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1.
J Med Case Rep ; 15(1): 549, 2021 Nov 05.
Artigo em Inglês | MEDLINE | ID: mdl-34740369

RESUMO

BACKGROUND: The aim of this study is to highlight the importance of having a central case managing team and to make some strong recommendations that can have a positive impact on the lives of hematopoietic stem cell transplantation survivors. CASE PRESENTATION: A 2-year-old white child who was diagnosed with acute myeloid leukemia and underwent hematopoietic stem cell transplantation in May 2014 relapsed in March 2017, and underwent a second hematopoietic stem cell transplantation in July 2017, at which point he suffered from graft-versus-host disease. This case report presents his journey and that of his caregivers, and the challenges they faced as patient and parents in pursuit of optimal quality of life during the survivorship period. The case study emphasizes not only the challenges faced by patients but also identified gaps in post-hematopoietic cell transplantation care service delivery. Furthermore, the case study also highlights the importance of involving caregivers in post-transplant care and having a better communication process and service facilitation process throughout the journey of the patient and their carer. CONCLUSIONS: Transplant centers have a duty of care, and a proactive approach with a well-defined pathway is needed for managing post-transplant complications and reducing stress and anxiety for patients and their caregivers.


Assuntos
Doença Enxerto-Hospedeiro , Transplante de Células-Tronco Hematopoéticas , Leucemia Mieloide Aguda , Ansiedade/terapia , Cuidadores , Pré-Escolar , Doença Enxerto-Hospedeiro/prevenção & controle , Humanos , Leucemia Mieloide Aguda/terapia , Qualidade de Vida
2.
J Anxiety Disord ; 84: 102494, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34763219

RESUMO

BACKGROUND: Internet cognitive behavioural therapy (iCBT) for health anxiety has demonstrated efficacy but has not been evaluated during the COVID-19 pandemic. This study presents the first evaluation of the uptake and outcomes of iCBT for health anxiety during the COVID-19 pandemic. METHODS: THIS WAY UP is an Australian digital mental health service which delivers iCBT interventions to community members. We compared the uptake of THIS WAY UP's iCBT course for health anxiety in an Australian adult sample who started the course before the pandemic (12th September 2019-11 th March 2020) to during the pandemic (12th March to 11th June 2020). The course was accessible to Australian adults over 18 years old, with no inclusion criteria. Outcomes included course registrations and commencements, lesson and course completion, and self-reported health anxiety (Short Health Anxiety Inventory), depression (Patient Health Questionnaire 9-item) and distress (Kessler-10). RESULTS: From March to June 2020, we observed significant increases in course registrations (N = 238 vs N = 1057); and course commencements (N = 126 vs. N = 778). Large, significant improvements in health anxiety (g = 0.89), and distress (K10: g = 0.91), and medium improvements in depression (g = 0.55) were found. Course completion during COVID was 30.5%. CONCLUSIONS: iCBT improved health anxiety during the COVID-19 pandemic, and provides scalable intervention that can address increased demands for mental health services in the community.


Assuntos
COVID-19 , Terapia Cognitivo-Comportamental , Adolescente , Adulto , Ansiedade/terapia , Austrália , Humanos , Internet , Pandemias , SARS-CoV-2 , Resultado do Tratamento
3.
Eur J Psychotraumatol ; 12(1): 1984049, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34745446

RESUMO

Background: Frontline healthcare workers, recovered COVID+ patients who had severe illness, and close others of COVID+ patients who have recovered or died are at risk for clinical levels of mental health symptoms in the context of the COVID-19 pandemic. RESTORE (Recovering from Extreme Stressors Through Online Resources and E-health) was specifically designed for this context. RESTORE is a transdiagnostic guided online intervention adapted from evidence-based cognitive-behavioural therapies. Objectives: RESTORE was designed to address depression, anxiety, and posttraumatic stress disorder symptoms associated with exposure to COVID-19-related traumatic and extreme stressors, and to overcome multiple barriers to accessing psychotherapies. Method: This paper describes the intervention components and platform, as well as the principles used to develop RESTORE. Current research and future directions in developing and testing RESTORE are outlined. Results: Preliminary data from an initial uncontrolled trial evaluating RESTORE in frontline healthcare workers is highly promising. Conclusion: We believe RESTORE has great potential to provide accessible, evidence-based psychological intervention to those in great need.


