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1.
Medicine (Baltimore) ; 100(35): e26821, 2021 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-34477119

RESUMO

ABSTRACT: Although reminiscence therapy alleviates mental illness and improves quality of life in neurocognitive disorders patients, little study reports its clinical application in cancer patients. Thus, this study aimed to explore the effect of reminiscence therapy on anxiety, depression, quality of life, and survival profile in postoperative gastric cancer patients.One hundred sixty surgical gastric cancer patients were enrolled in this randomized, controlled study, then randomly assigned to Reminiscence therapy group (N = 80) and Control group (N = 80) as 1:1 ratio. The evaluation was carried at baseline (M0), month 3 (M3), month 6 (M6), month 9 (M9), and month 12 (M12) after intervention by Hospital Anxiety and Depression Scale and European Organization for Research and Treatment of Cancer quality of life Questionnaire-Core 30 (QLQ-C30). Furthermore, disease-free survival and overall survival were analyzed using follow-up data.Reminiscence therapy decreased HADS for anxiety score at M6, M9, and M12, decreased anxiety rate at M9 and M12 compared to control care; while it did not affect HADS for depression score or depression rate at any time-point. Also, reminiscence therapy raised QLQ-C30 global health status score at M12, reduced QLQ-C30 symptoms score at M6, while did not affect QLQ-C30 function score at any time-point compared to control care. Reminiscence therapy did not affect disease-free survival and overall survival, either. Further subgroup analyses (divided by age and gender) observed that the effect of reminiscence therapy seemed more obvious in patients with age ≤60 years and male patients.Reminiscence therapy exhibits alleviation of anxiety and improvement of quality of life in postoperative gastric cancer patients.


Assuntos
Ansiedade/terapia , Psicoterapia de Grupo/normas , Qualidade de Vida/psicologia , Neoplasias Gástricas/complicações , Idoso , Ansiedade/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Psicometria/instrumentação , Psicometria/métodos , Psicoterapia/métodos , Psicoterapia/normas , Psicoterapia/estatística & dados numéricos , Psicoterapia de Grupo/métodos , Psicoterapia de Grupo/estatística & dados numéricos , Neoplasias Gástricas/terapia , Inquéritos e Questionários
2.
An. psicol ; 37(2): 210-220, mayo-sept. 2021. tab
Artigo em Inglês | IBECS | ID: ibc-202545

RESUMO

BACKGROUND: Prison victimization has been a focus of attention by the scientific community with studies that indicate a high prevalence and negative effects on mental health and social reintegration of prisoners. However, there is few information on intervention responses, so it is relevant to obtain reliable data about intervention strategies that seeks to mitigate its consequences and provide support to victims. OBJECTIVE: accomplish a detailed description of the literature on psychological intervention that seeks to respond to victimization in prison and its consequences. METHOD: Systematic review (SR) using the PRISMA-P method. The research was carried out in 10 electronic databases and the data collection and analysis process carried out by two independent researchers. RESULTS: Five publications were included, three quantitative studies and two theoretical articles although none specifically focuses on intervention with individuals subject to prison victimization. This feature is addressed and theoretically analyzed throughout the discussion. CONCLUSION: There are few publications on intervention with victims of pris-on victimization and existing ones do not focus on specific intervention in the context of this type of victimization. However, important guidelines were obtained to be included into future intervention proposals. There is a consensus regarding the need to adopt empirically validated intervention models, referring to the Cognitive Behavior Therapy (CBT), specifically to the Trauma-Informed Treatment (TIT)


INTRODUCCIÓN: La victimización penitenciaria ha sido el foco de atención de la comunidad científica con estudios que indican una alta prevalencia y efectos negativos en la salud mental y en la reintegración social de los presidiarios. Sin embargo, existe poca información sobre las intervenciones, por lo que es relevante obtener datos confiables sobre estrategias de intervención que busquen mitigar sus consecuencias y ofrecer apoyo a las víctimas. OBJETIVO: realizar una descripción detallada de la literatura sobre intervención psicológica que busca dar respuesta a la victimización en prisión y sus consecuencias. MÉTODO: Revisión sistemática (RS) mediante el método PRISMA-P. La investigación se realizó en 10 bases de datos electrónicas y el proceso de recolección y análisis de datos fue realizado por dos investigadores independientes. RESULTADOS: Se incluyeron cinco publicaciones, tres estudios cuantitativos y dos artículos teóricos, aunque ninguno se centra específicamente en la intervención con personas sometidas a victimización penitenciaria. Este as-pecto se aborda y analiza teóricamente a lo largo de la discusión. CONCLUSIÓN: Existen pocas publicaciones sobre intervención con personas victimizadas en prisión y las existentes no enfocan en detalle en la intervención en este tipo de victimización. Sin embargo, se obtuvieron datos relevantes para ser incluidos en futuras propuestas de intervención. Existe consenso en cuanto a la necesidad de adoptar modelos de intervención valida-dos empíricamente, refiriéndose a la Terapia Cognitivo Conductual (TCC), específicamente al Tratamiento Informado por Trauma (TIT)


