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1.
Pain Med ; 21(12 Suppl 2): S21-S28, 2020 12 12.
Artigo em Inglês | MEDLINE | ID: mdl-33313733

RESUMO

BACKGROUND: Given access barriers to cognitive behavioral therapy for chronic pain (CBT-CP), this pragmatic superiority trial will determine whether a remotely delivered CBT-CP intervention that addresses these barriers outperforms in-person and other synchronous forms of CBT-CP for veterans with musculoskeletal pain. DESIGN: This pragmatic trial compares an asynchronous form of CBT-CP that uses interactive voice response (IVR) to allow patients to participate from their home (IVR CBT-CP) with synchronous CBT-CP delivered by a Department of Veterans Affairs (VA) clinician. Veterans (n=764; 50% male) with chronic musculoskeletal pain throughout nine VA medical centers will participate. The primary outcome is pain interference after treatment (4 months). Secondary outcomes, including pain intensity, depression symptom severity, sleep, self-efficacy, and global impression of change, are also measured after treatment. Where possible, outcomes are collected via electronic health record extraction, with remaining measures collected via IVR calls to maintain blinding. Quantitative and qualitative process evaluation metrics will be collected to evaluate factors related to implementation. A budget impact analysis will be performed. SUMMARY: This pragmatic trial compares the outcomes, cost, and implementation of two forms of CBT-CP as delivered in the real-world setting. Findings from the trial can be used to guide future policy and implementation efforts related to these interventions and their use in the health system. If one of the interventions emerges as superior, resources can be directed to this modality. If both treatments are effective, patient preferences and health care system factors will take precedence when making referrals. Implications of COVID-19 on treatment provision and trial outcomes are discussed.


Assuntos
/tratamento farmacológico , Terapia Cognitivo-Comportamental , Autogestão , /virologia , Dor Crônica/terapia , Terapia Cognitivo-Comportamental/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ensaios Clínicos Pragmáticos como Assunto , Telemedicina/métodos , Veteranos
2.
Medicine (Baltimore) ; 99(49): e23362, 2020 Dec 04.
Artigo em Inglês | MEDLINE | ID: mdl-33285717

RESUMO

Binge eating disorder (BED) is a common dietary disorder among obese people. Obesity and eating disorders are related to mental health and physical health. At present, there is no definite and effective method for treatment in clinic. The curative effect of electroacupuncture on obesity is definite. Although there is no conclusive evidence to support its long-term benefits, electroacupuncture has been increasingly used in clinic. This retrospective study determined the prognosis and outcome of electro-acupuncture on obese patients with BED.One hundred forty-three patients with BED and obesity were found from 658 people who participated in the scientific experiment of obesity treatment in Nanjing Hospital of Traditional Chinese Medicine and Nanjing Brain Hospital from March 2015 to June 2018, and 84 patients (aged 18-40 years old) with valid data and uninterrupted treatment were found to be eligible for this retrospective study. According to the intervention methods, the patients were divided into electro-acupuncture combined with cognitive group (n = 32), cognitive therapy group (n = 28), and control group (n = 24). In this study, the 5th edition of Diagnosis and Statistics Manual of Mental Diseases, fasting blood glucose, fasting insulin, total cholesterol (TC), triglyceride, high-density lipoprotein, low-density lipoprotein, body fat rate, muscle mass, visceral index grade, nutrient intake (energy, protein, fat, carbohydrate), body weight, and weight changes before and after treatment were observed.Compared with the cognitive therapy group, negative emotion score, TC, triglyceride, high-density lipoprotein, waist circumference, BW, BMI, body fat percentage of the electroacupuncture combined with cognitive group were lower, while positive emotional scores were higher, and there were significant differences in negative emotional scores, TC, waist circumference and BMI (P < .05). The dietary energy and three major nutrients in the electroacupuncture combined with cognitive group were lower than those in the cognitive group and the blank group (P < .05).The current results suggest that electroacupuncture combined with cognitive therapy is more effective than cognitive therapy alone in treating obese patients with BED. Future prospective studies are necessary to further study the mechanism of electroacupuncture on the obese with BED.


