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Introduction: Enhanced recovery after surgery (ERAS) protocols have been implemented to decrease opioid use and decrease patient hospital length of stay (LOS, days). Serratus anterior plane (SAP) blocks anesthetize the T2 through T9 dermatomes of the breast and can be applied intraoperatively. The purpose of this study was to compare postoperative opioid (OME) consumption and LOS between a control group, an ERAS group, and an ERAS/local anesthetic cocktail group in patients who underwent implant-based breast reconstruction. Methods: In this study, 142 women who underwent implant-based breast reconstruction between 2004 and 2020 were divided into Group A (46 patients), a historical cohort; Group B (73 patients), an ERAS/no-block control group; and Group C (23 patients), an ERAS/anesthetic cocktail study group. Primary outcomes of interest were postanesthesia care unit (PACU), inpatient and total hospital OME consumption, and PACU LOS. Results: A significant decrease was observed from Group A to C in PACU LOS (103.3 vs. 80.2 vs. 70.5; p = 0.011), OME use (25.1 vs. 11.4 vs. 5.7; p < 0.0001), and total hospital OME (120.3 vs. 95.2 vs. 35.9; p < 0.05). No difference was observed in inpatient OMEs between the three groups (95.2 vs. 83.8 vs. 30.8; p = 0.212). Despite not reaching statistical significance, Group C consumed an average of 50-60 % less opioids per patient than did Group B in PACU, inpatient, and total hospital OMEs. Conclusion: Local anesthetic blocks are important components of ERAS protocols. Our results demonstrate that a combination regional block with a local anesthetic cocktail in an ERAS protocol can decrease opioid consumption in implant-based breast reconstruction.
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BACKGROUND: Access to evidence-based interventions is urgently required, especially for individuals of minoritized identities who experience unique barriers to mental health care. Digital mental health interventions have the potential to increase accessibility. Previous pilot studies testing HabitWorks, a smartphone app providing an interpretation bias intervention, have found strong engagement and adherence for HabitWorks; however, previous trials' samples consisted of predominantly non-Hispanic, White individuals. OBJECTIVE: This study conducted an open trial of HabitWorks in a community sample of adults who identified as Black, Hispanic or Latinx, or both. This study aims to test safety, acceptability, and engagement with the HabitWorks app for Black and Latinx adults. METHODS: Black, Hispanic or Latinx adults (mean age 32.83, SD 11.06 y; 22/31, 71% women) who endorsed symptoms of anxiety or depression were asked to complete interpretation modification exercises via HabitWorks 3 times per week for 1 month. Interpretation bias and anxiety and depression symptoms were assessed at baseline and posttreatment assessments. Participants completed qualitative interviews to assess overall perceptions of HabitWorks. RESULTS: Of the 31 participants that downloaded the app, 27 (87%) used HabitWorks all 4 weeks. On average, participants completed 15.74 (SD 7.43) exercises out of the 12 prescribed, demonstrating high engagement. Acceptability ratings met all a priori benchmarks except for relevancy. Qualitative interviews also demonstrated high acceptability and few negative experiences. Significant improvements were found in interpretation style (t30=2.29; P<.001), with a large effect size (Cohen d=1.53); anxiety symptoms (t30=2.29; P=.03), with a small effect size (Cohen d=0.41); and depression symptoms (t30=3.065; P=.005), with a medium effect size (Cohen d=0.55). CONCLUSIONS: This study adds to the literature evaluating digital mental health interventions in Black and Latinx adults. Preliminary results further support a future controlled trial testing the effectiveness of HabitWorks as an intervention.