Assuntos
Humanos , Violência/psicologia , Prisioneiros/psicologia , Psicoterapia/métodos , Vítimas de Crime/psicologia , Prisões , Saúde Mental , Resultado do Tratamento
3.
J Consult Clin Psychol ; 89(6): 499-513, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34264698

RESUMO

OBJECTIVE: To assess the efficacy of the PSYCHOPATHY.COMP program in reducing psychopathic traits among male detained youth. METHOD: In this controlled trial, a treatment group (n = 58) and a control group (n = 61) answered the Youth Psychopathic Traits Inventory-Short (YPIS) and the Proposed Specifiers for Conduct Disorder (PSCD) at baseline, posttreatment, and 6-month follow-up. Treatment participants attended the PSYCHOPATHY.COMP; controls only received Treatment As Usual (TAU). Treatment effects were tested with latent growth curve models (LGCM). RESULTS: At baseline, no significant differences between groups were found. Results from LGCM showed that condition was a significant predictor of change over time observed in almost all outcome measures. Concerning the YPIS, treatment participants presented a significant decrease both in the total score and in the YPIS factors scores when compared with the controls (medium/large effect sizes; growth modeling analysis-GMA d ranging from .58 to 1.12). Considering the PSCD, treatment participants also showed a significant decrease both in the total score and in the PSCD factors scores (except for the grandiose-manipulative factor) when compared with controls (medium effect sizes; GMA d ranging from .53 to .72). Results also showed that treatment effects were maintained 6 months after the PSYCHOPATHY.COMP completion. CONCLUSIONS: Findings indicate that the PSYCHOPATHY.COMP is a promising treatment approach to reduce psychopathic traits among male detained youth, suggesting that interventions targeting these traits should be considered in their rehabilitation, as the absence of tailored interventions may increase the levels of psychopathic traits and their associated risks. (PsycInfo Database Record (c) 2021 APA, all rights reserved).


Assuntos
Transtorno da Personalidade Antissocial/terapia , Psicoterapia/métodos , Adolescente , Transtorno da Conduta/terapia , Empatia , Seguimentos , Humanos , Masculino
4.
J Consult Clin Psychol ; 89(6): 537-550, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34264701

RESUMO

OBJECTIVE: To determine if the Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C) improves functional impairment, psychiatric symptoms, and sleep and circadian functioning. METHOD: Adults diagnosed with serious mental illness (SMI) and sleep and circadian dysfunction (N = 121) were randomly allocated to TranS-C plus usual care (TranS-C + UC; n = 61; 8 individual weekly sessions) or 6 months of Usual Care followed by Delayed Treatment with TranS-C (UC-DT; n = 60). Schizophrenia (45%) and anxiety disorders (47%) were common. Blind assessments were conducted pre-treatment, post-treatment, and 6 months later (6FU). The latter two were the post-randomization points of interest. The location was Alameda County Behavioral Health Care Services (ACBHCS), a Community Mental Health Center (CMHC) in California. RESULTS: For the primary outcomes, relative to UC-DT, TranS-C + UC was associated with reduction in functional impairment (b = -3.18, p = 0.025, d = -0.58), general psychiatric symptoms (b = -5.88, p = 0.001, d = -0.64), sleep disturbance (b = -5.55, p < .0001, d = -0.96), and sleep-related impairment (b = -9.14, p < .0001, d = -0.81) from pre-treatment to post-treatment. These effects were maintained to 6-month follow-up (6FU; d = -0.42 to -0.82), except functional impairment (d = -0.37). For the secondary outcomes, relative to UC-DT, TranS-C + UC was associated with improvement in sleep efficiency and on the Sleep Health Composite score from pre-treatment to 6FU. TranS-C + UC was also associated with reduced total wake time and wake time variability from pre-treatment to post-treatment, as well as reduced hallucinations and delusions, bedtime variability, and actigraphy measured waking activity count variability from pre-treatment to 6FU. CONCLUSIONS: A novel transdiagnostic treatment, delivered within a CMHC setting, improves selected measures of functioning, symptoms of comorbid disorders, and sleep and circadian outcomes. (PsycInfo Database Record (c) 2021 APA, all rights reserved).


Assuntos
Centros Comunitários de Saúde Mental , Transtornos Mentais/terapia , Psicoterapia/métodos , Transtornos do Sono do Ritmo Circadiano/terapia , Transtornos do Sono-Vigília/terapia , Adulto , Ansiedade/terapia , Transtornos de Ansiedade/terapia , California , Feminino , Humanos , Masculino , Transtornos Mentais/complicações , Pessoa de Meia-Idade , Esquizofrenia/terapia , Sono , Transtornos do Sono do Ritmo Circadiano/complicações , Transtornos do Sono-Vigília/complicações , Resultado do Tratamento
5.
Riv Psichiatr ; 56(4): 198-204, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34310577

