Pallidum volume as a predictor for the effectiveness of mindfulness-based cognitive therapy and psycho-education in unmedicated patients with obsessive-compulsive disorder.

BACKGROUND: Mindfulness-based cognitive therapy (MBCT) has been documented to be effective in treating obsessive-compulsive disorder (OCD). However, the neurobiological basis of MBCT remains largely elusive, which makes it clinically challenging to predict which patients are more likely to respond poorly. Hence, identifying biomarkers for predicting treatment outcomes holds both scientific and clinical values. This prognostic study aims to investigate whether pre-treatment brain morphological metrics can predict the effectiveness of MBCT, compared with psycho-education (PE) as an active placebo, among patients with OCD. METHODS: A total of 32 patients with OCD were included in this prognostic study. They received magnetic resonance imaging (MRI) brain scans before treatment. Subsequently, 16 patients received 10 weeks of MBCT, while the other 16 patients underwent a 10-week PE program. The effectiveness of the treatments was primarily assessed by the reduction rate of the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) total score before and after the treatment. We investigated whether several predefined OCD-associated brain morphological metrics, selected based on prior published studies by the ENIGMA Consortium, could predict the treatment effectiveness. RESULTS: Both the MBCT and PE groups exhibited substantial reductions in Y-BOCS scores over 10 weeks of treatment, with the MBCT group showing a larger reduction. Notably, the pallidum total volume was associated with treatment effectiveness, irrespective of the intervention group. Specifically, a linear regression model utilizing the pre-treatment pallidum volume to predict the treatment effectiveness suggested that a one-cubic-centimeter increase in pallidum volume corresponded to a 22.3% decrease in the Y-BOCS total score reduction rate. CONCLUSIONS: Pallidum volume may serve as a promising predictor for the effectiveness of MBCT and PE, and perhaps, other treatments with the shared mechanisms by MBCT and PE, among patients with OCD.

A Randomized Controlled Trial of Mindfulness in Recovery from Colorectal Cancer.

OBJECTIVE: This study examined whether a 4-week group-based mindfulness intervention would be superior in reducing psychological distress in colorectal cancer (CRC) patients compared to a psychoeducation and cognitive behavioural skills learning support active control group. METHODS: Patients with CRC were randomized via Computerised Permuted Block Randomisation to mindfulness or active control groups (2-h weekly sessions over 4 weeks). Outcomes were measured pre-intervention, and 8 weeks and 6 months post-baseline. The primary outcome was psychological distress measured by the Hospital Anxiety and Depression Scale. Secondary outcomes were generic quality of life (QoL), disease specific QoL, mindfulness, and intervention credibility and acceptability. RESULTS: Sixty-eight participants were randomized to mindfulness (n=35) or active control group (n=33). Uptake of potentially eligible patients consenting was low (28.0%) and the dropout rate was 33.8%. Depression scores were reduced in both groups at week 8 (P=0.020). Control participants had greater improvement in generic mental QoL scores at week 8 than mindfulness (P=0.023). In disease specific QoL, there was reduction in impotence symptom in the mindfulness group (P=0.022) and reduction in faecal incontinence in the control group (P=0.019). The embarrassment symptom had a significantly lower increase in the mindfulness group at week 8 compared to the control group (P=0.009). Both groups rated the treatments as credible and acceptable. CONCLUSIONS: Mindfulness was not superior to the active control group in terms of alleviating psychological distress but both treatments were associated with some improvements in depression. There was low uptake of both interventions. (Trial registration number: ACTRN12616001033437).

Effects of a Video Sequence Based Intervention on Anxiety, Fatigue and Depression in Cancer Patients: Results of a Randomized Controlled Trial.

BACKGROUND: Cancer patients often suffer from psychological symptoms and need psychological support. Especially during the COVID-19 pandemic, eHealth interventions might be helpful to overcome the obstacles of the pandemic. This study evaluates the effectiveness of a video sequence-based eHealth intervention on anxiety, fatigue, and depression in cancer patients. METHODS: Patients (N = 157) with different tumor entities were randomly assigned to the video intervention group (IG) and the waiting control group (CG). Patients in the IG received a video intervention comprising 8 video sequences over 4 weeks. The videos included psychoeducation on distress and psychological symptoms, Acceptance and Commitment Therapy elements, and Yoga and Qigong exercises. Patients' anxiety and fear of progression (primary outcomes) and secondary outcomes were assessed before randomization (T1) and after the end of the intervention for IG or the waiting period for CG (T2) using self-reported questionnaires (GAD-7, PA-F-KF, EORTC QLQ-FA12, PHQ-8). RESULTS: Patients of the IG showed no significant improvement in anxiety (GAD-7; P = .75), fear of progression (FoP-Q-SF; P = .29), fatigue (EORTC QLQ-FA12; P = .72), and depression (PHQ-8; P = .95) compared to patients in the waiting CG. However, symptoms of anxiety, fatigue, and depression decreased in both groups. Exploratory subgroup analysis regarding sex, therapy status, therapy goal, and tumor entity showed no effects. Overall, the intervention had a high level of acceptance. CONCLUSIONS: The video intervention was ineffective in reducing the psychological burden compared to a waiting CG. The findings support prior observations of the value of therapeutic guidance and promoting self-management for improving patients' psychological burdens. Further studies are required to evaluate the effectiveness of psycho-oncological eHealth delivered through video sequences.

