Sertraline medications plus dialectical behavior therapy for depressed adolescents with nonsuicidal self-injury behaviors.

OBJECTIVE: The study aims to investigate the efficacy of sertraline medication plus dialectical behavior therapy (DBT) in reducing nonsuicidal self-injury (NSSI) behavior and depression among adolescents. METHODS: Participants were 100 adolescents with depression and NSSI behaviors, 50 of whom received sertraline medication plus DBT and 50 of whom received sertraline medication plus cognitive behavioral therapy (CBT) for 12 weeks. RESULTS: During 6 months post intervention, 26 (57.8%) participants did not report having engaged in any form of NSSI in the sertraline + DBT group and 15 (32.6%) in the sertraline + CBT group, showing significant difference. The sertraline + DBT group and the sertraline + CBT group exhibited significant difference regarding the proportions of cutting skin and biting self. The scores of anxiety, depression, aggression against self in four modified overt aggression scale categories, and Personal and Social Performance were notably lower in the sertraline + DBT group than those in the sertraline + CBT group at 6 months post intervention. CONCLUSION: Sertraline medication plus DBT could decrease NSSI episodes and improve symptoms of anxiety and depression for adolescents, and these changes were comparable to those of CBT. More importantly, DBT was demonstrated better clinical improvements at 6-month follow-up.

Internet-based cognitive behavioral therapy for individuals with gambling disorder in Indonesia: protocol for a pilot and feasibility study.

Background: Gambling disorder (GD) has become a wide concern in Indonesia, as many negative consequences arise from this psychiatric condition. Prompt treatment with an appropriate method of delivery is required to achieve optimal outcomes in GD patients. This protocol paper outlines a study to determine the effectiveness, acceptability, and feasibility of internet-based cognitive behavioral therapy (iCBT) in treating GD in Indonesia. Methods: This non-randomized pilot and feasibility study will recruit 20 people with GD. All participants will receive the iCBT intervention through self-learning videos and guided weekly group sessions. The effectiveness of the intervention will be assessed at baseline (week 0), post- treatment completion (week 10), and 6 weeks post-treatment (week 16). The outcomes measured will be the change in gambling symptoms, gambling urges, cognitive distortions, readiness to change, emotional problems, and quality of life of the participants. Discussion: The feasibility of iCBT for GD patients in Indonesia will be assessed by this study. The study's results will give an indication of the acceptability of the intervention and the feasibility of a subsequent conclusive trial. The delivery of iCBT may help to address the issue of treatment access in an extensive geographical region and provide immediate implications as a treatment resource for GD in practice.

Predictors of treatment response trajectories to cognitive behavioral therapy for chronic fatigue syndrome: A cohort study.

BACKGROUND: The response to cognitive behavioral therapy (CBT) for chronic fatigue syndrome (CFS) varies greatly between patients, but predictors of treatment success remain to be elucidated. We aimed to identify patient subgroups based on fatigue trajectory during CBT, identify pre-treatment predictors of subgroup membership, and disentangle the direction of predictor - outcome relationships over time. METHODS: 297 individuals with CFS were enrolled in a standardized CBT program consisting of 17 sessions, with session timing variable between participants. Self-reported levels of fatigue, depressive, anxiety, and somatic symptoms, perceived stress, and positive affect were collected pre-treatment, and after 3, 10, and 15 sessions. Latent Class Growth Analysis (LCGA) was used to identify subgroups based on fatigue trajectories and baseline predictors of group membership. Cross-lagged structural equation models were used to disentangle predictor-outcome relationships. RESULTS: LCGA identified four fatigue trajectory subgroups, which were labelled as "no improvement" (23 %), "weak improvement" (45 %), "moderate improvement" (23 %), and "strong improvement" (9 %) classes. Higher pre-treatment levels of depressive, anxiety, and somatic symptoms, stress, and lower levels of positive affect predicted membership of the "no improvement" subgroup. Reductions in anxiety preceded reductions in fatigue, while the depressive symptoms - fatigue relationship was bidirectional. CONCLUSIONS: On a group level, there were statistically significant reductions in fatigue after 15 sessions of CBT, with important individual differences in treatment response. Higher pre-treatment levels of anxious, depressive, and somatic symptoms and perceived stress are predictors of lack of response, with reductions in anxiety and stress preceding improvements in fatigue.