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Negro o Afroamericano , Hispánicos o Latinos , Aplicaciones Móviles , Aceptación de la Atención de Salud , Teléfono Inteligente , Humanos , Femenino , Adulto , Masculino , Hispánicos o Latinos/psicología , Negro o Afroamericano/psicología , Aceptación de la Atención de Salud/psicología , Aceptación de la Atención de Salud/etnología , Depresión/terapia , Depresión/etnología , Depresión/psicología , Adulto Joven , Ansiedad/terapia , Ansiedad/psicología , Ansiedad/etnología , Persona de Mediana EdadRESUMEN
OBJECTIVE: Numerous psychiatric populations have demonstrated reduced tendency to adopt others' perspectives relative to those without psychiatric illness; yet, the clinical implications of these deficits remain unclear. We examined whether impairments in perspective-taking are prospectively associated with symptom severity and functional outcomes in an acute psychiatric sample. We hypothesized that poorer perspective-taking would prospectively predict more severe depressive symptoms, functional impairment, and relationship problems. METHOD: Participants were 421 adults seeking psychiatric treatment at a partial hospital program. Participants completed the following self-report questionnaires at admission and discharge: Interpersonal Reactivity Index, Patient Health Questionnaire, Work and Social Adjustment Scale, and Behavior and Symptom Identification Scale. We conducted cross-lagged panel models to estimate directional effects. RESULTS: Consistent with hypotheses, more frequent perspective-taking was significantly and prospectively associated with less overall functional impairment (ß = -0.08, p = 0.04) and fewer relationship problems (ß = -0.11, p = 0.02). When modelled together, perspective-taking remained a significant and bidirectional predictor of relationship problems, but not overall functional impairment. Inconsistent with hypotheses, perspective-taking did not prospectively predict depressive symptoms. CONCLUSIONS: Results suggest that perspective-taking deficits are uniquely associated with relationship problems among adults with severe mental illness and highlight a potential target for future intervention.
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BACKGROUND: Despite the pervasiveness of patient-reported emptiness and the high burden it carries, emptiness is poorly understood. In the current study, we used a general inductive approach to examine experiences with emptiness in a diagnostically diverse sample of treatment-seeking patients with severe and acute psychopathology. As a secondary aim, we also examined whether identified themes differed among patients with a primary diagnosis of borderline personality disorder or major depressive disorder. METHOD: Participants (n = 150) ranged from 18 to 69 years old (M = 33.15, SD = 12.41; 79.3% non-Hispanic White; 57.3% females). All patients completed the borderline personality disorder module of the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Personality Disorders and the Mini International Neuropsychiatric Interview. Interviewers documented patients' responses to follow-up questions. Patients were included in the study if they endorsed chronic feelings of emptiness and elaborations were documented. RESULTS: We identified 10 themes associated with patient-reported emptiness: (1) purposeless, (2) lack of connection, (3) numbness, (4) self-deprecation, (5) lack of identity, (6) lack of motivation, (7) hopelessness, (8) lack of pleasure, (9) physical sensation, and (10) dissociation. Themes were consistent across diagnostic status, with one exception: patients with borderline personality disorder were more likely to report that emptiness was associated with dissociation relative to patients with major depressive disorder. CONCLUSION: Our results suggest that emptiness may reflect a multifaceted and transdiagnostic construct. Identified themes may help to support the assessment of emptiness and can be used to guide individualized treatments.
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Trastorno de Personalidad Limítrofe , Trastorno Depresivo Mayor , Humanos , Femenino , Masculino , Adulto , Persona de Mediana Edad , Trastorno de Personalidad Limítrofe/diagnóstico , Trastorno Depresivo Mayor/diagnóstico , Adolescente , Anciano , Adulto JovenRESUMEN
INTRODUCTION: Religion is a salient aspect of patient background in treatment (The psychology of religion and coping: Theory, research, practice; Guilford Press). However, research investigating the role of religion in suicide is lacking and inconsistent (Journal of Religion and Health, 57, 2478-2499). The current study (1) clarifies the association between religious identity and fearlessness about death in a psychiatric sample and (2) tests whether religious identity moderates the association between fearlessness about death and suicidal ideation. METHODS: Participants were 155 patients seeking treatment in a partial hospital program. Religious identity was assessed using the Identities in Treatment Scale (The Behavior Therapist). Fearlessness about death was assessed with two relevant items from the acquired capability with rehearsal for suicide scale (Psychological Assessment, 28, 1452-1464), as in prior studies (Suicide & Le-Threatening Behavior, 50, 1230-1240; Journal of Affective Disorders Reports, 12, 100492). RESULTS: Fearlessness about death interacted with religious identity to predict suicidal ideation, b = 0.47, 95% C.I. [0.02, 0.91], p = 0.042. Conditional effects showed that greater fearlessness about death was associated with greater suicidal ideation among non-religious patients, b = -0.56, 95% C.I. [-0.88, -0.24], p = 0.001, but not in religious patients, b = -0.09, 95% C.I. [-0.41, 0.22], p = 0.559. CONCLUSIONS: Our results suggest that fearlessness about death is a risk factor for suicidal ideation, but only among those who do not identify as religious. Results from this study inform theories of suicide and elucidate the influence of religious identity on links among suicide risk factors and suicide-related outcomes.
