The effect of therapies on the quality of life of patients with systemic lupus erythematosus: a meta-analysis of randomized trials

Abstract Introduction Systemic lupus erythematosus (SLE) is a multi-systemic, chronic inflammatory disease of autoimmune nature, which can impair performance in daily life activities, causing to a compromised quality of life. Thus, the aim of this study was to evaluate the effect of therapies, such as physical activity, cognitive behavioral therapy, pharmacological treatment and phytotherapy in the quality of life of patients with systemic lupus erythematosus. Materials and methods A systematic review with a meta-analysis of randomized clinical trials was conducted by searching the PubMed database, including studies comparing patients who participated in cognitive therapy, physical activity, pharmacological treatment or phytotherapeutic treatment. Results Of the seven studies included in this meta-analysis, a significant difference was observed in the quality of life of patients with lupus who participated in the intervention groups compared to the control groups (− 10.27 95% CI: − 15, 77 at − 4.77, p = 0.0003, I2 = 0%). Conclusion Interventions improve the Quality of life of patients with SLE. However, the methodological quality of the included articles and the sizes of the samples for being small propose that new randomized clinical trials be performed.(AU)

A smartphone application for treating depressive symptoms: study protocol for a randomised controlled trial.

BACKGROUND: Depression is a commonly occurring disorder linked to diminished role functioning and quality of life. The development of treatments that overcome barriers to accessing treatment remains an important area of clinical research as most people delay or do not receive treatment at an appropriate time. The workplace is an ideal setting to roll-out an intervention, particularly given the substantial psychological benefits associated with remaining in the workforce. Mobile health (mhealth) interventions utilising smartphone applications (apps) offer novel solutions to disseminating evidence based programs, however few apps have undergone rigorous testing. The present study aims to evaluate the effectiveness of a smartphone app designed to treat depressive symptoms in workers. METHODS: The present study is a multicentre randomised controlled trial (RCT), comparing the effectiveness of the intervention to that of an attention control. The primary outcome measured will be reduced depressive symptoms at 3 months. Secondary outcomes such as wellbeing and work performance will also be measured. Employees from a range of industries will be recruited via a mixture of targeted social media advertising and Industry partners. Participants will be included if they present with likely current depression at baseline. Following baseline assessment (administered within the app), participants will be randomised to receive one of two versions of the Headgear application: 1) Intervention (a 30-day mental health intervention focusing on behavioural activation and mindfulness), or 2) attention control app (mood monitoring for 30 days). Participants will be blinded to their allocation. Analyses will be conducted within an intention to treat framework using mixed modelling. DISCUSSION: The results of this trial will provide valuable information about the effectiveness of mhealth interventions in the treatment of depressive symptoms in a workplace context. TRIAL REGISTRATION: The current trial is registered with the Australian and New Zealand Clinical Trials Registry ( ACTRN12617000547347 , Registration date: 19/04/2017).

Evaluación de un caso de trastorno obsesivo compulsivo e intervención / Assessment of and intervention in a child with an obsessive-compulsive disorder

Se describe el caso de un niño de 11 años que presenta un trastorno obsesivo compulsivo (TOC). Desde bebé era un niño miedoso con características temperamentales de inflexibilidad y persistencia. Los síntomas del cuadro surgen a partir de un episodio familiar negativo y se intensificaron en los últimos dos años. En el momento de la evaluación, el TOC interfería negativamente en la dinámica familiar, personal y social del niño. Se realizó un diagnóstico de sus dificultades por medio de entrevista clínica, instrumentos de observación y pruebas estandarizadas. Se llevó a cabo una intervención basada en el entrenamiento cognitivo-conductual, en el que se incluyó tanto a los padres como a los profesores de su colegio. Se relata la evolución del problema y el seguimiento del caso

The case of an eleven-year old child with an obsessive compulsive disorder is described. He was coward since he was a baby, with temperamental characteristics of inflexibility and persistence. The symptoms appeared from a negative family event and increased over the last two years. At the moment of evaluation the disorder interfered negatively in the child's family, personal, and social dynamics. A diagnosis of his difficulties was made by means of a clinical interview, observation, and standard tests. An intervention consisting of cognitive behavioral training was carried out, with the participation of parents and teachers. The case's evolution and follow up are described

