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Stein J, Vöhringer M, Wagner B, Stammel N, Nesterko Y, Böttche M, Knaevelsrud C. Exposure Versus Cognitive Restructuring Techniques in Brief Internet-Based Cognitive Behavioral Treatment for Arabic-Speaking People With Posttraumatic Stress Disorder: Randomized Clinical Trial. JMIR Ment Health 2023; 10:e48689. [PMID: 38090792 PMCID: PMC10753431 DOI: 10.2196/48689] [Citation(s) in RCA: 1] [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: 07/27/2023] [Revised: 09/15/2023] [Accepted: 09/16/2023] [Indexed: 12/30/2023] Open
Abstract
BACKGROUND Cognitive behavioral interventions delivered via the internet are demonstrably efficacious treatment options for posttraumatic stress disorder (PTSD) in underserved, Arabic-speaking populations. However, the role of specific treatment components remains unclear, particularly in conflict-affected areas of the Middle East and North Africa. OBJECTIVE This study aims to evaluate 2 brief internet-based treatments in terms of efficacy, including change in PTSD symptom severity during treatment. Both treatments were developed in line with Interapy, an internet-based, therapist-assisted cognitive behavioral therapy protocol for PTSD and adapted to the specific research question. The first treatment comprised self-confrontation and social sharing (exposure treatment; 6 sessions); the second comprised cognitive restructuring and social sharing (cognitive restructuring treatment; 6 sessions). The 2 treatments were compared with each other and with a waitlist control group. METHODS In total, 365 Arabic-speaking participants from the Middle East and North Africa (mean age 25.49, SD 6.68 y) with PTSD were allocated to cognitive restructuring treatment (n=118, 32.3%), exposure treatment (n=122, 33.4%), or a waitlist control group (n=125, 34.2%) between February 2021 and December 2022. PTSD symptom severity, posttraumatic maladaptive cognitions, anxiety, depressive and somatoform symptom severity, and quality of life were assessed via self-report at baseline and after treatment or waiting time. PTSD symptom severity was also measured throughout treatment or waiting time. Treatment satisfaction was assessed after treatment completion. Treatment use and satisfaction were compared between the 2 treatment conditions using appropriate statistical tests (eg, chi-square and Welch tests). Multiple imputation was performed to address missing data and evaluate treatment-associated changes. These changes were analyzed using multigroup change modeling in the completer and intention-to-treat samples. RESULTS Overall, 200 (N=240, 83.3%) participants started any of the treatments, of whom 123 (61.5%) completed the treatment. Treatment condition was not significantly associated with the proportion of participants who started versus did not start treatment (P=.20) or with treatment completion versus treatment dropout (P=.71). High treatment satisfaction was reported, with no significant differences between the treatment conditions (P=.48). In both treatment conditions, PTSD, anxiety, depressive and somatoform symptom severity, and posttraumatic maladaptive cognitions decreased, and quality of life improved significantly from baseline to the posttreatment time point (P≤.001 in all cases). Compared with the baseline assessment, overall PTSD symptom severity decreased significantly after 4 sessions in both treatment conditions (P<.001). Moreover, both treatment conditions were significantly superior to the waitlist control group regarding overall PTSD symptom severity (P<.001) and most other comorbid mental health symptoms (P<.001 to P=.03). Differences between the 2 conditions in the magnitude of change for all outcome measures were nonsignificant. CONCLUSIONS Internet-based cognitive behavioral treatments for PTSD focusing primarily on either self-confrontation or cognitive restructuring are applicable and efficacious for Arabic-speaking participants. TRIAL REGISTRATION German Clinical Trials Register DRKS00010245; https://drks.de/search/de/trial/DRKS00010245.
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Affiliation(s)
- Jana Stein
- Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
- Department for Transcultural and Traumatic Stress Studies, Center ÜBERLEBEN, Berlin, Germany
| | - Max Vöhringer
- Department for Transcultural and Traumatic Stress Studies, Center ÜBERLEBEN, Berlin, Germany
| | - Birgit Wagner
- Clinical Psychology and Psychotherapy, Medical School Berlin, Berlin, Germany
| | - Nadine Stammel
- Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Yuriy Nesterko
- Department for Transcultural and Traumatic Stress Studies, Center ÜBERLEBEN, Berlin, Germany
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
| | - Maria Böttche
- Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Christine Knaevelsrud
- Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
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Conner KR, Maisto SA, Abar B, Szafranski S, Chiang A, Hutchison M, Aldalur A, Stecker T. Brief, cognitive-behavioral intervention to promote treatment seeking in adults with severe alcohol use disorder: A randomized controlled trial. Addiction 2023; 118:2342-2351. [PMID: 37488997 PMCID: PMC10805959 DOI: 10.1111/add.16300] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 06/20/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND AND AIMS There is little RCT evidence that brief interventions improve treatment seeking in individuals with severe alcohol use disorder (AUD) or treatment seeking reduces alcohol use. The aim was to test the efficacy of a brief intervention to increase treatment seeking in treatment naïve adults with severe AUD and measure its effects on alcohol use. DESIGN Parallel group, non-pharmacologic RCT with intervention (n = 197) and active control (n = 203) conditions, with blinded assessors conducting follow-ups at 1, 3 and 6 months. SETTING Online recruitment in a 17-county region of upstate New York, USA. PARTICIPANTS Inclusion criteria consisted of ages ≥18 years, Alcohol Use Disorders Identification Test score ≥16, exceeds recommended limits for alcohol use and no history of AUD treatment. n = 400; 50% female; 79% white; mean age, 40.7; mean education, 14.6 years. INTERVENTION AND COMPARATOR One-session telephone-delivered interventions: Cognitive-Behavioral Therapy for Treatment Seeking (CBT-TS; intervention), review of a National Institute on Alcohol Abuse and Alcoholism pamphlet on AUD treatment (control). MEASUREMENTS Self-report of any AUD treatment use over 3 months (primary outcome) and two standard measures of alcohol use over 6 months (secondary outcomes). FINDINGS Intent-to-treat analyses were used. Assessment follow-up rates were ≥93%. Any alcohol-related treatment use over 3-month follow-up was obtained by 38 (19%) intervention participants and 36 (18%) control participants, a non-significant difference, χ2 [1] = 0.16, P = 0.689. Secondary analysis showed a significant interaction term between sex and intervention assignment (β = -1.197, P = 0.027). The interaction suggested CBT-TS was effective in men (22% vs 13%), although the evidence was somewhat weak (P = 0.071), and it was not effective in women (17% vs 24%). CONCLUSIONS A one-session cognitive-behavioral therapy intervention to increase treatment seeking in treatment naïve adults with severe alcohol use disorder did not increase treatment seeking.