RESUMO

The covid-19 lockdown forced psychotherapists to use videoconferencing psychotherapy (VCP). There is little literature on the relationship between VCP and the theoretical orientation of the psychotherapist. The aim of our research work is to explore to what extent the Italian therapists used VCP and how they experienced the change in setting during lockdown. A sample of psychotherapists completed an on-line questionnaire including data about any previous experience of remote work, information on changes in setting during lockdown and their opinions on this experience. In the second phase, a statistical analysis of the data collected was performed with SPSS. The most represented theoretical orientations are psychoanalytic, Gestalt, systemic-relational and psychodynamic. Almost all the respondents had chosen to change the setting, opting for remote work via video calls, with no differences in terms of theoretical orientation and age group. Psychotherapeutic orientation seems to affect the type of difficulties encountered. The scientific literature on remote psychotherapy (VCP) so far does not correlate it with any specific theoretical-clinical model. Our research work offers some preliminary hypotheses about potential correlations between setting variations with the theoretical-clinical models.


Assuntos
Atitude do Pessoal de Saúde , COVID-19 , Pandemias , Psicoterapeutas/psicologia , Psicoterapia/métodos , SARS-CoV-2 , Telemedicina/métodos , Adulto , Idoso , Agendamento de Consultas , Continuidade da Assistência ao Paciente , Feminino , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Modelos Teóricos , Satisfação Pessoal , Quarentena , Inquéritos e Questionários , Telemedicina/estatística & dados numéricos , Telefone , Comunicação por Videoconferência , Carga de Trabalho
6.
J Consult Clin Psychol ; 89(6): 528-536, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34264700

RESUMO

OBJECTIVE: Despite considerable evidence that supports perceived burdensomeness (PB) and thwarted belongingness (TB) as risk factors for suicidal ideation (SI), far less is known about the direction of effects between these constructs in treatments for suicidal adolescents. The present study examined bidirectional relations between PB, TB, and adolescents' suicidal ideation (SI) during a 16-week randomized clinical trial. METHOD: 129 depressed and suicidal adolescents completed PB, TB, and SI measures at three time points: baseline (T1), mid-treatment (T2), and treatment completion (T3). Random-intercept cross-lagged panel models (RI-CLPM) examined within-subject direction of effects between interpersonal variables (PB & TB) and suicidal ideation (SI) in the first and second halves of treatment. RESULTS: Within-subjects, autoregressive paths indicated significant carryover in PB and SI. In the first half of treatment, a significant cross-lagged path indicated that T1 PB predicted change in T2 SI, and in the last half of treatment change in T2 SI predicted change in T3 PB. There were no significant auto-regressive or cross-lagged effects for TB. CONCLUSIONS: In the first half of treatment, baseline PB predicted fewer reductions in SI suggesting that PB initially moderated adolescents' response to treatment. However, in the last half of treatment, initial reductions in SI predicted subsequent reductions in PB suggesting that adolescents' initial response to treatment decreased their perceptions of burdening others. The clinical and treatment implications of these bidirectional findings are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).


Assuntos
Depressão/terapia , Terapia Familiar/métodos , Suicídio/prevenção & controle , Suicídio/psicologia , Adolescente , Feminino , Humanos , Relações Interpessoais , Masculino , Relações Pais-Filho , Teoria Psicológica , Psicoterapia/métodos , Fatores de Risco , Ideação Suicida , Inquéritos e Questionários
7.
J Consult Clin Psychol ; 89(5): 379-392, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34124925

RESUMO

Objective: Psychotherapy for depression is effective for many veterans, but the relationship between number of treatment sessions and symptom outcomes is not well established. The Dose-Effect model predicts that greater psychotherapeutic dose (total sessions) yields greater symptom improvement with each additional session resulting in smaller session-to-session improvement. In contrast, the Good-Enough Level (GEL) model predicts that rate of symptom improvement varies by total psychotherapeutic dose with faster improvement associated with earlier termination. This study compared the dose-effect and GEL model among veterans receiving psychotherapy for depression within the Veterans Health Administration. Method: The sample included 13,647 veterans with ≥2 sessions of psychotherapy for depression with associated Patient Health Questionnaire-9 (PHQ-9) scores in primary care (n = 7,502) and specialty mental health clinics (n = 6,145) between October 2014 and September 2018. Multilevel longitudinal modeling was used to compare the Dose-Effect and GEL models within each clinic type. Results: The GEL model demonstrated greater fit for both clinic types relative to dose-effect models. In both treatment settings, veterans with fewer sessions improved faster than those with more sessions. In primary care clinics, veterans who received 4-8 total sessions achieved similar levels of symptom response. In specialty mental health clinics, increased psychotherapeutic dose was associated with greater treatment response up to 16 sessions. Veterans receiving 20 sessions demonstrated minimal treatment response. Conclusions: These findings support the GEL model and suggest a flexible approach to determining length of psychotherapy for depression may be useful for optimizing treatment response and allocation of clinical resources. (PsycInfo Database Record (c) 2021 APA, all rights reserved).


