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1.
Epidemiol Psychiatr Sci ; 29: e150, 2020 Aug 03.
Artigo em Inglês | MEDLINE | ID: mdl-32744223

RESUMO

Recently, mental health and ill health have been reframed to be seen as a continuum from health to ill health, through the stages of being asymptomatic 'at risk', to experiencing 'mental distress', 'sub-syndromal symptoms' and finally 'mental disorders'. This new conceptualisation emphasised the importance of mental health promotion and prevention interventions, aimed at reducing the likelihood of future disorders with the general population or with people who are identified as being at risk of a disorder. This concept generated discussion on the distinction between prevention and treatment interventions, especially for those mental health conditions which lie between psychological distress and a formal psychiatric diagnosis. The present editorial aims to clarify the definition of promotion, prevention and treatment interventions delivered through a task-shifting approach according to a global mental health perspective.


Assuntos
Antidepressivos/uso terapêutico , Transtornos Mentais/terapia , Serviços Preventivos de Saúde/estatística & dados numéricos , Psicoterapia Breve/estatística & dados numéricos , Feminino , Humanos , Renda , Masculino , Transtornos Mentais/prevenção & controle , Serviços de Saúde Mental/economia , Serviços de Saúde Mental/estatística & dados numéricos , Serviços Preventivos de Saúde/organização & administração
2.
Psychol Trauma ; 12(S1): S174-S176, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32551775

RESUMO

During the unprecedented COVID-19 pandemic, people around the world have faced a myriad of heart-rending and ethically difficult scenarios (e.g., not being able to tend to a sick or dying loved one) that may lead to subsequent guilt, shame, or moral injury. Trauma-informed guilt reduction therapy is a brief intervention that helps clients accurately appraise their role in a stressful event (such as those experienced during the COVID-19 pandemic) and find positive ways to express important values going forward. Future studies of trauma-informed guilt reduction therapy with those affected by COVID-19 will be helpful for clarifying its effectiveness with this population. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


Assuntos
Terapia Cognitivo-Comportamental/métodos , Infecções por Coronavirus/psicologia , Culpa , Princípios Morais , Pneumonia Viral/psicologia , Trauma Psicológico/terapia , Vergonha , Adulto , Humanos , Pandemias , Trauma Psicológico/etiologia , Psicoterapia Breve
3.
Trials ; 21(1): 402, 2020 May 13.
Artigo em Inglês | MEDLINE | ID: covidwho-245680

RESUMO

OBJECTIVES: This study aims to assess the effectiveness of delivering Solution Focused Brief Therapy (SFBT) through telecommunication with a group of adolescents who present anxiety symptoms during the COVID-19 outbreak. We hypothesize that participants who are randomly assigned to receive 2-4 sessions of Solution Focused Brief Therapy would have better clinical outcomes than participants who are in the waitlist group. We additionally hypothesized that using SFBT can also change participants' depression levels and their coping strategies in dealing with distress during the COVID-19 pandemic. TRIAL DESIGN: This study employs a randomized delayed crossover open label controlled trial in adolescents who are presenting anxiety symptoms during the COVID-19 outbreak. Participants who meet the enrollment criteria stated below will be invited to participate in this study through telecommunication. Those accepting will be randomly allocated to the intervention group or waitlist group.


Assuntos
Ansiedade/terapia , Betacoronavirus , Infecções por Coronavirus/psicologia , Pneumonia Viral/psicologia , Psicoterapia Breve , Ensaios Clínicos Controlados Aleatórios como Assunto , Adolescente , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Feminino , Humanos , Masculino , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Telemedicina
4.
Pediatrics ; 145(Suppl 2): S165-S174, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32358207