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Affiliation(s)
- Kenneth R Conner
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, New York, USA
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| | - Stephen A Maisto
- Department of Psychology, Syracuse University, Syracuse, New York, USA
| | - Beau Abar
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Sarah Szafranski
- College of Nursing, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Andrew Chiang
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Morica Hutchison
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| | - Aileen Aldalur
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, New York, USA
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| | - Tracy Stecker
- College of Nursing, Medical University of South Carolina, Charleston, South Carolina, USA
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Vincent N, Dirkse D, Giannouli E, McQuarrie A. Transdiagnostic cognitive behavioral therapy for nightmares and parasomnias. J Clin Sleep Med 2023; 19:499-509. [PMID: 36468650 PMCID: PMC9978420 DOI: 10.5664/jcsm.10374] [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: 09/07/2022] [Revised: 10/26/2022] [Accepted: 10/26/2022] [Indexed: 12/12/2022]
Abstract
STUDY OBJECTIVES This pilot study determined whether transdiagnostic cognitive behavioral therapy for parasomnias (CBTp) reduces parasomnia and activity levels during sleep in a sample of adult sleep clinic outpatients. A secondary objective was to assess whether treatment produces improvements in daytime fatigue/sleepiness, perceived cognition, mood, and depression/anxiety/stress, as well as functional impairment in work and leisure activities. METHODS This was a randomized controlled trial with CBTp and self-monitoring control conditions. Participants were 19 adults with a DSM 5 parasomnia disorder who received individual CBTp virtually from their homes. CBTp consisted of psychoeducation, sleep hygiene and safety instructions, relaxation training, parasomnia techniques, and relapse prevention in a 6-week manualized, structured program. RESULTS Using a repeated measures analysis of variance model, and relative to a self-monitoring control condition, results showed that CBTp produced statistically significant improvements in parasomnia frequency, severity, nocturnal activity, and sleep efficiency. There was a trend toward reduced sleep-onset latency and improved work and social adjustment. Of treated participants, 100% rated themselves as improved at study conclusion. CONCLUSIONS Implications of these findings are that cognitive behavioral interventions for parasomnias are effective in lessening parasomnias. More investigation into this type of treatment is warranted. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Name: Impact of Cognitive Behavioral Therapy on Parasomnias; URL: https://clinicaltrials.gov/ct2/show/NCT04633668; Identifier: NCT04633668. CITATION Vincent N, Dirkse D, Giannouli E, McQuarrie A. Transdiagnostic cognitive behavioral therapy for nightmares and parasomnias. J Clin Sleep Med. 2023;19(3):499-509.
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Affiliation(s)
- Norah Vincent
- Department of Clinical Health Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Dale Dirkse
- Department of Clinical Health Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Eleni Giannouli
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Amanda McQuarrie
- Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
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McCrae CS, Craggs JG, Curtis AF, Nair N, Kay D, Staud R, Berry RB, Robinson ME. Neural activation changes in response to pain following cognitive behavioral therapy for patients with comorbid fibromyalgia and insomnia: a pilot study. J Clin Sleep Med 2022; 18:203-215. [PMID: 34310276 PMCID: PMC8807905 DOI: 10.5664/jcsm.9540] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
STUDY OBJECTIVES To examine whether cognitive behavioral treatments for insomnia (CBT-I) and pain (CBT-P) lead to neural activation changes in response to pain in fibromyalgia. METHODS Thirty-two patients with fibromyalgia (mean age = 55.9, standard deviation = 12.2) underwent an experimental pain protocol during functional magnetic resonance imaging and completed 14-day diaries assessing total wake time, total sleep time, and pain intensity before and after CBT-I, CBT-P, or waitlist control. Random effects analysis of covariance identified regions with significant group (CBT-I, CBT-P, waitlist control) by time (baseline, post-treatment) interactions in blood oxygen level-dependent response to pain. Linear regressions using residualized change scores examined how changes in total wake time, total sleep time, and pain intensity were related to activation (blood oxygen level-dependent) changes. RESULTS Twelve regions exhibited small to moderate effects with significant interactions Ps < .00; right hemisphere: inferior frontal, middle occipital, and superior temporal gyri, insula, lentiform nucleus; left hemisphere: angular, superior temporal, midfrontal, inferior occipital, midtemporal, and inferior frontal gyri. Blood oxygen level-dependent response to pain decreased in 8 regions following CBT-I, and in 3 regions following CBT-P (CBT-I effects > CBT-P). Blood oxygen level-dependent response also increased in 3 regions following CBT-P and in 6 regions following waitlist control. Improved total wake time and/or total sleep time, not pain intensity, predicted decreased blood oxygen level-dependence in 7 regions (Ps < .05), accounting for 18%-47% of the variance. CONCLUSIONS CBT-I prompted greater decreases in neural activation in response to pain across more regions associated with pain and sleep processing than CBT-P. Reported sleep improvements may underlie those decreases. Future research examining the longer-term impact of CBT-I and improved sleep on central pain and sleep mechanisms is warranted. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Title: Sleep and Pain Interventions in Fibromyalgia (SPIN); Identifier: NCT02001077; URL: https://clinicaltrials.gov/ct2/show/NCT02001077. CITATION McCrae CS, Craggs JG, Curtis AF, et al. Neural activation changes in response to pain following cognitive behavioral therapy for patients with comorbid fibromyalgia and insomnia: a pilot study. J Clin Sleep Med. 2022;18(1):203-215.
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Affiliation(s)
- Christina S. McCrae
- Department of Psychiatry, University of Missouri, Columbia, Missouri,Address correspondence to: Christina S. McCrae, PhD, Department of Psychiatry, 1 Hospital Drive, Columbia, MO 65212; Tel: (573) 882-0982; Fax: (573) 884-1070;
| | - Jason G. Craggs
- Physical Therapy, University of Missouri, Columbia, Missouri,Department of Psychological Sciences, University of Missouri, Columbia, Missouri
| | - Ashley F. Curtis
- Department of Psychiatry, University of Missouri, Columbia, Missouri,Department of Psychological Sciences, University of Missouri, Columbia, Missouri
| | - Neetu Nair
- Department of Psychiatry, University of Missouri, Columbia, Missouri
| | - Daniel Kay
- Department of Psychology, Brigham Young University, Provo, Utah
| | - Roland Staud
- Rheumatology and Clinical Immunology, University of Florida, Gainesville, Florida
| | - Richard B. Berry
- Division of Pulmonary, Critical Care, and Sleep Medicine, Gainesville, Florida
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Westerberg B, Bäärnhielm S, Giles C, Hylén U, Holländare F, Bejerot S. An Internet Based Intervention for Adults With Autism Spectrum Disorder-A Qualitative Study of Participants Experiences. Front Psychiatry 2021; 12:789663. [PMID: 35002808 PMCID: PMC8729877 DOI: 10.3389/fpsyt.2021.789663] [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: 10/05/2021] [Accepted: 12/02/2021] [Indexed: 12/01/2022] Open
Abstract
Background: Adults with autism spectrum disorder face several barriers to accessing evidence-based care, including difficulties in communicating needs, social anxiety or in traveling to a health care unit. In recent years, several forms of internet-based treatments have shown to be effective for a variety of psychiatric conditions. Internet-based treatment alternatives allow convenient and flexible formats, and therefore have the potential to increase access to health care for individuals with autism spectrum disorder. However, knowledge about how internet-based treatment features may suit the needs of individuals with autism is limited. The aim of this study was to explore the participant experiences of an internet-based intervention for adults with autism spectrum disorder. The primary focus of the investigation was on autism-specific needs in relation to the features unique to the online format. Methods: In this qualitative study, semi-structured telephone interviews were conducted with 14 participants who had completed a text-based internet-based intervention for adults with autism spectrum disorder. We used an inductive approach and analyzed the data using qualitative content analysis. Results: Five main categories were identified: (1) implications of the online format, (2) the fixed non-individualized model, (3) therapist interaction, (4) interacting with other participants, and (5) making use of the treatment content. Overall, participants appreciated the availability and that they could work on their treatment independent of time or location. Among those participating in group-based chat-sessions with the other participants, it was considered a generally positive experience. Furthermore, most participants felt safe and relaxed in relation to the therapist and appreciated the text-based format. However, several participants felt that the format and content of the treatment was not sufficiently adapted to their individual life situation. Conclusion: In conclusion, this internet-based treatment constitutes an accessible and energy-saving treatment alternative for adults with autism. Further, integrating group-based components seems feasible in an otherwise individual internet-based treatment for individuals with autism. However, group-based components do require a clear purpose and rationale. Future studies should develop and evaluate treatment adaptations tailored to individual needs.