Assuntos
Depressão/terapia , Atenção Primária à Saúde/estatística & dados numéricos , Psicoterapia/métodos , Veteranos/psicologia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
8.
Bull Menninger Clin ; 85(3): 283-297, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33939499

RESUMO

The coronavirus disease (COVID-19) has impacted life for people throughout the world, especially for those in health care who experience unique stressors. To support the psychological needs of staff, faculty, and learners at a biomedical sciences university, faculty at Baylor College of Medicine created a mental health and wellness support program consisting of multiple behavioral health care pathways, including phone support, a self-guided mental health app, a coping skills group, and individual therapy services. The authors present this program as a model for academic institutions to support the well-being of faculty, staff, and learners.


Assuntos
COVID-19/psicologia , Docentes/psicologia , Transtornos Mentais/terapia , Psicoterapia/métodos , Estudantes de Medicina/psicologia , Telemedicina/métodos , Centros Médicos Acadêmicos , Adaptação Psicológica , Humanos , Transtornos Mentais/psicologia , Saúde Mental , Aplicativos Móveis , Psicoterapia de Grupo , SARS-CoV-2 , Estresse Psicológico
9.
Int J Psychoanal ; 102(1): 139-158, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33952011

RESUMO

This article follows almost chronologically the COVID crisis between March and May 2020 during what is called, at least in Europe, the "first wave". Each 'Act' of our internal and external theatre is therefore a moment with a specific date, with the questions that were then pertinent. These 'Acts' were: First was the setting up of remote sessions under health pressures and the recommendations of our psychoanalytic institutions. This change in the frame and its consequences will be presented from various technical points of view, which have ostensibly raised some original metapsychological hypotheses.Then, concerning our profession, its very status as either essential or inessential has been discussed by public authorities, and inevitably by our patients, who will après-coup have to give meaning to our reactions during this crisis.We will next study the effects of remote sessions, particularly from its psychoanalytic 'economic' perspective, and as a kind of 'credit for in-presence' in the early stages of quarantine.We will then be looking at the hypothesis of a maternal element in the sessions, imperceptible in normal times, but suddenly palpable in the context of the absence of physical bodies.Finally, we will propose developments through workshops as an option in order to find a response to this unexpected event at the global scale.


Assuntos
COVID-19/prevenção & controle , Psicoterapia/economia , Psicoterapia/métodos , Telemedicina/métodos , COVID-19/economia , Europa (Continente) , Humanos , Psicoterapia/legislação & jurisprudência , SARS-CoV-2 , Telemedicina/economia , Telemedicina/legislação & jurisprudência
10.
Psychopathology ; 54(3): 150-158, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33951644

RESUMO

INTRODUCTION: Research on body aspects in depression primarily focuses on somatic complaints, while phenomenologists emphasize the pre-reflective bodily experience of depression as relevant for the psychopathology of it. Despite this increasing acknowledgement of the subjective body's impact on depression, empirically, it remains rarely studied. METHODS: Relying on the psychotherapy method of Focusing (Gendlin, 1982), interviews were developed, which enable participants with depression to get in contact with pre-reflective bodily experiences through turning inward, attentively observing all bodily feelings that arise, and finding symbolizations for these feelings. RESULTS: In 501 codings of the conducted interviews, the theme of passivity emerged on a continuum ranging from inhibition of drive to lack of drive. It can be split into 5 components (heaviness, emptiness, paralysis, blockage, and alienation), which were felt in the head or the whole body. Moreover, participants reported active, pressuring feelings in the chest and stomach areas, which were associated with specific emotions in some participants. DISCUSSION: In conclusion, through focusing, participants were able to take note of their pre-reflective bodily feelings and described feelings of passivity, active, pressuring feelings, and an ambivalence between these two parts. Results support the notion that depression is associated with specific pre-reflective bodily experiences and lay a foundation for future research.


Assuntos
Depressão/psicologia , Emoções/fisiologia , Entrevista Psicológica/métodos , Psicoterapia/métodos , Adulto , Afeto , Feminino , Humanos , Masculino
11.
Nat Hum Behav ; 5(5): 631-652, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33875837

RESUMO

Our current understanding of the efficacy of psychological interventions in improving mental states of wellbeing is incomplete. This study aimed to overcome limitations of previous reviews by examining the efficacy of distinct types of psychological interventions, irrespective of their theoretical underpinning, and the impact of various moderators, in a unified systematic review and meta-analysis. Four-hundred-and-nineteen randomized controlled trials from clinical and non-clinical populations (n = 53,288) were identified for inclusion. Mindfulness-based and multi-component positive psychological interventions demonstrated the greatest efficacy in both clinical and non-clinical populations. Meta-analyses also found that singular positive psychological interventions, cognitive and behavioural therapy-based, acceptance and commitment therapy-based, and reminiscence interventions were impactful. Effect sizes were moderate at best, but differed according to target population and moderator, most notably intervention intensity. The evidence quality was generally low to moderate. While the evidence requires further advancement, the review provides insight into how psychological interventions can be designed to improve mental wellbeing.