RESUMO

Various states have legalized marijuana for medical purposes and/or decriminalized recreational marijuana use. These changes coincide with a decrease in perceived harmfulness of the drug and an increase in its use among youth. This change is of critical concern because of the potential harmful impact of marijuana exposure on adolescents. Marijuana use has been associated with several adverse mental health outcomes, including increased incidence of addiction and comorbid substance use, suicidality, and new-onset psychosis. Negative impacts on cognition and academic performance have also been observed. As the trend toward legalization continues, the pediatric community will be called on to navigate the subsequent challenges that arise with changing policies. Pediatricians are uniquely positioned to provide innovative care and educate youth and families on the ever-evolving issues pertaining to the impact of marijuana legalization on communities. In this article, we present and analyze the most up-to-date data on the effects of legalization on adolescent marijuana use, the effects of adolescent use on mental health and cognitive outcomes, and the current interventions being recommended for use in pediatric office settings.


Assuntos
Legislação de Medicamentos , Uso da Maconha/legislação & jurisprudência , Adolescente , Comorbidade , Estudos Transversais , Humanos , Uso da Maconha/efeitos adversos , Uso da Maconha/epidemiologia , Uso da Maconha/terapia , Maconha Medicinal/efeitos adversos , Maconha Medicinal/uso terapêutico , Transtornos Mentais/epidemiologia , Entrevista Motivacional , Psicoterapia Breve , Estados Unidos , Adulto Jovem
5.
Trials ; 21(1): 402, 2020 May 13.
Artigo em Inglês | MEDLINE | ID: mdl-32404126

RESUMO

OBJECTIVES: This study aims to assess the effectiveness of delivering Solution Focused Brief Therapy (SFBT) through telecommunication with a group of adolescents who present anxiety symptoms during the COVID-19 outbreak. We hypothesize that participants who are randomly assigned to receive 2-4 sessions of Solution Focused Brief Therapy would have better clinical outcomes than participants who are in the waitlist group. We additionally hypothesized that using SFBT can also change participants' depression levels and their coping strategies in dealing with distress during the COVID-19 pandemic. TRIAL DESIGN: This study employs a randomized delayed crossover open label controlled trial in adolescents who are presenting anxiety symptoms during the COVID-19 outbreak. Participants who meet the enrollment criteria stated below will be invited to participate in this study through telecommunication. Those accepting will be randomly allocated to the intervention group or waitlist group.


Assuntos
Ansiedade/terapia , Betacoronavirus , Infecções por Coronavirus/psicologia , Pneumonia Viral/psicologia , Psicoterapia Breve , Ensaios Clínicos Controlados Aleatórios como Assunto , Adolescente , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Feminino , Humanos , Masculino , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Telemedicina
6.
J Oleo Sci ; 69(5): 455-460, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32378549

RESUMO

Emulsions are colloid dispersions which are attractive for use as drug carriers due to their simple structure and facile preparation. However, their low physicochemical stability has been problematic. In order to solve this problem, a spontaneous emulsification technique composed of porous silica particles has been developed. In this study, we investigated the conditions for effective formation of protein-encapsulated solid-in-oil-in-water (S/O/W) emulsions using this technique. Porous silica particles having a hydrophilic surface promoted the formation of a fine and uniform emulsion. It was found that the progression of emulsification was affected by electrolytes in aqueous solution. Moreover, it was confirmed that the S/O/W emulsion prepared using this method could successfully encapsulate protein.


Assuntos
Emulsões/química , Dióxido de Silício/química , Fenômenos Químicos , Estabilidade de Medicamentos , Eletrólitos , Interações Hidrofóbicas e Hidrofílicas , Óleos , Tamanho da Partícula , Psicoterapia Breve , Água
7.
Cochrane Database Syst Rev ; 4: CD012005, 2020 04 16.
Artigo em Inglês | MEDLINE | ID: mdl-32297974

RESUMO

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.