The Effects of a Mindfulness-Based Family Psychoeducation Intervention for the Caregivers of Young Adults with First-Episode Psychosis: A Randomized Controlled Trial.

OBJECTIVE: In this study, we investigated the effects of a mindfulness-based family psychoeducation (MBFPE) program on the mental-health outcomes of both caregivers and young adults with first-episode psychosis with an onset in the past three years through a multi-site randomized controlled trial. We also studied the outcomes of three potential mediating effects of interpersonal mindfulness, expressed emotions, and non-attachment on the program. METHOD: We randomly assigned 65 caregivers of young adults with psychosis to MBFPE (n = 33) or an ordinary family psychoeducation (FPE) program (n = 32); among them, 18 young adults in recovery also participated in the evaluation of outcomes. RESULTS: Intent-to-treat analyses were conducted. No significant time × group interaction effects of MBFPE and FPE programs were found in any of the caregivers' outcomes. However, the young adults with psychosis reported higher levels of recovery after the MBFPE program than after the ordinary FPE program (F = 8.268, p = 0.012, d = 1.484). They also reported a larger reduction in over-involvement of their caregivers (F = 4.846, p = 0.044, d = 1.136), showing that MBFPE had a superior effect to FPE in promoting recovery and reducing over-involvement. CONCLUSIONS: A brief psychoeducation program may not reduce the burden on or improve the mental-health outcome of caregivers of individuals with recent-onset psychosis. However, integrating mindfulness into a conventional family psychoeducation program may reduce the expressed emotions of caregivers, especially over-involvement. Further studies should explore how psychoeducation programs can reduce the impact of psychosis on family through sustainable effects in terms of reducing their burden and expressed emotions, using a rigorous study and adequate sample size.

Comparing the effectiveness of imagery focussed cognitive therapy to group psychoeducation for patients with bipolar disorder: A randomised trial.

BACKGROUND: Bipolar disorder is a severe, chronic mental disorder. Treatment options are limited, with pharmacological approaches continuing to dominate. However, relapse rates remain high. Several adjunctive psychosocial interventions, mostly psychoeducation (PE) and cognitive behavioural therapy (CBT), have been trialled, but treatment innovation is still needed. In the past, brief group PE has proven as beneficial as longer individual CBT in reducing levels of depression and increasing self-management strategies. We compared the relative effectiveness of group PE to an imagery focussed cognitive behavioural therapy (ImCT). STUDY DESIGN: This was a randomised parallel group study with both daily and weekly measures. A total of 62 adult patients were randomly allocated to either ImCT or group PE. Daily, weekly and pre-and post-intervention measures were used to assess impact on (i) mood instability, (ii) overall levels of depression, anxiety and mania, and (iii) general functioning, hopelessness and imagery characteristics. A four-week baseline and 16-week follow-up period were included. RESULTS: Mood instability reduced in both conditions after intervention. Levels of mania, depression and anxiety also reduced in both conditions, but on the daily measures, depression and anxiety significantly more so in the ImCT condition. Compared with the PE condition, the ImCT condition additionally showed increased level of functioning, reduced hopelessness, and a decrease in intrusive, problematic imagery. LIMITATIONS: These findings need to be replicated in a larger trial. CONCLUSIONS: Findings suggest that ImCT is a promising new avenue for management of bipolar disorder, an area in which treatment development is urgently needed.

Resilience, Insight, Self-Compassion, and Empowerment (RISE): A Randomized Controlled Trial of a Psychoeducational Group Program for Nurses.

