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1.
Medicine (Baltimore) ; 99(4): e18833, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31977878

RESUMO

BACKGROUND: Fibromyalgia (FM) is a chronic pain syndrome characterized by widespread musculoskeletal pain and multiple symptoms. It is a common clinical condition whose etiology is unclear. Currently, there is no gold standard treatment for FM. Management of this condition is therefore aimed at reducing symptoms and maintaining the individual's ability to function optimally. Based on the principal symptoms and characteristics of individuals with FM, we hypothesized that the implementation of a multicomponent treatment (with physical exercise, cognitive behavioral therapy adding to a graded motor imagery program, and therapeutic neuroscience education) would be more effective than conventional treatment in women with FM. This paper describes the rationale and methods of study intended to test the effectiveness of multicomponent treatment versus conventional treatment in patients with FM. METHOD/DESIGN: Fifty-six female individuals between 18 and 65 years of age, who were referred to the physical therapy department of the Rehabilitar Center in Chile, will be randomized into two treatment arms. The intervention group will receive a multicomponent treatment program for duration of 12 weeks. The control group will receive a conventional treatment for this condition for 12 weeks. The primary outcome measure will be the pain intensity score, measured by the numeric pain rating scale (NPRS), and the secondary outcomes will be the FM Impact Questionnaire (FIQ), and affective components of pain, such as catastrophizing using the Pain Catastrophizing Scale (PCS), fear of movement using the Tampa Scale Kinesiophobia (TSK), and sleep quality as measured by the Pittsburgh Sleep Quality Index (PSQI). DISCUSSION: This paper reports the design of a randomized clinical trial aimed at assessing the effectiveness of the multicomponent treatment versus conventional treatment in women with FM. TRIAL REGISTRATION: Brazilian registry of clinical trials UTN number U1111-1232-0862. Registered 22 April 2019.


Assuntos
Terapia Cognitivo-Comportamental/métodos , Terapia por Exercício/métodos , Fibromialgia/terapia , Adulto , Idoso , Catastrofização/prevenção & controle , Catastrofização/psicologia , Feminino , Fibromialgia/psicologia , Humanos , Pessoa de Meia-Idade , Dor/psicologia , Medição da Dor , Ensaios Clínicos Controlados Aleatórios como Assunto , Adulto Jovem
2.
Medicine (Baltimore) ; 99(4): e18456, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31977844

RESUMO

BACKGROUND: In this study, we aim to assess the psychological effects of cognitive behavioral therapy (CBT) on internet addiction (IA) in adolescents. METHODS: This study will search the following databases of Cochrane Library, PUBMED, EMBASE, Scopus, Web of Science, PsycINFO, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure. All these electronic databases will be searched from inception to the September 30, 2019 without any language limitation. Two authors will conduct study selection, data extraction, and study quality assessment, respectively. Any disagreements between 2 authors will be solved by a third author through discussion. Statistical analysis will be performed using RevMan 5.3 software. RESULTS: This study will investigate the psychological effects of CBT on IA in adolescents by measuring psychopathological symptoms, depression, anxiety, time spent on the internet (hours/day), and health-related quality of life. CONCLUSION: This study summarizes current evidence of CBT on IA in adolescents and may provide guidance for both intervention and future researches.PROSPERO registration number: PROSPERO CRD42019153290.


Assuntos
Comportamento Aditivo/terapia , Terapia Cognitivo-Comportamental/métodos , Internet , Adolescente , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa
3.
Expert Rev Pharmacoecon Outcomes Res ; 19(6): 663-676, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31859542

RESUMO

Introduction: Health anxiety, also known as 'hypochondriasis', is a common, distressing and costly condition that responds to cognitive behavior therapy (CBT) but evidence pertaining to response and remission rates, treatment in routine care, therapist-guided Internet-delivered CBT (ICBT) and health economics has not been systematically reviewed.Areas covered: In this systematic review and meta-analysis we searched PubMed, PsycINFO, and OATD (17/06/2019) for randomized controlled trials (RCTs) comparing CBT to non-CBT controls for health anxiety. Based on 19 RCTs, the pooled between-group effect on health anxiety was moderate to large (g = 0.79; 95% CI: 0.57-1.01; adjusted for publication bias: g = 0.62), with small to moderate effects on secondary symptoms and effects largely sustained 12-18 months after treatment. Moderators were control condition and recruitment path, but not treatment setting. The pooled CBT response rate was 66%, and the remission rate 48%. ICBT had effects comparable to face-to-face CBT. CBT for health anxiety is probably cost-effective, but with limited effect on the quality of life.Expert opinion: CBT is a highly efficacious and probably cost-effective treatment for health anxiety. We recommend that ICBT is implemented more widely, and that health economic outcomes and ways of increasing response and remission rates are explored further.