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Actitud Frente a la Muerte , Miedo , Religión y Psicología , Ideación Suicida , Humanos , Masculino , Femenino , Adulto , Miedo/psicología , Persona de Mediana Edad , Adulto JovenRESUMEN
Trauma-related intrusive memories (TR-IMs) are hallmark symptoms of posttraumatic stress disorder (PTSD), but their neural correlates remain partly unknown. Given its role in autobiographical memory, the hippocampus may play a critical role in TR-IM neurophysiology. The anterior and posterior hippocampi are known to have partially distinct functions, including during retrieval of autobiographical memories. This study aimed to investigate the relationship between TR-IM frequency and the anterior and posterior hippocampi morphology in PTSD. Ninety-three trauma-exposed adults completed daily ecological momentary assessments for fourteen days to capture their TR-IM frequency. Participants then underwent anatomical magnetic resonance imaging to obtain measures of anterior and posterior hippocampal volumes. Partial least squares analysis was applied to identify a structural covariance network that differentiated the anterior and posterior hippocampi. Poisson regression models examined the relationship of TR-IM frequency with anterior and posterior hippocampal volumes and the resulting structural covariance network. Results revealed no significant relationship of TR-IM frequency with hippocampal volumes. However, TR-IM frequency was significantly negatively correlated with the expression of a structural covariance pattern specifically associated with the anterior hippocampus volume. This association remained significant after accounting for the severity of PTSD symptoms other than intrusion symptoms. The network included the bilateral inferior temporal gyri, superior frontal gyri, precuneus, and fusiform gyri. These novel findings indicate that higher TR-IM frequency in individuals with PTSD is associated with lower structural covariance between the anterior hippocampus and other brain regions involved in autobiographical memory, shedding light on the neural correlates underlying this core symptom of PTSD.
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Trastornos por Estrés Postraumático , Adulto , Humanos , Trastornos por Estrés Postraumático/diagnóstico , Evaluación Ecológica Momentánea , Encéfalo/patología , Hipocampo/diagnóstico por imagen , Hipocampo/patología , Corteza Prefrontal/patología , Imagen por Resonancia Magnética/métodosRESUMEN
Obsessive-compulsive and related disorders (OCRDs) are associated with increased risk of suicidal thoughts and behaviors (STBs), yet research characterizing suicidality in OCRDs remains limited. A major challenge in assessing STBs is the reliance on explicit self-report. This study utilized multi-method assessment to examine changes in both implicit and explicit STBs in 31 adults receiving partial/residential treatment for OCRDs. Assessments were administered at admission and weekly during treatment. Approximately three-quarters of participants reported lifetime suicidal thoughts, with 16 % reporting a prior suicide attempt. OCD severity was significantly correlated with lifetime suicidal thoughts, and was significantly higher for those with lifetime suicidal thoughts and prior attempts compared to those without. Implicit biases towards death were not associated with OCD severity, and did not predict explicitly endorsed STBs. This is the first study to measure both explicit and implicit STBs in adults with OCRDs. Limitations included small sample size and lack of racial/ethnic diversity. Given the majority had recent suicidal thoughts and one in six had a prior attempt, we emphasize the importance of STB assessment in OCD treatment settings.