Assuntos
Saúde Mental , Psicoterapia/métodos , Terapia de Aceitação e Compromisso , Terapia Comportamental , Humanos , Intervenção Psicossocial , Resultado do Tratamento
12.
J Consult Clin Psychol ; 89(5): 371-378, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33829817

RESUMO

OBJECTIVE: The relationship between the therapeutic alliance and outcome has been supported consistently over time. More recently, studies have examined therapist effects in the alliance-outcome relationship and came up with somewhat mixed findings. The purpose of this study was to replicate and extend previous meta-analytic work using a much larger data set, permitting not only the verification of the overall impact of the therapists' contribution but, at the same time, controlling for several potential covariates effecting this relationship. METHOD: We conducted two- and three-level mixed-effects meta-analyses (k = 152; 827 total effect sizes) to examine the significance of several potential moderators of the alliance-outcome correlation. These moderators included (a) Patient-Therapist Ratio (PTR; Patient N divided by therapist N to test therapist effects), (b) Alliance and Outcome Rater's contribution (patient, therapist, observer, and other), (c) Alliance Measures, (d) Research Design (RCT, Other) and (e) Personality Disorder. RESULTS: The PTR, an index of the therapist's contribution to the alliance, was a significant moderator of the alliance-outcome correlation in both the two- and three-level models. When several potential confounds were simultaneously tested in a three-level multipredictor metaregression, including rater of alliance and outcome, research design, alliance measure, and personality disorder, PTR remained a significant moderator of the alliance-outcome correlation. CONCLUSION: Replicating and extending previous research, this study supported the significance of therapists' impact in the alliance-outcome relationship. These results remained significant even when, using three-level metaregressions, several potential covariates were simultaneously controlled. (PsycInfo Database Record (c) 2021 APA, all rights reserved).


Assuntos
Psicoterapia/métodos , Aliança Terapêutica , Humanos , Análise Multinível , Transtornos da Personalidade/terapia , Resultado do Tratamento
13.
J Consult Clin Psychol ; 89(5): 393-405, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33914570

RESUMO

Objective: Although there is evidence that the positive impact of multisystemic therapy for problem sexual behaviors (MST-PSB) reaches as far as young adulthood, the longer-term effects of MST-PSB into midlife are unknown. The present study examined criminal and civil court outcomes for sexually offending youths who participated on average 24.9 years earlier in a clinical trial of MST-PSB (Borduin et al., Journal of Consulting and Clinical Psychology, 2009, 77, p. 26). Method: Participants were 48 individuals who were originally randomized to MST-PSB or usual community services (UCS) and were at high risk of continued criminality. Arrest, incarceration, and civil suit data were obtained in middle adulthood when participants averaged 39.4 years of age. Results: Intent-to-treat analyses showed that MST-PSB participants had 85% fewer sexual offenses and 70% fewer nonsexual offenses than did UCS participants. In addition, MST-PSB participants were sentenced to 46% fewer days of incarceration and had 62% fewer family-related civil suits. Moreover, the favorable effects of MST-PSB on participants' crimes and civil suits were mediated by improved peer and family relations during treatment. Conclusion: The current study represents the longest and most comprehensive follow-up to date of an MST-PSB clinical trial and demonstrates that the positive effects of an evidence-based youth treatment for sexual crimes can last well into adulthood. Implications of the findings for policymakers, service providers, and researchers are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).


Assuntos
Comportamento Problema/psicologia , Psicoterapia/métodos , Delitos Sexuais/psicologia , Comportamento Sexual/psicologia , Adolescente , Adulto , Criminosos/psicologia , Feminino , Seguimentos , Humanos , Delinquência Juvenil/psicologia , Masculino , Grupo Associado , Adulto Jovem
14.
Phys Med Rehabil Clin N Am ; 32(2): 405-418, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33814065

RESUMO

With the evolution of the COVID-19 pandemic in the United States in March 2020, most ambulatory care environments rapidly pivoted to extensive use to telehealth to protect patients and providers while continuing to provide care. This shift resulted in the expansion of telehealth platforms and workflows. Many behavioral health services can be provided in a telehealth format. The case example in this article illustrates that transition to telehealth is feasible and sustainable. Limitations include preoperative psychological assessments and certain neuropsychological tests requiring material manipulation. Careful consideration of risk factors should be exerted for more vulnerable patient populations.


Assuntos
Acesso aos Serviços de Saúde , Transtornos Mentais/terapia , Psicoterapia/métodos , Telemedicina/métodos , COVID-19/epidemiologia , Humanos , Testes Neuropsicológicos , Pandemias , SARS-CoV-2
15.
JAMA Netw Open ; 4(4): e216614, 2021 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-33861328

