Postresidency Impact of Alcohol and Drug Screening and Intervention Training.

BACKGROUND AND OBJECTIVES: Many residency programs provide alcohol and drug screening, brief intervention (BI), and referral to treatment (SBIRT) training, hoping to impact residents' future practice activities. Little is known about postresidency use of these skills. This study assesses postresidency impact of SBIRT training. METHODS: Over 3 years, physicians who participated in SBIRT training in four residency programs were recruited for follow-up. Participants chose between a paper and online questionnaire 12-24 months after graduation; participants received $20 gift cards. We first analyzed postresidency responses only (n=74), then compared pre- and posttraining results of those completing both surveys (n=50). RESULTS: Of 182 enrolled graduates, 74 (41%) completed questionnaires. In paired comparisons to their pretraining responses, graduates increased endorsement of statements that BIs can reduce risky use and reduced endorsement of statements that they do not have adequate training or time to address patients' alcohol use, or that discussing alcohol use with patients is uncomfortable. While most barriers to providing interventions were endorsed less frequently by SBIRT-trained clinicians in postresidency surveys, ongoing concerns included poor reimbursement, little time, low success rates, and some discomfort with interventions. Seventy percent of graduates felt motivational interviewing techniques created stronger doctor-patient relationships; 16% reported colleagues in their practices had increased SBIRT activities after they joined the practice. CONCLUSIONS: SBIRT trainees reported high levels of SBIRT activity 12-24 months after graduation and increased SBIRT activities by their colleagues. While some barriers remain, residency training appears to be a promising approach for disseminating SBIRT into clinical practice.

The future orientation of constructive memory: An evolutionary perspective on therapeutic hypnosis and brief psychotherapy.

We explore a new distinction between the future, prospective memory system being investigated in current neuroscience and the past, retrospective memory system, which was the original theoretical foundation of therapeutic hypnosis, classical psychoanalysis, and psychotherapy. We then generalize a current evolutionary theory of sleep and dreaming, which focuses on the future, prospective memory system, to conceptualize a new evolutionary perspective on therapeutic hypnosis and brief psychotherapy. The implication of current neuroscience research is that activity-dependent gene expression and brain plasticity are the psychobiological basis of adaptive behavior, consciousness, and creativity in everyday life as well as psychotherapy. We summarize a case illustrating how this evolutionary perspective can be used to quickly resolve problems with past obstructive procrastination in school to facilitate current and future academic success.

To be mindful of the breath or pain: Comparing two brief preoperative mindfulness techniques for total joint arthroplasty patients.

OBJECTIVE: Total joint arthroplasty (TJA) often reduces pain and improves function, but it is also a risk factor for the development of chronic pain and postoperative opioid use. To protect against these untoward postsurgical outcomes, TJA patients need better, non-pharmacological pain management strategies. This study compared two, promising, mindfulness-based pain management techniques. METHOD: We conducted a single-site, three-arm, parallel-group randomized controlled study conducted at an orthopedic clinic among patients undergoing TJA of the knee or hip. TJA patients (N = 118, M age = 65, female = 73, Caucasian = 110) were randomized to either a preoperative mindfulness of breath (MoB), mindfulness of pain (MoP), or cognitive-behavioral pain psychoeducation (CB) intervention, approximately 3 weeks before surgery. Each intervention was delivered in a single, 20-min session during a 2-hr, preoperative education program. Change in pain intensity was the sole preoperative outcome. The postoperative outcomes, pain intensity, pain interference, and opioid use were assessed on the 2nd, 3rd, 7th, 14th, 21st, and 28th postoperative days. RESULTS: MoB was found to most effectively decrease preoperative pain scores, F(2, 89) = 5.28, p = .007, while MoP resulted in the least amount of postoperative pain intensity, F(8, 94) = 3.21, p = .003, and interference, F(8, 94) = 2.52, p = .016). Both MoB and MoP decreased postoperative opioid use relative to CB, F(8, 83) = 16.66, p < .001. CONCLUSION: A brief preoperative MBI may be able to prevent both postoperative pain and opioid use. Moreover, the MBIs used in this study are highly feasible, capable of being delivered by nearly any healthcare provider, and requiring minimal clinic time given their brevity. As such, embedding MBIs in surgical care pathways has considerable potential. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Meta-Analysis of the Treatment of Posttraumatic Stress Disorder in Adults With Comorbid Severe Mental Illness.