Videoconference-Delivered Cognitive Behavioral Therapy for Parents of Adolescents With Internet Addiction: Pilot Randomized Controlled Trial.

BACKGROUND: The rise in internet addiction, including web-based gaming and social networking services, is a serious concern. Even with access to medical institutions and counseling services, individuals with internet addiction, particularly adolescents, often refuse medical treatment or counseling. Parent-focused psychological intervention may lead to positive outcomes by improving the parent-adolescent relationship and helping parents identify and modify their adolescent's problematic behaviors, including internet addiction. OBJECTIVE: This study was a pilot randomized controlled trial to test the feasibility of remote cognitive behavioral therapy via videoconferencing for parents of adolescents with internet addiction. METHODS: A total of 13 parents of adolescents aged 12-20 years with internet addiction were recruited and randomly assigned to either 12 sessions of the videoconference-delivered cognitive behavioral therapy (vCBT) group (n=6, 46%) or the waitlist control group (n=7, 54%). The study period was from March 1, 2018, to March 31, 2022. The primary outcome was the scores of the Young Internet Addiction Test reported by the adolescents. The secondary outcomes were adolescents' hours of internet use per day (Internet Addiction Test), reported by the adolescents and by their parents; the Young Diagnostic Questionnaire, completed by the parents; and the quality of life of the adolescents and the parents, measured by the EQ-5D-5L. These were evaluated at weeks 0 and 13. RESULTS: As the primary outcome, the mean total Internet Addiction Test score decreased from 67.7 (SD 18.3; 6/13, 46%) at week 0 to 56.2 (SD 25.1; 5/9, 56%) at week 13 in the vCBT group, compared to an increase from 66.9 (SD 21.9; 7/13, 54%) to 68.0 (SD 18.7; 4/9, 44%) in the control group. For all outcomes, no significant differences were found between the 2 groups (all P>.05). CONCLUSIONS: This study suggested the practical feasibility of vCBT for parents of adolescents with internet addiction. Further large-scale, multicenter randomized controlled trials are necessary to examine the effectiveness. TRIAL REGISTRATION: UMIN Clinical Trials Registry UMIN000032483; https://tinyurl.com/yuhen6c9.

Treatment of Psychological Symptoms in Patients with Cystic Fibrosis.

The aim of this article is to identify and illustrate the most used psychological techniques in the field of cystic fibrosis (CF) and to help clinicians choose the most appropriate strategy among various possibilities. The disease and its medical treatments can be difficult to tolerate and can cause anxiety about health status or feelings of hopelessness and stress. The prevalence of depression and anxiety is 2.3 times higher in adults with CF than in community samples. A strong correlation has been identified between elevated psychological distress and unfavorable health outcomes, including, among others, impaired lung function, reduced BMI, an increased incidence of pulmonary exacerbations, and an elevated risk of transplantation. The use of psychological interventions is useful in addressing these common distresses in CF patients. Aware of the necessity of identifying efficacious interventions for all levels of depression and anxiety in CF patients, this study presents an overview of the research on psychological interventions for patients with CF, in order to complement the treatments suggested by the international guidelines on mental health in CF cases. In fact, the aim of this study is to conduct a review and quantitative synthesis of the psychological intervention techniques that are currently available for individuals with CF.

Digital cognitive-behavioral therapy for substance use: systematic review and meta-analysis of randomized controlled trials.