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Trastorno Obsesivo Compulsivo , Ideación Suicida , Adulto , Humanos , Intento de Suicidio , Trastorno Obsesivo Compulsivo/terapia , Pacientes , AutoinformeRESUMEN
Evidence-based interventions vary in effectiveness for individuals with depression, which has a large public health burden. Readiness for change or treatment can be an important individual difference predictor of depression outcomes. To inform public service initiatives targeting readiness for treatment, characterizing readiness across settings and levels of care is key. However, limited data exist on the role of readiness for treatment in acute psychiatric settings and in particular, partial hospital programs which are key points in the continuity of inpatient and outpatient care. The present study assessed readiness for treatment in terms of importance, confidence, and motivation to engage in a partial hospital program and tested whether higher levels of readiness were associated with better treatment outcomes among clients with depression. Participants (N = 192) with major depressive disorder rated their readiness for treatment (Readiness Rulers), depression (Patient Health Questionnaire-9), and global improvement (Clinical Global Impression Scale-Improvement Self-Report) while enrolled in a partial hospital program. Generalized linear regression models assessed the effect of baseline readiness on outcomes at discharge, adjusted for baseline level of the outcome, age, sex, race, and ethnicity. Greater baseline readiness predicted reduced depression and better global improvement at discharge. Higher confidence and motivation to engage in treatment, but not importance, were associated with better depression outcomes. Identifying and addressing readiness for treatment by leveraging public health systems and services (e.g., help lines, family interventions) prior to or upon starting a partial hospital program may be useful to maximize gains in treatment. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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OBJECTIVE: Although impairments in attentional control are pervasive across psychopathology, there is substantial individual differences. In the current study, we examined whether individual differences in self-reported and performance-based measures of attentional control predict changes in depressive symptoms and well-being in a diagnostically diverse sample of patients attending a CBT-based partial hospital program. METHOD: Participants were 89 patients (56.2% men, 75.3% non-Hispanic White). At baseline, patients completed the self-reported Attentional Control Scale and the Rapid Serial Visual Presentation task (RSVP), a behavioral measure of attentional control. Depressive symptoms were assessed daily using the Patient Health Questionnaire and well-being was assessed using the Mental Health Continuum Short Form. RESULTS: On average, greater self-reported attentional control was significantly associated with lower depressive symptoms, ß = -0.49, t(52) = 4.84, p < .001, 95% CIs [-0.69, -0.29], and greater well-being, ß = 0.45, t(53) = 3.90, p < .001, 95% CIs [0.22, 0.67]. More accurate task-based performance was associated with a decline in depressive symptoms over time, ß = -0.02, t(32) = 2.50, p = .02, 95% CIs [-0.04, -0.01]. Neither self-reported nor performance-based measures of attentional control predicted changes in well-being. Finally, exploratory analyses suggest that depressive symptoms also improved over time for individuals who underestimated self-reported attentional control abilities relative to task-based performance, ß = -0.19, t(32) = 2.23, p = .03, 95% CIs [-0.36, -0.02]. CONCLUSIONS: Results suggest that performance-based attentional control may be an important target for assessment and intervention, as well as a potential mechanism underlying risk and recovery.
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Psicoterapia Breve , Masculino , Humanos , Femenino , Depresión/psicología , Atención , Autoinforme , IndividualidadRESUMEN
OBJECTIVE: Improvement in emotion regulation is a proposed transdiagnostic mechanism of change. However, treatment research is limited by disorder-specific investigations that assess a narrow number of emotion regulation strategies. Moreover, most assess pre-to-post-treatment change without examining short-term changes throughout psychotherapy that might influence treatment response. METHOD: To address these gaps, this study uses daily diary methodology to examine trajectories of change in use of six emotion regulation strategies during partial hospitalization psychiatric treatment. Treatment was rooted in cognitive behavioral principles and included skills adapted from empirically supported cognitive behavioral therapy (CBT) and dialectical behavior therapy (DBT) manuals. Participants were adults (N = 364; Mage = 34.6 years; 60% female; 85% non-Hispanic White) with various profiles of mood, anxiety, and obsessive-compulsive disorders who completed symptom measures at