Assuntos
Transtorno da Compulsão Alimentar/epidemiologia , Transtorno da Compulsão Alimentar/terapia , Eletroacupuntura/métodos , Obesidade/epidemiologia , Obesidade/terapia , Adolescente , Adulto , Transtorno da Compulsão Alimentar/psicologia , Glicemia , Índice de Massa Corporal , Pesos e Medidas Corporais , Terapia Cognitivo-Comportamental/métodos , Terapia Combinada , Feminino , Humanos , Lipídeos/sangue , Masculino , Obesidade/psicologia , Estudos Retrospectivos , Adulto Jovem
3.
J Med Internet Res ; 22(12): e24268, 2020 12 18.
Artigo em Inglês | MEDLINE | ID: mdl-33264099

RESUMO

BACKGROUND: The COVID-19 crisis and consequent confinement restrictions have caused significant psychosocial stress and reports of sleep complaints, which require early management, have increased during recent months. To help individuals concerned about their sleep, we developed a smartphone-based app called KANOPEE that allows users to interact with a virtual agent dedicated to autonomous screening and delivering digital behavioral interventions. OBJECTIVE: Our objective was to assess the feasibility of this app, in terms of inclusion rate, follow-up rate, perceived trust and acceptance of the virtual agent, and effects of the intervention program, in the context of COVID-19 confinement in France. METHODS: The virtual agent is an artificial intelligence program using decision tree architecture and interacting through natural body motion and natural voice. A total of 2069 users aged 18 years and above downloaded the free app during the study period (April 22 to May 5, 2020). These users first completed a screening interview based on the Insomnia Severity Index (ISI) conducted by the virtual agent. If the users were positive for insomnia complaints (ISI score >14), they were eligible to join the 2-stage intervention program: (1) complete an electronic sleep diary for 1 week and (2) follow personalized sleep recommendations for 10 days. We collected and analyzed the following measures: sociodemographic information, ISI scores and sleep/wake schedules, and acceptance and trust of the agent. RESULTS: Approximately 76% (1574/2069) of the app users completed the screening interview with the virtual agent. The virtual agent was well accepted by 27.4% (431/1574) of the users who answered the acceptance and trust questionnaires on its usability, satisfaction, benevolence, and credibility. Of the 773 screened users who reported sleep complaints (ISI score >14), 166 (21.5%) followed Step 1 of the intervention, and only 47 of those (28.3%) followed Step 2. Users who completed Step 1 found that their insomnia complaints (baseline mean ISI score 18.56, mean ISI score after Step 1 15.99; P<.001) and nocturnal sleep quality improved significantly after 1 week. Users who completed Step 2 also showed an improvement compared to the initial measures (baseline mean ISI score 18.87, mean ISI score after Step 2 14.68; P<.001). Users that were most severely affected (ISI score >21) did not respond to either intervention. CONCLUSIONS: These preliminary results suggest that the KANOPEE app is a promising solution to screen populations for sleep complaints and that it provides acceptable and practical behavioral advice for individuals reporting moderately severe insomnia.


Assuntos
/epidemiologia , Terapia Cognitivo-Comportamental/métodos , Distúrbios do Início e da Manutenção do Sono/terapia , Smartphone , Isolamento Social/psicologia , Adolescente , Adulto , Idoso , Inteligência Artificial , Árvores de Decisões , Estudos de Viabilidade , Feminino , França , Humanos , Masculino , Pessoa de Meia-Idade , Aplicativos Móveis , Estudo de Prova de Conceito , Quarentena , Sono , Estresse Psicológico/complicações , Inquéritos e Questionários , Telemedicina , Adulto Jovem
4.
Lancet Child Adolesc Health ; 4(12): 889-898, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33217358

RESUMO

Death of a parent in childhood and adolescence is a distressing life event. Childhood grief reactions are distinct from those in adults, and are affected by developmental and contextual factors such as age of the child and changes in caregiving environments. Following parental bereavement, children and adolescents face unique emotional and behavioural challenges, and are susceptible to several adverse biopsychosocial outcomes. Empirically supported interventions can help young people to navigate the many grief-related challenges, and the core treatment components include grief psychoeducation, building emotion identification and regulation skills, cognitive coping and restructuring, grief and trauma processing, memorialising and continuing bonds, meaning making, involvement of caregivers in grief treatment, and future planning. Health-care professionals often interact with children and adolescents following bereavement; therefore, it is important they have the foundational knowledge and skills to communicate effectively about the death, recognise and normalise different ways grief can manifest across development, and support surviving caregivers in facilitating adaptive grief in their children.