Objective: To evaluate the efficacy of psychosocial treatments for posttraumatic stress disorder (PTSD) among individuals with a comorbid severe mental illness (SMI; ie, schizophrenia, bipolar disorder, major depressive disorder).Data Sources: PubMed, PsycINFO, CINAHL, and Cochrane Library were searched from January 1998 to March 2020 using keywords related to PTSD, treatment, and severe mental illness.Study Selection: All clinical trials for PTSD psychotherapy among individuals with SMI were included. From 38 potentially eligible studies, a total of 14 clinical trials across 684 individuals with comorbid SMI and PTSD were identified and included in the analysis.Data Extraction: Data on demographic, SMI diagnosis, symptom severity, sample attrition, and treatment protocol received were extracted. Effect size calculations and subsequent meta-analyses were conducted using the Meta-Analysis Package for R (metafor) version 2.1-0 in R (3.6.0).Results: PTSD treatments had a large effect on PTSD outcomes among individuals with SMI, with patients experiencing a standard deviation reduction in PTSD symptomatology pre- to post-treatment (g = -1.009, P < .001, k = 34). Prolonged exposure (g = -1.464; P < .001; SE = 0.276; k = 5), eye movement desensitization and reprocessing (g = -1.351; P < .001; SE = 0.276; k = 5), and brief treatment program (g = -1.009; P < .001; SE = 0.284; k = 5) had the largest effects on PTSD symptoms.Conclusions: Although underrepresented in the PTSD literature, PTSD psychotherapies are effective for individuals with SMI. Treatments with an exposure-based component may have greater efficacy in this clinical population.

Brief mindfulness-based training and mindfulness trait attenuate psychological stress in university students: a randomized controlled trial.

BACKGROUND: Psychological distress in University settings has grown and became a public health concern. In this context, contemplative practices such as mindfulness have been proposed as a strategy to help students on stress management. METHODS: Forty university students (20 female), aged between 18 to 30 years (mean = 24.15; SD = 3.56), with no previous experience with meditation or yoga were recruited at the Federal University of Rio Grande do Norte and randomized to a mindfulness training (MT) or active control (AC) groups. We analyzed measures of anxiety, affect, stress, as well as state and trait mindfulness in order to evaluate the effects of trait mindfulness and a brief mindfulness intervention in forty healthy young students. Participants were classified as Low (n = 27, females = 13) or High (n = 13, females = 7) Trait Mindfulness by k-means clustering and compared between them using Wilcoxon sum rank test. Furthermore, the sample was randomly allocated to an AC (n = 20, females = 10) or a MT (n = 20, females = 10) group, and mixed analysis of variance was performed to analyze the effect of interventions. The mechanisms and role of trait mindfulness in the intervention was assessed by a moderated mediation analysis. RESULTS: We found that High Trait individuals have lower anxiety trait, anxiety state and perceived stress levels. Only the MT group reduced their anxiety state and perceived stress after the intervention and increased their state mindfulness. Both groups reduced negative affect and cortisol, and no change was found in positive affect. Moderated mediation analysis showed that the training-induced change in state mindfulness mediated the increase in positive affect and the decrease in perceived stress and cortisol, regardless of trait mindfulness. For anxiety state the decrease only occurred in individuals with High Trait Mindfulness. CONCLUSIONS: Together, these results suggest that higher trait mindfulness is associated with low levels of psychological distress and that a brief mindfulness-based intervention seems to be useful to reduce distress measures in university students. TRIAL REGISTRATION: ReBEC, U1111-1194-8661. Registered 28 March 2017-Retrospectively registered, http://www.ensaiosclinicos.gov.br/rg/RBR-7b8yh8.

Effects of brief stress management interventions on distress and leukocyte nuclear factor kappa B expression during primary treatment for breast cancer: A randomized trial.