baseline and discharge and daily measures of emotion regulation. RESULTS: In the first 7 treatment days, patients increased use of engagement strategies (reappraisal, acceptance) and decreased use of disengagement (expressive suppression) and cognitive perseveration (experiential avoidance, rumination) strategies. Day-to-day trajectories found that decreased use of experiential avoidance predicted next-day changes in distraction and suppression use. In predicting treatment outcomes, steeper rates of decreased suppression use predicted reductions in anxiety, depression, and general psychopathology symptoms; similar patterns were observed for decreased rumination and experiential avoidance use and increased reappraisal use. CONCLUSION: Results add to a growing literature on the value of intentional, constructive engagement with emotional experiences as a mechanism of psychological health. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Terapia Cognitivo-Conductual , Regulación Emocional , Humanos , Adulto , Femenino , Masculino , Centros de Día , Psicoterapia , EmocionesRESUMEN
ABSTRACT: The synergistic epidemics of COVID-19, racial injustice, and health inequities sparked an unprecedented commitment from US hospital systems and treatment settings to address health disparities by increasing access to care for historically oppressed and underserved communities. However, the inability of hospital systems to actually provide multiculturally responsive care and, more broadly, to consistently practice cultural humility will only exacerbate patient distrust and the deleterious health and social outcomes we seek to mitigate. This perspective article describes the development of a multidisciplinary team of mental health providers committed to delivering culturally responsive mental health treatment while promoting inclusive workplace environments. We outline the Multicultural Psychology Consultation Team's (MPCT) origin, design, process, and structure and discuss successes and challenges in maintaining the model in its first two years. We recommend that systemic infusion of cultural humility, multiculturally responsive clinical care, and support for providers delivering care be prioritized in concert with efforts to increase access to care for diverse patients. We offer MPCT as a model for supporting these aims.
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COVID-19 , Humanos , Centros Médicos Académicos , Salud Mental , Psicoterapia , Derivación y ConsultaRESUMEN
Rapid serial visual presentation (RSVP) tasks have been frequently used to assess attentional control in psychiatric samples; however, it is unclear whether RSVP tasks exhibits the psychometric properties necessary to assess these individual differences. In the current study, we examined the reliability and validity of single-target computerized RSVP task outcomes in a sample of 63 participants with moderate to severe psychiatric illness. At the group level, we observed the classical attentional blink phenomenon. At the individual level, conventional indices of attentional blink magnitude exhibited poor internal consistency. We empirically evaluated a novel index for assessing attentional blink magnitude using a single-target RSVP task that involves collapsing across experimental trials in which the attentional blink phenomenon occurs and disregarding performance on control trials, which suffer from ceiling effects. We found that this new index resulted in much improved reliability estimates. Both novel and conventional indices provided evidence of convergent validity. Consequently, this novel index may be worth examining and adopting for researchers interested in assessing individual differences in attentional blink magnitude.
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ABSTRACT: Hair pulling disorder (HPD; trichotillomania) and skin picking disorder (SPD; excoriation disorder) are understudied psychiatric disorders. The aim of this study was to examine the prevalence and correlates of HPD and SPD in an acute psychiatric sample. Semistructured interviews and self-report measures were administered to patients in a psychiatric partial hospital (N = 599). The past-month prevalence of HPD and SPD was 2.3% and 9%, respectively. HPD and SPD had highly similar clinical characteristics and a strong co-occurrence. Patients with HPD/SPD were significantly younger than other patients and more likely to be female. Logistic regression controlling for age and sex showed that diagnosis of HPD/SPD was not significantly associated with suicidal ideation, suicidal behaviors, nonsuicidal self-injury, or emotional disorder diagnoses (e.g., borderline personality disorder, major depressive disorder). HPD/SPD status was significantly associated with an increased risk of generalized anxiety disorder. However, patients with HPD/SPD did not differ from other patients on self-report measures of generalized anxiety, depression, and distress intolerance. HPD and SPD are common and frequently co-occurring disorders in psychiatric settings.