Assuntos
Ansiedade/terapia , COVID-19/psicologia , Terapia Cognitivo-Comportamental , Depressão/terapia , Pessoal de Saúde/psicologia , Intervenção Baseada em Internet , Transtornos de Estresse Pós-Traumáticos/terapia , Ansiedade/psicologia , COVID-19/epidemiologia , Depressão/psicologia , Humanos , Saúde Mental , Pandemias , SARS-CoV-2 , Transtornos de Estresse Pós-Traumáticos/psicologia
4.
Trials ; 22(1): 785, 2021 Nov 08.
Artigo em Inglês | MEDLINE | ID: mdl-34749784

RESUMO

BACKGROUND: Canada has one of the highest rates of multiple sclerosis (MS) in the world. Treatments and supports for people with MS (PwMS) have become increasingly complex, requiring individualized and adaptive care. Specialized NPs provide advanced skills to those with complex medical conditions, with potential to enhance the health, functioning, and quality of life for PwMS. This study aims to determine the effect of a Nurse Practitioner (NP) on depression and anxiety levels in PwMS. METHODS: We will perform a parallel randomized controlled trial. PwMS who are followed by general private-practice neurologists will be randomly assigned to the intervention group (NP-led care) or the 'usual care' control group (general neurologist or family physician and registered nurse support). In the intervention group, the NP will assess and provide care to the MS patient and their caregiver at a baseline visit, with 3-month and 6-month follow-up visits. PwMS in the control group will receive usual care provided by their community neurologists or family physicians with the standard assistance provided by registered nurses experienced in MS care. The primary outcome will be the difference in change in the patient's anxiety and depression scores as measured by the validated Hospital Anxiety and Depression Scale (HADS) questionnaire at 3 months. Secondary outcomes will include difference in change in HADS at 6 months; Modified Fatigue Impact Scale scores (MSIF) at 3 and 6 months; EQ-5D scores at 3 and 6 months; caregiver health-related quality of life in MS measures (CAREQOL-MS) at 3 and 6 months; number of visits and phone calls to healthcare professionals recorded by patient, and satisfaction with NP-led care vs usual care measured by the validated Consultant Satisfaction Questionnaire. DISCUSSION: Findings from this study will contribute to exploring benefits of advanced nursing practitioner interventions for PwMS followed by general neurologists and family physicians in a community setting. It will provide evidence of the benefits of NP-led care for PwMS and offer an alternative healthcare resource for management of MS. TRIAL REGISTRATION: ClinicalTrials.gov Pro00069595 . Retrospectively registered on June 26, 2020. Protocol version: January 2017, version 1.


Assuntos
Esclerose Múltipla , Profissionais de Enfermagem , Ansiedade/diagnóstico , Ansiedade/terapia , Depressão/diagnóstico , Depressão/terapia , Humanos , Esclerose Múltipla/diagnóstico , Esclerose Múltipla/terapia , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto
5.
BMC Health Serv Res ; 21(1): 1243, 2021 Nov 17.
Artigo em Inglês | MEDLINE | ID: mdl-34789239

RESUMO

BACKGROUND: Clinical pathways (CPs) can improve health outcomes, but to be sustainable, must be deemed acceptable and appropriate by staff. A CP for screening and management of anxiety and depression in cancer patients (the ADAPT CP) was implemented in 12 Australian oncology services for 12 months, within a cluster randomised controlled trial of core versus enhanced implementation strategies. This paper compares staff-perceived acceptability and appropriateness of the ADAPT CP across study arms. METHODS: Multi-disciplinary lead teams at each service tailored, planned, championed and implemented the CP. Staff at participating services, purposively selected for diversity, completed a survey and participated in an interview prior to implementation (T0), and at midpoint (6 months: T1) and end (12 months: T2) of implementation. Interviews were recorded, transcribed and thematically analysed. RESULTS: Seven metropolitan and 5 regional services participated. Questionnaires were completed by 106, 58 and 57 staff at T0, T1 and T2 respectively. Eighty-eight staff consented to be interviewed at T0, with 89 and 76 at T1 and T2 (response rates 70%, 66% and 57%, respectively). Acceptability/appropriateness, on the quantitative measure, was high at T0 (mean of 31/35) and remained at that level throughout the study, with no differences between staff from core versus enhanced services. Perceived burden was relatively low (mean of 11/20) with no change over time. Lowest scores and greatest variability pertained to perceived impact on workload, time and cost. Four major themes were identified: 1) Mental health is an important issue which ADAPT addresses; 2) ADAPT helps staff deliver best care, and reduces staff stress; 3) ADAPT is fit for purpose, for both cancer care services and patients; 4) ADAPT: a catalyst for change. Opposing viewpoints are outlined. CONCLUSIONS: This study demonstrated high staff-perceived acceptability and appropriateness of the ADAPT CP with regards to its focus, evidence-base, utility to staff and patients, and ability to create change. However, concerns remained regarding burden on staff and time commitment. Strategies from a policy and managerial level will likely be required to overcome the latter issues. TRIAL REGISTRATION: The study was registered prospectively with the ANZCTR on 22/3/2017. Trial ID ACTRN12617000411347. https://www.anzctr.org.au/ .