Assuntos
Terapia Cognitivo-Comportamental/métodos , Hipocondríase/terapia , Terapia Cognitivo-Comportamental/economia , Análise Custo-Benefício , Economia Médica , Humanos , Hipocondríase/economia , Internet , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
5.
Adv Exp Med Biol ; 1192: 263-279, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31705499

RESUMO

This article gives an overview of the concept and brain mechanisms of Internet game and smartphone addiction and the applicability of precision medicine and smart healthcare system. Internet game and smartphone addiction are categorized as behavioral addictions, which share similar phenomenology and neurobiological underpinnings with substance addictions. Neuroimaging studies revealed the alteration in the functional activity and structure of individuals with Internet game and smartphone addiction, which also can be potent biomarkers. Precision medicine is defined as treatments targeted to the individual patients on the basis of genetic, biomarker, phenotypic or psychosocial characteristics. Recent advances in high-throughput technology and bioinformatics have enabled us to integrate these big data with behavioral data collected from smartphones or other wearable devices. Data collected via smart devices can be transferred to medical institute and integrated in order to diagnose current status precisely and to provide optimal intervention. The feedbacks of intervention are sent back to the medical provider via self-reports or objective measures to evaluate the appropriateness of the intervention. In conclusion, Internet game and smartphone addiction can be diagnosed precisely using high-throughput technology and optimally managed via smart healthcare system.


Assuntos
Comportamento Aditivo/diagnóstico , Terapia Cognitivo-Comportamental/métodos , Assistência à Saúde/métodos , Internet , Transtornos Mentais/epidemiologia , Medicina de Precisão , Smartphone , Comportamento Aditivo/terapia , Humanos , Neuroimagem , Transtornos Relacionados ao Uso de Substâncias , Jogos de Vídeo
6.
Clin Ter ; 170(5): e382-e387, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31612197

RESUMO

This systematic review of randomized controlled trials (RCTs) aims at evaluating the efficacy of Occupational therapy (OT) interventions in Asperger's syndrome (AS) pediatric patients. We conducted a systematic review according to PRISMA guidelines. The screening of the literature was carried out on PUBMED, SCOPUS, WEB OF SCIENCE and OT SEEKER databases, TO December 2018. We selected three RCTs having the common objective to evaluate whether children with AS can improve their social skills thanks to OT treatments. The interventions targeted by the three selected studies were: LEGO therapy, Social Use of Language Programme, Let's Face It! software and Parent Training combined with the administration of risperidone. All the studies showed that the intervention groups improved their overall social ability.This review shows that OT interventions can help concretely AS children in overcoming their social issues. Nevertheless, more RCTs are needed to better understand the OT's benefits and limitations in AS patients.


Assuntos
Síndrome de Asperger/terapia , Terapia Cognitivo-Comportamental/métodos , Terapia Ocupacional/métodos , Índice de Gravidade de Doença , Síndrome de Asperger/psicologia , Criança , Humanos , Terapia Ocupacional/psicologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
8.
BMC Health Serv Res ; 19(1): 686, 2019 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-31597555

RESUMO

BACKGROUND: Low-intensity treatments imply reduced therapist contact due to an emphasis on self-help and the use of technologies to deliver treatment. The role of the remoteness, the reduced therapist contact, and the interplay of these components has not been differentiated from a patients' perspective so far. This study's purpose is to capture patients' experiences with telephone-based self-help cognitive behavioural therapy (tel-CBT). METHODS: A subsample of mildly to moderately depressed patients (N = 13) who finished tel-CBT as part of a larger randomised controlled trial (RCT) in routine care were interviewed using a semi-structured questionnaire. Interviews were audiotaped, transcribed verbatim, and independently coded by two coders blind to treatment outcome. Using qualitative content analysis with deductive and inductive procedures, a two-level category system was established. RESULTS: The category system contains four category clusters regarding expectations, self-help related aspects, telephone-related aspects, and implications for patients' treatment pathway, and subsumes a total of 15 categories. Self-help related aspects circulate around the interplay between written materials and professional input, trust and support in the therapeutic relationship and its relation to the initial personal contact, as well as CBT principles. Telephone-related aspects entail perceived advantages and disadvantages of the telephone on an organisational and content level as well as a discourse around distance and closeness in the interaction. Although patients raised doubts regarding the long-term effect of the intervention on symptomatology, patients expressed satisfaction with the treatment and reported an immediate as well as a longer lasting personal impact of the treatment. These results indicate user acceptance with tel-CBT. CONCLUSIONS: This qualitative analysis captures patients' experiences with tel-CBT and the perceived helpfulness of the diverse treatment components. This can facilitate refining aspects of low-intensity treatments and might improve dissemination. TRIAL REGISTRATION: ClinicalTrials.gov NCT02667366. Registered on 3 December 2015.