Estudio piloto de la eficacia de empoderar a pacientes mediante coaching como tratamiento asociado en el trastorno por déficit de atención e hiperactividad / Pilot study of the efficacy of empowering patients through coaching as a complementary therapy in attention deficit hyperactivity disorder

Introducción: El trastorno por déficit de atención e hiperactividad (TDAH) es el trastorno del neurodesarrollo más frecuente y debe ser considerado un problema de primer orden de salud pública por sus repercusiones funcionales a nivel escolar, familiar y social. Empoderar en salud es un modelo innovador en el cuidado de pacientes con enfermedades crónicas, basado en la educación de automanejo. Nuestro objetivo es valorar la eficacia de empoderar mediante coaching, dentro de un plan de tratamiento multimodal en pacientes pediátricos con TDAH. Material y métodos: estudio descriptivo, abierto y prospectivo. Incluimos a niños de entre 6 y 12 años pertenecientes a una asociación de pacientes de un área suburbana de la Comunidad de Madrid. Valoramos la situación previa y posterior a 5 sesiones gratuitas de coaching mediante el Cuestionario de conducta de Conners de dificultades a lo largo del día (D-DTODS) y escalas de satisfacción. Resultados: Incluimos a 49 pacientes, el 73,5% varones, con una edad media de 8,5 años. El 63,3% tenía TDAH subtipo hiperactivo/impulsivo y el 77,6% algún tipo de comorbilidad. Todos tratados con metilfenidato y mala evolución clínica. El 79,6% mejoró clínicamente, con una reducción media ± DT de los síntomas del 34,6 ± 11,1% y mantenida en el 79,6% tras 6 meses de seguimiento post coaching. Alcanzamos un nivel de satisfacción de 7,8 ± 1,7 sobre 10 y el 95,9% recomendó el tratamiento a otras familias. Conclusiones: Nuestros resultados aportan información sobre los posibles beneficios del coaching como tratamiento asociado en el TDAH

Introduction: Attention deficit hyperactivity disorder (ADHD) is the most frequent neurodevelopmental disorder and must be considered a public health priority because of its functional repercussions in school, family, and social settings. Health empowerment is an innovative model of care for patients with chronic diseases based on self-management education. Our goal is to evaluate the effectiveness of empowerment using coaching within a multimodal treatment plan in paediatric patients with ADHD. Material and methods: Descriptive open prospective study. We included children between 6 and 12 years old belonging to patient association in a suburban area of the Region of Madrid. We evaluated the situation before and after 5 cost-free coaching sessions using the Conners Questionnaire, Dundee difficult times of day scale, and satisfaction scales. Results: We included 49 patients (73.5% males) with an average age of 8.5 years. The ADHD hyperactive-impulsive subtype was present in 63.3% and 77.6% had some type of comorbidity. All were treated with methylphenidate and their clinical course was poor. Clinical improvements were observed in 79.6% with a 34.6% mean reduction in symptoms (SD 11.1), and improvements remained stable at 6 months follow-up after coaching. We reached a satisfaction level of 7.8 out of 10 (SD 1.7), and 95.9% of the participants recommended this treatment to other families. Conclusions: Our results provide information on the potential benefits of coaching as complementary treatment for ADHD

Intervenciones psicoterapéuticas y psicosociales para el manejo del estrés en esclerosis múltiple: aportación de intervenciones basadas en mindfulness / Psychotherapeutic and psychosocial interventions for managing stress in multiple sclerosis: the contribution of mindfulness-based interventions