BACKGROUND: Nurses tend to be vulnerable to burnout and compassion fatigue due to constant workplace stressors. There is a need to provide advocacy, education, programming, and resources in the areas of positive coping and self-care to reduce burnout symptoms and promote well-being. RISE is an 8-week psychoeducational group intervention for nurses with four themes: resilience, insight, self-compassion, and empowerment. AIMS: This randomized controlled trial examined the effects of RISE on mental well-being. METHODS: The sample included 75 registered nurses who work in a hospital-based setting. Outcomes included resilience, insight, self-compassion, empowerment, stress mind-set, perceived stress, and burnout. Independent-samples t tests were conducted to compare outcomes between intervention and wait-list control groups at baseline and 1-month follow-up, as well as at 3-month follow-up. Supplemental analyses included paired-samples t tests and linear mixed models to compare the outcomes of the intervention group participants at baseline to 1-month follow-up, as well as at 3-month and 6-month follow-ups. RESULTS: Participants in the intervention group showed improved levels of insight (i.e., engagement in self-reflection), perceived stress, and burnout (i.e., emotional exhaustion) when compared with the control group and improved levels of resilience, self-compassion, stress mind-set, and perceived stress when compared with their baseline. CONCLUSIONS: This study informs how RISE affects nurse well-being and may be an effective intervention for reducing burnout and stress. This type of whole-person intervention can support nurses to improve their well-being and ability to cope amid the complex interplay of factors at the individual, unit, and organizational levels.

Nonpharmacologic Interventions and Seizure Frequency in Patients With Psychogenic Nonepileptic Seizures: An Integrative Review.

BACKGROUND: Psychogenic nonepileptic seizures (PNES) pose a heavy burden on patients' lives and the health care system. The symptoms of PNES are often debilitating and cause high rates of disability and poor quality of life. Many treatment options are available, but there is no clear consensus on best practices. AIM: To critique and synthesize the current literature on nonpharmacologic interventions and effects on seizure frequency in patients with PNES. METHODS: An integrative review guided by the Whittemore and Knafl approach. RESULTS: The review included 24 studies published from 2010 to 2020. Interventions for PNES included individualized psychotherapies, group therapies, multimodal psychotherapies, self-help therapies, and complementary and alternative medicine therapies. Individual psychotherapies such as cognitive behavioral therapy and psychoeducation were the most used treatment modalities. The most effective treatments for seizure frequency reduction were those that included multiple psychotherapy sessions with a health care provider and covered multiple domains (e.g., understanding of diagnosis, identifying triggers, and developing effective coping strategies). CONCLUSIONS: Seizure frequency can be reduced in patients with PNES with multiple nonpharmacologic interventions. However, seizure frequency is not considered a comprehensive outcome measure and provides little insight into other important life domains. Further research is needed on nonpharmacologic interventions for PNES and effects on other areas of life such as sleep, employment status, global functioning, and self-efficacy.

Mindfulness-based cognitive therapy versus psychoeducational intervention in bipolar outpatients: Results from a randomized controlled trial.

INTRODUCTION: Few controlled trials have assessed the impact of Mindfulness Based Cognitive Therapy (MBCT) on symptoms and functioning in bipolar disorder (BD). This study aims to evaluate the effectiveness of MBCT adjunctive group treatment. MATERIAL AND METHODS: Randomized, prospective, multicenter, single-blinded trial that included BP-outpatients with subthreshold depressive symptoms. Participants were randomly assigned to three arms: treatment as usual (TAU); TAU plus psychoeducation; and TAU plus MBCT. Primary outcome was change in Hamilton-D score; secondary endpoints were change in anxiety, hypo/mania symptoms and functional improvement. Patients were assessed at baseline (V1), 8 weeks (V2) and 6 months (V3). Main hypothesis was that adjunctive MBCT would improve depressive symptoms more than psychoeducation. RESULTS: Eighty-four participants were recruited (MBCT=40, Psychoeducation=34, TAU=10). Depressive symptoms improved in the three arms between V1 and V2 (p<0.0001), and between V1 and V3 (p<0.0001), and did not change between V2 and V3. At V3 no significant differences between groups were found. There were no significant differences in other measures either. CONCLUSIONS: In our BD population we did not find superiority of adjunctive MBCT over adjunctive Psychoeducation or TAU on subsyndromal depressive symptoms; neither on anxiety, hypo/mania, relapses, or functioning.

A Psychoeducational Group Intervention for Nurses: Rationale, Theoretical Framework, and Development.

OBJECTIVE: Nursing is a demanding profession with constant stressors, which makes nurses vulnerable to the detrimental effects of high stress, burnout, and compassion fatigue. There is a need for a multidimensional group intervention facilitated by a licensed mental health professional to improve mental health and well-being in nurses. An intervention called RISE, which is an acronym for resilience, insight, self-compassion, and empowerment, was developed to promote self-care, protect against burnout, and improve indicators of well-being among nurses. We explain the rationale, theoretical framework, and development of RISE. METHODS: RISE is based on an integrative theoretical framework of mindfulness, acceptance and commitment therapy, and cognitive-behavioral therapy. It consists of eight psychoeducational group sessions with topics related to the four RISE themes of resilience, insight, self-compassion, and empowerment. RESULTS: RISE is a contribution to the literature on well-being interventions for nurses. It will further the understanding of effective interventions to mediate the detrimental effects of stress and burnout in nursing and to improve the mental health and well-being of nurses amid the complex interplay of factors at the individual, unit, and organizational levels. CONCLUSIONS: As an approach that combines education with therapeutic process and support to improve coping and well-being inside and outside of the workplace, RISE addresses the underlying causes and effects of high stress, burnout, and compassion fatigue.