Background: Prior meta-analyses have evaluated digital interventions for alcohol exclusively and alcohol/tobacco combined. These meta-analyses showed positive outcomes pertaining to alcohol and alcohol/tobacco combined. Yet questions remain pertaining to the effect of digital cognitive-behavioral therapy (CBT) on reducing alcohol and drug use.Objectives: The purpose of the meta-analysis was to determine the mean effect size, relative to control groups, of digital CBT, for posttest reductions in drug and/or alcohol use.Methods: The Preferred Reporting Items for Systematic Reviews and Meta-analyses criteria was used to guide this review and meta-analysis. Electronic databases (APA PsycArticles, Academic Search Complete, APA PsycInfo, CINAHL Complete, ERIC, MEDLINE, Psychology and Behavioral Sciences Collection, Social Sciences Full Text, Social Work Abstracts, SocINDEX), clinicaltrials.gov, reference lists were searched. The protocol was registered in PROSPERO (ID#: CRD42023471492). The CBT interventions included cognitive restructuring.Results: All but one of the effect sizes favored digital CBT (from -0.02 to -1.45). After the removal an outlier, a small, significant, random effects model Hedges' g summary effect of -0.23 (95% confidence interval: -0.32, -0.14, p < .0001) showed a reduction in substance use at the posttest, favoring digital CBT relative to the control group. A variety of control conditions were used; however, the effects sizes had minimal heterogeneity (k = 17, I2 = 5.34, Q = 16.9, p = .39). The funnel plot and Egger regression test intercept (0.01, p = .99) lacked publication bias.Conclusion: The meta-analytic findings suggest digital CBT is an efficacious treatment for reducing alcohol and drug use overall.

Effects of Mobile Application-Based Cognitive Behavioral Therapy on Psychological Outcomes in Women Treated for Breast Cancer: A Randomized Controlled Pilot Trial in Germany.

OBJECTIVE: Breast cancer has a strong impact on the mental state of those affected. Cognitive behavioral therapy (CBT) is one effective approach to reduce disease burden. This randomized controlled pilot trial aimed to assess the effect of the digital CBT-based application Living Well on psychological outcomes in a German female breast cancer population. METHODS: Female breast cancer patients (n = 70) with ongoing or finished oncological treatment that is who were receiving or had received any type of oncological treatment were included in the study and randomized to an intervention group (IG, n = 32) receiving Living Well in addition to care as usual, and a control group (CG, n = 38) receiving care as usual only. Participants completed standardized questionnaires at baseline and after 2, 4, 8, and 12 weeks to assess anxiety and depression (HADS) as primary outcomes, distress (DT), health-related quality of life (HRQoL, AQoL-8D), and illness perception (B-IPQ) as secondary outcomes. RESULTS: After 12 weeks, significant (p < 0.05) higher improvements in the IG could be observed in anxiety levels, HRQoL, and illness perception, when compared to the CG. Age and time since diagnosis were found to be relevant covariates for anxiety levels. In distress levels, the IG showed a clinically relevant and nearly significant reduction compared to the CG (p = 0.057). No effects could be observed in depression levels. CONCLUSIONS: The results demonstrate the potential of Living Well to improve psychological outcomes of female breast cancer patients and encourage further studies evaluating the effectiveness of the digital application. TRIAL REGISTRATION: The trial has been registered in the German Clinical Trials Register (DRKS00029918).

[Summarising the efficiency of psychological interventions in the treatment of endometriosis]. / Az endometriózis pszichológiai ellátásában használatos beavatkozások hatékonyságának összegzése.

Endometriosis is a common gynecological disease affecting 5-10% of women resulting in several psychological impacts. Regarding the high prevalence as well as extensive somatic symptoms, this has become a growing issue of psychological research in recent years. Thanks to its rising importance the negative effect on quality of life, mood, and anxiety symptoms has been proven. Thus we aimed to organize psychological interventions affecting the mentioned constructs and also examine their efficiency and scientific standards. Our inclusion criteria referred to studies based on randomized controlled trials, systematic reviews, and meta-analyses. We selected seven types of interventions, such as psychoeducation, cognitive behavioural therapy, mindfulness-based methods, progressive muscle relaxation, yoga, physical activity, and complex programs. Regarding the quality of life, mood, and anxiety cognitive behavioural therapy and progressive muscle relaxation were the most effective methods, however, other interventions had promising results either. Besides, there is a growing demand for psychological and mind-body interventions, which should get a more important place in the primary care of endometriosis next to medical treatment. We find inevitable further high-quality examinations, and from the point of practice, we consider it crucial to implement current evidence-based methods in the psychological care of endometriosis. Keywords: , , , , , , , , , , , .