Assuntos
Depressão , Neoplasias , Ansiedade/diagnóstico , Ansiedade/etiologia , Ansiedade/terapia , Transtornos de Ansiedade , Austrália , Procedimentos Clínicos , Depressão/diagnóstico , Depressão/etiologia , Depressão/terapia , Humanos , Neoplasias/complicações , Neoplasias/terapia
6.
BMC Psychol ; 9(1): 150, 2021 Oct 07.
Artigo em Inglês | MEDLINE | ID: mdl-34615559

RESUMO

BACKGROUND: Psychological interventions such as behavioral activation (BA) that focus on overt behaviors rather than complex cognitive skills may be developmentally well-suited to address youth mental health problems. The current systematic review synthesized evidence on the characteristics, effectiveness and acceptability of behavioral activation (BA) to examine its role as a potential 'active ingredient' for alleviating depression and anxiety among young people aged 14 to 24 years. METHODS: Evidence across the following sources were synthesized: (i) randomized control trials (RCT) evaluating interventions where BA has been used as a standalone intervention or as part of a multicomponent intervention, (ii) qualitative studies examining the acceptability of BA as an intervention or as a coping strategy among young people with lived experiences. Consultations with a youth advisory group (YAG) from India were used to draw inferences from existing evidence and identify future research priorities. RESULTS: As part of the review, 23 RCTs were identified; three studies examined BA as a standalone intervention, and the remaining studies examined multicomponent intervention where BA was a constituent element. The intervention protocols varied in composition, with the number of intervention elements ranging between 5 to 18. There was promising but limited evidence in standalone interventions for thse effectiveness of BA for depression. The impact of BA in multicomponent interventions was difficult to evaluate in the absence of focal assessment of activation outcomes. Evidence from 37 additional qualitative studies of youth lived experience literature, corroborated by the YAG inputs, indicated that young people preferred using behavioral strategies similar to BA to cope with depression in their own life. Themes indicated that the activities that are important to an individual and their socio-contextual factors need to be considered in the planning and implementing BA intervention. Evidence for the use of BA in anxiety was limited across data sources. CONCLUSIONS: Overall, there was preliminary empirical evidence for the effectiveness and acceptability of BA for youth depression. Further research is needed to examine the components and mechanisms that contribute to its effectiveness as an active intervention ingredient for depression and anxiety.


Assuntos
Ansiedade , Depressão , Adolescente , Ansiedade/terapia , Depressão/terapia , Humanos , Índia , Pesquisa Qualitativa
7.
Acta Med Indones ; 53(3): 352-359, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34611077

RESUMO

BACKGROUND: COVID-19 is an infectious disease that is easily widespread and has clinical manifestations as mild, moderate, or severe disease. COVID-19 patients are required to be isolated during treatment to reduce transmission. This can cause anxiety and depression, which in turn worsens the patient's illness. Providing supportive psychotherapy can help provide a feeling of safety, comfort and calm for patients. The choice of method in providing supportive psychotherapy can be done online/teleconsultation or internet-based. This clinical review aims to determine the effect of online teleconsultation or internet-based psychotherapy on COVID-19 patients. METHODS: A systematic search was performed using online databases, such as PubMed, Cochrane, EBSCO/CINAHL and ProQuest. The identified articles were screened using eligibility criteria. There were 2 studies (Zhou et al, and Wei et al) which were analyzed critically using the Newcastle Ottawa Scale. RESULTS: Both studies showed that management of psychotherapy through teleconsultation or internet-based on COVID-19 patients can help relieve the patient's psychological symptoms. Zhou et al studied 63 suspected COVID-19 with 23.8% (n = 15) having a Hospital Anxiety Depression Scale (HADS) score of 8 or more. There was a significant decrease in HADS-A nxiety (HADS-A) scores (p <0.01) and HADS-Depression (HADS-D) scores (p <0.01) in 15 patients, and from the overall HADS scores (p < 0.01). Wei et al. Showed 17-HAMD and HAMA scores in the online psychological intervention group also showed a significant reduction in symptoms of depression and anxiety compared to controls. CONCLUSION: Psychotherapy through online teleconsultation or internet-based on COVID-19 patients can help relieve symptoms of anxiety and depression and teleconsultation and also effective in dealing with psychological complications in patients with COVID-19.