La presencia de depresión o ansiedad asociada al diagnóstico de esclerosis múltiple (EM) se ha relacionado con una peor evolución de la enfermedad, con mayor número de brotes, con peor adherencia al tratamiento y una mayor disregulación del sistema inmune. Estudios recientes indican que intervenciones psicoterapéuticas dirigidas al manejo del estrés, entre ellas, intervenciones basadas en mindfulness (Mindfulness-Based Interventions, MBI), pueden mejorar la calidad de vida, la depresión, la ansiedad y la fatiga en pacientes con diagnóstico de EM. Mindfulness o atención plena fomenta la capacidad para observar las experiencias tal y como son y mejora la regulación emocional. Esta habilidad o actitud se aprende por entrenamiento y tiene la ventaja sobre otras intervenciones de que el efecto puede prolongarse a lo largo del tiempo al depender de la práctica personal. El objetivo del presente artículo es revisar la evidencia disponible sobre la eficacia de intervenciones psicosociales y psicoterapéuticas, específicamente MBI, en el manejo de la sintomatología ansioso-depresiva y del estrés percibido en pacientes con diagnóstico de EM

Depression or anxiety in multiple sclerosis (MS) has been linked to a more severe course of the disease and higher numbers of relapses, in addition to poorer treatment adherence and exacerbated immune system dysregulation. Recent investigations indicate that psychotherapeutic interventions for stress management, such as mindfulness-based interventions (MBIs), could improve quality of life, depression, anxiety, and fatigue in MS patients. Mindfulness fosters the ability to slow down and observe experiences as they truly are, which improves affect regulation. Mindfulness is acquired through training; its advantage over other psychotherapeutic interventions is that effects may remain over time, since cultivating mindfulness depends on regular practising of abilities learned during training. The objective of this article is to review the current evidence of psychotherapeutic and psychosocial interventions, including MBIs for stress management, and their beneficial effects on MS patients

StepKinnection: A Fall Prevention Game Mindfully Designed for the Elderly.

This paper presents the StepKinnection game, a Kinect-driven stepping game for the elderly that delivers stepping exercises to train specific cognitive and physical abilities associated with falls. This system combines a set of suitable age-related features, meaningful exercise routines and an embedded clinical test for fall risk assessment. The combination of these three aspects makes the game potentially useful in practice as the game is appealing to the elderly cohort, trains one of the most important abilities to prevent falls and at the same time allows for a continuous assessment of health outcomes; characteristics not available in the literature nor in current commercial games.

Telephone-based goal management training for adults with mild traumatic brain injury: study protocol for a randomized controlled trial.

BACKGROUND: Approximately 1 million individuals experience a mild traumatic brain injury (TBI) and cost the United States nearly $17 billion each year. Many trauma survivors with mild TBI have debilitating and long-term physical, emotional, and cognitive impairments that are unrecognized at trauma centers. Early intervention studies are needed to address these impairments, especially cognitive deficits in executive functioning. Goal management training (GMT) is a structured cognitive rehabilitation program that has been found to improve executive functioning in patients with moderate to severe TBI. The current study adapted the GMT program for telephone delivery in order to improve the accessibility of rehabilitation services in a patient population with multiple barriers to care and significant yet unrecognized cognitive impairment. The primary objective of this study is to examine the efficacy of telephone-based GMT for improving executive functioning, functional status, and psychological health in trauma survivors with mild TBI. METHODS/DESIGN: This study is a three-group randomized controlled trial being conducted at a Level I trauma center. Ninety trauma survivors with mild TBI and cognitive deficits in executive functioning will be randomized to receive telephone-based GMT, telephone-based education, or usual care. GMT and education programs will be delivered by a physical therapist. The first in-person session is 1 h and the remaining six telephone sessions are 30 min. A battery of well-established cognitive tests will be conducted and validated questionnaires will be collected that measure executive functioning, functional status, and depressive and posttraumatic stress disorder symptoms at 6 weeks, 4 months, and 7 months following hospital discharge. DISCUSSION: This study supports a telephone-delivery approach to rehabilitation services in order to broaden the availability of evidence-based cognitive strategies. TRIAL REGISTRATION: This trial was registered with Clinicaltrials.gov on 10 October 2012, registration number: NCT01714531.

The relation between mindfulness and fear of negative evaluation over the course of cognitive behavioral therapy for social anxiety disorder.