Protocol for a randomized controlled trial: exercise-priming of CBT for depression (the CBT+ trial).

BACKGROUND: Depression is a leading cause of disability worldwide, and treatments could be more effective. Identifying methods to improve treatment success has the potential to reduce disease burden dramatically. Preparing or "priming" someone to respond more effectively to psychotherapy (e.g., cognitive behavioral therapy [CBT]) by preceding sessions with aerobic exercise, a powerful neurobiological activator, could enhance the success of the subsequently performed therapy. However, the success of this priming approach for increasing engagement of working mechanisms of psychotherapy (e.g., increased working alliance and behavioral activation) has yet to be formally tested. METHODS: The CBT + trial will be a parallel-arm randomized controlled trial that will recruit 40 adult participants with DSM-5 diagnosed depression (verified with clinical interview) via referrals, mass emails, local flyers, and social media posts. Participants will be randomized to an ActiveCBT or CalmCBT condition. The ActiveCBT group will receive an 8-week CBT intervention primed with 30 min of moderate-intensity aerobic exercise (cycling on a stationary bike at a 13 rating of perceived exertion). The CalmCBT group will receive the same 8-week CBT intervention while resting for 30 min before CBT (i.e., cycling vs no cycling is the only difference). The primary outcome measures will be mean working alliance (assessed with the client version of the Working Alliance Inventory-Short Revised) and mean behavioral activation (self-reported Behavioral Activation for Depression Scale) recorded at each of the 8 therapy sessions. Secondary outcomes include evaluation of state anhedonia and serum brain-derived neurotrophic factor before the active/calm conditions, between the condition and therapy, and after the therapy. Additional exploratory analyses will evaluate group differences in algorithm-generated ratings of therapist-participant interactions via the Lyssn platform. DISCUSSION: The novel approach of priming CBT with moderate-intensity aerobic exercise evaluated in a randomized controlled trial (CBT + trial) has the potential to demonstrate the usefulness of exercise as an augmentation strategy that improves working mechanisms of therapy and overall treatment outcomes for adults with depression. TRIAL REGISTRATION: ClinicalTrials.gov NCT06001346 . Registered on August 21, 2023.

Concussion Health Improvement Program (CHIP): study protocol for a randomized controlled optimization trial for youth with persistent post-concussive symptoms.

BACKGROUND: Up to 1.9 million youth in the USA sustain a concussion each year, and up to 30% experience persistent post-concussive symptoms (PPCS) lasting 1 month or more. PPCS can substantially interfere with social, emotional, and academic functioning. Despite these concerns, few evidence-based treatments are available for youth with PPCS. We previously found effectiveness in treating youth with concussion using a collaborative care intervention that integrates mental health care into a medical model, with improvements in concussive symptoms and quality of life at 1 year. Using the multiphase optimization strategy (MOST) framework, we now aim to assess the contribution of each of the three components that were part of collaborative care: concussion-focused cognitive behavioral therapy (cf-CBT), parenting skills training (PST), and care management (CM). METHODS: The MOST factorial design examines all three intervention components with two levels of each (present or absent), resulting in 8 possible treatment combinations. We will recruit 368 youth with PPCS from 2 geographic locations (Seattle and Dallas), randomizing them to 1 of 8 treatment groups. Youth and/or parents will attend treatment sessions via video conferencing software over 3 months, and complete surveys regarding primary outcomes (concussive symptoms and health-related quality of life) and secondary outcomes (sleep, pain, mood, and parental distress) at 6 weeks and 3, 6, and 12 months. We will also assess potential mediators and moderators to allow for future tailoring and refinement. DISCUSSION: The overarching goal of this investigation is to determine which collaborative care components (delivered individually or in combination) are most effective in treating PPCS in concussion-exposed youth. The investigation will inform mental health screening, intervention, and referral procedures for youth and families following concussion. At the completion of this study, we will have an optimized and refined intervention for youth with PPCS ready for large-scale implementation and dissemination. TRIAL REGISTRATION: ClinicalTrials.gov NCT06036147. Registered on September 13, 2023.