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Affiliation(s)
- Britta Westerberg
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Sofie Bäärnhielm
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm Health Care Services, Stockholm, Sweden
| | - Clover Giles
- Center for Lifespan Developmental Research, Örebro University, Örebro, Sweden
| | - Ulrika Hylén
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Fredrik Holländare
- Department of Psychiatry, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Susanne Bejerot
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Chinman M, McCarthy S, Holden J, Link P, Granholm E. Pilot Test of Using Peer Specialists to Deliver Cognitive-Behavioral Social Skills Training. Am J Psychiatr Rehabil 2021; 22:168-178. [PMID: 36714045 PMCID: PMC9881229] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
A pilot study of Veterans with serious mental illness assessed fidelity and preliminary outcomes of peer specialist (PS)-delivered Cognitive-Behavioral Social Skills Training (CBSST). A single-arm, baseline-post pilot involved 4 PSs and 12 Veterans, split between two sites. Five functioning and symptom measures were administered before and after the 12-week intervention. Half of all sessions were rated on a standardized fidelity measure. Four outcomes (symptoms, hope, defeatist attitudes, skill learning) showed statistically significant improvement. Effect sizes and fidelity ratings matched previous trials with the training, and the fidelity ratings exceeded the threshold for competence. Although more research is needed, PSs could improve services for serious mental illness by delivering structured interventions.
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Affiliation(s)
- Matthew Chinman
- VA Pittsburgh Healthcare System University Drive Division, CHERP/MIRECC, Pittsburgh, PA, USA; RAND Corporation, Santa Monica, CA, USA
| | - Sharon McCarthy
- VA Pittsburgh Healthcare System University Drive Division, Health Science, Pittsburgh, PA, USA
| | - Jason Holden
- VA San Diego Healthcare System, San Diego, CA, USA
| | - Peter Link
- VA San Diego Healthcare System, San Diego, CA, USA
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Proserpio P, Marra S, Campana C, Agostoni EC, Palagini L, Nobili L, Nappi RE. Insomnia and menopause: a narrative review on mechanisms and treatments. Climacteric 2020; 23:539-549. [PMID: 32880197 DOI: 10.1080/13697137.2020.1799973] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The menopausal transition is associated with an increased frequency of sleep disturbances. Insomnia represents one of the most reported symptoms by menopausal women. According to its pathogenetic model (3-P Model), different predisposing factors (i.e. a persistent condition of past insomnia and aging per se) increase the risk of insomnia during menopause. Moreover, multiple precipitating and perpetuating factors should favor its occurrence across menopause, including hormonal changes, menopausal transition stage symptoms (i.e. hot flashes, night sweats), mood disorders, poor health and pain, other sleep disorders and circadian modifications. Thus, insomnia management implies a careful evaluation of the psychological and somatic symptoms of the individual menopausal woman by a multidisciplinary team. Therapeutic strategies encompass different drugs but also behavioral interventions. Indeed, cognitive behavioral therapy represents the first-line treatment of insomnia in the general population, regardless of the presence of mood disorders and/or vasomotor symptoms (VMS). Different antidepressants seem to improve sleep disturbances. However, when VMS are present, menopausal hormone therapy should be considered in the treatment of related insomnia taking into account the risk-benefit profile. Finally, given its good tolerability, safety, and efficacy on multiple sleep and daytime parameters, prolonged-released melatonin should represent a first-line drug in women aged ≥ 55 years.
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Affiliation(s)
- P Proserpio
- Center of Sleep Medicine, Department of Neuroscience, Niguarda Hospital, Milan, Italy
| | - S Marra
- DINOGMI, University of Genoa, Genoa, Italy
| | - C Campana
- Center of Sleep Medicine, Department of Neuroscience, Niguarda Hospital, Milan, Italy
| | - E C Agostoni
- Center of Sleep Medicine, Department of Neuroscience, Niguarda Hospital, Milan, Italy
| | - L Palagini
- Department of Clinical Experimental Medicine, Psychiatric Unit, School of Medicine, University of Pisa, Pisa, Italy
| | - L Nobili
- DINOGMI, University of Genoa, Genoa, Italy.,IRCCS G. Gaslini Institute, University of Genoa, Genoa, Italy
| | - R E Nappi
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, Obstetrics and Gynecology Unit, IRCCS S. Matteo Foundation, Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy
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Sheffer CE, Stein JS, Petrucci C, Mahoney MC, Johnson S, Giesie P, Carl E, Krupski L, Tegge AN, Reid ME, Bickel WK, Hyland A. Tobacco Dependence Treatment in Oncology: Initial Patient Clinical Characteristics and Outcomes from Roswell Park Comprehensive Cancer Center. Int J Environ Res Public Health 2020; 17:E3907. [PMID: 32486463 PMCID: PMC7312979 DOI: 10.3390/ijerph17113907] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/11/2020] [Accepted: 05/22/2020] [Indexed: 01/28/2023]
Abstract
Despite the importance of smoking cessation to cancer care treatment, historically, few cancer centers have provided treatment for tobacco dependence. To address this gap, the National Cancer Institute (NCI) launched the Cancer Center Cessation Initiative (C3i). As part of this effort, this study examined implementation outcomes in a cohort of cancer survivors (CSs) who smoked cigarettes in the first year of an ongoing process to develop and implement a robust Tobacco Treatment Service at Roswell Park Comprehensive Cancer Center. We provide a comprehensive description of the new tobacco use assessment and referral process, and of the characteristics of cancer survivors who agreed to treatment including traditional tobacco-related psychosocial and cancer treatment-related characteristics and novel characteristics such as delay discounting rates. We also examine characteristic differences among those who agreed to treatment between those who attended and those who did not attend treatment. As the new tobacco assessment was implemented, the number of referrals increased dramatically. The mean number of treatment sessions attended was 4.45 (SD = 2.98) and the six-month point prevalence intention to treat abstinence rate among those who attended was 22.7%. However, only 6.4% agreed to treatment and 4% attended at least one treatment session. A large proportion of cancer survivors who agreed to treatment were women, of older age, of lower socioeconomic status (SES), and who had high levels of depressive symptomology. The findings demonstrate that the implementation of system changes can significantly improve the identification of cancer survivors who use tobacco and are referred to tobacco use treatment. Among those who attend, treatment is effective. However, the findings also suggest that a systematic assessment of barriers to engagement is needed and that cancer survivors may benefit from additional treatment tailoring. We present plans to address these implementation challenges. Systematic electronic medical record (EMR)-sourced referral to tobacco treatment is a powerful tool for reaching cancer survivors who smoke, but more research is needed to determine how to enhance engagement and tailor treatment processes.