OBJECTIVES: This study examined the relation between mindfulness and fear of negative evaluation over the course of nonmindfulness based cognitive-behavioral therapy (CBT) for social anxiety disorder (SAD). We expected that higher levels of mindfulness would be associated with a more positive response to treatment. METHOD: This study is a secondary report from a randomized controlled trial in which participants (N = 65) diagnosed with SAD were randomly assigned to receive 8 weeks of 1 of 2 manualized treatments (exposure group therapy, n = 33; or virtual reality exposure therapy, n = 32) either immediately or following an 8 week waiting period. RESULTS: Fear of negative evaluation decreased following treatment and was negatively related to mindfulness throughout treatment and follow-up. Mindfulness did not moderate treatment outcome. CONCLUSIONS: These findings indicate that while mindfulness is related to fear, it is not a moderator of symptom reduction in nonmindfulness-based treatment. Implications for treatment and future research are discussed.

A national survey of health service infrastructure and policy impacts on access to computerised CBT in Scotland.

BACKGROUND: NICE recommends computerised cognitive behavioural therapy (cCBT) for the treatment of several mental health problems such as anxiety and depression. cCBT may be one way that services can reduce waiting lists and improve capacity and efficiency. However, there is some doubt about the extent to which the National Health Service (NHS) in the UK is embracing this new health technology in practice. This study aimed to investigate Scottish health service infrastructure and policies that promote or impede the implementation of cCBT in the NHS. METHODS: A telephone survey of lead IT staff at all health board areas across Scotland to systematically enquire about the ability of local IT infrastructure and IT policies to support delivery of cCBT. RESULTS: Overall, most of the health boards possess the required software to use cCBT programmes. However, the majority of NHS health boards reported that they lack dedicated computers for patient use, hence access to cCBT at NHS sites is limited. Additionally, local policy in the majority of boards prevent staff from routinely contacting patients via email, skype or instant messenger, making the delivery of short, efficient support sessions difficult. CONCLUSIONS: Conclusions: Overall most of the infrastructure is in place but is not utilised in ways that allow effective delivery. For cCBT to be successfully delivered within a guided support model, as recommended by national guidelines, dedicated patient computers should be provided to allow access to online interventions. Additionally, policy should allow staff to support patients in convenient ways such as via email or live chat. These measures would increase the likelihood of achieving Scottish health service targets to reduce waiting time for psychological therapies to 18 weeks.

Technology complementing military behavioral health efforts at tripler army medical center.

The purpose of this article is to provide a short narrative on the ways that behavioral health professionals and their patients are currently benefitting from the use of technology. Examples stem from applications of technology to patients/research participants at the Tripler Army Medical Center. The paper also discusses how current use of this technology has made it possible to serve individuals in their own cultural environment, providing a cost-effective means of providing mental health services.

Wearable sensor platform and mobile application for use in cognitive behavioral therapy for drug addiction and PTSD.

We present a wearable sensor platform designed for monitoring and studying autonomic nervous system (ANS) activity for the purpose of mental health treatment and interventions. The mobile sensor system consists of a sensor band worn on the ankle that continuously monitors electrodermal activity (EDA), 3-axis acceleration, and temperature. A custom-designed ECG heart monitor worn on the chest is also used as an optional part of the system. The EDA signal from the ankle bands provides a measure sympathetic nervous system activity and used to detect arousal events. The optional ECG data can be used to improve the sensor classification algorithm and provide a measure of emotional "valence." Both types of sensor bands contain a Bluetooth radio that enables communication with the patient's mobile phone. When a specific arousal event is detected, the phone automatically presents therapeutic and empathetic messages to the patient in the tradition of Cognitive Behavioral Therapy (CBT). As an example of clinical use, we describe how the system is currently being used in an ongoing study for patients with drug-addiction and post-traumatic stress disorder (PTSD).

Internet-delivered exposure and mindfulness based therapy for irritable bowel syndrome--a randomized controlled trial.

