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1.
Medicine (Baltimore) ; 100(6): e23859, 2021 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-33578513

RESUMO

BACKGROUND: We aimed to examine the feasibility of our newly-developed, integrated, and high-intensity individual cognitive behavioral therapy (CBT) protocol for treatment-resistant chronic pain. METHODS: We conducted an open-labeled prospective single-arm trial for patients aged 18 years and above, suffering from chronic pain, and diagnosed with somatic symptom disorder with predominant pain. We provided 16 weekly sessions of CBT, each lasting for 50 minutes, which included 4 new strategies: attention shift, memory work, mental practice, and video feedback. For comparison, the study had a pre-test post-test design. The primary outcome was the change from baseline (week 1) to 16, as indicated by the Numerical Rating Scale and Pain Catastrophizing Scale. In addition, we evaluated depression, anxiety, disability, and quality of life as secondary outcomes. RESULTS: Sixteen patients with chronic pain underwent our CBT program. Though there was no reduction in pain intensity, catastrophic cognition showed statistically significant improvement with a large effect size. Depression, anxiety, and disability demonstrated statistically significant improvements, with small to moderate effect sizes. No adverse events were reported. CONCLUSION: Our newly integrated CBT program for chronic pain may improve catastrophic cognition, depression, anxiety, and disability. Large-scale randomized controlled studies are necessary to investigate the program's effectiveness in the future.


Assuntos
Dor Crônica/terapia , Terapia Cognitivo-Comportamental/métodos , Manejo da Dor/métodos , Adulto , Idoso , Ansiedade/etiologia , Ansiedade/terapia , Dor Crônica/complicações , Dor Crônica/psicologia , Terapia Cognitivo-Comportamental/estatística & dados numéricos , Depressão/etiologia , Depressão/terapia , Avaliação da Deficiência , Estudos de Viabilidade , Feminino , Humanos , Japão/epidemiologia , Masculino , Sintomas Inexplicáveis , Pessoa de Meia-Idade , Estudos Prospectivos , Qualidade de Vida , Resultado do Tratamento
2.
Trials ; 21(1): 870, 2020 Oct 21.
Artigo em Inglês | MEDLINE | ID: mdl-33087178

RESUMO

BACKGROUND: The acknowledgment of the mental health toll of the COVID-19 epidemic in healthcare workers has increased considerably as the disease evolved into a pandemic status. Indeed, high prevalence rates of depression, sleep disorders, and post-traumatic stress disorder (PTSD) have been reported in Chinese healthcare workers during the epidemic peak. Symptoms of psychological distress are expected to be long-lasting and have a systemic impact on healthcare systems, warranting the need for evidence-based psychological treatments aiming at relieving immediate stress and preventing the onset of psychological disorders in this population. In the current COVID-19 context, internet-based interventions have the potential to circumvent the pitfalls of face-to-face formats and provide the flexibility required to facilitate accessibility to healthcare workers. Online cognitive behavioral therapy (CBT) in particular has proved to be effective in treating and preventing a number of stress-related disorders in populations other than healthcare workers. The aim of our randomized controlled trial study protocol is to evaluate the efficacy of the 'My Health too' CBT program-a program we have developed for healthcare workers facing the pandemic-on immediate perceived stress and on the emergence of psychiatric disorders at 3- and 6-month follow-up compared to an active control group (i.e., bibliotherapy). METHODS: Powered for superiority testing, this six-site open trial involves the random assignment of 120 healthcare workers with stress levels > 16 on the Perceived Stress Scale (PSS-10) to either the 7-session online CBT program or bibliotherapy. The primary outcome is the decrease of PSS-10 scores at 8 weeks. Secondary outcomes include depression, insomnia, and PTSD symptoms; self-reported resilience and rumination; and credibility and satisfaction. Assessments are scheduled at pretreatment, mid-treatment (at 4 weeks), end of active treatment (at 8 weeks), and at 3-month and 6-month follow-up. DISCUSSION: This is the first study assessing the efficacy and the acceptability of a brief online CBT program specifically developed for healthcare workers. Given the potential short- and long-term consequences of the COVID-19 pandemic on healthcare workers' mental health, but also on healthcare systems, our findings can significantly impact clinical practice and management of the ongoing, and probably long-lasting, health crisis. TRIAL REGISTRATION: ClinicalTrials.gov NCT04362358 , registered on April 24, 2020.


Assuntos
Betacoronavirus/genética , Terapia Cognitivo-Comportamental/métodos , Infecções por Coronavirus/terapia , Pessoal de Saúde/psicologia , Intervenção Baseada em Internet/estatística & dados numéricos , Pneumonia Viral/terapia , Adulto , Idoso , Biblioterapia/métodos , Estudos de Casos e Controles , Terapia Cognitivo-Comportamental/estatística & dados numéricos , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/psicologia , Infecções por Coronavirus/virologia , Assistência à Saúde/estatística & dados numéricos , Depressão/epidemiologia , Depressão/prevenção & controle , Feminino , França/epidemiologia , Humanos , Masculino , Saúde Mental/normas , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/psicologia , Pneumonia Viral/virologia , Prevalência , Estudos Prospectivos , Resiliência Psicológica , Transtornos do Sono-Vigília/epidemiologia , Transtornos do Sono-Vigília/prevenção & controle , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Transtornos de Estresse Pós-Traumáticos/prevenção & controle , Resultado do Tratamento
3.
PLoS Med ; 17(3): e1003073, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32231364