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Affiliation(s)
- Christine E. Sheffer
- Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA; (C.P.); (M.C.M.); (S.J.); (P.G.); (E.C.); (L.K.); (M.E.R.); (A.H.)
| | - Jeffrey S. Stein
- Fralin Biomedical Research Institute at VTC, Roanoke, VA 24016, USA; (J.S.S.); (A.N.T.); (W.K.B.)
| | - Cara Petrucci
- Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA; (C.P.); (M.C.M.); (S.J.); (P.G.); (E.C.); (L.K.); (M.E.R.); (A.H.)
| | - Martin C. Mahoney
- Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA; (C.P.); (M.C.M.); (S.J.); (P.G.); (E.C.); (L.K.); (M.E.R.); (A.H.)
| | - Shirley Johnson
- Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA; (C.P.); (M.C.M.); (S.J.); (P.G.); (E.C.); (L.K.); (M.E.R.); (A.H.)
| | - Pamela Giesie
- Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA; (C.P.); (M.C.M.); (S.J.); (P.G.); (E.C.); (L.K.); (M.E.R.); (A.H.)
| | - Ellen Carl
- Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA; (C.P.); (M.C.M.); (S.J.); (P.G.); (E.C.); (L.K.); (M.E.R.); (A.H.)
| | - Laurie Krupski
- Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA; (C.P.); (M.C.M.); (S.J.); (P.G.); (E.C.); (L.K.); (M.E.R.); (A.H.)
| | - Allison N. Tegge
- Fralin Biomedical Research Institute at VTC, Roanoke, VA 24016, USA; (J.S.S.); (A.N.T.); (W.K.B.)
| | - Mary E. Reid
- Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA; (C.P.); (M.C.M.); (S.J.); (P.G.); (E.C.); (L.K.); (M.E.R.); (A.H.)
| | - Warren K. Bickel
- Fralin Biomedical Research Institute at VTC, Roanoke, VA 24016, USA; (J.S.S.); (A.N.T.); (W.K.B.)
| | - Andrew Hyland
- Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA; (C.P.); (M.C.M.); (S.J.); (P.G.); (E.C.); (L.K.); (M.E.R.); (A.H.)
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Abstract
This study examined the effects of cognitive behavioral treatment for insomnia. A randomized controlled trial was performed on 44 women. The intervention included one group session of sleep hygiene education and four individual sessions of counseling. The instruments included the Insomnia Severity Index, Pittsburgh Sleep Quality Index, the Center for Epidemiological Studies Depression Scale, and Menopausal quality of life. The data were analyzed using repeated measure MANOVA, followed by repeated measure ANOVA. Repeated measure MANOVA showed that time had a significant main effect on the anthropometric variables (body mass index, waist circumference, and blood pressures) and revealed significant main effects of the group and time on the psychosocial variables (sleep quality, insomnia, depressive symptoms, and quality of life) (p < .05). Repeated measure ANOVA results indicated a significant effect of the group on insomnia and sleep quality (p < .05). Overall, the intervention was effective in improving insomnia and poor sleep quality.
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Affiliation(s)
- Ok Kyung Ham
- Department of Nursing, Inha University, Incheon, Republic of Korea
| | - Bo Gyeong Lee
- College of Nursing, Daegu Catholic University, Daegu, Republic of Korea
| | - Eunju Choi
- College of Nursing, University of Texas at Austin, Austin, TX, USA
| | - Su Jung Choi
- Graduate School of Clinical Nursing Science, Samsung Medical Center, Sungkyunkwan University, Suwon, Republic of Korea
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Barnes DM, Jarlais DD. Feasibility of a simple and scalable cognitive-behavioral intervention to treat problem substance use. J Subst Use 2019; 24:693-695. [PMID: 31692875 DOI: 10.1080/14659891.2019.1657190] [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] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Our proof-of-concept study tested a simple cognitive-behavioral strategy based on experimental psychology research that draws on the concept of self-distancing and is consistent with mindfulness principles - using non-first person self-talk when facing substance use cues or cravings -- to help people achieve substance use goals. We evaluated participants' understanding, use, and utility of the intervention at follow-up. METHOD We recruited 17 New York City residents who used drugs. At baseline, we collected demographic and substance use data and conducted the intervention. At one-week follow-up, participants were asked about their understanding, use, and perceived utility of the intervention, and asked to complete an anonymous five-item assessment of the intervention. RESULTS Sixteen participants completed follow-up. Understanding was judged "acceptable" or better for 15; 11 used their scripts during follow-up; four described their scripts as very useful, one as moderately, five as a little, and one as not useful. Nine returned assessments; ratings were strongly favorable. CONCLUSIONS Results from our pilot are encouraging and point to further research on this intervention. The intervention is suitable for integration into longer-term therapy and we envision non-first person self-talk as one strategy alongside others individuals can employ to moderate their substance use.
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Affiliation(s)
- David M Barnes
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, 39 Broadway, Suite 530, New York, NY 10006, U.S.A.,Permanent address: Department of Epidemiology, College of Global Public Health, New York University, 665 Broadway, 8 floor, New York, NY 10012, U.S.A
| | - Don Des Jarlais
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, 39 Broadway, Suite 530, New York, NY 10006, U.S.A.,Permanent address: Department of Epidemiology, College of Global Public Health, New York University, 665 Broadway, 8 floor, New York, NY 10012, U.S.A
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11
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Abstract
One-Session Treatment is a well-established evidence-based treatment for specific phobias in youths that incorporates reinforcement, cognitive challenges, participant modeling, psychoeducation, and skills training into a single, massed session of graduated exposure. This review begins by briefly examining the phenomenology, etiology, epidemiology, and assessment of specific phobias and then pivots to a description of One-Session Treatment. We examine the use of One-Session Treatment with children and adolescents, briefly discussing its components and application, and subsequently review almost two decades of research supporting its efficacy. Finally, we propose future directions for research and practice.
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Affiliation(s)
- Thompson E Davis
- Department of Psychology, Louisiana State University, Baton Rouge, Louisiana 70803, USA;
| | - Thomas H Ollendick
- Department of Psychology, Virginia Polytechnic Institute and State University, Blacksburg, Virginia 24060, USA;
| | - Lars-Göran Öst
- Department of Psychology, Stockholm University, SE-106 91 Stockholm, Sweden;
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12
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Sevil Degirmenci S, Kosger F, Altinoz AE, Essizoglu A, Aksaray G. The relationship between separation anxiety and intolerance of uncertainty in pregnant women. J Matern Fetal Neonatal Med 2019; 33:2927-2932. [PMID: 30585096 DOI: 10.1080/14767058.2018.1564030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background and aim: Pregnancy is a risky period to develop Adult Separation Anxiety Disorder (ASAD). The aim of this study was to investigate the frequency of separation anxiety in pregnant women, and the relationship of separation anxiety with sociodemographic variables and intolerance of uncertainty.Methods: This study included 310 pregnant women and used the Adult Separation Anxiety Questionnaire (ASAQ) and Intolerance of Uncertainty Scale-Short Form (IUS-12).Results: The average age in pregnant women with ASAD was lower. IUS-12 total score, prospective anxiety, and inhibitory anxiety subscale scores were significantly higher in the ASAD group. There were moderate and statistically significant positive correlations between the ASAD score and the IUS-12 total, prospective anxiety and inhibitory anxiety subscale scores.Conclusion: Intolerance of uncertainty may be an important factor in the mental processes of individuals with separation anxiety. Pregnancy period can be a risky period for developing ASAD. Cognitive behavioral treatments including intolerance of uncertainty may be effective in the treatment of ASAD. There is a need for follow-up studies on the effects of separation anxiety during pregnancy on maternal-fetal health.