Assuntos
Ansiedade , COVID-19/psicologia , Depressão , Intervenção Baseada em Internet , Psicoterapia/métodos , Consulta Remota/métodos , Ansiedade/etiologia , Ansiedade/terapia , COVID-19/epidemiologia , COVID-19/prevenção & controle , Controle de Doenças Transmissíveis/métodos , Depressão/etiologia , Depressão/terapia , Humanos , SARS-CoV-2
8.
BMJ Open ; 11(10): e053971, 2021 10 25.
Artigo em Inglês | MEDLINE | ID: mdl-34697123

RESUMO

INTRODUCTION: Approximately 30% of people with long-term physical health conditions (LTCs) experience mental health problems, with negative consequences and costs for individuals and healthcare services. Access to psychological treatment is scarce and, when available, often focuses on treating primary mental health problems rather than illness-related anxiety/depression. The aim of this study is to evaluate the clinical efficacy of a newly developed, therapist-supported, digital cognitive-behavioural treatment (COMPASS) for reducing LTC-related psychological distress (anxiety/depression), compared with standard charity support (SCS). METHODS AND ANALYSIS: A two-arm, parallel-group randomised controlled trial (1:1 ratio) with nested qualitative study will be conducted. Two-hundred adults with LTC-related anxiety and depression will be recruited through national LTC charities. They will be randomly allocated to receive COMPASS or SCS only. An independent administrator will use Qualtrics randomiser for treatment allocation, to ensure allocation concealment. Participants will access treatment from home over 10 weeks. The COMPASS group will have access to the digital programme and six therapist contacts: one welcome message and five fortnightly phone calls. Data will be collected online at baseline, 6 weeks and 12 weeks post-randomisation for primary outcome (Patient Health Questionnaire Anxiety and Depression Scale) and secondary outcomes (anxiety, depression, daily functioning, COVID-19-related distress, illness-related distress, quality of life, knowledge and confidence for illness self-management, symptom severity and improvement). Analyses will be conducted following the intention-to-treat principle by a data analyst blinded to treatment allocation. A purposively sampled group of COMPASS participants and therapists will be interviewed. Interviews will be thematically analysed. ETHICS AND DISSEMINATION: The study is approved by King's College London's Psychiatry, Nursing and Midwifery Research Ethics Subcommittee (reference: LRS-19/20-20347). All participants will provide informed consent to take part if eligible. Findings will be published in peer-reviewed journals and presented at conferences. TRIAL REGISTRATION NUMBER: NCT04535778.


Assuntos
COVID-19 , Terapia Cognitivo-Comportamental , Adulto , Ansiedade/terapia , Depressão/terapia , Humanos , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , SARS-CoV-2 , Resultado do Tratamento
9.
J Affect Disord ; 295: 856-864, 2021 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-34706456

RESUMO

BACKGROUND: Cranial Electrotherapy Stimulation (CES) is a promising non-invasive brain stimulation technique with the potential to alleviate anxiety. We examined the effectiveness of home-based CES with novel, headphone-like, in-ear electrodes on anxiety-related symptoms and resting-state brain activity. METHODS: This study spanned 3-weeks, with randomized, double blind, and active-controlled design. Nonclinical volunteers experiencing daily anxiety were randomly assigned to either the active or the sham groups. CES provides an alternating current (10 Hz frequency, 500 µA intensity), connected to smartphone recording treatment logs. Participants treated themselves with 20 trials of CES at home. We evaluated the effectiveness using State-Trait Anxiety Inventory (STAI), Beck Depression Inventory (BDI), Wisconsin Card Sort Test (WCST), and resting-state electroencephalography (EEG). RESULTS: The active group showed a significant improvement in state-anxiety compared to sham, while there was a statistical trend in the WCST-Category Completed (p = .061) and no change in depression. In EEG analysis, the active group showed significantly increased relative power for theta in the left frontal region compared with the sham, and this significantly correlated with the changes in state-anxiety. The active group exhibited significantly increased high-beta source activity in cuneus and middle occipital gyrus after intervention compared with the baseline. LIMITATIONS: This study had a relatively short treatment period and small sample size. CONCLUSIONS: Our findings provide the first electrophysiological evidence for CES for novel in-ear electrodes to improve anxiety. The modulatory effects of CES on resting-state oscillations of EEG imply that CES could beneficially affect functional brain activity.