RESUMO

BACKGROUND: This randomised controlled trial (RCT) aims to compare 6-week posttreatment outcomes of an Integrative Adapt Therapy (IAT) to a Cognitive Behavioural Therapy (CBT) on common mental health symptoms and adaptive capacity amongst refugees from Myanmar. IAT is grounded on psychotherapeutic elements specific to the refugee experience. METHODS AND FINDINGS: We conducted a single-blind RCT (October 2017 -May 2019) with Chin (39.3%), Kachin (15.7%), and Rohingya (45%) refugees living in Kuala Lumpur, Malaysia. The trial included 170 participants receiving six 45-minute weekly sessions of IAT (97.6% retention, 4 lost to follow-up) and 161 receiving a multicomponent CBT also involving six 45-minute weekly sessions (96.8% retention, 5 lost to follow-up). Participants (mean age: 30.8 years, SD = 9.6) had experienced and/or witnessed an average 10.1 types (SD = 5.9, range = 1-27) of traumatic events. We applied a single-blind design in which independent assessors of pre- and posttreatment indices were masked in relation to participants' treatment allocation status. Primary outcomes were symptom scores of Post Traumatic Stress Disorder (PTSD), Complex PTSD (CPTSD), Major Depressive Disorder (MDD), the 5 scales of the Adaptive Stress Index (ASI), and a measure of resilience (the Connor-Davidson Resilience Scale [CDRS]). Compared to CBT, an intention-to-treat analysis (n = 331) at 6-week posttreatment follow-up demonstrated greater reductions in the IAT arm for all common mental disorder (CMD) symptoms and ASI domains except for ASI-3 (injustice), as well as increases in the resilience scores. Adjusted average treatment effects assessing the differences in posttreatment scores between IAT and CBT (with baseline scores as covariates) were -0.08 (95% CI: -0.14 to -0.02, p = 0.012) for PTSD, -0.07 (95% CI: -0.14 to -0.01) for CPTSD, -0.07 for MDD (95% CI: -0.13 to -0.01, p = 0.025), 0.16 for CDRS (95% CI: 0.06-0.026, p ≤ 0.001), -0.12 (95% CI: -0.20 to -0.03, p ≤ 0.001) for ASI-1 (safety/security), -0.10 for ASI-2 (traumatic losses; 95% CI: -0.18 to -0.02, p = 0.02), -0.03 for ASI-3 (injustice; (95% CI: -0.11 to 0.06, p = 0.513), -0.12 for ASI-4 (role/identity disruptions; 95% CI: -0.21 to -0.04, p ≤ 0.001), and -0.18 for ASI-5 (existential meaning; 95% CI: -0.19 to -0.05, p ≤ 0.001). Compared to CBT, the IAT group had larger effect sizes for all indices (except for resilience) including PTSD (IAT, d = 0.93 versus CBT, d = 0.87), CPTSD (d = 1.27 versus d = 1.02), MDD (d = 1.4 versus d = 1.11), ASI-1 (d = 1.1 versus d = 0.85), ASI-2 (d = 0.81 versus d = 0.66), ASI-3 (d = 0.49 versus d = 0.42), ASI-4 (d = 0.86 versus d = 0.67), and ASI-5 (d = 0.72 versus d = 0.53). No adverse events were recorded for either therapy. Limitations include a possible allegiance effect (the authors inadvertently conveying disproportionate enthusiasm for IAT in training and supervision), cross-over effects (counsellors applying elements of one therapy in delivering the other), and the brief period of follow-up. CONCLUSIONS: Compared to CBT, IAT showed superiority in improving mental health symptoms and adaptative stress from baseline to 6-week posttreatment. The differences in scores between IAT and CBT were modest and future studies conducted by independent research teams need to confirm the findings. TRIAL REGISTRATION: The study is registered under Australian New Zealand Clinical Trials Registry (ANZCTR) (http://www.anzctr.org.au/). The trial registration number is: ACTRN12617001452381.


Assuntos
Terapia Cognitivo-Comportamental/métodos , Transtorno Depressivo Maior/terapia , Refugiados/psicologia , Resiliência Psicológica , Transtornos de Estresse Pós-Traumáticos/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Terapia Cognitivo-Comportamental/estatística & dados numéricos , Transtorno Depressivo Maior/psicologia , Feminino , Humanos , Malásia , Masculino , Saúde Mental/estatística & dados numéricos , Pessoa de Meia-Idade , Mianmar , Refugiados/estatística & dados numéricos , Método Simples-Cego , Transtornos de Estresse Pós-Traumáticos/psicologia , Adulto Jovem
4.
PLoS One ; 15(3): e0229905, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32155186

RESUMO

BACKGROUND: The Capital Card, developed by WDP, is a digital innovation which acts as a form of contingency management, and aims to significantly improve service user outcomes. WDP is a substance misuse treatment provider commissioned by local authorities across the UK to support service users and their families affected by addiction. The Capital Card, much like commercial loyalty cards, uses a simple earn-spend points system which incentivises and rewards service users for engaging with services e.g. by attending key work sessions, Blood Borne Virus appointments or group-work sessions. The Spend activities available to service users are designed to improve overall wellbeing and build social and recovery capital, and include activities such as educational classes, fitness classes, driving lessons, and cinema tickets. METHODS AND FINDINGS: We compared successful completion rates of 1,545 service users accessing one of WDP's London based community services over a two-year period; before and after the Capital Card was introduced. Client demographics (age, sex and primary substance) were controlled for during the analysis. Once client demographics were controlled for, analysis showed that clients with a Capital Card were 1.5 times more likely to successfully complete treatment than those who had not had the Capital Card (OR = 1.507, 95% CI = 1.194 to 1.902). CONCLUSIONS: The results of this initial evaluation are of particular interest to commissioners and policy makers as it indicates that the Capital Card can be used effectively as a form of contingency management to enhance recovery outcomes for service users engaging in community-based substance misuse services.