Assuntos
Pesar , Morte Parental/psicologia , Adaptação Psicológica , Adolescente , Cuidadores/psicologia , Criança , Terapia Cognitivo-Comportamental/métodos , Humanos , Psicoterapia de Grupo/métodos , Apoio Social
5.
Am Fam Physician ; 102(11): 668-672, 2020 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-33252911

RESUMO

Seasonal affective disorder is a mood disorder that is a subtype or qualifier of major depressive disorder or bipolar disorder in the Diagnostic and Statistical Manual of Mental Disorders. It is characterized by depressive symptoms that occur at a specific time of year (typically fall or winter) with full remission at other times of year (typically spring or summer). Possible risk factors include family history, female sex, living at a more northern latitude, and young adulthood (18 to 30 years of age). With the temporal nature of the mood episodes, diagnosis requires full remission when the specified season ends and two consecutive years of episodes in the same season. First-line therapy for seasonal affective disorder includes light therapy, antidepressants, and cognitive behavior therapy, alone or in combination. Commercial devices are available for administering light therapy or dawn simulation. The light intensity and duration of treatment depend on the device and the patient's initial response, but 2,500 to 10,000 lux for 30 to 60 minutes at the same time every day is typically effective. Lifestyle interventions, such as increasing exercise and exposure to natural light, are also recommended. If seasonal affective disorder recurs, long-term treatment or preventive intervention is typically indicated, and bupropion appears to have the strongest evidence supporting long-term use. Continuing light therapy or other antidepressants is likely beneficial, although evidence is inconclusive. Evidence is also inconclusive for psychotherapy and vitamin D supplementation.


Assuntos
Medicina de Família e Comunidade/métodos , Transtorno Afetivo Sazonal/terapia , Antidepressivos/uso terapêutico , Ritmo Circadiano/fisiologia , Terapia Cognitivo-Comportamental/métodos , Feminino , Humanos , Masculino , Fototerapia/métodos , Psicoterapia/métodos , Transtorno Afetivo Sazonal/diagnóstico
7.
J Fam Pract ; 69(7 Suppl): S45-S50, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-33104107

RESUMO

Apply evidence-based diagnostic guidelines for patients who have clinical features consistent with insomnia. Use evidence-based guidelines to develop comprehensive treatment plans that include cognitive-behavioral therapy, pharmacologic treatment, and combination therapies to achieve optimal outcomes Identify basic elements of cognitivebehavioral therapy for insomnia Differentiate among medications FDA-approved for treating insomnia by discussing mechanism of action, safety, efficacy, and use.


Assuntos
Distúrbios do Início e da Manutenção do Sono/diagnóstico , Distúrbios do Início e da Manutenção do Sono/terapia , Terapia Cognitivo-Comportamental/métodos , Terapia Combinada/métodos , Humanos , Hipnóticos e Sedativos/uso terapêutico , Distúrbios do Início e da Manutenção do Sono/psicologia
8.
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
9.
J Stud Alcohol Drugs ; 81(5): 655-663, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-33028479

RESUMO

OBJECTIVE: Social networks play an important role in the development of and recovery from problem drinking behaviors; however, few studies have measured the social networks of individuals convicted of driving under the influence (DUI) or assessed the relationship between social network characteristics and risk for DUI relapse and recidivism. The goal of this study is to describe the social network characteristics of a first-time DUI population in the 2 weeks before the DUI incident; examine demographic differences in social network characteristics by age, ethnicity, and gender; and assess the relationship between social network characteristics and risk factors for DUI. METHOD: We collected personal (egocentric) social network survey data from 94 participants (65% male) enrolled in a randomized clinical trial comparing the effects of cognitive behavioral therapy with usual care for individuals convicted of a first-time DUI. Multivariate models were used to assess the relationship between pre-DUI personal network characteristics and risk factors for DUI measured at baseline interview. RESULTS: Results indicate that the proportion of drinking partners in one's personal network was positively associated with drinks per week, binge drinking, alcohol use, marijuana use, and alcohol-related consequences. Several dimensions of personal network support were inversely associated with risk factors for DUI. CONCLUSIONS: The pre-DUI composition of personal networks has a strong relationship to baseline risk factors for DUI; networks composed of more risky individuals (e.g., drinking partners) were associated with greater substance use and drinking and driving behaviors. Networks with greater levels of social support were associated with lower likelihood of self-reported driving after drinking and intentions to drive after drinking. Interventions that target positive and negative aspects of personal networks may enhance clinical treatments.


Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Alcoolismo/epidemiologia , Dirigir sob a Influência/estatística & dados numéricos , Uso da Maconha/epidemiologia , Adulto , Idoso , Terapia Cognitivo-Comportamental/métodos , Grupos Étnicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Autorrelato , Rede Social , Apoio Social , Inquéritos e Questionários , Adulto Jovem
10.
An. psicol ; 36(3): 427-435, oct. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-195658

RESUMO

La evaluación de la eficacia del tratamiento de maltratadores en los Registros Oficiales o los Informes de las parejas no es válida, al tiempo que las intervenciones eficaces se dirigen a dotarlos de competencia cognitiva y conductual. Por ello diseñamos un estudio de campo para medir los efectos de la intervención en la competencia cognitiva. Un total de 100 condenados por violencia de género que completaron un programa penitenciario de tratamiento en la comunidad fueron evaluados pre- y post-tratamiento en la competencia cognitiva, esto es, auto-concepto, inteligencia emocional, atribución de responsabilidad, destrezas cognitivas para el afrontamiento de eventos estresantes en pareja, expresión y control de la ira, y creencias irracionales y pensamientos distorsionados. Los resultados mostraron un efecto significativo del tratamiento en la adquisición de las destrezas cognitivas. Sucintamente, el tratamiento potenció el auto-concepto general el 18.2% y las dimensiones internas del auto-concepto auto-satisfacción el 33.5% y comportamiento el 25.6%; y la claridad para discriminar las emociones el 31.8%. Además, el tratamiento incrementó la asunción interna de responsabilidad el 31.8%; el control de la ira el 19.1%; y el uso de estrategias adaptativas para el afrontamiento de eventos estresantes en pareja entre el 48.9% y el 61.3%. Finalmente, el tratamiento redujo el uso de estrategias desadaptativas entre el 25.6% y el 35.1%; y las creencias irracionales y pensamientos distorsionados relacionados con el uso de la violencia, rol de género y dependencia emocional, en el 78.2%, 48.2% y 63.6%, respectivamente. No obstante, no todos los maltratadores se beneficiaron del tratamiento


The evaluation of the efficacy of treatment of batterers in Official or Couple Records is not valid, whilst the efficient interventions are focused on the empowerment of cognitive and behavioural competence. A field study for measuring the effects of the treatment on the cognitive competence was designed. A total of 100 batterers who had completed a community penitentiary intervention programme, were assessed pre- and post-treatment in cognitive competence i.e., self-concept, emotional intelligence, attribution of responsivity, cognitive skills to cope intimate-partner-related stressful events, expression and control of anger, and irrational beliefs and distorted thoughts. The results showed a significant effect of the treatment in the acquisition of cognitive competence skills. Succinctly, treatment empowered the general self-concept in 18.2%, and the internal dimensions of self-concept self-satisfaction in 33.5% and behaviour in 25.6%; and clarity to discriminate among moods in 31.8%. Moreover, treatment increased the assumption of internal responsivity in 31.8%; anger control in 19.1%; and the use of adaptive strategies to cope intimate-partner-related stressful events between 48.9% and 61.3%. Finally, treatment involved a fall in the use of maladaptive strategies to cope intimate-partner-related stressful events between 25.6% and 35.1%; and in the irrational beliefs and distorted thoughts related with the use of violence, in 78.2%, 48.2% y 63.6%, for use of violence, gender roles and emotional dependence, respectively. Nonetheless, not all the batterers benefited from treatment


Assuntos
Humanos , Masculino , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Criminosos/psicologia , Terapia Cognitivo-Comportamental/métodos , Violência por Parceiro Íntimo/prevenção & controle , Escala de Avaliação Comportamental , Inquéritos e Questionários , Cognição , Análise Multivariada , Resultado do Tratamento , Reprodutibilidade dos Testes , Autoimagem
11.
PLoS One ; 15(10): e0240466, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33045002