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Trastorno Depresivo Mayor , Conducta Autodestructiva , Tricotilomanía , Humanos , Femenino , Masculino , Tricotilomanía/epidemiología , Tricotilomanía/complicaciones , Tricotilomanía/diagnóstico , Prevalencia , Trastorno Depresivo Mayor/epidemiología , Trastorno Depresivo Mayor/complicaciones , Conducta Autodestructiva/psicología , CabelloRESUMEN
OBJECTIVE: Despite a proliferation of virtual partial hospital programs (PHP) during the COVID-19 pandemic, there is a dearth of research on such programs. In the current study, we compared treatment outcomes and patient satisfaction between an in-person and a virtual PHP. Further, we examined patients' qualitative feedback about the virtual PHP. METHOD: Participants included 282 patients attending a virtual PHP during the COVID-19 pandemic and 470 patients attending an in-person PHP one year prior. Patients completed daily measures of symptom severity, and post-treatment measures of patient satisfaction and treatment outcomes. Patients in the virtual PHP provided feedback about virtual care. Quantitative data were analyzed using multilevel modeling, and qualitative data were analyzed using the principles of inductive analysis. RESULTS: Patients experienced a reduction in depression (b = -.28, p < .001) and anxiety symptoms (b = -.25, p < .001) over time and reported high satisfaction in both the in-person and virtual PHPs. There were no significant differences across programs. Virtual PHP patients identified unique advantages and disadvantages of virtual care. CONCLUSION: Our results suggest that virtual PHPs should be explored as an ongoing model of care that may help to systematically reduce barriers to accessing mental health services.
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COVID-19 , Satisfacción del Paciente , Humanos , Pandemias , Resultado del Tratamiento , HospitalesRESUMEN
Research is needed to better understand and characterize individuals who do not benefit from evidence-based psychiatric services or whose symptoms worsen following treatment. This study aimed to compare clinical severity at admission, treatment outcomes, treatment beliefs, and satisfaction with care among patients (N = 5,129) with perceived improved, unchanged, or worsened mental health at discharge from a partial hospital program. Chi-square tests, one-way analyses of variances (ANOVAs), analyses of covariances (ANCOVAs), and qualitative analyses were used to probe study aims. Patients perceiving overall unchanged or worsened mental health at discharge did not appear more clinically severe at admission compared to patients perceiving overall improved mental health at discharge; however, they did report more negative beliefs about treatment, poorer outcomes across specific clinical severity indices, and poorer patient satisfaction at discharge. Patients most frequently attributed their unchanged or worsened mental health to engaging with difficult emotions for the first time, being a poor fit for an otherwise helpful program, and/or needing more time to apply new skills. Findings suggest that patients who do not perceive benefit from evidence-based acute psychiatric care may not be more clinically severe at admission, yet they may enter care with more negative treatment perceptions and report poorer outcomes on specific psychiatric indices at discharge compared to those perceiving treatment benefit. Efforts are needed to improve treatment for patients who do not benefit from psychiatric services; yet, for some, unchanged or worsened mental health in the short term may represent a step along the trajectory to long-term recovery. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Trastornos Mentales , Salud Mental , Humanos , Trastornos Mentales/terapia , Alta del Paciente , Hospitales , Resultado del TratamientoRESUMEN
Interpretation bias is a transdiagnostic mechanism underlying anxiety. Theoretical models highlight the role of parental interpretation bias in predicting and maintaining child anxiety. However, very few studies have examined parent interpretation bias as a treatment target. The current pilot study tested the feasibility and acceptability of an interpretation bias intervention delivered by a smartphone app, called HabitWorks, in parents of anxious children who self-reported at least mild symptoms of anxiety and negative interpretation bias. Parents of anxious youth (ages 8 to 16) were recruited from the waitlists of three child anxiety clinics. They were asked to complete interpretation modification exercises via the HabitWorks app 3 times per week for 1 month. Participants completed assessments at pre- and post-intervention and 1-month follow-up to assess changes in interpretation bias, anxiety symptoms, and overall perceptions of HabitWorks. Participants (N=14) (Mage=44.36; 14.29% men, 85.71% women) completed an average of 13.29 exercises out of the 12 prescribed. Acceptability ratings were high. Interpretation bias, as measured by an assessment version of the intervention exercise, significantly improved from pre- to posttreatment, and these improvements were maintained at the 1-month follow-up. Anxiety symptoms significantly improved from the "mild" severity range to the "none to minimal" range. In this pilot feasibility study in parents of anxious youth, HabitWorks was a feasible and acceptable low-intensity intervention. These preliminary results support a future controlled trial of HabitWorks for parents. Future studies are also needed to test whether targeting interpretation bias in parents has downstream effects on maladaptive parent behaviors and ultimately, child interpretation bias and anxiety.