Assuntos
Fadiga/terapia , Doenças Inflamatórias Intestinais/complicações , Adalimumab/administração & dosagem , Adalimumab/efeitos adversos , Anti-Inflamatórios/administração & dosagem , Anti-Inflamatórios/efeitos adversos , Terapia Cognitivo-Comportamental , Eletroacupuntura , Exercício Físico , Fadiga/etiologia , Ácidos Graxos Ômega-3/administração & dosagem , Ácidos Graxos Ômega-3/efeitos adversos , Compostos Férricos/efeitos adversos , Hematínicos/efeitos adversos , Humanos , Psicoterapia Breve , Pironas/efeitos adversos , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto
8.
Rev Infirm ; 69(257): 43-44, 2020 Jan.
Artigo em Francês | MEDLINE | ID: mdl-32146967

RESUMO

In the field of addictology, care integrates activities that reactivate forgotten senses, emotions and postures. A "Photographs" workshop, led by a nurse in the addictology department, was modulated into a "Brief group photo-motivational intervention" to help people quit smoking. From this experience emerged an educational sequence of "Photo-Expression" integrated into the patient's therapeutic education programme "Help to stop smoking".


Assuntos
Abandono do Hábito de Fumar/métodos , Humanos , Entrevista Motivacional , Educação de Pacientes como Assunto , Fotografação , Psicoterapia Breve , Psicoterapia de Grupo
9.
J Oleo Sci ; 69(3): 271-276, 2020 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-32051359

RESUMO

In this study, we investigated the direct detection of DNA, without pretreatment, using a quartz crystal microbalance (QCM) sensor. This sensor is modified by a self-assembled monolayer of a thiol derivative that has an amino group as the terminal functional group. Contact angle values and the attenuated total reflectance Fourier transform infrared (ATR/FT-IR) spectra of the QCM sensors after immersion into an ethanol solution of thiol derivatives clearly showed that self-assembled monolayers of the derivatives were formed on the QCM sensors. Although QCM measurements using unmodified and carboxylic group-modified sensors could not detect DNA-Na salt, the sensor modified with amino groups could detect the DNA. This system can be used for the analysis of the interaction between DNA and DNAbinding proteins.


Assuntos
DNA/análise , Técnicas de Microbalança de Cristal de Quartzo/métodos , Compostos de Sulfidrila/química , Etanol , Psicoterapia Breve , Espectroscopia de Infravermelho com Transformada de Fourier
10.
NeuroRehabilitation ; 46(2): 143-155, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32083598

RESUMO

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.


Assuntos
Lesões Encefálicas/psicologia , Lesões Encefálicas/terapia , Terapia Familiar/métodos , Psicoterapia Breve/métodos , Humanos , Redação
11.
J Oleo Sci ; 69(1): 65-72, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31902896

RESUMO

The secondary structures of human serum albumin (HSA) and bovine serum albumin (BSA) were disrupted in the solution of sodium dodecyl sulfate (SDS), while being hardly damaged in the solution of the bile salt, sodium cholate (NaCho). In the present work, the removal of dodecyl sulfate (DS) ions bound to these proteins was attempted by adding various amounts of NaCho. The extent of removal was estimated by the restoration of α-helical structure of each protein disrupted by SDS. Increases and decreases in α-helical structure were examined using the mean residue ellipticity at 222 nm, [θ]222, which was frequently used as a measure of α-helical structure content. The magnitudes of [θ]222 of HSA and BSA, weakened by SDS, were restrengthened upon the addition of NaCho. This indicated that the α-helical structures of HSA and BSA that were disrupted by the binding of DS ions were nearly reformed by the addition of NaCho. The NaCho concentration at which the maximum restoration of [θ]222 of each protein was attained increased nearly linearly with SDS concentration. These results indicated that most of the bound DS ions were removed from the proteins but the removal was incomplete. The removal of DS ions, examined by means of the equilibrium dialysis, was also incomplete. The α-helical structure restoration and the DS ion removal by NaCho were considered to be due to the ability of cholate anions to strip the surfactant ions bound to HSA and BSA. These stripped DS ions appeared to be more likely to form SDS-NaCho mixed micelles in bulk rather than SDS-NaCho mixed aggregates on the proteins.