RESUMO

Importance: Self-harm and suicidal behavior are associated with substantial morbidity and mortality among children and adolescents. The comparative performance of psychotherapies for suicidality is unclear because few head-to-head clinical trials have been conducted. Objective: To compare the efficacy of psychotherapies for the treatment of self-harm and suicidality among children and adolescents. Data Sources: Four major bibliographic databases (PubMed, MEDLINE, PsycINFO, and Embase) were searched for clinical trials comparing psychotherapy with control conditions from inception to September 2020. Study Selection: Randomized clinical trials comparing psychotherapies for suicidality and/or self-harm with control conditions among children and adolescents were included after a blinded review by 3 independent reviewers (A.B., M.P., and J.W.). Data Extraction and Synthesis: The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline was followed for data abstraction, and the Cochrane risk of bias tool was used to evaluate study-level risk of bias. Data abstraction was performed by 1 reviewer (A.B.) and confirmed by 2 independent blinded reviewers (J.W. and M.P.). Data were analyzed from October 15, 2020, to February 15, 2021. Main Outcomes and Measures: The primary outcomes were dichotomized self-harm and retention in treatment. The secondary outcomes were dichotomized all-cause treatment discontinuation and scores on instruments measuring suicidal ideation and depressive symptoms. Effect sizes were pooled using frequentist random-effects network meta-analysis models to generate summary odds ratios (ORs) and Cohen d standardized mean differences (SMDs). Negative Cohen d SMDs or ORs less than 1 indicated that the treatment reduced the parameter of interest relative to the control condition (eg, signifying a beneficial association with suicidal ideation). Results: The systematic search generated 1272 unique records. Of those, 44 randomized clinical trials (5406 total participants; 4109 female participants [76.0%]) from 49 articles were selected (5 follow-up studies were merged with their primary clinical trials to avoid publication bias). The selected clinical trials spanned January 1, 1995, to December 31, 2020. The median duration of treatment was 3 months (range, 0.25-12.00 months), and the median follow-up period was 12 months (range, 1-36 months). None of the investigated psychotherapies were associated with increases in study withdrawals or improvements in retention in treatment compared with treatment as usual. Dialectical behavioral therapies were associated with reductions in self-harm (OR, 0.28; 95% CI, 0.12-0.64) and suicidal ideation (Cohen d SMD, -0.71; 95% CI, -1.19 to -0.23) at the end of treatment, while mentalization-based therapies were associated with decreases in self-harm (OR, 0.38; 95% CI, 0.15-0.97) and suicidal ideation (Cohen d SMD, -1.22; 95% CI, -2.18 to -0.26) at the end of follow-up. The quality of evidence was downgraded because of high risk of bias overall, heterogeneity, publication bias, inconsistency, and imprecision. Conclusions and Relevance: Although some psychotherapeutic modalities appear to be acceptable and efficacious for reducing self-harm and suicidality among children and adolescents, methodological issues and high risk of bias prevent a consistent estimate of their comparative performance.


Assuntos
Saúde do Adolescente , Saúde da Criança , Psicoterapia/métodos , Comportamento Autodestrutivo/terapia , Adolescente , Terapia Comportamental , Criança , Terapia Cognitivo-Comportamental , Depressão/terapia , Terapia Familiar , Feminino , Humanos , Masculino , Ideação Suicida
16.
Nutrients ; 13(4)2021 Apr 13.
Artigo em Inglês | MEDLINE | ID: mdl-33924294

RESUMO

Approximately one-fifth to one-third of patients with adolescent anorexia nervosa (AN) need intensive care in the course of their illness. This article provides an update and discussion on different levels of intensive care (inpatient treatment (IP), day patient treatment (DP) and home treatment (HoT)) in different health care systems based on recently published literature. Important issues discussed in this article are new recommendations for the refeeding process and the definition of target weight as well as principles of medical stabilization and psychotherapeutic approaches. The pros and cons of longer or shorter hospitalization times are discussed, and the advantages of stepped care and day patient treatment are described. A new promising intensive treatment method involving the patient, their caregivers and the direct home environment is introduced. Parents and caregivers should be included in treatment research to foster collaborative work with the attending clinicians. There is an urgent need to evaluate the mid- to long-term outcomes of various intensive treatment programs to compare their effectiveness and costs across different health care systems. This could help policy makers and other stakeholders, such as public and private insurances, to enhance the quality of eating disorder care.


Assuntos
Serviços de Saúde do Adolescente/organização & administração , Anorexia Nervosa/terapia , Cuidados Críticos/métodos , Apoio Nutricional/métodos , Psicoterapia/métodos , Adolescente , Assistência Ambulatorial/métodos , Assistência Ambulatorial/organização & administração , Anorexia Nervosa/mortalidade , Anorexia Nervosa/psicologia , Índice de Massa Corporal , Cuidadores , Cuidados Críticos/organização & administração , Política de Saúde , Serviços Hospitalares de Assistência Domiciliar/organização & administração , Hospitalização , Humanos , Pais , Qualidade da Assistência à Saúde , Participação dos Interessados , Resultado do Tratamento
17.
J Consult Clin Psychol ; 89(3): 200-213, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33829808