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Objectives: Summarize existing literature on cognitive outcomes of MBSR and MBCT for individuals with depression. Methods: Following PRISMA (2021) guidance, we conducted a systematic review. We searched databases for studies published from 2000 to 2020 which examined cognitive outcomes of MBSR and MBCT in individuals with at least mild depressive symptoms. The search result in 10 studies (11 articles) meeting inclusion criteria. Results: We identified five single armed trials and five randomized controlled trials. Results indicated that three studies did not show any improvements on cognitive outcomes, and seven studies showed at least one improvement in cognitive outcomes. Conclusions: Overall, the review highlighted several inconsistencies in the literature including inconsistent use of terminology, disparate samples, and inconsistent use of methodology. These inconsistencies may help to explain the mixed results of MBSR and MBCT on cognitive outcomes. Recommendations include a more streamlined approach to studying cognitive outcomes in depressed individuals in the context of MBSR and MBCT.
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BACKGROUND: Engagement with mental health smartphone apps is an understudied but critical construct to understand in the pursuit of improved efficacy. OBJECTIVE: This study aimed to examine engagement as a multidimensional construct for a novel app called HabitWorks. HabitWorks delivers a personalized interpretation bias intervention and includes various strategies to enhance engagement such as human support, personalization, and self-monitoring. METHODS: We examined app use in a pilot study (n=31) and identified 5 patterns of behavioral engagement: consistently low, drop-off, adherent, high diary, and superuser. RESULTS: We present a series of cases (5/31, 16%) from this trial to illustrate the patterns of behavioral engagement and cognitive and affective engagement for each case. With rich participant-level data, we emphasize the diverse engagement patterns and the necessity of studying engagement as a heterogeneous and multifaceted construct. CONCLUSIONS: Our thorough idiographic exploration of engagement with HabitWorks provides an example of how to operationalize engagement for other mental health apps.
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Cognitive models implicate interpretation bias in the development and maintenance of obsessive compulsive and related disorders (OCRDs), and research supports Cognitive Bias Modification for Interpretation (CBM-I) in targeting this mechanism. However, prior studies in OCRDs have been limited to nonclinical populations, adolescents, and adults in a laboratory setting. This study evaluated the feasibility and acceptability of CBM-I as an adjunctive intervention during intensive/residential treatment (IRT) for adults with OCRDs. We modified a lab-based CBM-I training for adults seeking IRT for OCRDs, and conducted a feasibility trial (Nâ¯=â¯4) and subsequent pilot RCT; participants (Nâ¯=â¯31) were randomized to receive CBM-I or psychoeducation. Benchmarks were met for feasibility, acceptability, and target engagement. From pre- to post-intervention, the CBM-I group showed a large effect for change in interpretation bias (dâ¯=â¯.90), whereas this effect was trivial (dâ¯=â¯.06) for psychoeducation. This was the first study to evaluate CBM-I in naturalistic treatment for adults seeking IRT for OCRDs. Findings support the feasibility and acceptability of CBM-I in this novel sample and setting. A larger scale RCT is needed to determine whether CBM-I can enhance OCRD treatment response.
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Terapia Cognitivo-Conductual , Trastorno Obsesivo Compulsivo , Adolescente , Adulto , Cognición , Estudios de Factibilidad , Humanos , Trastorno Obsesivo Compulsivo/psicología , Trastorno Obsesivo Compulsivo/terapia , Proyectos Piloto , Resultado del TratamientoRESUMEN
Free tissue transfer is a cornerstone of complex reconstruction. In many cases, it represents the last option available for a patient and their reconstruction. At high-volume centers, the risk of free flap failure is low but its occurrence can be devastating. Currently, the mainstay for flap monitoring is the clinical examination. Though reliable when performed by experienced clinicians, the flap exam is largely subjective, is performed discontinuously, and often results in significant time delay between detection of flap compromise and intervention. Among emerging flap monitoring technologies, the most promising appear to be those that rely on noninvasive transcutaneous oxygen and carbon dioxide measurements, which provide information regarding flap perfusion. In this article, we review and summarize the literature on various techniques but primarily emphasizing those technologies that rely on transcutaneous gas measurements. We also define characteristics for the ideal flap monitoring tool and discuss critical barriers, predominantly cost, preventing more widespread utilization of adjunct monitoring technologies, and their implications.