Assuntos
Soroalbumina Bovina/química , Albumina Sérica/química , Colato de Sódio/química , Dodecilsulfato de Sódio/isolamento & purificação , Tensoativos/isolamento & purificação , Animais , Bovinos , Humanos , Ligação Proteica , Psicoterapia Breve , Dodecilsulfato de Sódio/química , Tensoativos/química
12.
BMC Public Health ; 20(1): 30, 2020 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-31914971

RESUMO

BACKGROUND: Young people account for more than a quarter of new HIV infections in the US, with the majority of cases among young men who have sex with men; young transgender women are also vulnerable to infection. Substance use, particularly alcohol misuse, is a driver of sexual transmission and a potential barrier to engagement in the HIV prevention and care continuum, however vulnerable youth are difficult to reach for substance use services due, in part, to complex social and structural factors and limited access to health care. The Community Prevention Services Task Force recommends electronic screening and brief intervention as an evidence-based intervention for the prevention of excessive alcohol consumption; however, no prior studies have extended this model to community-based populations of youth that are susceptible to HIV infection. This paper describes the study protocol for an electronic screening and brief intervention to reduce alcohol misuse among adolescents and young adults vulnerable to HIV infection in community-based settings. METHODS: This study, Step Up, Test Up, is a randomized controlled trial of an electronic alcohol screening and brief intervention among youth, ages 16-25, who are vulnerable to HIV infection. Individuals who present for HIV testing at one of three community-based locations are recruited for study participation. Eligibility includes those aged 16-25 years, HIV-negative or unknown HIV status, male or trans female with a history of sex with men, and English-speaking. Participants who screen at moderate to high risk for alcohol misuse on the Alcohol Use Disorders Identification Test (AUDIT) are randomized (1:1) to either an electronic brief intervention to reduce alcohol misuse or a time-and attention-matched control. The primary outcome is change in the frequency/quantity of recent alcohol use at 1, 3, 6 and 12-month follow-up. DISCUSSION: Testing of evidence-based interventions to reduce alcohol misuse among youth vulnerable to HIV infection are needed. This study will provide evidence to determine feasibility and efficacy of a brief electronically-delivered intervention to reduce alcohol misuse for this population. TRIAL REGISTRATION: ClinicalTrials.gov number, NCT02703116, registered March 9, 2016.


Assuntos
Alcoolismo/prevenção & controle , Infecções por HIV/prevenção & controle , Homossexualidade Masculina/psicologia , Programas de Rastreamento/métodos , Psicoterapia Breve , Pessoas Transgênero/psicologia , Populações Vulneráveis/psicologia , Adolescente , Adulto , Feminino , Infecções por HIV/epidemiologia , Homossexualidade Masculina/estatística & dados numéricos , Humanos , Masculino , Projetos de Pesquisa , Medição de Risco , Pessoas Transgênero/estatística & dados numéricos , Resultado do Tratamento , Populações Vulneráveis/estatística & dados numéricos , Adulto Jovem
13.
BMC Psychiatry ; 20(1): 26, 2020 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-31992251