RESUMO

OBJECTIVE: Most research on the dose-effect (DE) and good-enough level (GEL) models of change has used general outcome measures. The purpose of this study was to determine if predictions from these models generalize to specific presenting concerns and outcome measures. METHOD: A large sample of treatment-seeking college students (N = 64,319) who attended different numbers of therapy sessions and completed the College Counseling Assessment of Psychological Symptoms-34 (CCAPS-34, Locke et al., Measurement & Evaluation in Counseling & Development, 2012, 45, p. 151) during sessions was used. An analysis of reliable and clinically significant improvement (RCSI) and latent growth curve models (LGCMs) were used for clients attending different numbers of sessions across eight scales from the CCAPS-34 to examine the: (a) amount of change from the first to last session, (b) rates of RCSI, (c) shape of change trajectories, and (d) rates of change across sessions. RESULTS: Across all CCAPS-34 scales, clients who attended more sessions tended to experience more improvement, had higher rates of RCSI, and the trajectories of change were nonlinear, consistent with the DE model. Clients who attended fewer sessions tended to experience faster rates of change than those who attended more sessions, consistent with the GEL model. CONCLUSIONS: Aspects of both the DE and GEL models appear to generalize to specific outcome measures on the CCAPS-34. Results suggest both individual differences in sensitivity to therapy and amount of therapy received influence therapeutic change. A greater focus on individual needs, especially early in treatment, may be especially important when determining the length of therapy. (PsycInfo Database Record (c) 2021 APA, all rights reserved).


Assuntos
Aconselhamento/métodos , Transtornos Mentais/terapia , Psicoterapia/métodos , Autorrelato/estatística & dados numéricos , Inquéritos e Questionários/estatística & dados numéricos , Adulto , Feminino , Humanos , Masculino , Índice de Gravidade de Doença , Estudantes/psicologia , Estudantes/estatística & dados numéricos , Resultado do Tratamento , Universidades , Adulto Jovem
18.
J Consult Clin Psychol ; 89(3): 227-239, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33829810

RESUMO

OBJECTIVE: The present study implements an automatic method of assessing arousal in vocal data as well as dynamic system models to explore intrapersonal and interpersonal affect dynamics within psychotherapy and to determine whether these dynamics are associated with treatment outcomes. METHOD: The data of 21,133 mean vocal arousal observations were extracted from 279 therapy sessions in a sample of 30 clients treated by 24 therapists. Before and after each session, clients self-reported their well-being level, using the Outcome Rating Scale. RESULTS: Both clients' and therapists' vocal arousal showed intrapersonal dampening. Specifically, although both therapists and clients departed from their baseline, their vocal arousal levels were "pulled" back to these baselines. In addition, both clients and therapists exhibited interpersonal dampening. Specifically, both the clients' and the therapists' levels of arousal were "pulled" toward the other party's arousal level, and clients were "pulled" by their therapists' vocal arousal toward their own baseline. These dynamics exhibited a linear change over the course of treatment: whereas interpersonal dampening decreased over time, there was an increase in intrapersonal dampening over time. In addition, higher levels of interpersonal dampening were associated with better session outcomes. CONCLUSIONS: These findings demonstrate the advantages of using automatic vocal measures to capture nuanced intrapersonal and interpersonal affect dynamics in psychotherapy and demonstrate how these dynamics are associated with treatment gains. (PsycInfo Database Record (c) 2021 APA, all rights reserved).


Assuntos
Afeto/fisiologia , Transtornos Mentais/terapia , Relações Profissional-Paciente , Psicoterapia/métodos , Comportamento Verbal/fisiologia , Adulto , Nível de Alerta , Bases de Dados Factuais , Feminino , Humanos , Masculino , Autorrelato , Resultado do Tratamento
19.
Cochrane Database Syst Rev ; 3: CD013667, 2021 03 07.
Artigo em Inglês | MEDLINE | ID: mdl-33677832