Assuntos
Terapia por Estimulação Elétrica , Ansiedade/terapia , Transtornos de Ansiedade , Encéfalo , Método Duplo-Cego , Eletrodos , Humanos
10.
Clin Nutr ESPEN ; 45: 75-90, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34620373

RESUMO

BACKGROUND & AIM: Probiotics in the gut have been suggested to have a beneficial effect on anxiety response and depressive disorder. Hence we conducted a systematic review and meta-analysis to summarize the effects of probiotics associated with or without pharmacological or psychological therapies in patients with depressive and/or anxiety symptoms or disorders. METHODS: We conducted searches of MEDLINE, EMBASE, CENTRAL, PsycINFO, CINAHL, ProQuest, LILACS, and Web of Science up to February 2020 to identify randomized controlled trials (RCTs) investigating the efficacy of probiotics associated with or without pharmacological or psychological therapies for patient-important outcomes including relief of depressive, anxiety and stress symptoms, cognitive functions, adverse events and quality of life. We used the GRADE approach to rate the overall certainty of the evidence by outcome. The protocol of the systematic review was registered with PROPSERO and published under the number CRD4202016329. RESULTS: 16 RCTs including 1,125 patients proved eligible. Results suggested a significant improvement in using Beck Depression Index (MD, -3.20 [95% CI, -5.91 to -0.49], p = 0.02; I2 = 21%, p = 0.28) for depression symptoms and State-Trait Anxiety Inventory (STAI) (MD, -6.88 [95% CI, -12.35 to -1.41], p = 0.01; I2 = 24%, p = 0.25) for anxiety with overall certainty in evidence rated as moderate and low, respectively. However, Depression Scale (DASS-Depression) (MD, 2.01 [95% CI, -0.80 to 4.82], p = 0.16; I2 = 0%, p = 0.62), Montgomery-Asberg Depression Rating Scale (MADRAS) (MD, -2,41 [95% CI, -10,55 to 5,72], p = 0,56; I2 = 87%, p = 0,006), Anxiety scale (DASS-Anxiety) (MD, 0.49 [95% CI, -4.05 to 5.02], p = 0.83; I2 = 74%, p = 0.05), and Stress Scale (DASS-Stress) (MD, 0.84 [95% CI, -2.64 to 4.33], p = 0.64; I2 = 34%, p = 0.22) showed no significant decrease in the relief of depression, anxiety and stress symptoms of probiotics compared to placebo with overall certainty in evidence rated as very low for all outcomes. We also found no differences in the Beck Anxiety Index (BAI) (MD, -3.21 [95% CI, -6.50 to 0.08], p = 0.06; I2 = 0%, p = 0.88) with overall certainty in evidence rated as low. Results suggested a non-statistically significantly effect of probiotics in the adverse events outcomes. CONCLUSIONS: The current review suggests that probiotics may improve symptoms of depression and anxiety in clinical patients. However, given the limitations in the included studies, RCTs with long-term follow-up and large sample sizes are needed.


Assuntos
Depressão , Probióticos , Ansiedade/terapia , Depressão/terapia , Humanos , Índia , Ensaios Clínicos Controlados Aleatórios como Assunto
11.
J Neurodev Disord ; 13(1): 46, 2021 10 11.
Artigo em Inglês | MEDLINE | ID: mdl-34635048

RESUMO

BACKGROUND: Anxiety disorders are highly prevalent in children and adolescents with autism spectrum disorder and often emerge before the age of 6 years. Yet, only a few studies have examined anxiety treatment for this group. Preliminary evidence from these studies suggests that utilizing cognitive behavioral therapy (CBT) as well as strategies to target intolerance of uncertainty (IU) and parental accommodation, known mechanistic and maintaining factors of anxiety may improve anxiety and optimize outcomes in this age group. MAIN BODY: To meet this need, we developed an integrated treatment called DINO Strategies for Anxiety and intolerance of Uncertainty Reduction (DINOSAUR), a 12-week group telehealth treatment for 4- to 6-year-old children with ASD. DINOSAUR works with young children and their parents to deliver CBT along with interventions targeting IU and parental accommodation. In this paper, we first discuss the rationale for developing this treatment and then describe a pilot study of its feasibility and preliminary efficacy. CONCLUSIONS: There is a great need to develop anxiety treatments for young children with ASD. We proposed a novel integrated treatment approach that aims to alter the way young children and parents respond to fear, which could potentially improve short- and long-term mental health outcomes for this age group. TRIAL REGISTRATION: ClinicalTrials.gov NCT04432077 on June 03, 2020.