A Randomized Controlled Trial of Mindfulness in Recovery from Colorectal Cancer / 中国结合医学杂志

OBJECTIVE@#This study examined whether a 4-week group-based mindfulness intervention would be superior in reducing psychological distress in colorectal cancer (CRC) patients compared to a psychoeducation and cognitive behavioural skills learning support active control group.@*METHODS@#Patients with CRC were randomized via Computerised Permuted Block Randomisation to mindfulness or active control groups (2-h weekly sessions over 4 weeks). Outcomes were measured pre-intervention, and 8 weeks and 6 months post-baseline. The primary outcome was psychological distress measured by the Hospital Anxiety and Depression Scale. Secondary outcomes were generic quality of life (QoL), disease specific QoL, mindfulness, and intervention credibility and acceptability.@*RESULTS@#Sixty-eight participants were randomized to mindfulness (n=35) or active control group (n=33). Uptake of potentially eligible patients consenting was low (28.0%) and the dropout rate was 33.8%. Depression scores were reduced in both groups at week 8 (P=0.020). Control participants had greater improvement in generic mental QoL scores at week 8 than mindfulness (P=0.023). In disease specific QoL, there was reduction in impotence symptom in the mindfulness group (P=0.022) and reduction in faecal incontinence in the control group (P=0.019). The embarrassment symptom had a significantly lower increase in the mindfulness group at week 8 compared to the control group (P=0.009). Both groups rated the treatments as credible and acceptable.@*CONCLUSIONS@#Mindfulness was not superior to the active control group in terms of alleviating psychological distress but both treatments were associated with some improvements in depression. There was low uptake of both interventions. (Trial registration number: ACTRN12616001033437).

A Randomized Controlled Trial of Mindfulness in Recovery from Colorectal Cancer / 中国结合医学杂志

OBJECTIVE@#This study examined whether a 4-week group-based mindfulness intervention would be superior in reducing psychological distress in colorectal cancer (CRC) patients compared to a psychoeducation and cognitive behavioural skills learning support active control group.@*METHODS@#Patients with CRC were randomized via Computerised Permuted Block Randomisation to mindfulness or active control groups (2-h weekly sessions over 4 weeks). Outcomes were measured pre-intervention, and 8 weeks and 6 months post-baseline. The primary outcome was psychological distress measured by the Hospital Anxiety and Depression Scale. Secondary outcomes were generic quality of life (QoL), disease specific QoL, mindfulness, and intervention credibility and acceptability.@*RESULTS@#Sixty-eight participants were randomized to mindfulness (n=35) or active control group (n=33). Uptake of potentially eligible patients consenting was low (28.0%) and the dropout rate was 33.8%. Depression scores were reduced in both groups at week 8 (P=0.020). Control participants had greater improvement in generic mental QoL scores at week 8 than mindfulness (P=0.023). In disease specific QoL, there was reduction in impotence symptom in the mindfulness group (P=0.022) and reduction in faecal incontinence in the control group (P=0.019). The embarrassment symptom had a significantly lower increase in the mindfulness group at week 8 compared to the control group (P=0.009). Both groups rated the treatments as credible and acceptable.@*CONCLUSIONS@#Mindfulness was not superior to the active control group in terms of alleviating psychological distress but both treatments were associated with some improvements in depression. There was low uptake of both interventions. (Trial registration number: ACTRN12616001033437).

Promoção da literacia em saúde mental: psicoeducação e autogestão da doença / Promoting mental health literacy: psychoeducation and illness self-management