Assuntos
Terapia Cognitivo-Comportamental/organização & administração , Condicionamento Operante , Cooperação do Paciente/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias/terapia , Adulto , Terapia Cognitivo-Comportamental/métodos , Terapia Cognitivo-Comportamental/estatística & dados numéricos , Estudos de Viabilidade , Feminino , Humanos , Londres , Masculino , Pessoa de Meia-Idade , Cooperação do Paciente/psicologia , Avaliação de Programas e Projetos de Saúde , Estudos Retrospectivos , Transtornos Relacionados ao Uso de Substâncias/psicologia , Resultado do Tratamento
5.
Intensive Crit Care Nurs ; 58: 102806, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32037134

RESUMO

INTRODUCTION: Following intensive care treatment, patients and thier spouse often report traumatic memories that are frequently associated with post-traumatic stress symptoms. In this case report, we describe the case of a sepsis survivor and his wife who both suffered concurrently from intensive care associated post-traumatic stress symptoms as long-term sequelae. Both were treated with internet-based cognitive-behaviuoral writing therapy (iCBT) for post-traumatic stress disorder (PTSD) after intensive care. METHODS: Traumatic memories recalled during exposure in sensu as part of iCBT are described. Outcome data measured before, during and after psychotherapeutic treatment were analyzed. FINDINGS: Both, the patient and his wife showed characteristic symptoms of PTSD three years after discharge from the intensive care unit (ICU) comprising of intrusions, negative emotions, and hyperarousal. They reported unpleasant ICU memories from a patient's and relative's perspective, respectively. In both, the patient and his wife, a decline of symptoms with respect to all outcome measures during the course of iCBT from pre-treatment to three-month follow-up was observed. CONCLUSION: Experiences of critical illness and intensive care can lead to post-traumatic stress in patients and their partners. Hence, it may be useful to offer mental health screening and psychotherapeutic treatment options to both ICU patients and their partners.


Assuntos
Terapia Cognitivo-Comportamental/normas , Sepse/psicologia , Cônjuges/psicologia , Transtornos de Estresse Pós-Traumáticos/terapia , Idoso , Terapia Cognitivo-Comportamental/métodos , Terapia Cognitivo-Comportamental/estatística & dados numéricos , Feminino , Humanos , Unidades de Terapia Intensiva/organização & administração , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Estudos Prospectivos , Sepse/complicações , Cônjuges/estatística & dados numéricos , Transtornos de Estresse Pós-Traumáticos/psicologia , Sobreviventes/psicologia
7.
J Consult Clin Psychol ; 88(1): 14-24, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31841021

RESUMO

OBJECTIVE: Depression is a highly common mental disorder and a major cause of disability worldwide. Several psychological interventions are available, but there is a lack of evidence to decide which treatment works best for whom. This study aimed to identify subgroups of patients who respond differentially to cognitive-behavioral therapy (CBT) or person-centered counseling for depression (CfD). METHOD: This was a retrospective analysis of archival routine practice data for 1,435 patients who received either CBT (N = 1,104) or CfD (N = 331) in primary care. The main outcome was posttreatment reliable and clinically significant improvement (RCSI) in the PHQ-9 depression measure. A targeted prescription algorithm was developed in a training sample (N = 1,085) using a supervised machine learning approach (elastic net with optimal scaling). The clinical utility of the algorithm was examined in a statistically independent test sample (N = 350) using chi-square analysis and odds ratios. RESULTS: Cases in the test sample that received their model-indicated "optimal" treatment had a significantly higher RCSI rate (62.5%) compared to those who received the "suboptimal" treatment (41.7%); χ2(df = 1) = 4.79, p = .03, OR = 2.33 (95% CI [1.09, 5.02]). CONCLUSION: Targeted prescription has the potential to make best use of currently available evidence-based treatments, improving outcomes for patients at no additional cost to psychological services. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Terapia Cognitivo-Comportamental/métodos , Aconselhamento/métodos , Transtorno Depressivo/terapia , Aprendizado de Máquina/estatística & dados numéricos , Adulto , Terapia Cognitivo-Comportamental/estatística & dados numéricos , Aconselhamento/estatística & dados numéricos , Feminino , Humanos , Masculino , Atenção Primária à Saúde , Projetos de Pesquisa , Estudos Retrospectivos , Resultado do Tratamento
8.
Nurse Educ Today ; 85: 104268, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31765872