Assuntos
Transtorno do Espectro Autista , Terapia Cognitivo-Comportamental , Dinossauros , Animais , Ansiedade/complicações , Ansiedade/terapia , Transtornos de Ansiedade/complicações , Transtornos de Ansiedade/terapia , Transtorno do Espectro Autista/complicações , Transtorno do Espectro Autista/terapia , Cognição , Projetos Piloto , Incerteza
12.
BMC Psychol ; 9(1): 151, 2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-34598734

RESUMO

BACKGROUND: Anxiety is common in youth on the autism spectrum and cognitive behavioural therapy (CBT) has been adapted to address associated symptoms. The aim of the current systematic review and meta-analysis was to examine the efficacy of CBT for reducing anxiety in autistic youth. METHOD: Searches of PubMed and Scopus databases were undertaken from January 1990 until December 2020. Studies were included if they consisted of randomised controlled trials (RCTs) using CBT to reduce anxiety in autistic youth. Separate random effects meta-analyses assessed anxiety ratings according to informant (clinician; parent; child), both at end-of-trial and at follow-up. RESULTS: A total of 19 RCTs met our inclusion criteria (833 participants: CBT N = 487; controls N = 346). Random effects meta-analyses revealed a large effect size for clinician rated symptoms (g = 0.88, 95% CI 0.55, 1.12, k = 11), while those for both parent (g = 0.40, 95% CI 0.24, 0.56; k = 18) and child-reported anxiety (g = 0.25, 95% CI 0.06, 0.43; k = 13) were smaller, but significant. These benefits were not however maintained at follow-up. Moderator analyses showed that CBT was more efficacious for younger children (for clinician and parent ratings) and when delivered as individual therapy (for clinician ratings). Using the Cochrane Risk of Bias 2 tool, we found concerns about reporting bias across most trials. CONCLUSIONS: The efficacy of CBT for anxiety in autistic youth was supported in the immediate intervention period. However, substantial inconsistency emerged in the magnitude of benefit depending upon who was rating symptoms (clinician, parent or child). Follow-up analyses failed to reveal sustained benefits, though few studies have included this data. It will be important for future trials to address robustness of treatment gains overtime and to further explore inconsistency in efficacy by informant. We also recommend pre-registration of methods by trialists to address concerns with reporting bias.


Assuntos
Transtorno Autístico , Terapia Cognitivo-Comportamental , Adolescente , Ansiedade/terapia , Transtornos de Ansiedade/terapia , Humanos , Pais
13.
Mo Med ; 118(5): 435-441, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34658436

RESUMO

In this pilot study, we examined the efficacy of Osteopathic Manipulative Treatment (OMT) for improving symptoms of stress, anxiety, and depression (SAD) to determine a correlation between overall improvement in health and quality of life for first responders. Participants received weekly OMT or sham OMT targeting autonomic imbalance. Indicators of SAD were examined pre- and post-study. Overall, this pilot study suggests improvement in both the social-psychological (mental) self-assessments, and alterations in SAD-associated biomarkers from OMT.


Assuntos
Socorristas , Manipulação Osteopática , Ansiedade/terapia , Depressão/terapia , Humanos , Projetos Piloto , Qualidade de Vida
14.
Zhen Ci Yan Jiu ; 46(10): 880-4, 2021 Oct 25.
Artigo em Chinês | MEDLINE | ID: mdl-34698464

RESUMO

OBJECTIVE: To observe the effect of auriculotherapy with miniature bian needle on anxious emotion, the condition of angina pectoris attack and sleep quality in the patients with anxiety after percutaneous coronary intervention (post-PCI). METHODS: A total of 74 eligible patients of post-PCI combined with anxious depression were randomized into an auriculotherapy group (37 cases, 2 cases dropped out) and a control group (37 cases, 3 cases dropped out). In the auriculotherapy group, on the base of the conventional secondary prevention medication for coronary heart disease (CHD), auriculotherapy with miniature bian needle was supplemented. In the control group, a proper physical exercise was combined on the base of the secondary prevention medication for CHD. The duration of treatment was 4 weeks in two groups. Separately, the score of Hamilton anxiety scale (HAMA), the score Seattle angina questionnaire (SAQ) and the score of Pittsburgh sleep quality index (PSQI) were assessed in the patients of the two groups before and after treatment. RESULTS: After treatment, the score of HAMA, the score of each item of SAQ and PSQI score were all improved significantly as compared with those before treatment respectively in both the auriculotherapy group and the control group (P<0.001, P<0.05). After treatment, HAMA score, PSQI score and the scores of physical limitation (PL), anginal stability (AS), anginal frequency (AF) and treatment satisfaction (TS) in SAQ in the auriculotherapy group were all better than those in the control group (P<0.001, P<0.05). The total effective rate was 91.43% (32/35) in the auriculotherapy group, obviously higher than 58.82% (20/34) in the control group (P<0.001). CONCLUSION: Auriculotherapy with miniature bian needle effectively relieves anxious emotions and the condition of angina pectrois attack and improves sleep quality in the post-PCI patients with anxiety.