RESUMO

Depressive symptoms are a serious problem in workplaces. Hospital staff members, such as newly licensed registered nurses (NLRNs), are at particularly increased risk of these symptoms owing to their limited experience. Previous studies have shown that a brief program-based cognitive behavioral therapy program (CBP) can offer effective treatment. Here, we conducted a longitudinal observational study of 683 NLRNs (CBP group, n = 522; no-CBP group, n = 181) over a period of 1 year (six times surveys were done during this period). Outcomes were assessed on the basis of surveys that covered the Beck Depression Inventory-I (BDI). The independent variables were CBP attendance (CBP was conducted 3 months after starting work), personality traits, personal stressful life events, workplace adversity, and pre-CBP change in BDI in the 3 months before CBP (ΔBDIpre-CBP). All factors were included in Cox proportional hazards models with time-dependent covariates for depressive symptoms (BDI ≥10), and we reported hazard ratios (HRs). Based on this analysis, we detected that CBP was significantly associated with benefit for depressive symptoms in all NLRNs (Puncorrected = 0.0137, HR = 0.902). To identify who benefitted most from CBP, we conducted a subgroup analysis based on the change in BDI before CBP (ΔBDIpre-CBP). The strongest association was when BDI scores were low after starting work and increased before CBP (Puncorrected = 0.00627, HR = 0.616). These results are consistent with previous findings, and indicate that CBP may benefit the mental health of NLRNs. Furthermore, selective prevention based on the pattern of BDI change over time may be important in identifying who should be offered CBP first. Although CBP is generally effective for all nurses, such a selective approach may be most appropriate where cost-effectiveness is a prominent concern.


Assuntos
Terapia Cognitivo-Comportamental/métodos , Transtorno Depressivo/terapia , Recursos Humanos de Enfermagem no Hospital/psicologia , Estresse Psicológico/complicações , Adulto , Transtorno Depressivo/etiologia , Transtorno Depressivo/psicologia , Feminino , Humanos , Estudos Longitudinais , Masculino , Prognóstico , Inquéritos e Questionários , Adulto Jovem
12.
PLoS One ; 15(10): e0238845, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33085672

RESUMO

Cognitive behavioural therapy (CBT) which includes Exposure and Response (ERP) is a highly effective, gold standard treatment for Obsessive-Compulsive Disorder (OCD). Nonetheless, not all patients with OCD significantly benefit from CBT. This has generated interest in the potential benefits of Mindfulness-Based Interventions (MBIs), either integrated with CBT, to enhance engagement with ERP tasks, or delivered as a stand-alone, first-line or therapy to augment CBT. This paper reports on two qualitative studies that involved a thematic analysis of interview data with participants in a 10-week Mindfulness-Based ERP (MB-ERP) course (study 1) and a 9-week Mindfulness-Based Cognitive Therapy course adapted for OCD (MBCT-OCD) (study 2). Whilst MB-ERP integrated a mindfulness component into a standard ERP protocol, MBCT-OCD adapted the psychoeducational components of the standard MBCT for depression protocol to suit OCD, but without explicit ERP tasks. Three common main themes emerged across MB-ERP and MBCT-OCD: 'satisfaction with course features', 'acceptability of key therapeutic tasks 'and 'using mindfulness to respond differently to OCD'. Sub-themes identified under the first two main themes were mostly unique to MB-ERP or MBCT-OCD, with the exception of '(struggles with) developing a mindfulness practice routine' whilst most of the sub-themes under the last main theme were shared across MB-ERP and MBCT-OCD participants. Findings suggested that participants generally perceived both MBIs as acceptable and potentially beneficial treatments for OCD, in line with theorised mechanisms of change.


Assuntos
Terapia Cognitivo-Comportamental/métodos , Atenção Plena/métodos , Transtorno Obsessivo-Compulsivo/terapia , Adulto , Inglaterra , Feminino , Humanos , Terapia Implosiva/métodos , Masculino , Pessoa de Meia-Idade , Transtorno Obsessivo-Compulsivo/psicologia , Aceitação pelo Paciente de Cuidados de Saúde , Satisfação do Paciente , Pesquisa Qualitativa , Resultado do Tratamento , Adulto Jovem
13.
Medicine (Baltimore) ; 99(40): e22501, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33019447