BACKGROUND: A randomized controlled trial (RCT) of 5-week stress management interventions teaching cognitive behavioral therapy (CBT) or relaxation training (RT) techniques showed decreases in stress and serum inflammatory markers over 12 months in women undergoing treatment for breast cancer (BCa). To understand the molecular mechanisms involved, we examined the effects of these interventions on the transcription factor NF-κB DNA binding activity in leukocytes in parallel with circulating inflammatory markers, stress management skill efficacy and multiple distress indicators. METHODS: This is a secondary analysis using blood samples of 51 BCa patients (Stage 0-III) with high cancer-specific distress selected from a completed RCT (NCT02103387). Women were randomized to one of three conditions, CBT, RT or health education control (HE). Blood samples and self-reported distress measures (Affects Balance Scale-Negative Affect [ABS-NA], Impact of Events Scale-hyperarousal [IES-H] and intrusive thoughts [IES-I]) were collected at baseline (T0) and 12-month follow-up (T2). Self-reported distress measures and perceived stress management skills (PSMS) were also measured immediately post-intervention (baseline + 2 months: T1). Repeated measures analyses compared changes in distress and NF-κB expression among conditions, controlling for age, stage of cancer, days from surgery to baseline, and receipt of chemotherapy and radiation. Regression analyses related T0 to T2 change in NF-κB expression with T0 to T1 changes in self-reported PSMS and distress measures. Exploratory regression analyses also associated change in NF-κB expression with change in serum cytokines (IL-1ß, IL-6 and TNF-α); and s100A8/A9, a circulating inflammatory marker important in breast cancer progression. RESULTS: There was a significant condition (CBT/RT, HE)xtime (T0, T2) effect on NF-κB, F(1, 39)= 5.267, p = 0.036, wherein NF-κB expression significantly increased over time for HE but did not change for RT or CBT. Greater increases in PSMS from T0 to T1 were associated with less increase in NF-κB expression over 12 months (ß = -0.426, t(36) = -2.637, p = 0.048). We found that women assigned to active intervention (CBT/RT) had significant decreases in ABS-NA (F(1, 40)= 6.537, p = 0.028) and IES-I (F(1, 40)= 4.391, p = 0.043) from T0 to T1 compared to women assigned to HE, who showed no change over time (p's > 0.10). For women assigned to CBT or RT, lower NF-κB expression at T2 was related to less ABS-NA, IES-H, and IES-I, all p's < 0.05, although T0-T1 change in distress was not related to T0-T2 change in NF-κB expression for those in an active intervention. CONCLUSIONS: Brief CBT or RT stress management interventions can mitigate increases in pro-inflammatory leukocyte NF-κB binding over 12 months of primary treatment in highly distressed BCa patients. These effects are likely brought about by improved stress management skills.

Brief imagery rescripting vs. usual care and treatment advice in refugees with posttraumatic stress disorder: study protocol for a multi-center randomized-controlled trial.

Background: Many refugees have experienced multiple traumatic events in their country of origin and/or during flight. Trauma-related disorders such as posttraumatic stress disorder (PTSD) or complex PTSD (CPTSD) are prevalent in this population, which highlights the need for accessible and effective treatment. Imagery Rescripting (ImRs), an imagery-based treatment that does not use formal exposure and that has received growing interest as an innovative treatment for PTSD, appears to be a promising approach. Objective: This randomized-controlled trial aims to investigate the efficacy of ImRs for refugees compared to Usual Care and Treatment Advice (UC+TA) on (C)PTSD remission and reduction in other related symptoms. Method: Subjects are 90 refugees to Germany with a diagnosis of PTSD according to DSM-5. They will be randomly allocated to receive either UC+TA (n = 45) or 10 sessions of ImRs (n = 45). Assessments will be conducted at baseline, post-intervention, three-month follow-up, and 12-month follow-up. Primary outcome is the (C)PTSD remission rate. Secondary outcomes are severity of PTSD and CPTSD symptoms, psychiatric symptoms, dissociative symptoms, quality of sleep, and treatment satisfaction. Economic analyses will investigate health-related quality of life and costs. Additional measures will assess migration and stress-related factors, predictors of dropout, therapeutic alliance and session-by-session changes in trauma-related symptoms. Results and Conclusions: Emerging evidence suggests the suitability of ImRs in the treatment of refugees with PTSD. After positive evaluation, this short and culturally adaptable treatment can contribute to close the treatment gap for refugees in high-income countries such as Germany. Trial registration: German Clinical Trials Register under trial number DRKS00019876, registered prospectively on 28 April 2020.