Digital transformation of mental health therapy by integrating digitalized cognitive behavioral therapy and eye movement desensitization and reprocessing.

Digital therapy has gained popularity in the mental health field because of its convenience and accessibility. One major benefit of digital therapy is its ability to address therapist shortages. Posttraumatic stress disorder (PTSD) is a debilitating mental health condition that can develop after an individual experiences or witnesses a traumatic event. Digital therapy is an important resource for individuals with PTSD who may not have access to traditional in-person therapy. Cognitive behavioral therapy (CBT) and eye movement desensitization and reprocessing (EMDR) are two evidence-based psychotherapies that have shown efficacy in treating PTSD. This paper examines the mechanisms and clinical symptoms of PTSD as well as the principles and applications of CBT and EMDR. Additionally, the potential of digital therapy, including internet-based CBT, video conferencing-based therapy, and exposure therapy using augmented and virtual reality, is explored. This paper also discusses the engineering techniques employed in digital psychotherapy, such as emotion detection models and text analysis, for assessing patients' emotional states. Furthermore, it addresses the challenges faced in digital therapy, including regulatory issues, hardware limitations, privacy and security concerns, and effectiveness considerations. Overall, this paper provides a comprehensive overview of the current state of digital psychotherapy for PTSD treatment and highlights the opportunities and challenges in this rapidly evolving field.

A digital iCBT intervention for social anxiety disorder in Quebec and Ontario: protocol for a multi-phase effectiveness-implementation study.

BACKGROUND: Social anxiety disorder (SAD) is one of the most prevalent anxiety disorders in Canada. Viable therapy options for the treatment of SAD include CBT being delivered virtually. In Australia, an innovative internet-delivered cognitive-behavioral therapy (iCBT) program for social anxiety has been developed, implemented, and demonstrated as effective. To make available high-quality and real-time evidence in response to the crucial need to access psychological services to meet population mental health needs, we propose to conduct a Canadian adaptation of the iCBT Shyness Program and to examine the program's effectiveness, and implementation in two Canadian provinces (Quebec and Ontario). METHODS: The overall study design is a hybrid effectiveness-implementation study of a quasi-experimental parallel group trial. Prior to implementing the iCBT Shyness Program, it will undergo an initial adaptation to the Canadian context and focus groups will be conducted with key actor groups to discuss the adaptations to the graphics, narration of the lessons, and this to better reflect varying socio-cultural context among Canadian French- and English-speaking populations. We will evaluate the effectiveness of the program in three parallel pathways reflecting real-world pathways: (1) self-refer to the intervention; (2) recommended by a health professional without guidance; and (3) recommended by a health professional, with low-intensity guidance. Data collection will be carried out at baseline, at the beginning of each lesson, 12-week and 6-month follow-up. Outcomes measured will include anxiety and depressive symptoms, psychological distress, disability, as well as health service utilization and satisfaction. Semi-structured interviews will then be conducted with study participants and health care providers to explore facilitating factors and barriers to the implementation of the iCBT adapted program. DISCUSSION: This study will provide evidence on the effectiveness, barriers and facilitating factors to implementing a low-intensity iCBT in the Canadian context for SAD, which will bridge an important care gap for undeserved populations in Canada with SAD. Findings will inform the eventual scaling up of the program in community-based primary care across Canada. This would improve equity of the health care system by helping a large number of Canadians to timely access to mental health services. TRIAL REGISTRATION: clinicaltrials.gov NCT06403995. Prospectively registered on 05/03/2024.

Prevalence of Incidental Findings and Assessment of Maxillary Sinus Pathologies and Dental Diseases Using Cone-Beam Computed Tomography (CBCT) in the Tamil Nadu Population: A Retrospective Study.

