of self-report, subjective, and electrocortical measures. J Affect Disord 2021; 279:334-342. [PMID: 33096332 DOI: 10.1016/j.jad.2020.10.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 08/16/2020] [Accepted: 10/11/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Contemporary models of cognitive behavioral therapy (CBT) for social anxiety disorder (SAD) emphasize emotion dysregulation as a core impairment whose reduction may play a causal role in psychotherapy. The current study examined changes in use of emotion regulation strategies as possible mechanisms of change in CBT for SAD. Specifically, we examined changes in expressive suppression and cognitive reappraisal during CBT and whether these changes predict treatment outcome. METHODS Patients (n = 34; 13 females; Mean age = 28.36 (6.97)) were allocated to 16-20 sessions of CBT. An electrocortical measure of emotion regulation and a clinician-rated measure of SAD were administered monthly. Self-report measures of emotion regulation and social anxiety were administered weekly. Multilevel models were used to examine changes in emotion regulation during treatment and cross-lagged associations between emotion regulation and anxiety. RESULTS CBT led to decreased suppression frequency, increased reappraisal self-efficacy, and decreased unpleasantness for SAD-related pictures (ps < .05). At post-treatment, patients were equivalent to healthy controls in terms of suppression frequency and subjective reactivity to SAD-related stimuli. Gains were maintained at 3-months follow-up. Decreases in suppression frequency and electrocortical reactivity to SAD-related pictures predicted lower subsequent anxiety but not the other way around (ps < .05). Lower anxiety predicted greater subsequent increases in reappraisal self-efficacy. LIMITATIONS The lack of a control group precludes conclusions regarding mechanisms specificity. CONCLUSIONS Decreased frequency of suppression is a potential mechanism of change in CBT for SAD.
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Affiliation(s)
- Yogev Kivity
- Department of Psychology, The Hebrew University of Jerusalem, Jerusalem, Israel.
| | - Lior Cohen
- Department of Psychology, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Michal Weiss
- Department of Psychology, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Jonathan Elizur
- Department of Psychology, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Jonathan D Huppert
- Department of Psychology, The Hebrew University of Jerusalem, Jerusalem, Israel
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Chey WD, Keefer L, Whelan K, Gibson PR. Behavioral and Diet Therapies in Integrated Care for Patients With Irritable Bowel Syndrome. Gastroenterology 2021; 160:47-62. [PMID: 33091411 DOI: 10.1053/j.gastro.2020.06.099] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/08/2020] [Accepted: 06/06/2020] [Indexed: 02/06/2023]
Abstract
Irritable bowel syndrome (IBS) is a common, symptom-based condition that has negative effects on quality of life and costs health care systems billions of dollars each year. Until recently, management of IBS has focused on over-the-counter and prescription medications that reduce symptoms in fewer than one-half of patients. Patients have increasingly sought natural solutions for their IBS symptoms. However, behavioral techniques and dietary modifications can be effective in treatment of IBS. Behavioral interventions include gastrointestinal-focused cognitive behavioral therapy and gut-directed hypnotherapy to modify interactions between the gut and the brain. In this pathway, benign sensations from the gut induce maladaptive cognitive or affective processes that amplify symptom perception. Symptoms occur in response to cognitive and affective factors that trigger fear of symptoms or lack of acceptance of disease, or from stressors in the external environment. Among the many dietary interventions used to treat patients with IBS, a diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols is the most commonly recommended by health care providers and has the most evidence for efficacy. Patient with IBS who choose to follow a diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols should be aware of its 3 phases: restriction, reintroduction, and personalization. Management of IBS should include an integrated care model in which behavioral interventions, dietary modification, and medications are considered as equal partners. This approach offers the greatest likelihood for success in management of patients with IBS.
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Affiliation(s)
- William D Chey
- Division of Gastroenterology, Michigan Medicine, Ann Arbor, Michigan.