Antecedentes: Muchos refugiados han experimentado múltiples eventos traumáticos en su país de origen y/o durante la huida. Los trastornos relacionados con el trauma, como el trastorno de estrés postraumático (TEPT) o el trastorno de estrés postraumático complejo (TEPTC), son frecuentes en esta población, lo que pone de relieve la necesidad de un tratamiento accesible y eficaz. La reescritura de imágenes (ImRs, en sus siglas en inglés), un tratamiento basado en imágenes que no utiliza la exposición formal y que ha recibido un creciente interés como tratamiento innovador para el TEPT, parece ser un enfoque prometedor.Objetivo: Este ensayo controlado aleatorizado tiene como objetivo investigar la eficacia de la ImRs para los refugiados en comparación con cuidado habitual y consejería de tratamiento (UC+TA) en la remisión del TEPT(C) y la reducción de otros síntomas relacionados.Método: Los sujetos son 90 refugiados en Alemania con un diagnóstico de TEPT según el DSM-5. Serán asignados aleatoriamente para recibir UC+TA (n = 45) o diez sesiones de ImRs (n = 45). Las evaluaciones se llevarán a cabo al inicio, post-intervención, con un seguimiento de tres meses y un seguimiento de 12 meses. El resultado primario es la tasa de remisión del TEPT(C). Los resultados secundarios son la gravedad de los síntomas del TEPT y del TEPTC, los síntomas psiquiátricos, los síntomas disociativos, la calidad del sueño y la satisfacción del tratamiento. Los análisis económicos investigarán la calidad de vida y los costos relacionados con la salud. Medidas adicionales evaluarán los factores relacionados con la migración y el estrés, los predictores de la deserción, la alianza terapéutica y los cambios sesión por sesión en los síntomas relacionados con el trauma.Resultados y conclusiones: Las evidencias emergentes sugieren la idoneidad de la ImRs en el tratamiento de los refugiados con TEPT. Después de una evaluación positiva, este tratamiento corto y culturalmente adaptable puede contribuir a reducir la brecha de tratamiento para los refugiados en países de altos ingresos como Alemania.

Psychotherapeutic Approach for Advanced Illness: Managing Cancer and Living Meaningfully (CALM) Therapy.

With advances in medical treatment and an aging population, there is an increasing global burden of advanced and life-limiting illnesses. Individuals living with these conditions may experience substantial distress related to disease progression, changes in important roles and life goals, loss of meaning, and uncertainty about the future, but there has been limited evidence to inform their psychotherapeutic care. Managing cancer and living meaningfully (CALM) therapy is a brief, evidence-based, semistructured intervention that provides a framework to address practical issues, such as navigating the health care system and treatment decisions, and existential issues, including finding meaning and hope in the face of mortality. CALM has been shown to alleviate and prevent depression and to facilitate preparation for the end of life among patients with advanced cancer. It is being adapted to other life-threatening illnesses and different cultural contexts and health care settings. Advocacy is needed to support such approaches for individuals living with advanced and life-threatening illness.

Large-group one-session treatment: Feasibility and efficacy in 138 individuals with phobic fear of flying.

Recent research suggests that exposure-based large-group one-session treatments (LG-OSTs) may represent useful and efficient treatment options for different types of phobic fear. Although there are effective single session- and small group-interventions for the treatment of clinically relevant Fear of Flying (FoF), no LG-OST for this type of phobic fear has been realized so far. The present study aimed to investigate feasibility and efficacy of an LG-OST for the treatment of clinically relevant FoF. Two months after an initial diagnostics to assess FoF severity and confirm the underlying diagnoses (89% specific flight phobia; 10% agoraphobia), 138 patients attended the LG-OST consisting of psychoeducation, imparting of a breathing technique and a joint 2 ½ hour exposure flight in a chartered airplane (Airbus A320). FoF again was assessed at pre- and post-treatment as well as at 6-months follow-up with the latter again containing clinical diagnostics. Only a small decrease in FoF emerged in the pre-treatment interval. From pre-to post-treatment however, substantial reductions in FoF were observed with a large mean 'intention-to-treat' effect size of Cohen's d = 1.42 that remained stable over time (mean d = 1.44). At follow-up, 71% of the patients were rated as fully (55%) or partially remitted (16%). Also concerning the treatment of clinically relevant FoF, a LG-OST proved feasible and effective. Therefore, LG-OST can be regarded as a highly efficient and promising treatment tool which in terms of efficiency combines the advantages of one-session individual and group treatments.

Integrative therapy (short-term psychodynamic psychotherapy & cognitive-behavioral therapy) and cognitive-behavioral therapy in the treatment of generalized anxiety disorder: A randomized controlled trial.

BACKGROUND: and purpose: Cognitive-behavioral therapy and psychodynamic psychotherapy are common psychotherapies used for mental disorders. The purpose of the present article was to achieve an integration of cognitive-behavioral therapy and short-term psychodynamic psychotherapy that enjoys simultaneously the effects of cognitive-behavioral therapies and the stability of short-term psychodynamic psychotherapies. MATERIALS AND METHODS: It was a pre-test/post-test experimental study. Selected based on a purposive non-probabilistic sampling method, the sample studied here consisted of 36 people diagnosed with generalized anxiety according to Clinical Diagnostic Interview, psychiatrist diagnosis and Hamilton Rating Scale for Anxiety (HRSA). They were divided randomly into three 12 person groups: two treated groups by integrative therapy and cognitive-behavioral therapy, and one control group. Only pre-test and post-test were employed for the control group without any kind of treatment. To select patients and evaluate the effects of each type of treatments, the "Hamilton Rating Scale for Anxiety" and "Beck Depression Inventory" were applied for the pre-test/post-test and the differential diagnosis, respectively. The results obtained were analyzed by covariance and ANOVA analyses using SPSS software. RESULTS: The results of the study indicate the efficacy of both cognitive-behavioral therapy and integrative therapy in the treatment of generalized anxiety and integrative therapy was more effective in the treatment of generalized anxiety compared to cognitive-behavioral therapy. CONCLUSION: Integrative treatment not only to be effective in the treatment of generalized anxiety disorder and the reduction of its symptoms, but also to be more effective than cognitive-behavioral therapy.