Background Cone-beam computed tomography (CBCT), a cross-sectional imaging technique, is valuable for clinical diagnosis and creating effective treatment plans. CBCT can precisely examine the connection between the maxillary sinuses and the maxillary root apices. Oral radiologists must be aware of all potential incidental findings and should be diligent in thoroughly identifying and assessing possible underlying diseases. Aim To determine the prevalence of incidental maxillary sinus pathologies and their relationship to dental diseases. Materials and methods In the present retrospective study, CBCT scans from 300 subjects (encompassing 600 right and left maxillary sinuses), aged 18 to 70, were gathered from various CBCT centers to represent the Tamil Nadu population. The CBCT images were analyzed using proprietary software, which provided both a panoramic reconstruction view and multiplanar reformation modules, including axial, sagittal, and coronal slices. The entire sample size was classified as follows: Group 1, age groups of 18 to 25 years; Group 2, age groups of 26 to 35 years; Group 3, age groups of 36 to 45 years; Group 4, age groups of 46 to 55 years; Group 5, age groups of 56 to 65 years; Group 6, age groups of 66 to 70 years. The prevalence of incidental maxillary sinus findings was analyzed, and their relationship with periapical abscess, periapical granuloma, periapical cyst, and breach was assessed. Results There was a prevalence of 52.05% of cases that had incidental maxillary sinus findings. Among them, 53.43% were males and 50.65% were females. Maxillary sinus pathologies were more common in individuals between 46 and 55 years, i.e., Group 4. In 300 datasets, the frequency of incidental maxillary sinus findings on the right is 21.33%, on the left is 24%, in both is 6.67%, and absent in 48% of the cases. Mucosal thickening was observed in 30% of cases with a periapical abscess, 19.52% with a periapical granuloma, 25% with a periapical cyst, and 51.79% with a breach. Polypoidal mucosal thickening was present in 32.50% of cases with a periapical abscess, 13.79% with a periapical granuloma, 50% with a periapical cyst, and 23.21% with a breach. Opacification occurred in 37.50% of cases with a periapical abscess, 20.69% with a periapical granuloma, 25% with a periapical cyst, and 25% with a breach. Conclusion Dental professionals should have a bird's-eye view in treating chronic odontogenic infections close to the maxillary sinus. Early diagnosis and prompt treatment of odontogenic infections help prevent maxillary sinus pathologies.

The therapeutic alliance in blended versus face-to-face cognitive behavioral therapy for adolescents and young adults with a depressive disorder.

Introduction: A depressive disorder during adolescence is a serious and disabling disorder, which has a high impact on the development of adolescents. Blended treatment, combining online and face-to-face sessions, is effective and can reduce some of the barriers for adolescents to use mental health care. There is a lack of knowledge about whether therapeutic alliance is established in blended treatment for adolescents and young adults suffering from a depressive disorder. This study examines whether the quality of the therapeutic alliance differs when cognitive behavior therapy (CBT) is delivered in combination with online intervention (b-CBT) compared to solely face-to-face (FtF-CBT) and the extent to which a stronger therapeutic alliance is associated with better treatment outcome. Methods: A pragmatic quasi-experimental design was used. Data collected within two separate studies were combined. A total of 85 participants (80 % female), aged 13-22 (mean = 16.63, SD = 1.92) were recruited within mental health care institutions and diagnosed with a depressive disorder (using K-SADS). Assessments were done at pre-treatment (T0), after five weeks (T1), after ten weeks (T2), post-treatment (T3) and one to four weeks after treatment (T4) and included measures of depressive symptomatology (CDI-2). The therapeutic alliance was measured at T1, T2 and T3 by the TASC. t-tests for independent samples were used to test differences in therapeutic alliance rates between b-CBT and FtF-CBT at post-treatment. A linear growth model for depressive symptoms based on five time points with Latent Growth Curve Analysis (LGCA) was used to test whether the therapeutic alliance is associated with depressive symptoms. Results: No differences in therapeutic alliance between b-CBT and FtF-CBT were found on either client-rated or therapist-rated therapeutic alliance. For both intervention groups, no significant association between the therapeutic alliance and depressive outcome was found. Discussion: This study shows that providing part of CBT using an online environment does not have a negative impact on the therapeutic alliance. In contrast to earlier research, no association was found between the therapeutic alliance and therapy outcome in neither the b-CBT nor the FtF-CBT intervention.