RESUMO

BACKGROUND: Brief Contact Interventions (BCIs) after a suicide attempt (SA) are an important element of prevention against SA and suicide. They are easier to generalize to an entire population than other forms of intervention. VigilanS generalizes to a whole French region a BCI combining resource cards, telephone calls and mailings, according to a predefined algorithm. It was implemented gradually in the Nord-Pas-de-Calais (NPC), France, between 2015 and 2018. Here, we evaluate the effectiveness of VigilanS, in terms of SA reduction, using annual data collected by participating centers. Hypothesis tested: the higher the VigilanS implementation in a center (measured by penetrance), the greater the decrease in the number of SA observed in this center. METHODS: The study period was from 2014 to 2018, across all of NPC centers. We performed a series of linear regressions, each center representing a statistical unit. The outcome was the change in the number of SA, relative to the initial number, and the predictive variable was VigilanS' penetrance: number of patients included in VigilanS over the total number of SA. Search for influential points (points beyond threshold values of 3 influence criteria) and weighted least squares estimations were performed. RESULTS: Twenty-one centers were running VigilanS in 2018, with an average penetrance of 32%. A significant relationship was identified, showing a sharp decrease in SA as a function of penetrance (slope = - 1.13; p = 3*10- 5). The model suggested that a 25% of penetrance would yield a SA decrease of 41%. CONCLUSION: VigilanS has the potential to reduce SA. Subgroup analyzes are needed to further evaluate its effectiveness. Subgroup analyses remain to be done, in order to evaluate the specific variations of SA by group.


Assuntos
Assistência ao Convalescente/métodos , Intervenção Médica Precoce/métodos , Recursos em Saúde , Psicoterapia Breve/métodos , Tentativa de Suicídio/prevenção & controle , Tentativa de Suicídio/psicologia , Adulto , Assistência ao Convalescente/tendências , Algoritmos , Intervenção Médica Precoce/tendências , Feminino , França/epidemiologia , Recursos em Saúde/tendências , Humanos , Masculino , Psicoterapia Breve/tendências , Tentativa de Suicídio/tendências
14.
Clin Child Psychol Psychiatry ; 25(1): 106-118, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31216867

RESUMO

BACKGROUND: Brief psychosocial intervention (BPI) is a treatment for adolescent depression that has recently demonstrated clinical effectiveness in a controlled trial. The aim of this study is to explore experiences of adolescents with major depression receiving BPI treatment in the context of good treatment outcomes. METHOD: A subsample of five interviews from a larger study of adolescents' experiences of BPI was purposively selected, focusing on good-outcome cases. Interviews were analysed using interpretative phenomenological analysis to provide a richer understanding of participants' experiences of overcoming depression in the BPI group. RESULTS: Four central themes were identified: 'Being heard and feeling safe', 'Collaborative working enhancing therapy', 'Gaining a different perspective on one's self and relationships' and 'A positive therapeutic relationship'. CONCLUSION: BPI is a novel approach with promising clinical effectiveness. Utilising adolescents' experiences has revealed potential psychological mechanisms of good treatment response to BPI. Overall implications for clinical practice with depressed adolescents are discussed.


Assuntos
Transtorno Depressivo Maior/terapia , Emoções , Psicoterapia Breve , Adaptação Psicológica , Adolescente , Transtorno Depressivo Maior/psicologia , Feminino , Humanos , Masculino , Resultado do Tratamento
15.
J Couns Psychol ; 67(3): 315-325, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31855026

RESUMO

To draw clinically meaningful evidence-supported implications about the alliance-outcome association, recent studies have investigated patient-therapist congruence on ruptures in alliance. The present study investigated patient-therapist congruence on ruptures and its consequences on subsequent session outcome in 2 types of treatments that differ in the training therapists receive to identify ruptures: brief relational therapy (BRT), in which therapists receive alliance-focused training, and cognitive-behavioral therapy (CBT), in which no training specifically focused on the alliance is provided. We implemented polynomial regression and response surface analysis, and the truth and bias model on data of 162 dyads reporting weekly on their levels of ruptures, for 30 sessions, during either CBT or BRT. Therapists and patients exhibited substantial temporal congruence in their session-by-session rupture ratings. Therapists showed a tendency to detect more ruptures than did their patients. This tendency correlated with higher levels of congruence and was more evident in BRT than in CBT. Agreement and disagreement between patients and therapists on the question of whether a rupture had occurred was found to have a greater effect on subsequent session outcomes in BRT than in CBT. These findings may suggest that therapists who are more attuned to their patients may demonstrate greater vigilance in identifying ruptures than their patients do. This vigilant stance may be taught. Greater congruence may result in better subsequent session outcome throughout treatment in BRT than in CBT. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