Brief mindfulness session improves mood and increases salivary oxytocin in psychology students.

Mindfulness-based interventions (MBI) have been shown to be effective in increasing empathy in health professionals. Yet, more research is needed to analyse the specific influence of mindfulness exercises on biological variables involved in empathy, such as the biological system of oxytocin activity. In this study, we analyse the effects of a brief mindfulness session on positive and negative affect, state anxiety and salivary oxytocin (sOXT) in psychology students (N = 68). In the experimental group (n = 42), a mindfulness session was performed that included different guided meditation exercises. In the control group (n = 26), an emotion recognition exercise was carried out, along with a series of creative activities. Results showed that the mindfulness session was effective, because there was a significant reduction in negative affect (d = -.56, p < .001) and state anxiety (d = -.54, p = .007) in the experimental group. Likewise, there was an increase in sOXT (d = .99, p < .001) in this group, compared with the control group. Guided mindfulness meditation practice could be useful to reach an emotional and biological state that facilitates empathy. In this regard, the increase in sOXT after the mindfulness session adds further evidence about the biological mechanisms underlying the benefits of MBI on empathy.

Integration of hypnotherapy with brief cognitive behaviour therapy (CBT) for treatment of depression.

The current study was planned to assess how the integration of brief cognitive behaviour therapy (CBT) with hypnotherapy can be productive for a client's quick progress in treatment. It illustrates the effectiveness of two methods of treatment integrated to make better prognosis in the treatment of a depressed Pakistani housewife aged 25 years, who had been suffering for a year. The sessions included hypnotic induction, teaching self-hypnosis with positive suggestions, mood monitoring, use of imagery and relaxation techniques along with specific strategies of brief CBT. Predominant feature of her clinical presentation was the belief of being unloved, and the negative thoughts of being devalued by the husband. Hypnotherapy contributed to achieving remarkable therapeutic progress in a relatively short time. At initial presentation, the depressive symptoms were extremely high as demonstrated by psychological assessment tests and Beck Depression Inventory (BDI). Subsequent test results indicated that she had returned to normal level of functioning (81-90) as assessed through the Global Assessment of Functioning Scale (GAFS). At the time of reporting the case, she was in the follow-up phase. The case highlights the value of hypnosis as a tool of empowerment especially important to diminish depression when used as an adjunct with cognitive behaviour therapy.

Interventions for fatigue in inflammatory bowel disease.