A multisite feasibility study of integrated cognitive-behavioral treatment for co-existing nocturia and chronic insomnia.

BACKGROUND: Nocturia (waking from sleep at night to void) and chronic insomnia frequently co-exist in older adults, contributing synergistically to sleep disturbance. Treatments typically target either nocturia or insomnia rather than simultaneously addressing shared mechanisms for these disorders. METHODS: We conducted a multisite feasibility study to: (1) test and refine a protocol for recruitment, randomization, and assessment of older adults with co-existing nocturia and insomnia; and (2) examine preliminary changes in outcome measures to inform a future larger, multisite clinical trial. Participants were men and women aged 60 years and older recruited from outpatient clinics, reporting an average of two or more nocturia episodes per night over the past 4 weeks and meeting diagnostic criteria for chronic insomnia disorder. Participants were randomized to receive either integrated cognitive-behavioral therapy for insomnia and nocturia or a health education control program involving five weekly visits with a trained nurse practitioner interventionist. Outcomes (e.g., nocturia episodes) were measured 1-week post-treatment and 4-month post-randomization. Descriptive statistics examined the feasibility of outcomes to guide preparations for a future efficacy trial. RESULTS: Of 245 adults screened, 55% were ineligible and 25% declined to participate. Sixty-one percent of 49 participants who provided informed consent were randomized. Of the 30 participants randomized (mean age = 70.6 years, 60% White), 14 were assigned to integrated cognitive-behavioral treatment and 16 to the control group. All randomized participants provided 4-month follow-up data. At 4 months, mean nightly nocturia episodes decreased by 0.9 (SD 1.0) in the integrated treatment group and by 0.2 (SD 1.2) in the control group compared with baseline. DISCUSSION: Findings demonstrate the feasibility of recruiting, randomizing, and collecting outcome data from older adults (predominantly male) assigned to an integrated cognitive-behavioral therapy for coexisting insomnia and nocturia or a health education control program.

[Which solution to functional somatic disorder: The ACSEPT program]. / Quelle réponse au trouble somatique fonctionnel : la filière ACSEPT.

BACKGROUND: Functional somatic disorder (FSD) is a prevalent disorder that can be severely disabling for the patient and is associated with major health costs. There are few formalized care programs for these disorders in the country, and their management encounters various difficulties, both in the diagnosis and its announcement and the treatment. Cognitive-behavioural and emotional therapy (CBT) is the standard on psychiatry care, and its efficacy has been demonstrated through several randomised controlled studies on the intensity of physical and psychological symptoms. INTERVENTION: At Lille's University Hospital Center, we have established the "ACSEPT" care pathway for TSF management which consists of a psychiatric consultation followed by an individual referral, including a treatment using repeated transcranial magnetic stimulation (rTMS) or the integration of a CBT-based psychoeducation group. This group had the particularity of caring for all patients presenting FSD regardless of the associated physical symptoms. Educating medical professionals and conducting FSD research were other goals of ACSEPT. DISCUSSION/CONCLUSION: ACSEPT allows an improvement in the care offered to these patients with a defined orientation and interdisciplinary, early, organized cares that are repeatable. Our goal is to study the effectiveness of these different interventions in subsequent studies, to continue the development of ACSEPT and to be able to distribute this intervention at the regional level to establish a clear care program allowing early management of these patients.

Verbal-Cue Rehabilitation Exercises Are Effective for the Mixed Callosal-Frontal Variant of Alien Hand Syndrome Following Stroke.