| | | | - Kevin Whelan
- Department of Nutritional Sciences, King's College London, London, United Kingdom
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Heapy AA, Driscoll MA, Buta E, LaChappelle KM, Edmond S, Krein SL, Piette JD, Mattocks K, Murphy JL, DeBar L, MacLean RR, Ankawi B, Kawecki T, Martino S, Wagner T, Higgins DM. Co-Operative Pain Education and Self-management (COPES) Expanding Treatment for Real-World Access (ExTRA): Pragmatic Trial Protocol. Pain Med 2020; 21:S21-S28. [PMID: 33313733 PMCID: PMC7734659 DOI: 10.1093/pm/pnaa365] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Given access barriers to cognitive behavioral therapy for chronic pain (CBT-CP), this pragmatic superiority trial will determine whether a remotely delivered CBT-CP intervention that addresses these barriers outperforms in-person and other synchronous forms of CBT-CP for veterans with musculoskeletal pain. DESIGN This pragmatic trial compares an asynchronous form of CBT-CP that uses interactive voice response (IVR) to allow patients to participate from their home (IVR CBT-CP) with synchronous CBT-CP delivered by a Department of Veterans Affairs (VA) clinician. Veterans (n=764; 50% male) with chronic musculoskeletal pain throughout nine VA medical centers will participate. The primary outcome is pain interference after treatment (4 months). Secondary outcomes, including pain intensity, depression symptom severity, sleep, self-efficacy, and global impression of change, are also measured after treatment. Where possible, outcomes are collected via electronic health record extraction, with remaining measures collected via IVR calls to maintain blinding. Quantitative and qualitative process evaluation metrics will be collected to evaluate factors related to implementation. A budget impact analysis will be performed. SUMMARY This pragmatic trial compares the outcomes, cost, and implementation of two forms of CBT-CP as delivered in the real-world setting. Findings from the trial can be used to guide future policy and implementation efforts related to these interventions and their use in the health system. If one of the interventions emerges as superior, resources can be directed to this modality. If both treatments are effective, patient preferences and health care system factors will take precedence when making referrals. Implications of COVID-19 on treatment provision and trial outcomes are discussed.
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Affiliation(s)
- Alicia A Heapy
- VA Connecticut Healthcare System, West Haven, Connecticut.,Yale University School of Medicine, New Haven, Connecticut
| | - Mary A Driscoll
- VA Connecticut Healthcare System, West Haven, Connecticut.,Yale University School of Medicine, New Haven, Connecticut
| | - Eugenia Buta
- Yale University School of Medicine, New Haven, Connecticut
| | | | - Sara Edmond
- VA Connecticut Healthcare System, West Haven, Connecticut.,Yale University School of Medicine, New Haven, Connecticut
| | - Sarah L Krein
- VA Ann Arbor Center for Clinical Management Research, Health Services Research and Development Center of Innovation, Ann Arbor, Michigan.,University of Michigan Medical School, Ann Arbor, Michigan
| | - John D Piette
- VA Ann Arbor Center for Clinical Management Research, Health Services Research and Development Center of Innovation, Ann Arbor, Michigan.,University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Kristin Mattocks
- VA Central Western Massachusetts Healthcare System, Leeds, Massachusetts.,University of Massachusetts Medical School, Worcester, Massachusetts
| | - Jennifer L Murphy
- US Department of Veterans Affairs Central Office, Washington, District of Columbia.,University of South Florida Morsani College of Medicine, Tampa, Florida
| | - Lynn DeBar
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - R Ross MacLean
- VA Connecticut Healthcare System, West Haven, Connecticut.,Yale University School of Medicine, New Haven, Connecticut
| | - Brett Ankawi
- VA Connecticut Healthcare System, West Haven, Connecticut.,Yale University School of Medicine, New Haven, Connecticut
| | - Todd Kawecki
- VA Connecticut Healthcare System, West Haven, Connecticut.,Yale University School of Medicine, New Haven, Connecticut
| | - Steve Martino
- VA Connecticut Healthcare System, West Haven, Connecticut.,Yale University School of Medicine, New Haven, Connecticut
| | - Todd Wagner
- Palo Alto VA Health Economics Resource Center, Menlo Park, California.,Department of Surgery, Stanford University, Palo Alto, California
| | - Diana M Higgins
- VA Boston Healthcare System, Boston, Massachusetts.,Boston University School of Medicine, Boston, Massachusetts, USA
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Hunger C, Hilzinger R, Klewinghaus L, Deusser L, Sander A, Mander J, Bents H, Ditzen B, Schweitzer J. Comparing Cognitive Behavioral Therapy and Systemic Therapy for Social Anxiety Disorder: Randomized Controlled Pilot Trial (SOPHO-CBT/ST). Fam Process 2020; 59:1389-1406. [PMID: 31657011 DOI: 10.1111/famp.12492] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This randomized controlled trial (RCT) aimed to pilot the newly developed manualized and monitored systemic therapy (ST) for social anxiety disorder (SAD), as compared to manualized and monitored cognitive behavioral therapy (CBT). We conducted a prospective multicenter, assessor-blind pilot RCT on 38 outpatients (ICD F40.1; Structured Clinical Interview for DSM (SCID); Liebowitz Social Anxiety Scale, LSAS-SR >30). The primary outcome was level of social anxiety (LSAS-SR) at the end of treatment. A total of 252 persons were screened, and 38 patients were randomized and started therapy (CBT: 20 patients; ST: 18 patients; age: M = 36 years, SD = 14). Within-group, simple-effect intent-to-treat analyses (ITT) showed significant reduction in LSAS-SR (CBT:d = 1.04; ST:d = 1.67), while ITT mixed-design ANOVA demonstrated the advantage of ST (d = 0.81). Per-protocol analyses supported these results. Remission based on reliable change indices also demonstrated significant difference (LSAS-SR: 15% in CBT; 39% in ST;h: 0.550), supported by blind diagnosticians' ratings of those who completed therapy (SCID; 45% in CBT, 78% in ST,p = .083). No adverse events were reported. CBT and ST both reduced social anxiety, supporting patient improvement with the newly developed ST for SAD; this has yet to be verified in a subsequent confirmatory RCT.