BACKGROUND: Inflammatory bowel disease (IBD) is an umbrella term used to describe a group of chronic, progressive inflammatory disorders of the digestive tract. Crohn's disease and ulcerative colitis are the two main types. Fatigue is a common, debilitating and burdensome symptom experienced by individuals with IBD. The subjective, complex nature of fatigue can often hamper its management. The efficacy and safety of pharmacological or non-pharmacological treatments for fatigue in IBD is not yet established through systematic review of studies. OBJECTIVES: To assess the efficacy and safety of pharmacological and non-pharmacological interventions for managing fatigue in IBD compared to no treatment, placebo or active comparator. SEARCH METHODS: A systematic search of the databases Embase, MEDLINE, Cochrane Library, CINAHL, PsycINFO was undertaken from inception to July 2018. A top-up search was run in October 2019. We also searched the Cochrane IBD Group Specialized Register, the Cochrane Central Register of Controlled Trials, ongoing trials and research registers, conference abstracts and reference lists for potentially eligible studies. SELECTION CRITERIA: Randomised controlled trials of pharmacological and non-pharmacological interventions in children or adults with IBD, where fatigue was assessed as a primary or secondary outcome using a generic or disease-specific fatigue measure, a subscale of a larger quality of life scale or as a single-item measure, were included. DATA COLLECTION AND ANALYSIS: Two authors independently screened search results and four authors extracted and assessed bias independently using the Cochrane 'Risk of bias' tool. The primary outcome was fatigue and the secondary outcomes included quality of life, adverse events (AEs), serious AEs and withdrawal due to AEs. Standard methodological procedures were used. MAIN RESULTS: We included 14 studies (3741 participants): nine trials of pharmacological interventions and five trials of non-pharmacological interventions. Thirty ongoing studies were identified, and five studies are awaiting classification. Data on fatigue were available from nine trials (1344 participants). In only four trials was managing fatigue the primary intention of the intervention (electroacupuncture, physical activity advice, cognitive behavioural therapy and solution-focused therapy). Electroacupuncture Fatigue was measured with Functional Assessment of Chronic Illness Therapy - Fatigue (FACIT-F) (scores range from 0 to 52). The FACIT-F score at week eight was 8.00 points higher (better) in participants receiving electroacupuncture compared with no treatment (mean difference (MD) 8.00, 95% CI 6.45 to 9.55; 1 RCT; 27 participants; low-certainty evidence). Results at week 16 could not be calculated. FACIT-F scores were also higher with electroacupuncture compared to sham electroacupuncture at week eight (MD 5.10, 95% CI 3.49 to 6.71; 1 RCT; 30 participants; low-certainty evidence) but not at week 16 (MD 2.60, 95% CI 0.74 to 4.46; 1 RCT; 30 participants; low-certainty evidence). No adverse events were reported, except for one adverse event in the sham electroacupuncture group. Cognitive behavioural therapy (CBT) and solution-focused therapy Compared with a fatigue information leaflet, the effects of CBT on fatigue are very uncertain (Inflammatory Bowel Disease-Fatigue (IBD-F) section I: MD -2.16, 95% CI -6.13 to 1.81; IBD-F section II: MD -21.62, 95% CI -45.02 to 1.78; 1 RCT, 18 participants, very low-certainty evidence). The efficacy of solution-focused therapy on fatigue is also very uncertain, because standard summary data were not reported (1 RCT, 98 participants). Physical activity advice One 2 x 2 factorial trial (45 participants) found physical activity advice may reduce fatigue but the evidence is very uncertain. At week 12, compared to a control group receiving no physical activity advice plus omega 3 capsules, FACIT-F scores were higher (better) in the physical activity advice plus omega 3 group (FACIT-F MD 6.40, 95% CI -1.80 to 14.60, very low-certainty evidence) and the physical activity advice plus placebo group (FACIT-F MD 9.00, 95% CI 1.64 to 16.36, very low-certainty evidence). Adverse events were predominantly gastrointestinal and similar across physical activity groups, although more adverse events were reported in the no physical activity advice plus omega 3 group. Pharmacological interventions Compared with placebo, adalimumab 40 mg, administered every other week ('eow') (only for those known to respond to adalimumab induction therapy), may reduce fatigue in patients with moderately-to-severely active Crohn's disease, but the evidence is very uncertain (FACIT-F MD 4.30, 95% CI 1.75 to 6.85; very low-certainty evidence). The adalimumab 40 mg eow group was less likely to experience serious adverse events (OR 0.56, 95% CI 0.33 to 0.96; 521 participants; moderate-certainty evidence) and withdrawal due to adverse events (OR 0.48, 95%CI 0.26 to 0.87; 521 participants; moderate-certainty evidence). Ferric maltol may result in a slight increase in fatigue, with better SF-36 vitality scores reported in the placebo group compared to the treatment group following 12 weeks of treatment (MD -9.31, 95% CI -17.15 to -1.47; 118 participants; low-certainty evidence). There may be little or no difference in adverse events (OR 0.55, 95% CI 0.26 to 1.18; 120 participants; low-certainty evidence) AUTHORS' CONCLUSIONS: The effects of interventions for the management of fatigue in IBD are uncertain. No firm conclusions regarding the efficacy and safety of interventions can be drawn. Further high-quality studies, with a larger number of participants, are required to assess the potential benefits and harms of therapies. Future studies should assess interventions specifically designed for fatigue management, targeted at selected IBD populations, and measure fatigue as the primary outcome.

Solution-Focused Brief Therapy (SFBT) with individuals with brain injury and their families.