Assuntos
Atitude Frente a Saúde , Terapia Cognitivo-Comportamental/métodos , Transtorno Depressivo/terapia , Adulto , Idoso , Transtorno Depressivo/psicologia , Feminino , Humanos , Internet , Masculino , Pessoa de Meia-Idade , Relações Profissional-Paciente , Pesquisa Qualitativa , Projetos de Pesquisa , Telemedicina/métodos , Telefone , Resultado do Tratamento
9.
Medicine (Baltimore) ; 98(41): e17289, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31593081

RESUMO

INTRODUCTION: Fibromyalgia (FM) is a chronic condition characterized by chronic pain, fatigue and loss of function which significantly impairs quality of life. Although treatment of FM remains disputed, some studies point at the efficacy of interdisciplinary therapy. This study aims to analyze the effectiveness, cost-utility and benefits of a multicomponent therapy on quality of life (main variable), functional impact, mood and pain in people suffering from FM that attend primary care centers (PCCs) of the Catalan Institute of Health (ICS). METHODS AND ANALYSIS: A 2-phase, mixed methods study has been designed following Medical Research Council guidance. Phase 1: Pragmatic randomized clinical trial with patients diagnosed with FM that attend one of the 11 PCCs of the ICS Gerència Territorial Terres de l'Ebre. We estimate a total sample of 336 patients. The control group will receive usual clinical care, while the multicomponent therapy group (MT group) will receive usual clinical care plus group therapy (consisting of health education, exercise and cognitive-behavioural therapy) during 12 weeks in 2-hourly weekly sessions. ANALYSIS: the standardized mean response and the standardized effect size will be assessed at 3, 9, and 15 months after the beginning of the study using multiple linear regression models. Utility measurements will be used for the economic analysis. Phase 2: Qualitative socio constructivist study to evaluate the intervention according to the results obtained and the opinions and experiences of participants (patients and professionals). We will use theoretical sampling, with 2 discussion groups of participants in the multicomponent therapy and 2 discussion groups of professionals of different PCCs. A thematic content analysis will be carried out. ETHICS AND DISSEMINATION: This study protocol has been approved by the Clinical Research Ethics Committee of the Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (code P18/068). Articles will be published in international, peer-reviewed scientific journals. TRIAL REGISTRATION: Clinical-Trials.gov: NCT04049006.


Assuntos
Terapia Cognitivo-Comportamental/métodos , Terapia por Exercício/métodos , Fibromialgia/terapia , Educação de Pacientes como Assunto/métodos , Atenção Primária à Saúde/métodos , Qualidade de Vida , Adulto , Terapia Cognitivo-Comportamental/economia , Terapia Combinada , Análise Custo-Benefício , Terapia por Exercício/economia , Estudos de Viabilidade , Feminino , Fibromialgia/economia , Fibromialgia/psicologia , Implementação de Plano de Saúde , Humanos , Masculino , Aceitação pelo Paciente de Cuidados de Saúde , Cooperação do Paciente , Educação de Pacientes como Assunto/economia , Atenção Primária à Saúde/economia , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa
10.
J Consult Clin Psychol ; 87(11): 1019-1029, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31556650

RESUMO

OBJECTIVE: We evaluated patterns and predictors of change from three efficacy trials of trauma-focused cognitive-behavioral treatments (TF-CBT) among service members (N = 702; mean age = 32.88; 89.4% male; 79.8% non-Hispanic/Latino). Rates of clinically significant change were also compared with other trials. METHOD: The trials were conducted in the same setting with identical measures. The primary outcome was symptom severity scores on the PTSD Symptom Scale-Interview Version (PSS-I; Foa, Riggs, Dancu, & Rothbaum, 1993). RESULTS: Symptom change was best explained by baseline scores and individual slopes. TF-CBT was not associated with better slope change relative to Present-Centered Therapy, a comparison arm in 2 trials. Lower baseline scores (ß = .33, p < .01) and higher ratings of treatment credibility (ß = -.22, p < .01) and expectancy for change (ß = -.16, p < .01) were associated with greater symptom change. Older service members also responded less well to treatment (ß = .09, p < .05). Based on the Jacobson and Truax (1991) metric for clinically significant change, 31% of trial participants either recovered or improved. CONCLUSIONS: Clinicians should individually tailor treatment for service members with high baseline symptoms, older patients, and those with low levels of credibility and expectancy for change. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Conflitos Armados/psicologia , Terapia Cognitivo-Comportamental/métodos , Militares/psicologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Transtornos de Estresse Pós-Traumáticos/terapia , Adulto , Feminino , Humanos , Masculino , Resultado do Tratamento , Adulto Jovem
11.
J Consult Clin Psychol ; 87(11): 989-1002, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31556653