A psicoeducação é uma estratégia de intervenção fundamental para o enfermeiro especialista em enfermagem de saúde mental e psiquiátrica e enquadra-se como boa prática na promoção da literacia em saúde mental, proporciona a capacitação da pessoa com doença mental, possibilita a compreensão dos processos de saúde e o envolvimento ativo no tratamento com o intuito de potenciar o empoderamento para a autogestão da doença. Existem diferentes programas psicoeducativos de acordo com o local onde é realizada, a pessoa ou o grupo a quem se aplica, sendo também possível a utilização de diferentes atividades criativas na sua dinamização. O relatório da Organização Mundial de Saúde (2019) encontra evidências na contribuição das atividades criativas na promoção da saúde e a prevenção da doença mental e física, bem como o tratamento ou a gestão de condições agudas e crónicas que surgem ao longo da vida. As atividades criativas facilitam a autoexpressão, interação social, comunicação, estimulação sensorial e alívio emocional. Promover a literacia em saúde mental, nomeadamente a autogestão da doença mental foi o objetivo geral deste projeto. Recorreu-se à aplicação de um programa psicoeducativo com recurso a mediadores expressivos no contexto de internamento e comunitário. Da análise da aplicação do programa constatou-se o incremento do conhecimento a nível da identificação de sinais de alerta. O uso do álcool e estratégias de coping apresentaram maior deficit de conhecimento. Concluiu-se que resultaram ganhos em saúde como a promoção do autoconhecimento, a capacitação para a tomada de decisão informada. Demonstrou-se a possibilidade de aplicar um programa psicoeducativo para a autogestão da doença em contexto de internamento. As atividades criativas revelaram-se facilitadoras no processo de capacitação na autogestão da doença mental. A intervenção produziu melhorias ao nível da literacia em saúde mental.

Psychoeducation is a key intervention strategy for the specialist nurse in mental health and psychiatric nursing. It is a good practice in the promotion of mental health literacy, provides empowerment to people with mental illness, allows for the understanding of health processes and the active involvement in treatment with the purpose of empowering them to self-manage the disease (OE, 2021). There are different psychoeducational programmes according to the place where it is carried out, the person or the group to whom it is applied, and it is also possible to use different creative activities in its dynamisation (Godoy et al., 2020). The WHO report (2019) finds evidence in the contribution of creative activities in health promotion and the prevention of mental and physical illness, as well as the treatment or management of acute and chronic conditions that arise throughout life. Creative activities facilitate self-expression, social interaction, communication, sensory stimulation and emotional relief (Vaartio Rajalin et al., 2021). The overall objective of this project was to promote mental health literacy, namely self-management of mental illness. A psycho-educational programme was applied using expressive mediators in the inpatient and community contexts. The analysis of the application of the programme showed an increase in knowledge regarding the identification of warning signs. Alcohol use and coping strategies showed a greater knowledge deficit. It was concluded that health gains resulted as the promotion of self knowledge, empowerment for informed decision making. The possibility of applying a psychoeducational programme for disease self-management in inpatient settings was demonstrated. The creative activities proved to be facilitators in the process of empowerment in self-management of mental illness. The intervention produced improvements in mental health literacy.

Intervenções psicoeducativas na promoção da mudança da pessoa com dependência de álcool / Psychoeducational interventions to promote change in people with alcohol dependence

O consumo de álcool é considerado um problema de saúde pública a nível mundial, sendo altos os custos e os encargos sociais daí decorrentes. Em Portugal apesar da relativa estabilidade de consumos recentes e atuais, relativamente a 2014, verifica-se atualmente um agravamento dos consumos de risco e dependência. A psicoeducação é reconhecida como uma estratégia eficaz, utilizada frequentemente nas intervenções de enfermagem. Na pessoa com dependência de álcool, a utilização de intervenções psicoeducativas, permite aumentar a ambivalência em relação ao consumo do álcool e a motivação intrínseca para a mudança de comportamento. A utilização da Entrevista Motivacional, considerado um estilo de comunicação centrada na pessoa, contribui para ajudar a pessoa a ultrapassar a ambivalência face à mudança, consolidando o compromisso deste processo. O presente trabalho constitui uma análise crítica-reflexiva, acerca das intervenções especializadas de saúde mental e psiquiátrica, desenvolvidas em contexto de estágio, que tiveram como objetivo principal a promoção da mudança da pessoa com dependência de álcool, tendo sido utilizada a psicoeducação como estratégia privilegiada de intervenção. Os estágios decorreram em duas unidades de cuidados de saúde mental, em contexto de internamento, na região de Lisboa e em contexto comunitário, na região de Setúbal. Os participantes foram os utentes destas unidades, do género masculino e feminino, com idades compreendidas entre os vinte cinco e os setenta oito anos. Foram implementadas intervenções em modalidade de grupo e individual. Os resultados obtidos evidenciam ganhos em saúde, nomeadamente no aumento do autocontrolo e autoeficácia, do autoconhecimento, na expressão de emoções e sentimentos, na vivência de experiências positivas e de bem-estar. As intervenções desenvolvidas foram assim facilitadoras no processo de consciencialização da problemática da dependência do álcool e para o aumento da ambivalência, contribuindo para a mudança de comportamento.