BACKGROUND: Brain injury is considered a chronic condition and the medical model has long been the traditional paradigm underlying rehabilitation programs for people after acquired brain injury (ABI). In recent years, strengths-based approaches have been increasingly proposed, but little has been written about specific psychotherapeutic application in ABI rehabilitation. OBJECTIVE: To describe a strengths-based model, Solution-Focused Brief Therapy (SFBT) and its clinical application to individuals with ABI and their families. METHODS: The author describes the assumptions, tenets, and principles of SFBT, a competency-based and resource-based model that orients to the future and focuses on strengths and successes. A direct comparison is made between the traditional medical paradigm and the solution-focused paradigm. RESULTS: Key ingredients of SFBT are described, including specific strategies, techniques, and its clinical application with individuals with ABI and their families. Limitations around using SFBT and the need for further research with ABI populations are reported. CONCLUSIONS: SFBT is a welcome shift away from the problem-saturated stories that underlie traditional rehabilitation approaches. The strengths-based underpinning of SFBT is a promising psychotherapeutic intervention that merits further investigation with ABI populations.

Care Coordination of Autism Spectrum Disorder: A Solution-Focused Approach.

The expanding practice of multi-disciplinary care to address the complex nature of Autism Spectrum Disorder (ASD) suggests that there is a need for a means of coordinating care that transcends the disciplinary distinctions of relevant ASD treatment providers. As ASD services become more specialized, there is a growing need for effective care coordination with providers across the systems of care. Nursing professionals are ideally qualified to support families affected by ASD, as they provide a necessary holistic lens of health and wellbeing to obtain the appropriate treatments. Solution-focused brief therapy has been applied to a growing number of clinical settings, indicating solution-focused techniques are applicable to the various contexts associated with ASD treatments. We provide a case presentation to demonstrate a solution-focused approach to address ASD-related concerns within the family that are generalizable to coordination of care.

Imagery rescripting in non-clinical paranoia: a pilot study of the impact on key cognitive and affective processes.

BACKGROUND: Paranoia is often accompanied by distressing intrusions associated with traumatic memories, yet one of the best-evidenced interventions, imagery rescripting (IR), is not routinely offered. This is likely to be due to poor understanding of the effects of IR on postulated mechanisms of change as well as the absence of a robust evidence base. AIMS: This study aimed to establish proof of principle that IR impacts key cognitive-affective processes associated with distressing intrusions - memory characteristics and self-representations - and level of paranoia. METHOD: We used a within-subject repeated measures design to examine the effect of single-session IR on memory characteristics (level of intrusions, vividness, distress, encapsulated belief strength, emotion intensity and frequency), self-representation variables, affect and paranoia. Fifteen participants were seen once before and once after the IR session, to gather baseline and follow-up data. RESULTS: As predicted, participants reported reductions in memory characteristics, improved self-esteem and positive affect, and reduced negative affect and paranoia, with large effect sizes. These effects were maintained at follow-up. CONCLUSIONS: While a within-subject design is useful for initial exploration of novel interventions, controlled studies are needed to determine causality. This is the first study to examine mechanisms of IR in paranoia. A controlled trial is now warranted.

The EMDR Recent Birth Trauma Protocol: a pilot randomised clinical trial after traumatic childbirth.

Objective: This pilot study investigated the effectiveness of brief EMDR intervention as compared to treatment-as-usual (TAU) in women with post-partum PTSD symptoms.Design: A pilot randomised controlled trial was conducted to evaluate possible differences between one EMDR session (n = 19) and one TAU session (n = 18) delivered in a maternity ward in the aftermath of childbirth.Main Outcome Measures: The primary outcome measure was the rate of remission of post-partum post-traumatic stress symptoms (i.e. IES-R score <23) in both groups at 6-weeks (T1) and 12-weeks' post-partum (T2). Secondary outcome measures were mother-to-infant bonding, post-partum depressive symptoms, the presence of flashbacks and level of distress.Results: Most of the women improved their post-partum post-traumatic stress symptoms after only one treatment session. EMDR resulted more effective than TAU in reducing the proportion of women with post-partum post-traumatic stress symptoms at 6-weeks' post-partum (78.9% EMDR vs. 39.9% TAU; p = .020). Moreover, women treated with EMDR experienced less flashbacks and distress as compared to TAU. No significant difference was found between treatments on mother-to-infant bonding and post-partum depressive symptoms.Conclusions: These findings, although preliminary, suggest that a brief EMDR intervention could be a viable and promising tool in the early treatment of post-traumatic stress related to traumatic childbirth.

How specific is cognitive change? A randomized controlled trial comparing brief cognitive and mindfulness interventions for depression.