Assuntos
Terapia Cognitivo-Comportamental/métodos , Relações Profissional-Paciente , Psicoterapia Breve/métodos , Adulto , Terapia Comportamental/métodos , Cognição/fisiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Vigília/fisiologia
16.
Cochrane Database Syst Rev ; 2019(11)2019 11 26.
Artigo em Inglês | MEDLINE | ID: mdl-31769015

RESUMO

BACKGROUND: Comorbid depression and substance use disorders are common and have poorer outcomes than either disorder alone. While effective psychological treatments for depression or substance use disorders are available, relatively few randomised controlled trials (RCTs) have examined the efficacy of these treatments in people with these comorbid disorders. OBJECTIVES: To assess the efficacy of psychological interventions delivered alone or in combination with pharmacotherapy for people diagnosed with comorbid depression and substance use disorders. SEARCH METHODS: We searched the following databases up to February 2019: Cochrane Central Register of Controlled Trials, PubMed, Embase, CINAHL, Google Scholar and clinical trials registers. All systematic reviews identified, were handsearched for relevant articles. SELECTION CRITERIA: The review includes data from RCTs of psychological treatments for people diagnosed with comorbid depression and substance use disorders, using structured clinical interviews. Studies were included if some of the sample were experiencing another mental health disorder (e.g. anxiety); however, studies which required a third disorder as part of their inclusion criteria were not included. Studies were included if psychological interventions (with or without pharmacotherapy) were compared with no treatment, delayed treatment, treatment as usual or other psychological treatments. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. MAIN RESULTS: Seven RCTs of psychological treatments with a total of 608 participants met inclusion criteria. All studies were published in the USA and predominately consisted of Caucasian samples. All studies compared different types of psychological treatments. Two studies compared Integrated Cognitive Behavioural Therapy (ICBT) with Twelve Step Facilitation (TSF), another two studies compared Interpersonal Psychotherapy for Depression (IPT-D) with other treatment (Brief Supportive Therapy (BST) or Psychoeducation). The other three studies compared different types or combinations of psychological treatments. No studies compared psychological interventions with no treatment or treatment as usual control conditions. The studies included a diverse range of participants (e.g. veterans, prisoners, community adults and adolescents). All studies were at high risk of performance bias, other main sources were selection, outcome detection and attrition bias. Due to heterogeneity between studies only two meta-analyses were conducted. The first meta-analysis focused on two studies (296 participants) comparing ICBT to TSF. Very low-quality evidence revealed that while the TSF group had lower depression scores than the ICBT group at post-treatment (mean difference (MD) 4.05, 95% confidence interval (CI) 1.43 to 6.66; 212 participants), there was no difference between groups in depression symptoms (MD 1.53, 95% CI -1.73 to 4.79; 181 participants) at six- to 12-month follow-up. At post-treatment there was no difference between groups in proportion of days abstinent (MD -2.84, 95% CI -8.04 to 2.35; 220 participants), however, the ICBT group had a greater proportion of days abstinent than the TSF group at the six- to 12-month follow-up (MD 10.76, 95% CI 3.10 to 18.42; 189 participants). There were no differences between the groups in treatment attendance (MD -1.27, 95% CI -6.10 to 3.56; 270 participants) or treatment retention (RR 0.95, 95% CI 0.72 to 1.25; 296 participants). The second meta-analysis was conducted with two studies (64 participants) comparing IPT-D with other treatment (Brief Supportive Psychotherapy/Psychoeducation). Very low-quality evidence indicated IPT-D resulted in significantly lower depressive symptoms at post-treatment (MD -0.54, 95% CI -1.04 to -0.04; 64 participants), but this effect was not maintained at three-month follow-up (MD 3.80, 95% CI -3.83 to 11.43) in the one study reporting follow-up outcomes (38 participants; IPT-D versus Psychoeducation). Substance use was examined separately in each study, due to heterogeneity in outcomes. Both studies found very low-quality evidence of no significant differences in substance use outcomes at post-treatment (percentage of days abstinent, IPD versus Brief Supportive Psychotherapy; MD -2.70, 95% CI -28.74 to 23.34; 26 participants) or at three-month follow-up (relative risk of relapse, IPT-D versus Psychoeducation; RR 0.67, 95% CI 0.30 to 1.50; 38 participants). There was also very low-quality evidence for no significant differences between groups in treatment retention (RR 1.00, 95% CI 0.81 to 1.23; 64 participants). No adverse events were reported in any study. AUTHORS' CONCLUSIONS: The conclusions of this review are limited due to the low number and very poor quality of included studies. No conclusions can be made about the efficacy of psychological interventions (delivered alone or in combination with pharmacotherapy) for the treatment of comorbid depression and substance use disorders, as they are yet to be compared with no treatment or treatment as usual in this population. In terms of differences between psychotherapies, although some significant effects were found, the effects were too inconsistent and small, and the evidence of too poor quality, to be of relevance to practice.