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Affiliation(s)
| | - Ferdi Kosger
- Department of Psychiatry, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Ali Ercan Altinoz
- Department of Psychiatry, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | | | - Gokay Aksaray
- Department of Psychiatry, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
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13
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Ferwerda M, van Beugen S, van Middendorp H, Visser H, Vonkeman H, Creemers M, van Riel P, Kievit W, Evers A. Tailored, Therapist-Guided Internet-Based Cognitive Behavioral Therapy Compared to Care as Usual for Patients With Rheumatoid Arthritis: Economic Evaluation of a Randomized Controlled Trial. J Med Internet Res 2018; 20:e260. [PMID: 30309835 PMCID: PMC6231867 DOI: 10.2196/jmir.9997] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 04/16/2018] [Accepted: 05/08/2018] [Indexed: 12/31/2022] Open
Abstract
Background Internet-based cognitive behavioral therapy can aid patients with rheumatoid arthritis with elevated levels of distress to enhance their quality of life. However, implementation is currently lacking and there is little evidence available on the (cost-) effectiveness of different treatment strategies. Objective Cost-benefit ratios are necessary for informing stakeholders and motivating them to implement effective treatment strategies for improving health-related quality of life (HRQoL) of patients with rheumatoid arthritis. A cost-effectiveness study from a societal perspective was conducted alongside a randomized controlled trial on a tailored, therapist-guided internet-based cognitive behavioral therapy (ICBT) intervention for patients with rheumatoid arthritis with elevated levels of distress as an addition to care as usual (CAU). Methods Data were collected at baseline or preintervention, 6 months or postintervention, and every 3 months thereafter during the 1-year follow-up. Effects were measured in terms of quality-adjusted life years (QALYs) and costs from a societal perspective, including health care sector costs (health care use, medication, and intervention costs), patient travel costs for health care use, and costs associated with loss of labor. Results The intervention improved the quality of life compared with only CAU (Δ QALYs=0.059), but at a higher cost (Δ=€4211). However, this increased cost substantially reduced when medication costs were left out of the equation (Δ=€1863). Of all, 93% (930/1000) of the simulated incremental cost-effectiveness ratios were in the north-east quadrant, indicating a high probability that the intervention was effective in improving HRQoL, but at a greater monetary cost for society compared with only CAU. Conclusions A tailored and guided ICBT intervention as an addition to CAU for patients with rheumatoid arthritis with elevated levels of distress was effective in improving quality of life. Consequently, implementation of ICBT into standard health care for patients with rheumatoid arthritis is recommended. However, further studies on cost reductions in this population are warranted. Trial Registration Nederlands Trial Register NTR2100; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2100 (Archived by WebCite at http://www.webcitation.org/724t9pvr2)
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Affiliation(s)
- Maaike Ferwerda
- Health, Medical and Neuropsychology Department, Institute of Psychology, Leiden University, Leiden, Netherlands.,Medical Psychology Department, Radboud University Medical Center, Nijmegen, Netherlands
| | - Sylvia van Beugen
- Health, Medical and Neuropsychology Department, Institute of Psychology, Leiden University, Leiden, Netherlands.,Medical Psychology Department, Radboud University Medical Center, Nijmegen, Netherlands
| | - Henriët van Middendorp
- Health, Medical and Neuropsychology Department, Institute of Psychology, Leiden University, Leiden, Netherlands.,Medical Psychology Department, Radboud University Medical Center, Nijmegen, Netherlands
| | - Henk Visser
- Department of Rheumatology, Rijnstate Hospital, Arnhem, Netherlands
| | - Harald Vonkeman
- University of Twente, Enschede, Netherlands.,Arthritis Center Twente, Department of Rheumatology and Clinical Immunology, Medisch Spectrum Twente, Enschede, Netherlands
| | - Marjonne Creemers
- Department of Rheumatology, Jeroen Bosch Hospital, Den Bosch, Netherlands
| | - Piet van Riel
- Scientific Institute for Quality of Healthcare, Radboud University Medical Center, Nijmegen, Netherlands
| | - Wietske Kievit
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, Netherlands
| | - Andrea Evers
- Health, Medical and Neuropsychology Department, Institute of Psychology, Leiden University, Leiden, Netherlands.,Medical Psychology Department, Radboud University Medical Center, Nijmegen, Netherlands
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14
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Abstract
This review provides an overview of learning mechanisms and memory aspects for the development of chronic pain. Pain can be influenced in important ways by an individual's personality, by family, and by the sociocultural environment in which they live. Therefore, learning mechanisms can explain why pain experience and pain behavior can increase or decrease. Linking pain with positive consequences or removing negative consequences can contribute significantly to the chronification of pain. We will provide an overview of treatment options that use the characteristics of extinction. Operant extinction training and cognitive behavioral approaches show promising results for the treatment of chronic pain.