Objective: There is a debate in psychotherapy research as to whether different kinds of psychotherapy work through specific mechanisms of change. Particularly, it is questioned whether cognitive change is specific to cognitive therapy. This study aimed to answer this question by comparing a brief cognitive intervention with an active comparison intervention (i.e., brief mindfulness-based intervention) and by following strict methodological guidelines. Method: 72 currently depressed outpatients were randomized to either cognitive intervention (n = 39) or mindfulness-based intervention (n = 33). Automatic thoughts (negative self-statements, well-being, and self-confidence), dysfunctional attitudes (performance evaluation and approval by others) and depressive symptoms were assessed before and six times during treatment. Within-person and between-person mediation effects were analyzed using multilevel structural equation modeling. Results: There was no difference in cognitive change between the interventions. Negative self-statements and performance evaluations were significant mediators of the within-person effect of time on depressive symptoms, while the three other cognitive variables did not change. Conversely, change in depressive symptoms also mediated within-person cognitive change. Conclusion: Cognitive change seems to be a general rather than a specific mechanism of change. However, the mutual impact of cognitive and depressive change does not support a unidirectional causal model.

Impact of brief intervention and art therapy for alcohol users / Impacto de la intervención breve y de la arteterapia en usuarios de alcohol / Impacto da intervenção breve e arteterapia para usuários de álcool

ABSTRACT Objective: To identify the impact of brief intervention paired with art therapy in patients who use alcohol. Method: This study presents intra-group design, with 11 alcoholics in the city of Tamarana-PR, Brazil, between 2015 and 2016. A test to identify the alcohol consumption level was used at the beginning/end of the actions. Cohen's effect size and paired t-test were used to identify the impact of the actions on the reduction of alcohol intake. Results: Six participants ceased alcohol consumption, four showed high level of consumption and one presented average consumption. The paired t-test result suggested statistically significant difference between the initial and final scores, as well as 0.76 effect size. Conclusion: The brief intervention associated with the art therapy resulted in significant impact in reducing alcohol consumption. Investing in the continuous training of primary health care professionals is crucial to consolidate the improvements achieved.

RESUMEN Objetivo: Evaluar el impacto de la intervención breve junto con la arteterapia en usuarios que consumen alcohol. Método: Diseño intragrupo, siendo realizado entre 2015 y 2016, con la participación de 11 alcohólicos de la ciudad de Tamarana (PR, Brasil). Se realizó una prueba para identificar el nivel de consumo de alcohol antes y después de las acciones, y se calcularon el tamaño del efecto de Cohen y la prueba t pareada para evaluar el impacto de las acciones en la reducción del consumo de alcohol. Resultados: Seis dejaron de consumir alcohol, cuatro presentaron un alto consumo y uno presentó un consumo mediano. El resultado de la prueba t pareada reveló una diferencia estadísticamente significativa entre los puntajes inicial y final, así como en el tamaño del efecto con un 0,76. Conclusión: La intervención breve asociada a la arteterapia tuvo un gran impacto en la disminuición del consumo de alcohol. Es fundamental invertir en la educación continuada de los profesionales de la atención primaria de salud para consolidar las mejoras obtenidas.

RESUMO Objetivo: Identificar o impacto da intervenção breve em conjunto com a arteterapia em usuários que consomem álcool. Método: Delineamento intragrupo, com 11 alcoolistas na cidade de Tamarana-PR, entre 2015 e 2016. Foi utilizado um teste para identificação do nível de consumo de álcool ao início/término das ações e calculada a medida de efeito de Cohen e teste t pareado, para identificar o impacto das ações na redução do consumo de álcool. Resultados: Houve seis cessares do consumo de álcool, quatro apresentaram nível elevado de consumo e um apresentou consumo mediano. O resultado do teste t pareado sugeriu diferença estatisticamente significativa entre os escores iniciais e finais, assim como a medida de efeito de 0,76. Conclusão: A intervenção breve associada à arteterapia resultaram em grande impacto para a redução do consumo de álcool. É fundamental investir na educação continuada dos profissionais da atenção primária em saúde para consolidar as melhorias obtidas.

Impact of brief intervention and art therapy for alcohol users.

OBJECTIVE: To identify the impact of brief intervention paired with art therapy in patients who use alcohol. METHOD: This study presents intra-group design, with 11 alcoholics in the city of Tamarana-PR, Brazil, between 2015 and 2016. A test to identify the alcohol consumption level was used at the beginning/end of the actions. Cohen's effect size and paired t-test were used to identify the impact of the actions on the reduction of alcohol intake. RESULTS: Six participants ceased alcohol consumption, four showed high level of consumption and one presented average consumption. The paired t-test result suggested statistically significant difference between the initial and final scores, as well as 0.76 effect size. CONCLUSION: The brief intervention associated with the art therapy resulted in significant impact in reducing alcohol consumption. Investing in the continuous training of primary health care professionals is crucial to consolidate the improvements achieved.