The aim of this study was to investigate if cognitive behavior therapy (CBT) based on exposure and mindfulness exercises delivered via the Internet would be effective in treating participants with irritable bowel syndrome (IBS). Participants were recruited through self-referral. Eighty-six participants were included in the study and randomized to treatment or control condition (an online discussion forum). One participant was excluded after randomization. The main outcome measure was IBS-symptom severity and secondary measures included IBS-related quality of life, GI-specific anxiety, depression and general functioning. Participants were assessed at pre-treatment, post-treatment and 3 month follow-up (treatment condition only). Four participants (5% of total sample) in the treatment condition did not participate in post-treatment assessment. Participants in the treatment condition reported a 42% decrease and participants in the control group reported a 12% increase in primary IBS-symptoms. Compared to the control condition, participants in the treatment group improved on all secondary outcome measures with a large between group effect size on quality of life (Cohen's d = 1.21). We conclude that CBT-based on exposure and mindfulness delivered via the Internet can be effective in treating IBS-patients, alleviating the total burden of symptoms and increasing quality of life.

Taking computerized CBT beyond primary care.

OBJECTIVES: This study seeks to determine whether the effectiveness of Beating the Blues (BtB), an established computer-based CBT (CCBT) programme, can extend beyond primary care. DESIGN: BtB was delivered and evaluated in an NHS specialist CBT care centre as part of routine care. METHOD: A sample of 104 service users, typically displaying chronic levels of depression and/or anxiety received CCBT. RESULTS: Completers' scores on the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM), as well as on single-item rating scales for anxiety and depression, improved significantly following the intervention. Statistically significant differences held during intention-to-treat analyses. Almost half of the completer sample achieved reliable and clinically significant change. The results were benchmarked against national data sets. CONCLUSIONS: These preliminary findings suggest a potential role for CCBT within secondary care as a first step, self-help treatment tool for anxiety and depression.

Hipnosis y terapias cognitivas / Hypnosis and cognitive therapies

La hipnosis y la terapia cognitiva parecen reflejar, enm principio, dos concepciones muy distintas de la intervención psicológica. Sin embargo, ambas contemplan entre sus objetivos la reorganización de las estructuras cognitivas del clinete. Este objetivo común las hace compatibles y podría permitir a las terapias cognitivas nuevas formas de intervenir en tales estructuras. La hipnosis promueve que el cliente haga por símismo este proceso de reestructuración sin el control racional y consciente, por lo que se pueden modificar estructuras inaccesibles a la conciencia, el lenguaje y, por tanto, al análisis cognitivo

Hypnosis and cognitive therapies may appear as two distant approaches for psychological practice. However, both retain among their aims the reorganization of theclients’ cognitive structures. These common goals make them compatible and allownew intervention pathways for cognitive therapists. Hypnosis stimulates clients to doby themselves a process of cognitive restructuring without monitoring and controllingit. Thus, cognitive structures which are not available through thinking and language can be modified without a cognitive analysis

Palmtop computer-assisted group therapy for social phobia.

This article describes the application of group computer-assisted therapy for social phobia. The computer program includes a diary function for ongoing self-monitoring of anxiety as well as guidance on the practice of relaxation, cognitive restructuring, and self-control desensitization. Although the program was originally designed to treat individuals with generalized anxiety disorder (GAD), it was hypothesized that the program also would be effective for individuals with social phobia; therefore, it was implemented in a group of individuals with a primary diagnosis of GAD or social phobia. We present the case of a client with social phobia who received six sessions of group therapy and who carried the ambulatory computer throughout this treatment. Outcome data suggest that the treatment was highly effective for this client as well as others with a diagnosis of social phobia or GAD.

El uso de la imagen y la metáfora en la terapia cognitiva / Using imagery and metaphor in cognitive therapy

El artículo presenta a la metáfora como "una poderosa herramienta del arsenal del terapeuta cognitivo", cuyo objetivo será que cada individuo desarrolle sus propias metáforas personales. Varias son las razones que fundamentan su uso: no son amenazadoras, son atemporales, pueden reflejar la vida cotidiana, ofrecen una "versión taquigráfica" de las ideas propuestas, pueden poner en debate temas difíciles, capturan fácilmente la atención y transmitir la experiencia del terapeuta, siendo útiles para pacientes de diversos grupos culturales y etáreos...(AU)