RESUMO

OBJECTIVE: The investigation of session-to-session effects of working alliance on symptoms and coping experiences in patients diagnosed with generalized anxiety disorder. In addition, investigating these effects dependent on whether therapists are primed to work with patients strength (resource priming) or to adhere to the treatment manual (adherence priming). METHOD: Data was drawn from a randomized controlled trial in which 57 patients were randomly assigned to either the resource priming condition or the adherence priming condition. Within- and between patient associations were disentangled using dynamic structural equation modeling. RESULTS: The total score of the working alliance, as well as all its overlapping components (i.e., goal agreement, task consensus, bond) showed significant within-patient effects on next session coping experiences. More specifically, better alliance scores in one session were followed by more coping experiences in the subsequent session. With regard to anxiety symptoms, an association was found only with the working alliance total score as well as for the bonds component, but not for the goals and task components of the working alliance. The priming condition (resource priming vs. adherence priming) had no influence on the within-patient alliance-outcome association. Between-patient alliance associations were only present with coping experiences, but not with anxiety symptoms. CONCLUSION: The findings provide further empirical evidence for the hypothesis that the working alliance may be a robust facilitative factor for change in CBT treatments for generalized anxiety disorder, which evolves irrespective of the strictness with which therapists adhere to the treatment manual. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Transtornos de Ansiedade/terapia , Terapia Cognitivo-Comportamental/métodos , Relações Profissional-Paciente , Adaptação Psicológica , Adulto , Transtornos de Ansiedade/psicologia , Feminino , Fidelidade a Diretrizes , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
12.
Maturitas ; 129: 23-29, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31547909

RESUMO

BACKGROUND: Menopause syndrome generally includes psychological problems. Group treatment delivered via the Internet and mobile phone (imGT) may improve women's physiological and psychological conditions. OBJECTIVE: To investigate the efficacy of group cognitive behavioural therapy of menopause-related mood swings and quality of life, delivered face to face or via the Internet and mobile phone. METHODS: This protocol is for a randomized controlled clinical trial with a sample of 140 menopausal women divided into 2 groups: imGT and face-to-face group treatment (ffGT). The primary outcome will be the improvement in the menopausal symptoms of the two groups, as assessed by the Greene Climacteric Scale. The secondary outcomes will be: quality of life, assessed by the Short Form 36 Health Survey Questionnaire; insomnia, assessed by the Pittsburgh Sleep Quality Inventory; anxiety, assessed by the Hamilton Anxiety Rating Scale; and therapeutic alliance, assessed by the Working Alliance Inventory-Short Revised and Client Sat-is-fac-tion Qes-tion-naire-8. imGT will be performed once a week for 1.5 h for 10 weeks with a daily 'Punched-in' on the WeChat app; ffGT will be performed once a week for 1.5 h for 10 weeks. All outcomes will be assessed at baseline, at a post-intervention evaluation (week 10), and at a follow-up evaluation (week 22). DISCUSSION: This study will be the first clinical trial to examine the effects of imGT on menopausal women in China. If imGT is found to be non-inferior to ffGT, it will facilitate access to menopausal health services.


Assuntos
Sintomas Afetivos/terapia , Telefone Celular , Terapia Cognitivo-Comportamental/métodos , Internet , Menopausa/psicologia , Psicoterapia de Grupo/métodos , Adulto , Ansiedade/terapia , China , Estudos de Equivalência como Asunto , Feminino , Humanos , Pessoa de Meia-Idade , Aplicativos Móveis , Qualidade de Vida/psicologia , Distúrbios do Início e da Manutenção do Sono/terapia , Inquéritos e Questionários , Síndrome
13.
Am J Psychother ; 72(3): 75-83, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31533453

RESUMO

In this article, a clinical protocol for delivering a flexible, spiritually integrated cognitive-behavioral therapy, called spiritual psychotherapy for inpatient, residential, and intensive treatment (SPIRIT), is presented, and its implementation is described.