Alcohol abuse is considered a public health problem worldwide, and the costs and social burdens are high. In Portugal, despite the relative stability of recent and current consumption, compared to 2014, there is currently a worsening of risky abuse and addiction. Psychoeducation is recognized as an effective strategy, frequently used in nursing interventions. In the person with alcohol dependency, the use of psychoeducational interventions allows to increase the ambivalence in relation to the consumption of alcohol and the intrinsic motivation for changing the behaviour. The use of Motivational Interviewing considered a style of communication centred on the person helps to overcome the ambivalence towards the change, consolidating the commitment with this process. The present work constitutes a critical and reflexive analysis of the specialized interventions in mental and psychiatric health, developed in the context of an internship that had as main objective the promotion of the change in people with alcohol dependence and the psychoeducation was used as a privileged strategy of intervention. The internships took place in two units of mental healthcare, in an impatient context in the region of Lisbon and in a community context in the region of Setúbal. The participants were the patients of these units, male and female, aged between twenty-five and seventy-eight years old. Group and individual interventions were implemented. The results obtained highlight gains in terms of health, namely with the increase of self-control and self-efficacy, self-knowledge, in the expression of emotions and feelings, in the perception of positive experiences and well-being. The interventions developed facilitated the process of awareness of the problem of alcohol abuse and the increase of ambivalence, contributing to the change in the behaviour.

Effect of mindfulness-based cognitive therapy vs. psychoeducational intervention on plasma brain-derived neurotrophic factor and cognitive function in bipolar patients: a randomized controlled trial.

Introduction: Few controlled trials have assessed the benefits of Mindfulness Based Cognitive Therapy (MBCT) on cognitive functions and brain-derived neurotrophic factor (BDNF) in bipolar disorder (BD). This study aims to evaluate the impact of MBCT adjunctive treatment on these variables. Main hypothesis was that MBCT would improve cognitive functioning and BDNF more than Psychoeducation and TAU. Methods: Randomized, multicenter, prospective and single-blinded trial. Included BD outpatients randomly assigned to three treatment arms: MBCT plus treatment as usual (TAU), Psychoeducation plus Tau and TAU. Cognitive functions were assessed with Continuous Performance Test-III, Stroop Test, Trail Making Test, Digit Span and Letter-Number Sequencing from Wechsler Adult Intelligence Scale III, Face Emotion Identification Task and Face Emotion Discrimination Task. BDNF serum level was measured with ELISA. Patients were assessed at baseline, 8 weeks and 6 months. Results: Eighty-four patients were recruited (TAU = 10, Psychoeducation = 34, MBCT = 40). No significant differences between treatment groups were found. MBCT does not achieve better results than Psychoeducation or TAU. Discussion: Being Psychoeducation and TAU efficient interventions, as well as the scarce duration of a more complex intervention, such as MBCT, are suggested as explanatory variables of these results. Trial registration: ClinicalTrials.gov: NCT02133170. Registered 04/30/2014.

Using Photovoice in a Mindfulness-Based Program to Understand the Experiences of Caregivers of Young Adults with Psychosis.

Studies have consistently shown that family caregivers experience caregiver burden and depression when they provide care for family members with psychosis. Photovoice is a participatory action research method of fostering dialogues about personal experiences by sharing and discussing photographs that may improve our understanding about how a mindfulness-based family psychoeducation program (MBFPE) can reduce the caregiver burden and improve their caregiving experience. We explored the experiences of the participants in their use of photovoice in a MBFPE. We investigated whether the MBFPE program generated positive changes for caregivers of young adults with psychosis. Using photovoice, we collected qualitative data to help develop a unique contextual understanding of MBFPE program outcomes and generate novel ideas, insights, suggestions, and questions on the basis of participant's perceptions. Participants in our pilot study and randomized controlled study of MBFPE were invited to participate in this photovoice activity. On the basis of a procedure developed for MBFPE, caregivers were invited to use photographs to express how mindfulness contributed to caregivers' management of their caregiving stress and burden. Caregiver's inquiry with the MBFPE instructors were transcribed for analysis together with the photographs. A grounded theory approach was adopted to analyze the photovoice images, participants' reflections, and inquiries of photographs. Six themes were developed in understanding the lived experience of caregivers in participation of MBFPE: (1) I pay attention to the present moment; (2) I care about my family; (3) I trust my children; (4) I appreciate the connection with and support from nature and the universe; (5) I observe my worries and guilt and learn not to be reactive; and (6) I find space in offering care and exercising self-care. The application of photovoice can offer an additional approach to enhance the awareness and insights of participants in a mindfulness-based program. Specific guidelines may be developed to enhance the learning of participants.