Alien hand syndrome (AHS) is a rare condition in which a brain-injured patient develops involuntary movements, particularly in the upper limbs, along with difficulty in controlling them and a loss of ownership of the affected hand. AHS is traditionally classified into frontal, callosal, and occipital types. Recently, mixed types have also been reported. In this report, we describe a case of mixed callosal-frontal type AHS following stroke, in which symptoms improved with a verbal-cue rehabilitation exercise. The patient was a 62-year-old woman diagnosed with cerebral infarction in the right frontal lobe and corpus callosum due to disruption of the right anterior cerebral artery. She exhibited left hemiplegia, left deep tendon hyperreflexia, and AHS in the left upper extremity. She received verbal-cue rehabilitation exercises for AHS in addition to regular rehabilitation therapy and medications. After treatment, AHS persisted but was remarkably attenuated.

"How Can I Get Out of This?": A Qualitative Study of the Phenomenology and Functional Impact of Misophonia in Youth and Families.

INTRODUCTION: Misophonia is an increasingly recognized disorder characterized by negative emotional and sensory reactions to specific noises. Although misophonia most often begins in childhood, there has been minimal research on its clinical presentation in youth. This qualitative study explored cognitive behavioral processes that are involved in misophonia and its associated functional impairment in young people and their families. METHODS: Focused interviews were conducted with 20 youth with misophonia (ages 10-17) and their parents. Thematic analyses of these interviews using a cognitive behavioral theoretical framework were conducted. RESULTS: A number of themes were identified, which included internalizing and externalizing cognitive behavioral processes at the individual level (e.g., hypervigilance, anticipatory anxiety, escape, automatic negative attributions), secondary emotional and functional consequences (e.g., negative perception of self, guilt, anxiety, depression, emotional exhaustion, concentration difficulties at school), as well as significant impacts to school, social life, and particularly to family life (e.g., conflict/tension, anger and resentment, family accommodation). These themes are integrated in a proposed theoretical model. DISCUSSION: Misophonia is characterized by several transdiagnostic cognitive behavioral processes, including avoidance, maladaptive cognitions, emotional reactivity, and family communication difficulties, as well as significant functional impairment. Developing treatments that target these processes has the potential to help youth overcome misophonia and improve the quality of life of youth and their families.

Client Perspectives of Case Stories in Internet-Delivered Cognitive Behavioral Therapy for Public Safety Personnel: Mixed Methods Study.

BACKGROUND: Internet-delivered cognitive behavioral therapy (ICBT) is an effective and convenient means of offering cognitive behavioral therapy to the general population. To increase access to ICBT among Canadian public safety personnel (PSP)-a group that experiences elevated rates of mental health concerns and barriers to mental health care-a clinical research unit called PSPNET has tailored ICBT to PSP, primarily through offering case stories and PSP-specific examples within an ICBT program. PSPNET's first and most frequently used ICBT program, called the PSP Wellbeing Course, has been found to reduce symptoms of mental disorders (eg, anxiety, depression, and posttraumatic stress) among PSP. Little research, however, has investigated clients' perceptions of the case stories in this course. OBJECTIVE: This study was designed to expand the literature on the use and evaluation of case stories in ICBT among PSP. Specifically, this study investigated (1) PSP's perceptions of the case stories using the theoretical model provided by Shaffer and Zikmund-Fisher and (2) PSP feedback on the case stories in the PSP Wellbeing Course. METHODS: This study included 41 clients who completed the PSP Wellbeing Course. Of these, 27 clients completed a bespoke questionnaire called the Stories Questionnaire, 10 of whom also participated in a semistructured interview. RESULTS: Findings show that perceptions of the case stories in the PSP Wellbeing Course were largely positive and that the case stories were generally successful in achieving the 5 purposes of case stories (ie, informing, comforting, modeling, engaging, and persuading) proposed by Shaffer and Zikmund-Fisher. Client feedback also identified 3 tangible areas for story improvement: characters, content, and delivery. Each area highlights the need for and potential benefits of story development. Not all PSP engaged with the case stories, though, so results must be interpreted with caution. CONCLUSIONS: Overall, this study adds to the growing body of research supporting the use of case stories in internet-delivered interventions among PSP. TRIAL REGISTRATION: ClinicalTrials.gov NCT04127032; https://www.clinicaltrials.gov/ct2/show/NCT04127032.