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15
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Bratti-van der Werf MK, Laurens MC, Postel MG, Pieterse ME, Ben Allouch S, Wiers RW, Bohlmeijer ET, Salemink E. Augmenting Outpatient Alcohol Treatment as Usual With Online Alcohol Avoidance Training: Protocol for a Double-Blind Randomized Controlled Trial. JMIR Res Protoc 2018; 7:e55. [PMID: 29496657 PMCID: PMC5856929 DOI: 10.2196/resprot.9287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 12/22/2017] [Accepted: 12/22/2017] [Indexed: 11/29/2022] Open
Abstract
Background Recent theoretical models emphasize the role of impulsive processes in alcohol addiction, which can be retrained with computerized Cognitive Bias Modification (CBM) training. In this study, the focus is on action tendencies that are activated relatively automatically. Objective The aim of the study is to examine the effectiveness of online CBM Alcohol Avoidance Training using an adapted Approach-Avoidance Task as a supplement to treatment as usual (TAU) in an outpatient treatment setting. Methods The effectiveness of 8 online sessions of CBM Alcohol Avoidance Training added to TAU is tested in a double-blind, randomized controlled trial with pre- and postassessments, plus follow-up assessments after 3 and 6 months. Participants are adult patients (age 18 years or over) currently following Web-based or face-to-face TAU to reduce or stop drinking. These patients are randomly assigned to a CBM Alcohol Avoidance or a placebo training. The primary outcome measure is a reduction in alcohol consumption. We hypothesize that TAU + CBM will result in up to a 13-percentage point incremental effect in the number of patients reaching the safe drinking guidelines compared to TAU + placebo CBM. Secondary outcome measures include an improvement in health status and a decrease in depression, anxiety, stress, and possible mediation by the change in approach bias. Finally, patients’ adherence, acceptability, and credibility will be examined. Results The trial was funded in 2014 and is currently in the active participant recruitment phase (since May 2015). Enrolment will be completed in 2019. First results are expected to be submitted for publication in 2020. Conclusions The main purpose of this study is to increase our knowledge about the added value of online Alcohol Avoidance Training as a supplement to TAU in an outpatient treatment setting. If the added effectiveness of the training is proven, the next step could be to incorporate the intervention into current treatment. Trial Registration Netherlands Trial Register NTR5087; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=5087 (Archived at WebCite http://www.webcitation.org/6wuS4i1tH)
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Affiliation(s)
| | - Melissa C Laurens
- Technology, Health & Care Research Group, Saxion University of Applied Sciences, Enschede, Netherlands.,Centre for eHealth and Well-Being Research, Department of Psychology, Health & Technology, University of Twente, Enschede, Netherlands
| | - Marloes G Postel
- Centre for eHealth and Well-Being Research, Department of Psychology, Health & Technology, University of Twente, Enschede, Netherlands.,Tactus Addiction Treatment, Enschede, Netherlands
| | - Marcel E Pieterse
- Centre for eHealth and Well-Being Research, Department of Psychology, Health & Technology, University of Twente, Enschede, Netherlands
| | - Somaya Ben Allouch
- Technology, Health & Care Research Group, Saxion University of Applied Sciences, Enschede, Netherlands
| | - Reinout W Wiers
- Addiction Development and Psychopathology Lab, Department of Development Psychology, University of Amsterdam, Amsterdam, Netherlands
| | - Ernst T Bohlmeijer
- Centre for eHealth and Well-Being Research, Department of Psychology, Health & Technology, University of Twente, Enschede, Netherlands
| | - Elske Salemink
- Addiction Development and Psychopathology Lab, Department of Development Psychology, University of Amsterdam, Amsterdam, Netherlands
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16
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Nyhuis PW, Niederhofer E, Scherbaum N, Schifano F, Bonnet U, Dembski N, Niederhofer A, Specka M, Tenbergen M. Effectiveness of Psychoanalytic-Interactional Group Therapy vs. Behavioral Group Therapy in Routine Outpatient Treatment of Alcohol-Dependent Patients. Subst Use Misuse 2018; 53:426-431. [PMID: 29016275 DOI: 10.1080/10826084.2017.1334065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 12/20/2022]
Abstract
BACKGROUND The cognitive behavioral therapy has been extensively investigated to assess relapse prevention rates in patients with alcohol dependence. In contrast, only little is known regarding the effectiveness of psychoanalytical psychotherapy in relapse prevention, although this treatment is widely used and especially so in Germany. The aim of this quasi-randomized study was to compare the effectiveness of these two group treatments' approaches under the condition of routine outpatient treatment in a non-university hospital. METHODS After inpatient detoxification, patients with alcohol dependence were allocated either to combined behavioral intervention (CBI) or to psychoanalytic-interactional therapy (PIT). The group treatment was carried out weekly over a period of six months. Also, the clinical care package included both individual treatment sessions (e.g. every 4-6 weeks) and abstinence supporting medication. The main outcome criteria included retention rates and frequency of alcohol relapse. RESULTS Some 215 patients (mean age 49.6 years [standard deviation, 10], 56.7% males, with a mean duration of alcohol dependence of 16.5 years [range: 1-50 years]) were included in the study. Overall, CBI clients showed a retention rate of 66.7%, compared to 81.8% for PIT clients (p =.008). An intention-to-treat analysis of alcohol relapses showed a significant difference between PIT and CBI groups (PIT: 33.6%; CBI: 49.5%; p =.018). There were no statistically significant differences between the 2 groups in terms of prescription rates of disulfiram, naltrexone or acamprosate. CONCLUSIONS Notwithstanding the study limitations, PIT seemed here to be at least as effective as CBI in terms of retention and relapse prevention rates' levels.
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Affiliation(s)
- Peter W Nyhuis
- a Department of Psychiatry, Psychotherapy and Psychosomatics , St. Marien Hospital Eickel , Herne , Germany
| | - Eva Niederhofer
- a Department of Psychiatry, Psychotherapy and Psychosomatics , St. Marien Hospital Eickel , Herne , Germany
| | - Norbert Scherbaum
- b LVR-Hospital Essen, Department of Addictive Behaviour and Addiction Medicine, Faculty of Medicine , University of Duisburg-Essen , Essen , Germany
| | - Fabrizio Schifano
- c Psychopharmacology, Substance Misuse and Novel Psychoactive Substances Research Unit , University of Hertfordshire , Hatfield , Hertfordshire , United Kingdom
| | - Udo Bonnet
- d Department of Psychiatry, Psychotherapy, and Psychosomatic Medicine , Evangelisches Krankenhaus Castrop-Rauxel, Academic Teaching Hospital of University of Duisburg/Essen Grutholzallee , Castrop-Rauxel , Germany
| | - Nikolai Dembski
- a Department of Psychiatry, Psychotherapy and Psychosomatics , St. Marien Hospital Eickel , Herne , Germany
| | - Anna Niederhofer
- a Department of Psychiatry, Psychotherapy and Psychosomatics , St. Marien Hospital Eickel , Herne , Germany
| | - Michael Specka
- b LVR-Hospital Essen, Department of Addictive Behaviour and Addiction Medicine, Faculty of Medicine , University of Duisburg-Essen , Essen , Germany
| | - Meike Tenbergen
- a Department of Psychiatry, Psychotherapy and Psychosomatics , St. Marien Hospital Eickel , Herne , Germany
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17
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White MA, Ivezaj V, Grilo CM. Evaluation of a web-based cognitive behavioral smoking cessation treatment for overweight/obese smokers. J Health Psychol 2017; 24:1796-1806. [PMID: 28810442 DOI: 10.1177/1359105317701560] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
This pilot study tested the efficacy of an Internet-administered smoking cessation treatment for overweight/obese smokers. Participants were 54 community volunteers with overweight/obesity who were regular smokers. Treatment consisted of 12 weeks of nicotine replacement therapy and randomization to Internet-administered cognitive behavioral treatment or health education. In-person assessments of key outcomes occurred at baseline, post-treatment, and at 24-week follow-up. Cessation rates did not differ across the two treatments (25.9% vs 18.5%). Participants receiving cognitive behavioral treatment gained less weight when abstinent than those receiving the standard treatment. Larger studies are needed to replicate these findings.
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Affiliation(s)
- Marney A White
- Department of Social and Behavioral Sciences, Yale School of Public Health, USA.,Program for Obesity, Weight, and Eating Research, Department of Psychiatry, Yale University School of Medicine, USA
| | - Valentina Ivezaj
- Program for Obesity, Weight, and Eating Research, Department of Psychiatry, Yale University School of Medicine, USA
| | - Carlos M Grilo
- Program for Obesity, Weight, and Eating Research, Department of Psychiatry, Yale University School of Medicine, USA.,Department of Psychology, Yale University, USA.,CASAColumbia, Yale University School of Medicine, USA
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18
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Abstract
Fibroline is a mobile application with a self-administered cognitive behavioral treatment for young people with fibromyalgia or chronic widespread pain, designed to reduce pain and other common negative symptoms and improve quality of life. Our aims are to report on the usability and feasibility protocols used to assess the app. Two usability cycles were implemented. A group of patients followed the cognitive behavioral treatment intervention to test its feasibility. Qualitative data were collected and content analyses were conducted. The results demonstrated that the app is error-free, easy to use, liked by the users, and acceptable.