Assuntos
Depressão/terapia , Psicoterapia/métodos , Transtornos Relacionados ao Uso de Substâncias/terapia , Terapia Cognitivo-Comportamental , Depressão/epidemiologia , Humanos , Psicoterapia Breve/métodos , Psicoterapia de Grupo , Ensaios Clínicos Controlados Aleatórios como Assunto , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Resultado do Tratamento
17.
BMC Psychiatry ; 19(1): 301, 2019 10 16.
Artigo em Inglês | MEDLINE | ID: mdl-31619196

RESUMO

BACKGROUND: Depressive symptoms are quite prevalent in Primary Care (PC) settings. The treatment as usual (TAU) in PC is pharmacotherapy, despite the high relapse rates it produces. Many patients would prefer psychotherapy, but specialized services are overloaded. Studies that apply Mindfulness-Based Interventions (MBIs) for the treatment of depression have obtained significant improvements. Brief low-intensity approaches delivered from PC could be a promising approach. This study aims to compare a low-intensity mindfulness intervention for the treatment of depression in PC using different intervention formats - a face-to-face MBI delivered in a group and the same MBI individually applied on the Internet - to a control group that will receive PC medical treatment as usual. METHODS: A randomized controlled clinical trial will be conducted in PC, with about 120 depressed patients allocated (1:1:1) to three groups: "face-to-face MBI + TAU", "Internet-delivered MBI + TAU", and "TAU alone". The MBI programs will be composed of four modules. The primary outcome will be depressive symptoms, measured through the Beck Depression Inventory, assessed at pre- and post-treatment and 6- and 12-month follow-ups. Other outcomes will be mindfulness, happiness, affectivity, quality of life, and the use of healthcare services. Intention-to-treat analysis using linear mixed models adjusted for baseline scores and routine sociodemographic analysis that could show baseline differences will be conducted. Per-protocol secondary outcome analyses will also be performed. DISCUSSION: This is the first Spanish RCT to apply a low-intensity face-to-face MBI (plus TAU) to treat depression in PC settings compared to TAU (alone). Moreover, this study will also make it possible to evaluate the same MBI program (plus TAU), but Internet-delivered, considering their cost-effectiveness. Positive results from this RCT might have an important impact on mental health settings, helping to decrease the overload of the system and offering treatment alternatives beyond antidepressant medication through high-quality, flexible PC interventions. TRIAL REGISTRATION: Clinical Trials.gov NCT03034343 . Trial Registration date 24 January 2017, retrospectively registered.