Assuntos
Terapia Cognitivo-Comportamental/métodos , Pacientes Internados/psicologia , Espiritualidade , Humanos
14.
Pan Afr Med J ; 33: 115, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31489093

RESUMO

Prader Willi syndrome is a rare genetic disease. Symptoms include binge eating disorder associated with the risk of morbid obesity, learning difficulties and behavioral problems or even major psychiatric disorders. The purpose of this case study is to conduct a literature review on Prader Willi syndrome and to highlight its impact on daily life, both on physical and mental health, as well as its management. We report the case of an 11-year old Moroccan girl presenting with Prader Willi syndrome. She was assisted in performing activities of daily living by using a comprehensive biopsychosocial approach which improved her quality of life. We here emphasize the primary and central role of the psychotherapist in the treatment of patients with Prader Willi syndrome which is based on counselling, motivational interviewing and cognitive behaviour therapy techniques. Prader Willi syndrome is a disease with severe psychiatric symptoms. Patient's care requires multidisciplinary team approach involving psychologist or psychiatrist.


Assuntos
Atividades Cotidianas/psicologia , Síndrome de Prader-Willi/terapia , Qualidade de Vida , Criança , Terapia Cognitivo-Comportamental/métodos , Feminino , Humanos , Marrocos , Entrevista Motivacional/métodos , Síndrome de Prader-Willi/psicologia
15.
Int. j. clin. health psychol. (Internet) ; 19(3): 218-227, sept. 2019. tab, graf
Artigo em Inglês | IBECS | ID: ibc-184968

RESUMO

Background/Objective: The aim of this paper was to evaluate the diferential efficacy of cognitive behavioral family treatment in children under 8 years of age with Obsessive-Compulsive Disorder (OCD) in the reduction of obsessive-compulsive responses and secondary outcomes in three treatment conditions: (a) Treatment of parents and child, (b) Treatment of mother and child, and (c) Treatment of mother. Method: Forty-four children with obsessive-compulsive disorder, aged 5.2-7.9 years old and their parents, were randomized to one of three groups in a 1:1:1 ratio. Seventy-five percent was male and 100% Caucasian (White-European). Treatment involved 12 individual sessions of is Cognitive-Behavioral Family-Based Treatment delivered. Results: The three conditions produced clinical improvements in post-test and follow-up in the primary (symptom severity OCD) and secondary outcomes. The results showed no intergroup differences in variables related to OCD symptom severity, although statistically significant differences were found in groups in Internalizing and Externalizing problem, mother and fathers accomodation. Conclusions: The most efficient condition was that including a greater number of family members even when there was high family accommodation. The direct involvement of the child in the psychological treatment was important in achieving better results


Antecedentes/Objetivo: El objetivo fue analizar la eficacia diferencial de un tratamiento cognitivo-conductual para la reducción de obsesiones y compulsions y otras medidas secundarias en niños menores de 8 años con Trastorno Obsesivo-Compulsivo (TOC). Las tres condiciones de tratamiento fueron: (a) Tratamiento a los padres y al niño, (b) Tratamiento a la madre y al niño, (3) Tratamiento a la madre. Método: Cuarenta y cuatro niños, con edades comprendidas entre 5,2-7,9 años, y sus padres fueron asignados al azar a uno de los tres grupos, ratio de 1:1:1. El 75% eran varones y el 100% españoles. El tratamiento consistió en 12 sesiones individuales de Terapia familiar cognitivo-conductual. Resultados: Las tres condiciones de tratamiento produjeron mejorías clínicas en el postest y seguimiento en las medidas primarias (severidad TOC) y secundarias. Los resultados mostraron que no existían diferencias entre los grupos en las variables relacionadas con síntomas de severidad, mientras que sí se hallaron en problemas internalizantes y externalizantes, y acomodación de la madre y del padre. Conclusiones: La condición más eficiente fue la que incluía mayor número de miembros familiares, sobre todo cuando había una mayor acomodación familiar. La participación directa del niño en el tratamiento psicológico fue importante para lograr mejores resultados


Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Transtorno Obsessivo-Compulsivo/terapia , Família/psicologia , Terapia Cognitivo-Comportamental/métodos , Resultado do Tratamento , Fatores Socioeconômicos
16.
J Consult Clin Psychol ; 87(9): 802-814, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31403816