RESUMO

BACKGROUND: Tinnitus is a common disease in otolaryngology. In China, acupuncture has been used as a promising treatment for tinnitus. Yet, the specific effect and safety of acupuncture are still disputable. The ultimate goal of this paper is to formulate a protocol for systematic review and meta-analysis, which can be employed in assessing the benefits and safety of acupuncture on tinnitus. METHODS: Seven databases should be retrieved from their establishment until June 2020, including PubMed, Cochrane Central Register of Controlled Trials, Excerpt Medical Database, Chinese Biomedical Literature Database, Chinese Science and Technology Periodical Database, China National Knowledge Infrastructure and Wan Fang Database. Randomized controlled trials of acupuncture treatment of tinnitus will be included. The experimental group is acupuncture or combined with additional treatment measures, and the control group is a placebo, sham acupuncture, Cognitive Behavioral Therapy, sound therapy, conventional medication, or same additional treatment. The clinical efficacy rate, Tinnitus Handicap Inventory, Tinnitus Questionnaire, visual analogue scale or other indicators are all concerned in the systematic evaluation of the program. Data collection, selection and extraction should be made separately by different researchers. The quality of the literature will be evaluated by the bias analysis table in the Cochrane Handbook, and Review Manager 5.3 software shall be applied to data analysis. RESULTS: This protocol has made a concrete plan to evaluate whether acupuncture is effective and safe in curing tinnitus. CONCLUSION: This protocol is suitable for evaluating the effectiveness and safety of acupuncture in curing tinnitus, and is helpful for subsequent evaluation.Open Science Framework Registration DOI: 10.17605/OSF.IO/85FCS.


Assuntos
Terapia por Acupuntura/métodos , Zumbido/terapia , Terapia por Acupuntura/efeitos adversos , Terapia Cognitivo-Comportamental/métodos , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa
14.
J Clin Neurosci ; 79: 246-250, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33070905

RESUMO

Traumatic Brain Injury (TBI) is the most common cause of long-term disability and death among young adults. Innovation technology, with regard to telerehabilitation, may be of help in managing these frail patients. The aim of the study is to evaluate whether TBI patients and caregivers are able to properly use a Tele-rehabilitation device during hospitalization. Ten TBI subjects (5 males and 5 females; mean age of 45.7 ± 14.4 years), and their caregivers (6 males and 4 females; mean age of 43.7 ± 13.5 years) were consecutively recruited in this preliminary study. After 3 meetings with the telemedicine operators aimed to provide both patients and caregivers with the basic information for the proper use of the device, patients were submitted to 6 training sessions, provided 3 times per week for two weeks, each session lasting about one hour. The telerehabilitation simulation was carried out using the tele-cockpit station and the VRRS-Tablet, used either in the patient's room or in the institute's Family Room. The motivation during training was positive, as per the Intrinsic Motivation Inventory score: 202.6 for patients and 216 for caregivers. Participants also presented positive usability scores, as per the System Usability Scale score: 68 for patients and 69 for caregivers. Our feasibility and usability study supports the idea that in-patients with severe TBI could benefit from cognitive telerehabilitation performed in the pre-discharge phase, in order to get a higher level of adherence to the home tele-treatment and potentially better outcomes.


Assuntos
Lesões Encefálicas Traumáticas/reabilitação , Terapia Cognitivo-Comportamental/métodos , Telerreabilitação/métodos , Adulto , Cognição , Feminino , Humanos , Pacientes Internados , Masculino , Pessoa de Meia-Idade
15.
J R Soc Med ; 113(10): 394-402, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32930040

RESUMO

OBJECTIVES: Cognitive behavioural therapy is commonly used to treat chronic fatigue syndrome and has been shown to be effective for reducing fatigue and improving physical functioning. Most of the evidence on the effectiveness of cognitive behavioural therapy for chronic fatigue syndrome is from randomised control trials, but there are only a few studies in naturalistic treatment settings. Our aim was to examine the effectiveness of cognitive behavioural therapy for chronic fatigue syndrome in a naturalistic setting and examine what factors, if any, predicted outcome. DESIGN: Using linear mixed effects analysis, we analysed patients' self-reported symptomology over the course of treatment and at three-month follow-up. Furthermore, we explored what baseline factors were associated with improvement at follow-up. SETTING: Data were available for 995 patients receiving cognitive behavioural therapy for chronic fatigue syndrome at an outpatient clinic in the UK. PARTICIPANTS: Participants were referred consecutively to a specialist unit for chronic fatigue or chronic fatigue syndrome. MAIN OUTCOME MEASURES: Patients were assessed throughout their treatment using self-report measures including the Chalder Fatigue Scale, 36-item Short Form Health Survey, Hospital Anxiety and Depression Scale and Global Improvement and Satisfaction. RESULTS: Patients' fatigue, physical functioning and social adjustment scores significantly improved over the duration of treatment with medium to large effect sizes (|d| = 0.45-0.91). Furthermore, 85% of patients self-reported that they felt an improvement in their fatigue at follow-up and 90% were satisfied with their treatment. None of the regression models convincingly predicted improvement in outcomes with the best model being (R2 = 0.137). CONCLUSIONS: Patients' fatigue, physical functioning and social adjustment all significantly improved following cognitive behavioural therapy for chronic fatigue syndrome in a naturalistic outpatient setting. These findings support the growing evidence from previous randomised control trials and suggest that cognitive behavioural therapy could be an effective treatment in routine treatment settings.