Assuntos
Depressão/terapia , Transtorno Depressivo/terapia , Atenção Plena/métodos , Atenção Primária à Saúde/métodos , Psicoterapia Breve/métodos , Adulto , Análise Custo-Benefício , Feminino , Humanos , Masculino , Escalas de Graduação Psiquiátrica , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
18.
Rev Bras Enferm ; 72(6): 1485-1489, 2019.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31644734

RESUMO

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.


Assuntos
Alcoolismo/reabilitação , Terapia pela Arte , Psicoterapia Breve , Adulto , Consumo de Bebidas Alcoólicas/terapia , Terapia pela Arte/métodos , Terapia pela Arte/estatística & dados numéricos , Brasil , Terapia Combinada/métodos , Terapia Combinada/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Atenção Primária à Saúde , Psicoterapia Breve/métodos , Psicoterapia Breve/estatística & dados numéricos , Resultado do Tratamento
19.
Psychol Addict Behav ; 33(7): 637-643, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31486660

RESUMO

Research has shown links between interpersonal conflict and problematic drinking behaviors as a way to cope. The present research examined the effects of a brief interpersonal conflict cognitive reappraisal intervention on short-term reductions in alcohol-related problems in a sample of college student drinkers. Undergraduates who were regular drinkers (N = 190) participated in a randomized control online study, completing self-reported measures of alcohol consumption and alcohol-related problems at baseline and 2 weeks later. After completing the baseline survey, participants completed a brief writing intervention during which they were asked to reflect on a recent interpersonal conflict and write about it from 1 of 3 possible perspectives, 2 of which were targeting cognitive reappraisal (i.e., a neutral, third-party perspective and the other party's perspective), their own perspective, or to reflect on their activities that day (control). Results from negative binomial regression models supported both reappraisal conditions: Compared with control, those who thought about the conflict from a neutral third-party perspective and those who thought about the conflict from the other party's perspective reported significantly fewer drinking problems at follow-up. Results from this study suggest preliminary efficacy of a single-session writing intervention aimed at reappraising interpersonal conflict. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Consumo de Bebidas Alcoólicas/terapia , Transtornos Relacionados ao Uso de Álcool/terapia , Conflito Psicológico , Relações Interpessoais , Psicoterapia Breve/métodos , Teoria da Mente , Adolescente , Adulto , Consumo de Álcool na Faculdade/psicologia , Transtornos Relacionados ao Uso de Álcool/prevenção & controle , Feminino , Humanos , Masculino , Resultado do Tratamento , Adulto Jovem
20.
Clin Psychol Psychother ; 26(6): 734-742, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31472014

RESUMO

Brief and single-symptom forms of cognitive behaviour therapy (CBT) for distressing voices may increase access to evidence-based psychological therapy and transcend diagnostic barriers. The current study evaluated the "C" and "B" in CBT for distressing voices in a transdiagnostic voices clinic. The B module (component of therapy) sought to enhance coping with voices, and the C module evaluated the accuracy of negative beliefs about the self and voices. The aims of the study were to investigate (a) whether modules B and/or C led to significant and clinically meaningful improvements on the primary outcome of voice-related distress, and (b) if changes in beliefs about self and voices (proposed change mechanisms) underpinned changes in voice distress across module C. Each module consisted of four sessions, individually tailored yet manualized, and designed with ease of staff training and delivery in mind. Assessment measures were administered at baseline (T1), post-module B (T2), and post-module C (T3). The results (N = 62) showed statistically significant medium-sized pre- and post-effects for voice-related distress from T1 to T2 and from T2 to T3, with large effects from T1 to T3. Just over half of the clients reported clinically meaningful improvements from T1 to T3. Neither beliefs about self nor voices were found to mediate improvements in voice distress during module C. The findings from this study suggest that both the B and C in CBT for voices can contribute to positive outcomes within routine clinical practice.


Assuntos
Terapia Cognitivo-Comportamental/métodos , Alucinações/terapia , Psicoterapia Breve/métodos , Adolescente , Adulto , Idoso , Feminino , Alucinações/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
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