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Affiliation(s)
- Rocío de la Vega
- 1 University of Washington, USA.,2 Universitat Rovira i Virgili, Catalonia, Spain
| | - Roman Roset
- 2 Universitat Rovira i Virgili, Catalonia, Spain
| | | | - Jordi Miró
- 2 Universitat Rovira i Virgili, Catalonia, Spain.,3 Chair in Pediatric Pain URV-Fundación Grünenthal, Catalonia, Spain
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19
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Abstract
Among the available treatments for disruptive behavior problems, a need remains for additional service options to reduce antisocial behavior and prevent further development along delinquent and violent pathways. The Stop Now and Plan (SNAP) Program is an intervention for antisocial behavior among boys between 6 and 11. This paper describes a randomized controlled treatment effectiveness study of SNAP versus standard behavioral health services. The treatment program was delivered to youth with aggressive, rule-breaking, or antisocial behavior in excess of clinical criterion levels. Outcomes were measured at 3, 9, and 15 months from baseline. Youth in the SNAP condition showed significantly greater reduction in aggression, conduct problems, and overall externalizing behavior, as well as counts of oppositional defiant disorder and attention deficit hyperactivity disorder symptoms. Additional benefits for SNAP were observed on measures of depression and anxiety. Further analyses indicated that the SNAP program was more effective among those with a higher severity of initial behavioral problems. At 1 year follow-up, treatment benefits for SNAP were maintained on some outcome measures (aggression, ADHD and ODD, depression and anxiety) but not others. Although overall juvenile justice system contact was not significantly different, youth in SNAP had significantly fewer charges against them relative to those standard services. The SNAP Program, when contrasted with standard services alone, was associated with greater, clinically meaningful, reductions in targeted behaviors. It may be particularly effective for youth with more severe behavioral problems and may result in improvements in internalizing problems as well.
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Affiliation(s)
- Jeffrey D Burke
- Western Psychiatric Institute and Clinic, University of Pittsburgh, 3811 O'Hara Street, Pittsburgh, PA, 15213, USA,
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20
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Abstract
This review discusses the research evidence for psychological treatment of gambling disorder. Several treatment options for gamblers have been explored, ranging from self-help and peer support, to brief and motivational interventions, to more intensive therapy approaches. Involvement in peer support programs seems to be optimal when combined with professional treatment; however, engagement and retention in peer support is limited. Self-directed interventions appear to benefit some gamblers; however, the involvement of therapist support, either in person or by telephone, may bolster these effects and such support need not be extensive. These self-directed options reduce the barriers associated with treatment-seeking, and may reach a wider range of gamblers than professionally delivered treatments alone. Brief and motivational approaches similarly may extend treatment options to more gamblers, namely at-risk and problem gamblers and those not seeking treatment. Of more extensive therapies, no consistent benefit of one approach emerges, although cognitive–behavioral interventions have been most often applied. Overall, several treatments have been developed for gambling disorder and results are promising, but variability in findings suggests a need for further systematic evaluation.
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Affiliation(s)
- Carla J Rash
- Department of Medicine, University of Connecticut Health Center, Farmington, CT, USA
| | - Nancy M Petry
- Department of Medicine, University of Connecticut Health Center, Farmington, CT, USA
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21
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Cachelin FM, Shea M, Phimphasone P, Wilson GT, Thompson DR, Striegel RH. Culturally adapted cognitive behavioral guided self-help for binge eating: a feasibility study with Mexican Americans. Cultur Divers Ethnic Minor Psychol 2014; 20:449-457. [PMID: 25045955 PMCID: PMC4107360 DOI: 10.1037/a0035345] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [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] [Indexed: 06/03/2023]
Abstract
Objective was to test feasibility and preliminary efficacy of a culturally adapted cognitive-behavioral self-help program to treat binge eating and related problems in Mexican Americans. Participants were 31 women recruited from the Los Angeles area and diagnosed with binge eating disorder, recurrent binge eating, or bulimia nervosa. Participants completed a culturally adapted version of a CBT-based self-help program with 8 guidance sessions over a 3-month period. Treatment efficacy was evaluated in terms of binge eating, psychological functioning, and weight loss. Intent-to-treat analyses revealed 35.5% abstinence from binge eating at posttreatment and 38.7% diagnostic remission. Results indicated significant pretreatment to posttreatment improvement on distress level, BMI, eating disorder psychopathology, and self-esteem. Satisfaction with the program was high. Findings demonstrate that the program is acceptable, feasible, and efficacious in reducing binge eating and associated symptoms for Mexican American women. Study provides "proof of concept" for implementation of culturally adapted forms of evidence-based programs.
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Affiliation(s)
- Fary M Cachelin
- Department of Psychology, University of North Carolina at Charlotte
| | - Munyi Shea
- Department of Psychology, California State University
| | | | - G Terence Wilson
- Graduate School of Applied and Professional Psychology, Rutgers, The State University of New Jersey
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22
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Dorrepaal E, Thomaes K, Hoogendoorn AW, Veltman DJ, Draijer N, van Balkom AJLM. Evidence-based treatment for adult women with child abuse-related Complex PTSD: a quantitative review. Eur J Psychotraumatol 2014; 5:23613. [PMID: 25563302 PMCID: PMC4199330 DOI: 10.3402/ejpt.v5.23613] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [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] [Received: 12/23/2013] [Revised: 07/14/2014] [Accepted: 08/19/2014] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Effective first-line treatments for posttraumatic stress disorder (PTSD) are well established, but their generalizability to child abuse (CA)-related Complex PTSD is largely unknown. METHOD A quantitative review of the literature was performed, identifying seven studies, with treatments specifically targeting CA-related PTSD or Complex PTSD, which were meta-analyzed, including variables such as effect size, drop-out, recovery, and improvement rates. RESULTS Only six studies with one or more cognitive behavior therapy (CBT) treatment conditions and one with a present centered therapy condition could be meta-analyzed. RESULTS indicate that CA-related PTSD patients profit with large effect sizes and modest recovery and improvement rates. Treatments which include exposure showed greater effect sizes especially in completers' analyses, although no differential results were found in recovery and improvement rates. However, results in the subgroup of CA-related Complex PTSD studies were least favorable. Within the Complex PTSD subgroup, no superior effect size was found for exposure, and affect management resulted in more favorable recovery and improvement rates and less drop-out, as compared to exposure, especially in intention-to-treat analyses. CONCLUSION Limited evidence suggests that predominantly CBT treatments are effective, but do not suffice to achieve satisfactory end states, especially in Complex PTSD populations. Moreover, we propose that future research should focus on direct comparisons between types of treatment for Complex PTSD patients, thereby increasing generalizability of results.