Assuntos
Terapia Cognitivo-Comportamental/métodos , Emoções/fisiologia , Síndrome de Fadiga Crônica/terapia , Nível de Saúde , Qualidade de Vida , Adulto , Síndrome de Fadiga Crônica/epidemiologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Autorrelato , Resultado do Tratamento , Reino Unido/epidemiologia
16.
Psychiatry Res ; 293: 113438, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32905864

RESUMO

COVID-19 affects many societies by measures as "social distancing", forcing mental health care professionals to deliver treatments online or via telephone. In this context, online Eye Movement Desensitization and Reprocessing (EMDR) is an emerging treatment for patients with Posttraumatic Stress Disorder (PTSD). We performed a systematic review of studies investigating online EMDR for PTSD. Only one trial was identified. That uncontrolled open trial showed promising results. There is an urgent need to further examine the effects of online EMDR for PTSD, before its wider dissemination is warranted. Remotely delivered cognitive behavioural therapy seems the preferred PTSD-treatment in times of COVID-19.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Dessensibilização e Reprocessamento através dos Movimentos Oculares/métodos , Pandemias , Pneumonia Viral , Transtornos de Estresse Pós-Traumáticos/psicologia , Transtornos de Estresse Pós-Traumáticos/terapia , Telemedicina/métodos , Terapia Cognitivo-Comportamental/métodos , Humanos , Isolamento Social/psicologia
17.
JAMA Netw Open ; 3(8): e2015633, 2020 08 03.
Artigo em Inglês | MEDLINE | ID: mdl-32865576

RESUMO

Importance: Eating disorders (EDs) are common, serious psychiatric disorders on college campuses, yet most affected individuals do not receive treatment. Digital interventions have the potential to bridge this gap. Objective: To determine whether a coached, digital, cognitive behavior therapy (CBT) intervention improves outcomes for college women with EDs compared with referral to usual care. Design, Setting, and Participants: This cluster randomized trial was conducted from 2014 to 2018 at 27 US universities. Women with binge-purge EDs (with both threshold and subthreshold presentations) were recruited from enrolled universities. The 690 participants were followed up for up to 2 years after the intervention. Data analysis was performed from February to September 2019. Interventions: Universities were randomized to the intervention, Student Bodies-Eating Disorders, a digital CBT-guided self-help program, or to referral to usual care. Main Outcomes and Measures: The main outcome was change in overall ED psychopathology. Secondary outcomes were abstinence from binge eating and compensatory behaviors, as well as ED behavior frequencies, depression, anxiety, clinical impairment, academic impairment, and realized treatment access. Results: A total of 690 women with EDs (mean [SD] age, 22.12 [4.85] years; 414 [60.0%] White; 120 [17.4%] Hispanic; 512 [74.2%] undergraduates) were included in the analyses. For ED psychopathology, there was a significantly greater reduction in the intervention group compared with the control group at the postintervention assessment (ß [SE], -0.44 [0.10]; d = -0.40; t1387 = -4.23; P < .001), as well as over the follow-up period (ß [SE], -0.39 [0.12]; d = -0.35; t1387 = -3.30; P < .001). There was not a significant difference in abstinence from any ED behaviors at the postintervention assessment (odds ratio, 1.48; 95% CI, 0.48-4.62; P = .50) or at follow-up (odds ratio, 1.51; 95% CI, 0.63-3.58; P = .36). Compared with the control group, the intervention group had significantly greater reductions in binge eating (rate ratio, 0.82; 95% CI, 0.70-0.96; P = .02), compensatory behaviors (rate ratio, 0.68; 95% CI, 0.54-0.86; P < .001), depression (ß [SE], -1.34 [0.53]; d = -0.22; t1387 = -2.52; P = .01), and clinical impairment (ß [SE], -2.33 [0.94]; d = -0.21; t1387 = -2.49; P = .01) at the postintervention assessment, with these gains sustained through follow-up for all outcomes except binge eating. Groups did not differ in terms of academic impairment. The majority of intervention participants (318 of 385 participants [83%]) began the intervention, whereas only 28% of control participants (76 of 271 participants with follow-up data available) sought treatment for their ED (odds ratio, 12.36; 95% CI, 8.73-17.51; P < .001). Conclusions and Relevance: In this cluster randomized clinical trial comparing a coached, digital CBT intervention with referral to usual care, the intervention was effective in reducing ED psychopathology, compensatory behaviors, depression, and clinical impairment through long-term follow-up, as well as realizing treatment access. No difference was found between the intervention and control groups for abstinence for all ED behaviors or academic impairment. Given its scalability, a coached, digital, CBT intervention for college women with EDs has the potential to address the wide treatment gap for these disorders. Trial Registration: ClinicalTrials.gov Identifier: NCT02076464.