RESUMO

BACKGROUND: Academic and clinical stressors are experienced by most nursing students enrolled in a nursing education program. The students who cannot effectively deal with these stressors experience stress, anxiety and depression. OBJECTIVE: The aim of this study was to determine the effects of group mindfulness-based cognitive therapy on mindfulness, depression, anxiety, and stress levels in nursing students. DESIGN: This quasi-experimental study was carried out using a nonrandomized control group pre-test, post-test, and follow up design. SETTING: Department of Nursing, Faculty of Health Sciences, University of Aksaray, Turkey. PARTICIPANTS: Eighty-two second-year undergraduate university nursing students. METHODS: The group mindfulness-based cognitive therapy program was conducted with the experimental group. The Mindful Attention Awareness Scale (MAAS) and The Depression, Anxiety and Stress Scale (DASS) were measured at pre- and post- intervention, and at a 4-months follow-up. RESULTS: The post-test mean scores of MAAS of the experimental group were statistically higher than the control group (p = .006). When the mean scores obtained in the pre-test, post-test and follow-up measurements were compared, the mean scores of MAAS increased (p = .000) and stress scores decreased significantly in the experimental group (p = .004). CONCLUSION: A group mindfulness-based cognitive therapy program conducted with nursing students had an effect on students' mindful attention awareness and stress levels. These study results indicate that this program can be used to reduce the levels of stress in nursing students.


Assuntos
Atenção Plena/educação , Psicoterapia de Grupo/normas , Estudantes de Enfermagem/psicologia , Terapia Cognitivo-Comportamental/métodos , Terapia Cognitivo-Comportamental/normas , Terapia Cognitivo-Comportamental/estatística & dados numéricos , Bacharelado em Enfermagem/métodos , Feminino , Humanos , Masculino , Atenção Plena/métodos , Psicometria/instrumentação , Psicometria/métodos , Psicoterapia de Grupo/métodos , Psicoterapia de Grupo/estatística & dados numéricos , Estudantes de Enfermagem/estatística & dados numéricos , Turquia , Adulto Jovem
9.
Span. j. psychol ; 23: e36.1-e36.14, 2020. tab, graf
Artigo em Inglês | IBECS | ID: ibc-200131

RESUMO

Acute stress disorder (ASD) refers to the symptoms associated with posttraumatic stress disorder (PTSD) within the first four weeks following the traumatic event. Recent theoretical models suggest that early detection of ASD provides an opportunity to implement early interventions to prevent the development of PTSD or ameliorate its symptomatology. The aim of the present study was the evaluation of the efficacy of an ASD treatment for earthquake victims, which would serve as an early intervention for PTSD. A single-case (n = 1) quasi-experimental design was used, with pre and post-assessments, as well as one, three and six-month follow-ups, with direct treatment replications. Fourteen participants completed the treatment and the follow-up measurements. The results obtained using a single-case analysis showed significant clinical improvement and clinically significant change when employing a clinical significance analysis and the reliable index of change. Statistical analyses of the dataset displayed statistically significant differences between the pre and post-assessments and the follow-up measures, as well as large effect sizes in all clinical measures. These results suggest that the treatment was an efficacious early intervention for PTSD during the months following the traumatic event, although some relevant study limitations are discussed in the text


No disponible


Assuntos
Humanos , Masculino , Feminino , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Vítimas de Desastres/psicologia , Transtornos de Estresse Traumático Agudo/psicologia , Intervenção na Crise/métodos , Terapia Cognitivo-Comportamental/métodos , Escalas de Graduação Psiquiátrica , México/epidemiologia , Terremotos/estatística & dados numéricos , Avaliação de Resultado de Intervenções Terapêuticas , Terapia Cognitivo-Comportamental/estatística & dados numéricos , Resultado do Tratamento
10.
Ir J Psychol Med ; 36(4): 249-258, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31747988

RESUMO

OBJECTIVE: In Ireland, National Clinical Programmes are being established to improve and standardise patient care throughout the Health Service Executive. In line with internationally recognised guidelines on the treatment of first episode psychosis the Early Intervention in Psychosis (EIP) programme is being drafted with a view to implementation by mental health services across the country. We undertook a review of patients presenting with a first episode of psychosis to the Dublin Southwest Mental Health Service before the implementation of the EIP. This baseline information will be used to measure the efficacy of our EIP programme. METHODS: Patients who presented with a first episode psychosis were retrospectively identified through case note reviews and consultation with treating teams. We gathered demographic and clinical information from patients as well as data on treatment provision over a 2-year period from the time of first presentation. Data included age at first presentation, duration of untreated psychosis, diagnosis, referral source, antipsychotic prescribing rates and dosing, rates of provision of psychological interventions and standards of physical healthcare monitoring. Outcome measures with regards to rates of admission over a 2-year period following initial presentation were also recorded. RESULTS: In total, 66 cases were identified. The majority were male, single, unemployed and living with their family or spouse. The mean age at first presentation was 31 years with a mean duration of untreated psychosis of 17 months. Just under one-third were diagnosed with schizophrenia. Approximately half of the patients had no contact with a health service before presentation. The majority of patients presented through the emergency department. Two-thirds of all patients had a hospital admission within 2 years of presentation and almost one quarter of patients had an involuntary admission. The majority of patients were prescribed antipsychotic doses within recommended British National Formulary guidelines. Most patients received individual support through their keyworker and family intervention was provided in the majority of cases. Only a small number received formal Cognitive-Behavioural Therapy. Physical healthcare monitoring was insufficiently recorded in the majority of patients. CONCLUSIONS: There is a shortage of information on the profile and treatment of patients presenting with a first episode of psychosis in Ireland. This baseline information is important in evaluating the efficacy of any new programme for this patient group. Many aspects of good practice were identified within the service in particular with regards to the appropriate prescribing of antipsychotic medication and the rates of family intervention. Deficiencies remain however in the monitoring of physical health and the provision of formal psychological interventions to patients. With the implementation of an EIP programme it is hoped that service provision would improve nationwide and to internationally recognised standards.