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Affiliation(s)
- Ethy Dorrepaal
- GGZ inGeest, Amsterdam, The Netherlands; Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands; EMGO Institute, VU University Medical Center, Amsterdam, The Netherlands; PsyQ, Parnassia Groep, The Hague, The Netherlands;
| | - Kathleen Thomaes
- GGZ inGeest, Amsterdam, The Netherlands; Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands
| | | | - Dick J Veltman
- GGZ inGeest, Amsterdam, The Netherlands; Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands
| | - Nel Draijer
- GGZ inGeest, Amsterdam, The Netherlands; Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands; EMGO Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Anton J L M van Balkom
- GGZ inGeest, Amsterdam, The Netherlands; Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands; EMGO Institute, VU University Medical Center, Amsterdam, The Netherlands
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23
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Dorrepaal E, Thomaes K, Smit JH, Veltman DJ, Hoogendoorn AW, van Balkom AJLM, Draijer N. Treatment compliance and effectiveness in complex PTSD patients with co-morbid personality disorder undergoing stabilizing cognitive behavioral group treatment: a preliminary study. Eur J Psychotraumatol 2013; 4:21171. [PMID: 24224077 PMCID: PMC3820917 DOI: 10.3402/ejpt.v4i0.21171] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Revised: 09/05/2013] [Accepted: 09/14/2013] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND In the empirical and clinical literature, complex posttraumatic stress disorder (PTSD) and personality disorders (PDs) are suggested to be predictive of drop-out or reduced treatment effectiveness in trauma-focused PTSD treatment. OBJECTIVE In this study, we aimed to investigate if personality characteristics would predict treatment compliance and effectiveness in stabilizing complex PTSD treatment. METHOD In a randomized controlled trial on a 20-week stabilizing group cognitive behavioral treatment (CBT) for child-abuse-related complex PTSD, we included 71 patients of whom 38 were randomized to a psycho-educational and cognitive behavioral stabilizing group treatment. We compared the patients with few PD symptoms (adaptive) (N=14) with the non-adaptive patients (N=24) as revealed by a cluster analysis. RESULTS We found that non-adaptive patients compared to the adaptive patients showed very low drop-out rates. Both non-adaptive patients, classified with highly different personality profiles "withdrawn" and "aggressive," were equally compliant. With regard to symptom reduction, we found no significant differences between subtypes. Post-hoc, patients with a PD showed lower drop-out rates and higher effect sizes in terms of complex PTSD severity, especially on domains that affect regulation and interpersonal problems. CONCLUSIONS Contrary to our expectations, these preliminary findings indicate that this treatment is well tolerated by patients with a variety of personality pathology. Larger sample sizes are needed to study effectiveness for subgroups of complex PTSD patients.
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Affiliation(s)
- Ethy Dorrepaal
- GGZ inGeest, Amsterdam, The Netherlands ; Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands ; EMGO Institute, VU University Medical Center, Amsterdam, The Netherlands ; PsyQ, Parnassiagroep, The Hague, The Netherlands
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24
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Abstract
INTRODUCTION Multimodal approaches in behavioral treatment have gained recent interest, with proven efficacy for migraine. The utility of the Internet has been demonstrated for behavioral treatment of headache disorders, but not specifically for migraine. The aim of the study was to develop and evaluate an Internet-based multimodal behavior treatment (MBT) program for migraine and to test hand massage treatment as an adjunct. METHODS Eighty-three adults, 58 women and 25 men, with at least two migraine attacks a month were recruited via advertisements. An MBT program aiming at improvements in life-style and stress coping was developed for this study and, together with a diary, adapted for use over the Internet. Participants were randomized to MBT with and without hand massage and to a control group, and were followed for 11 months. Questionnaires addressing issues of quality of life (PQ23) and depressive symptoms (MADRS-S) were used. RESULTS A 50%, or greater, reduction in migraine frequency was found in 40% and 42% of participants of the two groups receiving MBT (with and without hand massage, respectively), who statistically were significantly more improved than participants in the control group. No effect of hand massage was detected, and gender did not show any independent contribution to the effect in a multivariate analysis. CONCLUSIONS MBT administered over the Internet appears feasible and effective in the treatment of migraine, but no effect of hand massage was found. For increased knowledge on long-term effects and the modes of action of the present MBT program, further studies are needed.
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Affiliation(s)
- Kerstin Hedborg
- Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, University of Gävle, Sweden.
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25
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Trotman AJ, Taxman FS. Implementation of a Contingency Management-Based Intervention in a Community Supervision Setting: Clinical Issues and Recommendations. J Offender Rehabil 2011; 50:235-251. [PMID: 22235164 PMCID: PMC3253349 DOI: 10.1080/10509674.2011.585924] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
A cognitive-behaviorally based substance abuse treatment program was implemented within a Community Supervision setting. This program included a goals group that included a contingency management component and included the probation agent as a part of treatment. This paper describes the contingency management component of the treatment and discusses, in detail, issues that arose throughout the course of the study. Possible causes and solutions to the issues are discussed from a contingency management perspective that can result in improved reinforcements to achieve better probationer outcomes.
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Affiliation(s)
- Adria J Trotman
- Department of Criminology, Law, and Society, George Mason University, Fairfax, Virginia, USA
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26
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Hien DA, Wells EA, Jiang H, Suarez-Morales L, Campbell ANC, Cohen LR, Miele GM, Killeen T, Brigham GS, Zhang Y, Hansen C, Hodgkins C, Hatch-Maillette M, Brown C, Kulaga A, Kristman-Valente A, Chu M, Sage R, Robinson JA, Liu D, Nunes EV. Multisite randomized trial of behavioral interventions for women with co-occurring PTSD and substance use disorders. J Consult Clin Psychol 2009; 77:607-19. [PMID: 19634955 PMCID: PMC2795638 DOI: 10.1037/a0016227] [Citation(s) in RCA: 196] [Impact Index Per Article: 13.1] [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: 11/08/2022]
Abstract
The authors compared the effectiveness of the Seeking Safety group, cognitive-behavioral treatment for substance use disorder and posttraumatic stress disorder (PTSD), to an active comparison health education group (Women's Health Education [WHE]) within the National Institute on Drug Abuse's Clinical Trials Network. The authors randomized 353 women to receive 12 sessions of Seeking Safety (M = 6.2 sessions) or WHE (M = 6.0 sessions) with follow-up assessment 1 week and 3, 6, and 12 months posttreatment. Primary outcomes were the Clinician Administered PTSD Scale (CAPS), the PTSD Symptom Scale-Self Report (PSS-SR), and a substance use inventory (self-reported abstinence and percentage of days of use over 7 days). Intention-to-treat analysis showed large, clinically significant reductions in CAPS and PSS-SR symptoms (d = 1.94 and 1.12, respectively) but no reliable difference between conditions. Substance use outcomes were not significantly different over time between the two treatments and at follow-up showed no significant change from baseline. Study results do not favor Seeking Safety over WHE as an adjunct to substance use disorder treatment for women with PTSD and reflect considerable opportunity to improve clinical outcomes in community-based treatments for these co-occurring conditions.
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Affiliation(s)
- Denise A Hien
- Department of Psychology, City University of New York, City College of New York, New York, NY 10030, USA.
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