Family-based cognitive behavioural therapy versus family-based relaxation therapy for obsessive-compulsive disorder in children and adolescents (the TECTO trial): a statistical analysis plan for the randomised clinical trial.

BACKGROUND: Obsessive-compulsive disorder (OCD) is a debilitating psychiatric disorder which affects up to 3% of children and adolescents. OCD in children and adolescents is generally treated with cognitive behavioural therapy (CBT), which, in more severely affected patients, can be combined with antidepressant medication. The TECTO trial aims to compare the benefits and harms of family-based CBT (FCBT) versus family-based psychoeducation/relaxation training (FPRT) in children and adolescents aged 8 to 17 years. This statistical analysis plan outlines the planned statistical analyses for the TECTO trial. METHODS: The TECTO trial is an investigator-initiated, independently funded, single-centre, parallel-group, superiority randomised clinical trial. Both groups undergo 14 sessions of 75 min each during a period of 16 weeks with either FCBT or FPRT depending on the allocation. Participants are randomised stratified by age and baseline Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) score. The primary outcome is the CY-BOCS score. Secondary outcomes are health-related quality of life assessed using KIDSCREEN-10 and adverse events assessed by the Negative Effects Questionnaire (NEQ). Primary and secondary outcomes are assessed at the end of the intervention. Continuous outcomes will be analysed using linear regression adjusted for the stratification variables and baseline value of the continuous outcome. Dichotomous outcomes will be analysed using logistic regression adjusted for the stratification variables. The statistical analyses will be carried out by two independent blinded statisticians. DISCUSSION: This statistical analysis plan includes a detailed predefined description of how data will be analysed and presented in the main publication before unblinding of study data. Statistical analysis plans limit selective reporting bias. This statistical analysis plan will increase the validity of the final trial results. TRIAL REGISTRATION: ClinicalTrials.gov NCT03595098. July 23, 2018.

A service evaluation of a community project combining psychoeducation and mind-body complementary approaches to support those with long covid in the UK.

Introduction: Post covid-19 syndrome or Long Covid has been estimated to impact 1.3 million individuals in the UK. This study evaluates the outcomes of delivering a complementary Long Covid support service using psycho-educational and mind-body approaches within a community setting. Methods: This study utilised quantitative methods to evaluate the outcomes of implementing a complementary approach to providing Long Covid support. The service offered a package of care including group sessions combining psychoeducation and mind-body complementary approaches and optional 1:2:1 sessions (physiotherapy and craniosacral therapy (CST)). Screening for the service and health information was obtained using the Covid-19-Yorkshire Rehabilitation Screening tool (C-19 YRS). The impact of the service was assessed using the patient reported outcome measure: Warwick Holistic Health Questionnaire (WHHQ-18), and a survey was designed for general evaluation and feedback about the service from participants. Results: 25 participants engaged with the service. The C-19YRS proved to be a useful tool to screen service users. The WHHQ-18 highlighted a positive group change (n = 16) in participants' mental, physical, emotional, and spiritual wellbeing: mean group score at the start = 33.7 (SD=12.5), mean group score at the follow up = 39.5 (SD=10.8). In the feedback from the service evaluation, participants reported that the service was useful in supporting them with their health challenges resulting from Long Covid and was delivered to the standard expected. Conclusion: In conclusion the psycho-educational and mind-body complementary approaches used within this service were well received and the measures used to evaluate were suitable for a service delivered within a community setting.

Psychodrama as a new intervention for reducing fear of childbirth: a randomised controlled trial.

This study was designed to examine the potential benefit of the addition of psychodrama classes to antenatal education as a new technique to address fear of childbirth. This was a randomised controlled trial. A total of 150 women were initially enrolled in two groups. Psychodrama sessions were added to standard antenatal education in the experiment group. The control group participated only in routine antenatal education classes. Birth outcomes and fear of childbirth were measured and analysed to assess the impact. The analysis was completed with an experimental group of 50 women and a control group of 49 women. At the conclusion of the training, it was observed that there was a greater decrease in fear of childbirth in the experiment group than in the control group. Additionally, in the postpartum period, the experimental group had a higher rate of vaginal childbirth and a shorter childbirth time than the control group. Psychodrama may be an effective means of reducing fear of childbirth and reduced caesarean section childbirth. Psychoeducation should be added antenatal education programs. Thus, it may represent an important tool in the efforts to improve maternal mental health and also provide broader social benefits.IMPACT STATEMENTWhat is already known on this subject? Studies examining means to reduce fear of childbirth have found that psychoanalysis, cognitive behavioural therapy, eye movement desensitisation and reprocessing, haptotherapy and art therapy were useful.What the results of this study add? Psychodrama as a new intervention may be beneficial decreased of fear of childbirth, increased of normal birth rate and at improving the experience of pregnancy and childbirth.What the implications are of these findings for clinical practice and/or further research? Protecting and caring for the mental health of the mother and child benefits the entire community. It has been reported that 1 in 5 mothers experience psychiatric difficulties during the postpartum period, and 7 of 10 do not receive treatment, which has a negative impact on the mother, the child and family. Assesment of the mental health of women during the postpartum period is not regularly performed in many countries and women are frequently left to struggle on their own. The identification of pregnant women who have a high fear of childbirth and who are at risk of developing a psychiatric disorder by nurses is an important element of providing of appropriate, high-quality care.