Assuntos
Serviços de Saúde Mental/normas , Assistência ao Paciente/normas , Transtornos Psicóticos/terapia , Esquizofrenia/diagnóstico , Adulto , Antipsicóticos/uso terapêutico , Terapia Cognitivo-Comportamental/métodos , Terapia Cognitivo-Comportamental/estatística & dados numéricos , Demografia , Intervenção Médica Precoce/métodos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Hospitalização/tendências , Humanos , Irlanda/epidemiologia , Masculino , Avaliação de Resultados em Cuidados de Saúde , Aptidão Física/psicologia , Transtornos Psicóticos/diagnóstico , Transtornos Psicóticos/epidemiologia , Estudos Retrospectivos , Esquizofrenia/epidemiologia
11.
Behav Ther ; 50(6): 1112-1124, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31735246

RESUMO

Traditional cognitive-behavioral therapy (CBT) for anxiety disorders has been designed to target reductions in negative affect (NA) associated with defense-related processes. However, a subset of anxiety disorders, including social anxiety disorder (SAD), are also characterized by low positive affect (PA) resulting from separate deficits in appetitive-related processes. In contrast to CBT, "third-wave" approaches, such as acceptance and commitment therapy (ACT), align more consistently with motivational processes and, as a result, PA. However, the differential effect of CBT and ACT on PA and NA has yet to be investigated. Using secondary data from a randomized controlled trial, the present study sought to compare CBT's (n = 45) and ACT's (n = 35) effect on PA and NA in SAD. Findings were compared to a wait-list (WL) control condition (n = 31), as well as normative data from a general adult sample. Baseline PA and NA were also examined as moderators and predictors of theory-relevant treatment outcomes. NA decreased significantly in both CBT and ACT from pre to posttreatment. Although ACT outperformed WL in reducing NA, this effect was not observed for CBT. PA increased significantly in both CBT and ACT from pre to posttreatment, with neither ACT nor CBT outperforming WL in increasing PA. Neither PA nor NA were found to moderate theoretically relevant treatment outcomes. Findings suggest that ACT and CBT share common treatment mechanisms, making them more similar than distinct. Further efforts should be focused on optimizing CBT's and ACT's influence on threat and reward learning, and elucidating common processes of change.


Assuntos
Terapia de Aceitação e Compromisso/estatística & dados numéricos , Afeto , Transtornos de Ansiedade/terapia , Terapia Cognitivo-Comportamental/estatística & dados numéricos , Adulto , Cognição , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Motivação , Fobia Social , Resultado do Tratamento , Listas de Espera , Adulto Jovem
12.
J Consult Clin Psychol ; 87(12): 1093-1105, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31599606

RESUMO

OBJECTIVE: This meta-analysis examined 30 randomized controlled trials (32 study sites; 35 study arms) that tested the efficacy of cognitive-behavioral therapy (CBT) for alcohol or other drug use disorders. The study aim was to provide estimates of efficacy against three levels of experimental contrast (i.e., minimal [k = 5]; nonspecific therapy [k = 11]; specific therapy [k = 19]) for consumption frequency and quantity outcomes at early (1 to 6 months [kes = 41]) and late (8+ months [kes = 26]) follow-up time points. When pooled effect sizes were statistically heterogeneous, study-level moderators were examined. METHOD: The inverse-variance weighted effect size was calculated for each study and pooled under random effects assumptions. Sensitivity analyses included tests of heterogeneity, study influence, and publication bias. RESULTS: CBT in contrast to minimal treatment showed a moderate and significant effect size that was consistent across outcome type and follow-up. When CBT was contrasted with a nonspecific therapy or treatment as usual, treatment effect was statistically significant for consumption frequency and quantity at early, but not late, follow-up. CBT effects in contrast to a specific therapy were consistently nonsignificant across outcomes and follow-up time points. Of 10 pooled effect sizes examined, two showed moderate heterogeneity, but multivariate analyses revealed few systematic predictors of between-study variance. CONCLUSIONS: The current meta-analysis shows that CBT is more effective than a no treatment, minimal treatment, or nonspecific control. Consistent with findings on other evidence-based therapies, CBT did not show superior efficacy in contrast to another specific modality. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Terapia Cognitivo-Comportamental/estatística & dados numéricos , Avaliação de Resultados em Cuidados de Saúde/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias/terapia , Alcoolismo/terapia , Humanos
14.
J Autism Dev Disord ; 49(11): 4421-4428, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31385175

RESUMO

Cognitive-behavioral therapy (CBT) can improve anxiety and depression in autistic adults, but few autistic adults receive this treatment. We examined factors that may influence clinicians' use of CBT with autistic adults. One hundred clinicians completed an online survey. Clinicians reported stronger intentions (p = .001), more favorable attitudes (p < .001), greater normative pressure (p < .001), and higher self-efficacy (p < .001) to start CBT with non-autistic adults than with autistic adults. The only significant predictor of intentions to begin CBT with clients with anxiety or depression was clinicians' attitudes (p < .001), with more favorable attitudes predicting stronger intentions. These findings are valuable for designing effective, tailored implementation strategies to increase clinicians' adoption of CBT for autistic adults.