Assuntos
Auriculoterapia , Intervenção Coronária Percutânea , Angina Pectoris/terapia , Ansiedade/terapia , Humanos , Qualidade de Vida , Resultado do Tratamento
15.
J Occup Environ Med ; 63(10): 865-874, 2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-34597283

RESUMO

OBJECTIVE: An open trial of an internet-based Cognitive Behavioural Therapy (iCBT) program for healthcare workers was conducted. METHODS: Healthcare workers on disability leave who used the iCBT program were assessed on: self-reported depression and anxiety symptoms using the Depression Anxiety Stress Scales-21; and, program usage. Healthcare workers' experience of using iCBT was evaluated in a separate survey. RESULTS: Of the 497 healthcare workers referred to the iCBT program, 51% logged in, 25% logged in more than once, and 12% logged in more than once and completed at least two assessments. For the latter group, self-reported depression and anxiety symptoms significantly decreased from the first assessment. CONCLUSIONS: This iCBT program was perceived to be of benefit to healthcare workers, with program usage and effectiveness that was similar to what has been previously reported for unguided iCBT.


Assuntos
Terapia Cognitivo-Comportamental , Depressão , Ansiedade/terapia , Depressão/terapia , Pessoal de Saúde , Humanos , Internet , Avaliação de Programas e Projetos de Saúde , Licença Médica , Resultado do Tratamento
16.
Medicine (Baltimore) ; 100(42): e27596, 2021 Oct 22.
Artigo em Inglês | MEDLINE | ID: mdl-34678909

RESUMO

BACKGROUND/OBJECTIVE: Anxiety is a significant problem affecting University students including undergraduate adult education and extra-mural studies students. This research evaluated the impact of a group rational-emotive behavioral education intervention (group rational-emotive behavioral education intervention [REBEI]) on social anxiety symptoms among undergraduate adult education and extra-mural studies students. METHOD: Eighty six students participated in the study by belonging to either treatment group (n = 43) or control group (n = 43). A REBEI treatment program was developed by the researchers was used to implement the experiment and data was collected using a 22-item questionnaire on social anxiety. Analyzes of data were done using repeated measures ANOVA and paired t-test. RESULTS: Results showed that despite the social anxiety experienced before exposure to the intervention, the social anxiety symptoms of the undergraduate adult education and extra-mural studies students in the treatment group reduced significantly at post-treatment and follow-up compared to students in the control group. CONCLUSION: REBEI demonstrated its clinical usefulness in treating undergraduate adult education and extra-mural studies students with social anxiety problem.


Assuntos
Ansiedade/terapia , Terapia Comportamental/métodos , Estudantes/psicologia , Universidades , Adulto , Feminino , Humanos , Masculino , Nigéria , Índice de Gravidade de Doença , Adulto Jovem
17.
Behav Ther ; 52(6): 1325-1338, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34656189

RESUMO

The Unified Protocol (UP) for Transdiagnostic Treatment of Emotional Disorders is an emotion-focused, cognitive-behavioral intervention developed to address the full range of anxiety, depressive, and related disorders. The UP consists of core therapeutic skills that, though unique in focus, are each designed to promote an approach-oriented stance toward emotional experiences. The goal of the present investigation was to characterize changes in these skills for patients that received a course of treatment with the UP, as well as to examine associations between skills and symptoms changes. Patients with principal anxiety disorders, assigned to receive treatment with the UP (N = 88) as part of a randomized controlled trial, were included in this study. They completed validated self-report measures of UP skills (Understanding Emotions, Mindful Emotion Awareness, Cognitive Flexibility, Countering Emotional Behaviors, and Interoceptive Awareness and Tolerance), as well as clinician-rated measures of psychological symptoms. Skill measures improved significantly over the course of 12 to 16 UP treatment sessions and changes in these skills measures were associated with improvements in anxiety symptoms. Determining whether improvement on all the skills learned during a course of treatment with UP is associated with symptom remission is critical to establishing the most streamlined and efficient interventions that may ultimately be best suited to widespread dissemination.