Do You Mind? Examining the Impact of Psychoeducation Specificity on Perceptions of Mindfulness-Based Programs.

OBJECTIVE: Mindfulness-based programs (MBPs) cultivate the capacity for mindfulness, defined as nonjudgmental acceptance and awareness of present-moment experience. Mindfulness has been associated with a host of benefits for users, such as improved indices of mental well-being. We examined public perceptions of acceptability (i.e., how appropriate the treatment is for a given problem) and credibility (i.e., how logical and convincing a treatment seems) of MBPs as a form of mental health intervention. The main objective of this study was to examine whether higher specificity of psychoeducational content improved perceptions of the acceptability and credibility of MBPs. METHODS: Participants (n = 188; female% = 39.4) were recruited online and randomly assigned to one of two conditions. In one condition, participants received balanced and evidence-based psychoeducation specific to MBPs for mental health. In the other condition, participants received general information about psychological treatments for mental health. Acceptability and credibility perceptions were measured by questionnaires across time (pre-and post-psychoeducation) and across specificity conditions (specific vs. general psychoeducation). RESULTS: Participants randomized to the general, but not the specific, psychoeducation-endorsed higher scores of acceptability of MBPs post-psychoeducation. Further, participants endorsed higher scores of MBP credibility post-psychoeducation, regardless of the specificity of psychoeducation provided. CONCLUSIONS: Perceptions of the acceptability of MBPs were improved following exposure to general psychoeducation, and perceptions of the credibility of MBPs were improved following psychoeducation, regardless of specificity. Examining public perceptions of MBPs is important for informing strategies to support access to and use of MBPs.

Family-based cognitive behavioural therapy versus family-based relaxation therapy for obsessive-compulsive disorder in children and adolescents: protocol for a randomised clinical trial (the TECTO trial).

BACKGROUND: Cognitive behavioural therapy (CBT) is the recommended first-line treatment for children and adolescents with obsessive-compulsive disorder (OCD), but evidence concerning treatment-specific benefits and harms compared with other interventions is limited. Furthermore, high risk-of-bias in most trials prevent firm conclusions regarding the efficacy of CBT. We investigate the benefits and harms of family-based CBT (FCBT) versus family-based psychoeducation and relaxation training (FPRT) in youth with OCD in a trial designed to reduce risk-of-bias. METHODS: This is an investigator-initiated, independently funded, single-centre, parallel group superiority randomised clinical trial (RCT). Outcome assessors, data managers, statisticians, and conclusion drawers are blinded. From child and adolescent mental health services we include patients aged 8-17 years with a primary OCD diagnosis and an entry score of ≥16 on the Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS). We exclude patients with comorbid illness contraindicating trial participation; intelligence quotient < 70; or treatment with CBT, PRT, antidepressant or antipsychotic medication within the last 6 months prior to trial entry. Participants are randomised 1:1 to the experimental intervention (FCBT) versus the control intervention (FPRT) each consisting of 14 75-min sessions. All therapists deliver both interventions. Follow-up assessments occur in week 4, 8 and 16 (end-of-treatment). The primary outcome is OCD symptom severity assessed with CY-BOCS at end-of-trial. Secondary outcomes are quality-of-life and adverse events. Based on sample size estimation, a minimum of 128 participants (64 in each intervention group) are included. DISCUSSION: In our trial design we aim to reduce risk-of-bias, enhance generalisability, and broaden the outcome measures by: 1) conducting an investigator-initiated, independently funded RCT; 2) blinding investigators; 3) investigating a representative sample of OCD patients; 3) using an active control intervention (FPRT) to tease apart general and specific therapy effects; 4) using equal dosing of interventions and therapist supervision in both intervention groups; 5) having therapists perform both interventions decided by randomisation; 6) rating fidelity of both interventions; 7) assessing a broad range of benefits and harms with repeated measures. The primary study limitations are the risk of missing data and the inability to blind participants and therapists to the intervention. TRIAL REGISTRATION: ClinicalTrials.gov : NCT03595098, registered July 23, 2018.