Assuntos
Atitude do Pessoal de Saúde , Transtorno Autístico/terapia , Terapia Cognitivo-Comportamental/estatística & dados numéricos , Agentes Comunitários de Saúde/psicologia , Serviços Comunitários de Saúde Mental/estatística & dados numéricos , Adulto , Ansiedade/psicologia , Transtorno Autístico/psicologia , Cognição , Depressão/psicologia , Feminino , Humanos , Intenção , Masculino , Pessoa de Meia-Idade , Autoeficácia , Inquéritos e Questionários , Resultado do Tratamento
15.
J Med Internet Res ; 21(8): e12775, 2019 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-31373272

RESUMO

BACKGROUND: Internet interventions can easily generate objective data about program usage. Increasingly, more studies explore the relationship between usage and outcomes, but they often report different metrics of use, and the findings are mixed. Thus, current evaluations fail to demonstrate which metrics should be considered and how these metrics are related to clinically meaningful change. OBJECTIVE: This study aimed to explore the relationship between several usage metrics and outcomes of an internet-based intervention for depression. METHODS: This is a secondary analysis of data from a randomized controlled trial that examined the efficacy of an internet-based cognitive behavioral therapy for depression (Space from Depression) in an adult community sample. All participants who enrolled in the intervention, regardless of meeting the inclusion criteria, were included in this study. Space from Depression is a 7-module supported intervention, delivered over a period of 8 weeks. Different usage metrics (ie, time spent, modules and activities completed, and percentage of program completion) were automatically collected by the platform, and composite variables from these (eg, activities per session) were computed. A breakdown of the usage metrics was obtained by weeks. For the analysis, the sample was divided into those who obtained a reliable change (RC)-and those who did not. RESULTS: Data from 216 users who completed pre- and posttreatment outcomes were included in the analyses. A total of 89 participants obtained an RC, and 127 participants did not obtain an RC. Those in the RC group significantly spent more time, had more log-ins, used more tools, viewed a higher percentage of the program, and got more reviews from their supporter compared with those who did not obtain an RC. Differences between groups in usage were observed from the first week in advance across the different metrics, although they vanished over time. In the RC group, the usage was higher during the first 4 weeks, and then a significant decrease was observed. Our results showed that specific levels of platform usage, 7 hours total time spent, 15 sessions, 30 tools used, and 50% of program completion, were associated with RC. CONCLUSIONS: Overall, the results showed that those individuals who obtained an RC after the intervention had higher levels of exposure to the platform. The usage during the first half of the intervention was higher, and differences between groups were observed from the first week. This study also showed specific usage levels associated with outcomes that could be tested in controlled studies to inform the minimal usage to establish adherence. These results will help to better understand how to use internet-based interventions and what optimal level of engagement can most affect outcomes. TRIAL REGISTRATION: ISRCTN Registry ISRCTN03704676; http://www.isrctn.com/ISRCTN03704676. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1186/1471-244X-14-147.


Assuntos
Terapia Cognitivo-Comportamental/estatística & dados numéricos , Depressão/terapia , Transtorno Depressivo/terapia , Intervenção Baseada em Internet/estatística & dados numéricos , Adulto , Terapia Cognitivo-Comportamental/métodos , Feminino , Humanos , Masculino , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Tempo , Resultado do Tratamento
16.
JMIR Mhealth Uhealth ; 7(8): e14284, 2019 08 26.
Artigo em Inglês | MEDLINE | ID: mdl-31452521

RESUMO

BACKGROUND: Depression is one of the most common mental health disorders and severely impacts one's physical, psychological, and social functioning. To address access barriers to care, we developed Ascend-a smartphone-delivered, therapist-supported, 8-week intervention based on several evidence-based psychological treatments for depression and anxiety. A previous feasibility study with 102 adults with elevated depression reported that Ascend is associated with a postintervention reduction in depression symptoms. OBJECTIVE: We aimed to examine whether Ascend is associated with a reduction in symptoms of anxiety, and importantly, whether reductions in symptoms of depression and anxiety are maintained up to 12-months postintervention. METHODS: We assessed whether the previously reported, end-of-treatment improvements seen in the 102 adults with elevated symptoms of depression extended up to 12 months posttreatment for depression symptoms (measured by the Patient Health Questionnaire-9 [PHQ-9]) and up to 6 months posttreatment for anxiety symptoms (added to the intervention later and measured using the Generalized Anxiety Disorder-7 [GAD-7] scale). We used linear mixed effects models with Tukey contrasts to compare time points and reported intention-to-treat statistics with a sensitivity analysis. RESULTS: The intervention was associated with reductions in symptoms of depression that were maintained 12 months after the program (6.67-point reduction in PHQ-9 score, 95% CI 5.59-7.75; P<.001; Hedges g=1.14, 95% CI 0.78-1.49). A total of 60% of the participants with PHQ-9 scores above the cutoff for major depression at baseline (PHQ≥10) reported clinically significant improvement at the 12-month follow-up (at least 50% reduction in PHQ-9 score and postprogram score <10). Participants also reported reductions in symptoms of anxiety that were maintained for at least 6 months after the program (4.26-point reduction in GAD-7 score, 95% CI 3.14-5.38; P<.001; Hedges g=0.91, 95% CI 0.54-1.28). CONCLUSIONS: There is limited evidence on whether outcomes associated with smartphone-based interventions for common mental health problems are maintained posttreatment. Participants who enrolled in Ascend experienced clinically significant reductions in symptoms of depression and anxiety that were maintained for up to 1 year and 6 months after the intervention, respectively. Future randomized trials are warranted to test Ascend as a scalable solution to the treatment of depression and anxiety.