RESUMO

OBJECTIVE: Problem gambling can cause severe harm to concerned significant others (CSOs) in the form of, for example, relationship problems, financial difficulties, and mental and physical illness. CSOs are important for their ability to support problem gamblers and motivate them to change. This study investigated the effect of an Internet-based intervention for CSOs of treatment-refusing problem gamblers on (a) gambling-related harm, (b) the gamblers' treatment-seeking rate, and (c) the relationship satisfaction and mental health of the CSOs. METHOD: A total of 100 CSOs of problem gamblers were randomized into one of two conditions: Internet-delivered cognitive-behavioral therapy for CSOs or a wait-list control group. The intervention group was given Internet-based treatment consisting of nine modules with therapist support available via telephone and e-mail. Outcome measures were collected up 12 months posttreatment. RESULTS: The intervention improved the psychological well-being of the CSOs compared to the wait-list group at the posttest (CSO's emotional consequences: d = -0.90, 95% CI [-1.47, -0.33]; relationship satisfaction: d = 0.41, 95% CI [0.05, 0.76]; anxiety: d = -0.45, 95% CI [-0.81, -0.09]; depression: d = -0.49, 95% CI [-0.82, -0.16]). However, the effects on the gambling outcomes were small and inconclusive (gambling losses: multiplicative effect = 0.73, 95% CI [0.29, 1.85]; treatment-seeking: hazard ratio = 0.86, 95% CI [0.31, 2.38]). CONCLUSION: The results confirm earlier studies' findings that affecting the gambler via a CSO is challenging, but it is possible to increase the CSO's coping and well-being. The trial's outcome data and scripts are available for download (https://osf.io/awtg7/). (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Terapia Cognitivo-Comportamental/métodos , Família/psicologia , Amigos/psicologia , Jogo de Azar/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Telemedicina/métodos , Adulto , Depressão/psicologia , Feminino , Jogo de Azar/terapia , Humanos , Internet , Masculino , Pessoa de Meia-Idade , Satisfação Pessoal , Listas de Espera
17.
Medicine (Baltimore) ; 98(33): e16803, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31415391

RESUMO

BACKGROUND: This proposed study will systematically assess the effect and safety of cognitive-behavioral therapy (CBT) for heart failure (HF). METHODS: We will search the following electronic databases for randomized controlled trials assessing the effect of CBT in patients with HF: PUBMED, EMBASE, Cochrane Library, Web of Science, Scopus, Chinese Biomedical Literature Database, China National Knowledge Infrastructure, VIP Information, and Wanfang Data from their inceptions to present without any language limitations. Two authors will independently conduct the study selection, data extraction, and methodological quality assessment. The methodological quality will be evaluated by Cochrane risk of bias tool. RESULTS: This study will assess the efficacy and safety of CBT for patients with HF. The primary outcomes consist of depression and anxiety. The secondary outcomes comprise of all-cause mortality, change in body weight, urine output, change in serum sodium; and any adverse events. CONCLUSION: The results of this study will summarize the up-to-date evidence on the effect and safety of CBT for HF. PROSPERO REGISTRATION NUMBER: PROSPERO CRD42019135932.


Assuntos
Ansiedade/terapia , Terapia Cognitivo-Comportamental/métodos , Depressão/terapia , Insuficiência Cardíaca/psicologia , Adulto , Idoso , Ansiedade/etiologia , Depressão/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa , Revisão Sistemática como Assunto , Resultado do Tratamento
18.
Lancet Psychiatry ; 6(9): 735-744, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31371212