Assuntos
Terapia Cognitivo-Comportamental , Atenção Plena , Ansiedade/terapia , Transtornos de Ansiedade/terapia , Emoções , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
18.
Behav Ther ; 52(6): 1377-1394, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34656193

RESUMO

CBT for anxious youth usually combines anxiety management strategies (AMS) with exposure, with exposure assumed to be critical for treatment success. To limit therapy time while retaining effectiveness, one might optimize CBT by restricting treatment to necessary components. This study tested whether devoting all sessions to exposure is more effective in reducing speech anxiety in youth than devoting half to AMS including cognitive or relaxation strategies and half to exposure. After a 6-week waitlist period, adolescents with speech anxiety (N = 65; age 12-15; 42 girls) were randomized to a 5-session in-school group-based CBT training consisting of either (1) exposure-only (EXP+EXP) or (2) cognitive strategies followed by exposure (COG+EXP) or (3) relaxation strategies followed by exposure (REL+EXP). Clinical interviews, speech tests, and self-report measures were assessed at pretest, posttest, and follow-up. For all conditions (a) the intervention period resulted in a stronger decline of speech anxiety than waitlist period; (b) there was a large sized reduction of speech anxiety that was maintained at six-week follow-up; (c) there was no meaningful difference in the efficacy of EXP+EXP versus COG+EXP or REL+EXP. These findings suggest that devoting all sessions to exposure is not more effective than combining exposure with AMS. AMS appeared neither necessary for CBT to be effective, nor necessary for youth to tolerate exposure. This indicates that CBT can be optimized by restricting treatment to exposure.


Assuntos
Terapia Cognitivo-Comportamental , Fala , Adolescente , Ansiedade/terapia , Transtornos de Ansiedade , Criança , Feminino , Humanos , Resultado do Tratamento
19.
Behav Ther ; 52(6): 1408-1417, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34656195

RESUMO

Anxiety control beliefs (i.e., beliefs regarding one's ability to cope with external, fear-inducing threats and internal reactions to those perceived threats) have been found to negatively predict anxiety symptoms in children and adults and to be modifiable by cognitive-behavioral therapy for anxiety disorders. The current study examines whether changes in anxiety control beliefs were seen following a brief, intensive treatment for specific phobias, and whether those changes were associated with improvements in the targeted phobia and comorbid anxiety disorder symptoms. Participants were 135 children and adolescents (M age = 9.01 years, 49% male) who received one-session treatment (OST) with or without parental involvement for their primary specific phobia. Results indicated that self-reported anxiety control beliefs significantly increased following treatment and that these increases significantly predicted reductions in specific phobia severity and symptoms of comorbid anxiety disorders 6 months and 1 year following treatment. Findings illustrate that involvement in a single 3-hour OST was associated with changes in anxiety control beliefs and demonstrate the potential importance of targeting control beliefs in pediatric anxiety treatment.


Assuntos
Terapia Cognitivo-Comportamental , Transtornos Fóbicos , Adolescente , Adulto , Ansiedade/terapia , Transtornos de Ansiedade/terapia , Criança , Medo , Feminino , Humanos , Masculino , Resultado do Tratamento
20.
JMIR Mhealth Uhealth ; 9(10): e26712, 2021 10 06.
Artigo em Inglês | MEDLINE | ID: mdl-34612833

RESUMO

BACKGROUND: A range of mobile apps for anxiety have been developed in response to the high prevalence of anxiety disorders. Although the number of publicly available apps for anxiety is increasing, attrition rates among mobile apps are high. These apps must be engaging and relevant to end users to be effective; thus, engagement features and the ability to tailor delivery to the needs of individual users are key. However, our understanding of the functionality of these apps concerning engagement and tailoring features is limited. OBJECTIVE: The aim of this study is to review how cognitive behavioral elements are delivered by anxiety apps and their functionalities to support user engagement and tailoring based on user needs. METHODS: A systematic search for anxiety apps described as being based on cognitive behavioral therapy (CBT) was conducted on Android and iPhone marketplaces. Apps were included if they mentioned the use of CBT for anxiety-related disorders. We identified 597 apps, of which 36 met the inclusion criteria and were reviewed through direct use. RESULTS: Cognitive behavioral apps for anxiety incorporate a variety of functionalities, offer several engagement features, and integrate low-intensity CBT exercises. However, the provision of features to support engagement is highly uneven, and support is provided only for low-intensity CBT treatment. Cognitive behavioral elements combine various modalities to deliver intervention content and support the interactive delivery of these elements. Options for personalization are limited and restricted to goal selection upon beginning use or based on self-monitoring entries. Apps do not appear to provide individualized content to users based on their input. CONCLUSIONS: Engagement and tailoring features can be significantly expanded in existing apps, which make limited use of social features and clinical support and do not use sophisticated features such as personalization based on sensor data. To guide the evolution of these interventions, further research is needed to explore the effectiveness of different types of engagement features and approaches to tailoring therapeutic content.


Assuntos
Terapia Cognitivo-Comportamental , Aplicativos Móveis , Ansiedade/terapia , Transtornos de Ansiedade/terapia , Exercício Físico , Humanos
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