Assuntos
Ansiedade/terapia , Depressão/terapia , Aplicativos Móveis/normas , Tempo , Adulto , Ansiedade/prevenção & controle , Ansiedade/psicologia , Terapia Cognitivo-Comportamental/métodos , Terapia Cognitivo-Comportamental/normas , Terapia Cognitivo-Comportamental/estatística & dados numéricos , Aconselhamento/métodos , Aconselhamento/normas , Aconselhamento/estatística & dados numéricos , Depressão/prevenção & controle , Depressão/psicologia , Feminino , Acesso aos Serviços de Saúde/normas , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Masculino , Aplicativos Móveis/estatística & dados numéricos , Psicometria/instrumentação , Psicometria/métodos , Inquéritos e Questionários
17.
JMIR Mhealth Uhealth ; 7(8): e13793, 2019 08 16.
Artigo em Inglês | MEDLINE | ID: mdl-31420960

RESUMO

BACKGROUND: Cue exposure therapy (CET) is a psychological approach developed to prepare individuals with alcohol use disorder (AUD) for confronting alcohol and associated stimuli in real life. CET has shown promise when treating AUD in group sessions, but it is unknown whether progressing from group sessions to using a mobile phone app is an effective delivery pathway. OBJECTIVE: The objectives of this study were to investigate (1) whether CET as aftercare would increase the effectiveness of primary treatment with cognitive behavior therapy, and (2) whether CET delivered through a mobile phone app would be similarly effective to CET via group sessions. METHODS: A total of 164 individuals with AUD were randomized to one of three groups: CET as group aftercare (CET group), CET as fully automated mobile phone app aftercare (CET app), or aftercare as usual. Study outcomes were assessed face-to-face at preaftercare, postaftercare, and again at 6 months after aftercare treatment. Generalized mixed models were used to compare the trajectories of the groups over time on drinking, cravings, and use of urge-specific coping skills (USCS). RESULTS: In all, 153 of 164 individuals (93%) completed assessments both at posttreatment and 6-month follow-up assessments. No differences in the trajectories of predicted means were found between the experimental groups (CET group and app) compared with aftercare as usual on drinking and craving outcomes over time. Both CET group (predicted mean difference 5.99, SE 2.59, z=2.31, P=.02) and the CET app (predicted mean difference 4.90, SE 2.26, z=2.31, P=.02) showed increased use of USCS compared to aftercare as usual at posttreatment, but this effect was reduced at the 6-month follow-up. No differences were detected between the two experimental CET groups on any outcomes. CONCLUSIONS: CET with USCS delivered as aftercare either via group sessions or a mobile phone app did not increase the effectiveness of primary treatment. This suggests that CET with USCS may not be an effective psychological approach for the aftercare of individuals treated for AUD. TRIAL REGISTRATION: ClinicalTrials.gov NCT02298751; https://clinicaltrials.gov/ct2/show/NCT02298751.


Assuntos
Assistência ao Convalescente/normas , Alcoolismo/terapia , Terapia Cognitivo-Comportamental/normas , Terapia Implosiva/instrumentação , Aplicativos Móveis/normas , Adulto , Assistência ao Convalescente/métodos , Assistência ao Convalescente/estatística & dados numéricos , Alcoolismo/psicologia , Instituições de Assistência Ambulatorial/organização & administração , Instituições de Assistência Ambulatorial/estatística & dados numéricos , Terapia Cognitivo-Comportamental/métodos , Terapia Cognitivo-Comportamental/estatística & dados numéricos , Feminino , Humanos , Terapia Implosiva/métodos , Terapia Implosiva/tendências , Masculino , Aplicativos Móveis/estatística & dados numéricos
18.
J Abnorm Psychol ; 128(6): 563-573, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31368735