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Affiliation(s)
- Christina Hunger
- Institute of Medical Psychology, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Rebecca Hilzinger
- Institute of Medical Psychology, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Laura Klewinghaus
- Institute of Medical Psychology, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Laura Deusser
- Institute of Medical Psychology, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Anja Sander
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Johannes Mander
- Center for Psychological Psychotherapy, University of Heidelberg, Heidelberg, Germany
| | - Hinrich Bents
- Center for Psychological Psychotherapy, University of Heidelberg, Heidelberg, Germany
| | - Beate Ditzen
- Institute of Medical Psychology, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Jochen Schweitzer
- Institute of Medical Psychology, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
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Han S, Hu Y, Lu H, Zhang L, Zhu Z, Luo J, Relf MV, Mulawa MI, Pei Y, Wu B. Cognitive behavioral therapy for persons living with HIV in China: A randomized pilot trial. J Affect Disord 2020; 277:640-648. [PMID: 32911214 DOI: 10.1016/j.jad.2020.08.085] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 07/09/2020] [Accepted: 08/25/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND Chinese persons living with HIV (PLWH) suffer from prevalent mental health issues. We aimed to develop a tailored cognitive behavioral therapy (CBT), test its feasibility, acceptability, and preliminary effects (depression, anxiety, and medication adherence) for Chinese PLWH. METHODS Twenty PLWH were assigned randomly. Intervention participants learned skills in CBT and relaxation training in a tailored group-based weekly 10-session project. Each session lasted for two hours and was delivered by nurses and volunteers. Control participants only received laboratory tests and free antiretroviral therapy (ART) medication. Feasibility and acceptability were descriptively summarized. Depression, anxiety, and ART medication adherence data were collected at the baseline (T0), after the intervention (T1) and after 6 months of follow-up (T2). RESULTS The average CBT attendance rate for all sessions was 60%. No participants in the intervention group dropped out of the study. All participants in the intervention group agreed that they could benefit from the CBT. Participants in the intervention group showed a greater improvement in anxiety and self-reported ART medication adherence than those in the control group at T1. However, no preliminary intervention effect was found at T2. LIMITATIONS The small sample size leads to a lack of representativeness in the study sample. We excluded participants with severe comorbidities, which may lead to an underestimate of the intervention effect of CBT among Chinese PLWH. CONCLUSIONS CBT is feasible and acceptable, demonstrating promising preliminary effects on anxiety and ART medication adherence among Chinese PLWH. Additional research is needed to test the effectiveness of this approach.
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Affiliation(s)
- Shuyu Han
- School of Nursing, Fudan University, Shanghai 200032, China
| | - Yan Hu
- School of Nursing, Fudan University, Shanghai 200032, China.
| | - Hongzhou Lu
- Shanghai Public Health Clinical Center Affiliated with Fudan University, Shanghai 201508, China.
| | - Lin Zhang
- Shanghai Public Health Clinical Center Affiliated with Fudan University, Shanghai 201508, China
| | - Zheng Zhu
- School of Nursing, Fudan University, Shanghai 200032, China
| | - Jianfeng Luo
- School of Public Health, Fudan University, Shanghai 200032, China
| | - Michael V Relf
- Duke Global Health Institute, Duke University, Durham, USA
| | - Marta I Mulawa
- Duke Global Health Institute, Duke University, Durham, USA
| | - Yaolin Pei
- Rory Meyers College of Nursing, New York University, New York, USA
| | - Bei Wu
- Rory Meyers College of Nursing, New York University, New York, USA
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Tillman B, Rogers C. COVID-19 as a Traumatic Event: Mental Health Lessons from Cognitive Behavioral Therapy. HCA Healthc J Med 2020; 1:335-338. [PMID: 37426854 PMCID: PMC10327966 DOI: 10.36518/2689-0216.1145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
Description As a psychiatry resident working on an internal medicine rotation during the COVID-19 crisis in April, 2020, I witnessed signs of the burgeoning mental health crisis first-hand-among patients, friends, and healthcare workers. It quickly became evident that this experience was akin to a mass trauma, and in this paper we explore this concept and propose using Cognitive Behavioral Therapy to address the secondary mental health pandemic of anxiety and stress disorders that is developing in real time.
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