RESUMO

BACKGROUND: Self-harm (SH; intentional self-poisoning or self-injury regardless of degree of suicidal intent or other types of motivation) is a growing problem in most countries, often repeated, and associated with suicide. Evidence assessing the effectiveness of interventions in the treatment of SH in children and adolescents is lacking, especially when compared with the evidence for psychosocial interventions in adults. This review therefore updates a previous Cochrane Review (last published in 2015) on the role of interventions for SH in children and adolescents. OBJECTIVES: To assess the effects of psychosocial interventions or pharmacological agents or natural products for SH compared to comparison types of care (e.g. treatment-as-usual, routine psychiatric care, enhanced usual care, active comparator, placebo, alternative pharmacological treatment, or a combination of these) for children and adolescents (up to 18 years of age) who engage in SH. SEARCH METHODS: We searched the Cochrane Common Mental Disorders Specialized Register, the Cochrane Library (Central Register of Controlled Trials [CENTRAL] and Cochrane Database of Systematic Reviews [CDSR]), together with MEDLINE, Ovid Embase, and PsycINFO (to 4 July 2020). SELECTION CRITERIA: We included all randomised controlled trials (RCTs) comparing specific psychosocial interventions or pharmacological agents or natural products with treatment-as-usual (TAU), routine psychiatric care, enhanced usual care (EUC), active comparator, placebo, alternative pharmacological treatment, or a combination of these, in children and adolescents with a recent (within six months of trial entry) episode of SH resulting in presentation to hospital or clinical services. The primary outcome was the occurrence of a repeated episode of SH over a maximum follow-up period of two years. Secondary outcomes included treatment adherence, depression, hopelessness, general functioning, social functioning, suicidal ideation, and suicide. DATA COLLECTION AND ANALYSIS: We independently selected trials, extracted data, and appraised trial quality. For binary outcomes, we calculated odds ratios (ORs) and their 95% confidence internals (CIs). For continuous outcomes, we calculated the mean difference (MD) or standardised mean difference (SMD) and 95% CIs. The overall quality of evidence for the primary outcome (i.e. repetition of SH at post-intervention) was appraised for each intervention using the GRADE approach. MAIN RESULTS: We included data from 17 trials with a total of 2280 participants. Participants in these trials were predominately female (87.6%) with a mean age of 14.7 years (standard deviation (SD) 1.5 years). The trials included in this review investigated the effectiveness of various forms of psychosocial interventions. None of the included trials evaluated the effectiveness of pharmacological agents in this clinical population. There was a lower rate of SH repetition for DBT-A (30%) as compared to TAU, EUC, or alternative psychotherapy (43%) on repetition of SH at post-intervention in four trials (OR 0.46, 95% CI 0.26 to 0.82; N = 270; k = 4; high-certainty evidence). There may be no evidence of a difference for individual cognitive behavioural therapy (CBT)-based psychotherapy and TAU for repetition of SH at post-intervention (OR 0.93, 95% CI 0.12 to 7.24; N = 51; k = 2; low-certainty evidence). We are uncertain whether mentalisation based therapy for adolescents (MBT-A) reduces repetition of SH at post-intervention as compared to TAU (OR 0.70, 95% CI 0.06 to 8.46; N = 85; k = 2; very low-certainty evidence). Heterogeneity for this outcome was substantial ( I² = 68%). There is probably no evidence of a difference between family therapy and either TAU or EUC on repetition of SH at post-intervention (OR 1.00, 95% CI 0.49 to 2.07; N = 191; k = 2; moderate-certainty evidence). However, there was no evidence of a difference for compliance enhancement approaches on repetition of SH by the six-month follow-up assessment, for group-based psychotherapy at the six- or 12-month follow-up assessments, for a remote contact intervention (emergency cards) at the 12-month assessment, or for therapeutic assessment at the 12- or 24-month follow-up assessments. AUTHORS' CONCLUSIONS: Given the moderate or very low quality of the available evidence, and the small number of trials identified, there is only uncertain evidence regarding a number of psychosocial interventions in children and adolescents who engage in SH. Further evaluation of DBT-A is warranted. Given the evidence for its benefit in adults who engage in SH, individual CBT-based psychotherapy should also be further developed and evaluated in children and adolescents.


Assuntos
Mentalização , Intervenção Psicossocial/métodos , Psicoterapia/métodos , Comportamento Autodestrutivo/terapia , Adolescente , Viés , Criança , Terapia Cognitivo-Comportamental/métodos , Intervalos de Confiança , Depressão/terapia , Terapia do Comportamento Dialético/métodos , Terapia Familiar , Feminino , Humanos , Masculino , Razão de Chances , Cooperação do Paciente , Ensaios Clínicos Controlados Aleatórios como Assunto , Recidiva , Prevenção Secundária/métodos , Comportamento Autodestrutivo/prevenção & controle , Comportamento Autodestrutivo/psicologia , Ideação Suicida , Resultado do Tratamento
20.
Sr Care Pharm ; 36(4): 191-207, 2021 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-33766192

RESUMO

OBJECTIVE: To review the clinical manifestations and treatment of post-traumatic stress disorder (PTSD) in adults and older people. DATA SOURCES: Articles indexed in PubMed, Embase, psychology databases, and the Cochrane library over the past 10 years using the key words "post-traumatic stress disorder," "stress disorders," and "post-traumatic stress disorder and treatment." STUDY SELECTION AND DATA EXTRACTION: Sixty-seven publications were reviewed and criteria supporting the primary objective were used to identify useful resources. DATA SYNTHESIS: The literature included practice guidelines; review articles; original research articles; and product prescribing information for the clinical manifestations, diagnosis, and treatment of PTSD. CONCLUSION: Psychotherapy is the first-line therapy for PTSD. Pharmacologic therapy is recommended, as second-line therapy, for adults living with PTSD who do not have access to psychotherapy or refuse psychotherapy. Pharmacologic therapy may also be considered in cases of partial, or no, response to psychotherapy. Current guidelines recommend prescribing one of 3 selective serotonin-reuptake inhibitors, either fluoxetine, paroxetine, or sertraline, or prescribing the serotonin norepinephrine reuptake inhibitor venlafaxine, for adult patients who do not have access to psychotherapy or prefer not to use psychotherapy. Unfortunately, these recommended medications have additional cautions for use in older people so may not be appropriate for many older people living with PTSD. Therapy for older people should be tailored to patient-specific symptoms, with careful consideration of the potential benefits and risks of the therapy and coexisting medical conditions of each patient.


Assuntos
Psicoterapia/métodos , Inibidores de Captação de Serotonina/uso terapêutico , Inibidores da Recaptação de Serotonina e Norepinefrina/uso terapêutico , Transtornos de Estresse Pós-Traumáticos/terapia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Resultado do Tratamento
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