RESUMO

Considerable effort and funding have been spent on developing Attention Bias Modification (ABM) as a treatment for anxiety disorders, theorized to exert therapeutic effects through reduction of a tendency to orient attention toward threat. However, meta-analytical evidence that clinical anxiety is characterized by threat-related attention bias is thin. The largest meta-analysis to date included dot-probe data for n = 337 clinically anxious individuals. Baseline measures of biased attention obtained in ABM RCTs form an additional body of data that has not previously been meta-analyzed. This article presents a meta-analysis of threat-related dot-probe bias measured at baseline for 1,005 clinically anxious individuals enrolled in 13 ABM RCTs. Random-effects meta-analysis indicated no evidence that the mean bias index (BI) differed from zero (k = 13, n = 1005, mean BI = 1.8 ms, SE = 1.26 ms, p = .144, 95% confidence interval [-0.6, 4.3]. Additional Bayes factor analyses also supported the point-zero hypothesis (BF10 = .23), whereas interval-based analysis indicated that mean bias in clinical anxiety is unlikely to extend beyond the 0 to 5 ms interval. Findings are discussed with respect to strengths (relatively large samples, possible bypassing of publication bias), limitations (lack of control comparison, repurposing data, specificity to dot-probe data), and theoretical and practical context. We suggest that it should no longer be assumed that clinically anxious individuals are characterized by selective attention toward threat. Clinically anxious individuals enrolled in RCTs for Attention Bias Modification are not characterized by threat-related attention bias at baseline. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Transtornos de Ansiedade/fisiopatologia , Transtornos de Ansiedade/terapia , Viés de Atenção/fisiologia , Terapia Cognitivo-Comportamental , Ensaios Clínicos Controlados Aleatórios como Assunto , Transtornos de Estresse Pós-Traumáticos/fisiopatologia , Transtornos de Estresse Pós-Traumáticos/terapia , Terapia Cognitivo-Comportamental/estatística & dados numéricos , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto/estatística & dados numéricos
19.
PLoS One ; 14(7): e0219541, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31291337

RESUMO

The possibilities of computer-based cognitive training (CCT) in postponing the onset of dementia are currently unclear, but promising. Our aim is to investigate older adults´ adherence to a long-term CCT program, and which participant characteristics are associated with adherence to the CCT. This study was part of the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER). Participants were 60-77-year-old individuals with increased dementia risk, recruited from previous population-based studies. The participants included in this study (n = 631) had been randomized to receive a multi-domain lifestyle intervention, including CCT. The measure of adherence was the number of completed CCT sessions (max = 144) as continuous measure. Due to a substantial proportion of participants with 0 sessions, the zero inflated negative binomial regression analyses were used to enable assessment of both predictors of starting the training and predictors of completing a higher number of training sessions. Several cognitive, demographic, lifestyle, and health-related variables were examined as potential predictors of adherence to CCT. Altogether, 63% of the participants participated in the CCT at least once, 20% completed at least half of the training, and 12% completed all sessions. Previous experience with computers, being married or cohabiting, better memory performance, and positive expectations toward the study predicted greater odds for starting CCT. Previous computer use was the only factor associated with a greater number of training sessions completed. Our study shows that there is a large variation in adherence to a long-lasting CCT among older adults with an increased risk of dementia. The results indicate that encouraging computer use, and taking into account the level of cognitive functioning, may help boost adherence to CCT.


Assuntos
Terapia Cognitivo-Comportamental/estatística & dados numéricos , Demência/prevenção & controle , Estilo de Vida , Cooperação do Paciente/estatística & dados numéricos , Terapia Assistida por Computador/estatística & dados numéricos , Idoso , Cognição , Terapia Cognitivo-Comportamental/métodos , Feminino , Finlândia , Humanos , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos/estatística & dados numéricos , Terapia Assistida por Computador/métodos , Resultado do Tratamento
20.
J Altern Complement Med ; 25(9): 902-909, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31328956

RESUMO

Objectives: The aim of this study was to evaluate utilization and outcomes of mindfulness-based cognitive therapy (MBCT) provided to veterans with psychiatric disorders. Design: Retrospective chart review. Settings: Veterans Administration Medical Center (VAMC). Subjects: Ninety-eight veterans with psychiatric illness who were enrolled in an MBCT class between May of 2012 and January of 2016. Subjects were predominately white (95%), male (81%), and >50 years old (74%). The most common psychiatric conditions were any mood disorder (82%) and post-traumatic stress disorder (54%). Intervention: Eight-week MBCT class. Outcome measures: Session attendance and pre- to postintervention changes in numbers of emergency department (ED) visits and psychiatric hospitalizations. Results: The average number of sessions attended was 4.87 of 8 and only 16% were present for all sessions. Veteran demographic variables did not predict the number of MBCT sessions attended. However, both greater numbers of pre-MBCT ED visits (p = 0.004) and psychiatric admissions (p = 0.031) were associated with attending fewer sessions. Among patients who experienced at least one pre- or post-treatment psychiatric admission in the 2 years pre- or postintervention (N = 26, 27%), there was a significant reduction in psychiatric admissions from pre to post (p = 0.002). There was no significant change in ED visits (p = 0.535). Conclusions: MBCT may be challenging to implement for veterans with psychiatric illness in, at least some, outpatient VAMC settings due to a high attrition rate. Possible mediation approaches include development of methods to screen for high dropout risk and/or development of shorter mindfulness-based interventions (MBIs) and/or coupling MBIs with pleasurable activities. The finding of a significant decrease in psychiatric hospitalizations from pre- to post-MBCT suggests that prospective studies are warranted utilizing MBCT for veterans at high risk for psychiatric hospitalization.


Assuntos
Terapia Cognitivo-Comportamental , Transtornos Mentais/terapia , Atenção Plena , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Veteranos/estatística & dados numéricos , Adulto , Terapia Cognitivo-Comportamental/métodos , Terapia Cognitivo-Comportamental/estatística & dados numéricos , Feminino , Humanos , Masculino , Meditação , Pessoa de Meia-Idade , Atenção Plena/métodos , Atenção Plena/estatística & dados numéricos , Estudos Retrospectivos , Transtornos de Estresse Pós-Traumáticos/terapia , Resultado do Tratamento , Adulto Jovem
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