RESUMO

BACKGROUND: Medication is commonly used to treat youth depression, but whether medication should be added to cognitive behavioural therapy (CBT) as first-line treatment is unclear. We aimed to examine whether combined treatment with CBT and fluoxetine was more effective than CBT and placebo in youth with moderate-to-severe major depressive disorder. METHODS: The Youth Depression Alleviation-Combined Treatment (YoDA-C) trial was a randomised, double-blind, placebo-controlled, multicentre clinical trial. Participants were aged 15-25 years with moderate-to-severe MDD and had sought care at one of four clinical centres in metropolitan Melbourne, Australia. Patients were randomly assigned (1:1) to receive CBT for 12 weeks, plus either fluoxetine or placebo. Participants began on one 20 mg capsule of fluoxetine or one placebo pill per day. All participants received CBT, delivered by therapists in weekly 50-minute sessions and attended interviews at baseline, and at weeks 4, 8, and 12, during which they completed assessments with research assistants. Participants saw a psychiatrist or psychiatry trainee to complete medical assessments at the same timepoints. The primary outcome was change in the interviewer-rated Montgomery-Åsberg Depression Rating Scale (MADRS) score at 12 weeks. The trial was registered with the Australian New Zealand Clinical Trials Registry (ACTRN12612001281886). FINDINGS: 153 participants (mean age 19·6 years [SD 2·7]) were enrolled from Feb 20, 2013, to Dec 13, 2016. 77 (50%) patients were allocated to CBT and placebo and 76 (50%) to CBT and fluoxetine. Participants had severe depression at baseline (mean MADRS score 33·6 [SD 5·1] in the CBT and placebo group and 32·2 [5·6] in the CBT and fluoxetine group), with high proportions of participants with anxiety disorder comorbidity (47 [61%] in the CBT and placebo group and 49 [64%] in the CBT and fluoxetine group) and past-month suicidal ideation (55 [71%] in the CBT and placebo group and 59 [78%] in the CBT and fluoxetine group). 59 (77%) participants in the CBT and placebo group and 64 (84%) in the CBT and fluoxetine group completed follow-up at week 12. After 12 weeks of treatment both groups showed a reduction in MADRS scores (-13·7, 95% CI -16·0 to -11·4, in the CBT and placebo group and -15·1, -17·4 to -12·9, in the CBT and fluoxetine group). There was no significant between-group difference in MADRS scores (-1·4, -4·7 to 1·8; p=0·39). There were five suicide attempts in the CBT and placebo group and one suicide attempt in the CBT and fluoxetine group (odds ratio 0·2, 0·0-1·8; p=0·21), and no significant between-group differences for other suicidal behaviours. INTERPRETATION: We did not find evidence that the addition of fluoxetine (rather than placebo) to CBT further reduced depressive symptoms in young people with moderate-to-severe MDD. Exploratory analyses showed that the addition of medication might be helpful for patients with comorbid anxiety symptoms and for older youth. FUNDING: Australian National Health and Medical Research Council.


Assuntos
Terapia Cognitivo-Comportamental/métodos , Terapia Combinada/métodos , Depressão/tratamento farmacológico , Transtorno Depressivo Maior/tratamento farmacológico , Fluoxetina/uso terapêutico , Adolescente , Adulto , Ansiedade/complicações , Ansiedade/tratamento farmacológico , Ansiedade/terapia , Austrália/epidemiologia , Comorbidade , Depressão/terapia , Transtorno Depressivo Maior/terapia , Método Duplo-Cego , Feminino , Fluoxetina/administração & dosagem , Humanos , Masculino , Inibidores de Captação de Serotonina/uso terapêutico , Ideação Suicida , Resultado do Tratamento , Adulto Jovem
19.
Clin Interv Aging ; 14: 1243-1254, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31371930

RESUMO

Objective: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the efficacy of cognitive stimulation therapy (CST) of different durations for Alzheimer's disease (AD). Methods: A comprehensive search was carried out in three databases. The primary outcome was Mini-Mental State Examination (MMSE) score. We conducted a meta-analysis with Review Manager, version 5.3 and assessed the methodological quality of the included studies using the Cochrane Collaboration Recommendations assessment tool. Results: Treatment effects from the meta-analysis showed that CST plus acetylcholinesterase inhibitors (ChEIs) was better than the control assessed by MMSE. In addition, the meta-analysis indicated that long-term CST was better than short-term or maintenance CST. Conclusion: Our study confirmed that the combination of CST and drug treatment for AD is effective in AD, regardless of whether short-term CST, maintenance CST, or long-term CST is used. The long-term CST appears to be more effective.


Assuntos
Doença de Alzheimer/terapia , Transtornos Cognitivos/terapia , Terapia Cognitivo-Comportamental/métodos , Doença de Alzheimer/complicações , Doença de Alzheimer/diagnóstico , Inibidores da Colinesterase/uso terapêutico , Transtornos Cognitivos/etiologia , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Comportamento Social
20.
Cochrane Database Syst Rev ; 8: CD006869, 2019 08 08.
Artigo em Inglês | MEDLINE | ID: mdl-31425615

RESUMO

BACKGROUND: The prevention of long-term psychological distress following traumatic events is a major concern. Systematic reviews have suggested that individual psychological debriefing is not an effective intervention at preventing post-traumatic stress disorder (PTSD). Over the past 20 years, other forms of intervention have been developed with the aim of preventing PTSD. OBJECTIVES: To examine the efficacy of psychological interventions aimed at preventing PTSD in individuals exposed to a traumatic event but not identified as experiencing any specific psychological difficulties, in comparison with control conditions (e.g. usual care, waiting list and no treatment) and other psychological interventions. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, PsycINFO and ProQuest's Published International Literature On Traumatic Stress (PILOTS) database to 3 March 2018. An earlier search of CENTRAL and the Ovid databases was conducted via the Cochrane Common Mental Disorders Controlled Trial Register (CCMD-CTR) (all years to May 2016). We handsearched reference lists of relevant guidelines, systematic reviews and included study reports. Identified studies were shared with key experts in the field.We conducted an update search (15 March 2019) and placed any new trials in the 'awaiting classification' section. These will be incorporated into the next version of this review, as appropriate. SELECTION CRITERIA: We searched for randomised controlled trials of any multiple session (two or more sessions) early psychological intervention or treatment designed to prevent symptoms of PTSD. We excluded single session individual/group psychological interventions. Comparator interventions included waiting list/usual care and active control condition. We included studies of adults who experienced a traumatic event which met the criterion A1 according to the Diagnostic and Statistical Manual (DSM-IV) for PTSD. DATA COLLECTION AND ANALYSIS: We entered data into Review Manager 5 software. We analysed categorical outcomes as risk ratios (RRs), and continuous outcomes as mean differences (MD) or standardised mean differences (SMDs), with 95% confidence intervals (CI). We pooled data with a fixed-effect meta-analysis, except where there was heterogeneity, in which case we used a random-effects model. Two review authors independently assessed the included studies for risk of bias and discussed any conflicts with a third review author. MAIN RESULTS: This is an update of a previous review.We included 27 studies with 3963 participants. The meta-analysis included 21 studies of 2721 participants. Seventeen studies compared multiple session early psychological intervention versus treatment as usual and four studies compared a multiple session early psychological intervention with active control condition.Low-certainty evidence indicated that multiple session early psychological interventions may be more effective than usual care in reducing PTSD diagnosis at three to six months' follow-up (RR 0.62, 95% CI 0.41 to 0.93; I2 = 34%; studies = 5; participants = 758). However, there was no statistically significant difference post-treatment (RR 1.06, 95% CI 0.85 to 1.32; I2 = 0%; studies = 5; participants = 556; very low-certainty evidence) or at seven to 12 months (RR 0.94, 95% CI 0.20 to 4.49; studies = 1; participants = 132; very low-certainty evidence). Meta-analysis indicated that there was no statistical difference in dropouts compared with usual care (RR 1.34, 95% CI 0.91 to 1.95; I2 = 34%; studies = 11; participants = 1154; low-certainty evidence) .At the primary endpoint of three to six months, low-certainty evidence indicated no statistical difference between groups in reducing severity of PTSD (SMD -0.10, 95% CI -0.22 to 0.02; I2 = 34%; studies = 15; participants = 1921), depression (SMD -0.04, 95% CI -0.19 to 0.10; I2 = 6%; studies = 7; participants = 1009) or anxiety symptoms (SMD -0.05, 95% CI -0.19 to 0.10; I2 = 2%; studies = 6; participants = 945).No studies comparing an intervention and active control reported outcomes for PTSD diagnosis. Low-certainty evidence showed that interventions may be associated with a higher dropout rate than active control condition (RR 1.61, 95% CI 1.11 to 2.34; studies = 2; participants = 425). At three to six months, low-certainty evidence indicated no statistical difference between interventions in terms of severity of PTSD symptoms (SMD -0.02, 95% CI -0.31 to 0.26; I2 = 43%; studies = 4; participants = 465), depression (SMD 0.04, 95% CI -0.16 to 0.23; I2 = 0%; studies = 2; participants = 409), anxiety (SMD 0.00, 95% CI -0.19 to 0.19; I2 = 0%; studies = 2; participants = 414) or quality of life (MD -0.03, 95% CI -0.06 to 0.00; studies = 1; participants = 239).None of the included studies reported on adverse events or use of health-related resources. AUTHORS' CONCLUSIONS: While the review found some beneficial effects of multiple session early psychological interventions in the prevention of PTSD, the certainty of the evidence was low due to the high risk of bias in the included trials. The clear practice implication of this is that, at present, multiple session interventions aimed at everyone exposed to traumatic events cannot be recommended. There are a number of ongoing studies, demonstrating that this is a fast moving field of research. Future updates of this review will integrate the results of these new studies.


Assuntos
Terapia Cognitivo-Comportamental , Transtornos de Estresse Pós-Traumáticos/prevenção & controle , Terapia Cognitivo-Comportamental/métodos , Dessensibilização Psicológica , Humanos , Psicoterapia/métodos , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Tempo , Listas de Espera
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