Assuntos
Terapia Cognitivo-Comportamental/métodos , Transtornos da Alimentação e da Ingestão de Alimentos/terapia , Adolescente , Adulto , Feminino , Humanos , Internet , Autocuidado , Resultado do Tratamento , Estados Unidos , Adulto Jovem
18.
J Med Internet Res ; 22(8): e18100, 2020 08 31.
Artigo em Inglês | MEDLINE | ID: mdl-32865497

RESUMO

BACKGROUND: Although there is evidence for the efficacy of internet-based cognitive behavioral therapy (iCBT), the generalizability of results to routine care is limited. OBJECTIVE: This study systematically reviews effectiveness studies of guided iCBT interventions for the treatment of depression or anxiety. METHODS: The acceptability (uptake, participants' characteristics, adherence, and satisfaction), effectiveness, and negative effects (deterioration) of nonrandomized pre-post designs conducted under routine care conditions were synthesized using systematic review and meta-analytic approaches. RESULTS: A total of 19 studies including 30 groups were included in the analysis. Despite high heterogeneity, individual effect sizes of investigated studies indicate clinically relevant changes, with effect sizes ranging from Hedges' g=0.42-1.88, with a pooled effect of 1.78 for depression and 0.94 for anxiety studies. Uptake, participants' characteristics, adherence, and satisfaction indicate a moderate to high acceptability of the interventions. The average deterioration across studies was 2.9%. CONCLUSIONS: This study provides evidence supporting the acceptability and effectiveness of guided iCBT for the treatment of depression and anxiety in routine care. Given the high heterogeneity between interventions and contexts, health care providers should select interventions that have been proven in randomized controlled clinical trials. The successful application of iCBT may be an effective way of increasing health care in multiple contexts.


Assuntos
Transtornos de Ansiedade/terapia , Terapia Cognitivo-Comportamental/métodos , Depressão/terapia , Intervenção Baseada em Internet/tendências , Adulto , Feminino , Humanos , Masculino , Adulto Jovem
19.
J Trauma Stress ; 33(5): 623-633, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32865850

RESUMO

The COVID-19 pandemic presents major challenges for mental health care providers. In particular, providers who treat posttraumatic stress disorder (PTSD) are now tasked with determining whether to initiate trauma-focused therapy during the pandemic and, if so, whether and how to adapt treatment. The purpose of this communication is to identify and organize key considerations for whether and how to deliver commonly used evidence-supported therapy protocols for trauma treatment-specifically, cognitive processing therapy (CPT) and prolonged exposure (PE) therapy-during the ongoing COVID-19 pandemic for adults who currently meet the criteria for PTSD. Based on relevant public health and clinical literature, we present a structured guide that can be used by treatment teams and individual providers to evaluate whether initiating CPT or PE is indicated given a particular patient-provider pair and system context amidst pandemic conditions. In addition, we suggest appropriate action steps, including problem-solving strategies, evidence-informed modifications to CPT and PE, and alternative intervention approaches.


Assuntos
Terapia Cognitivo-Comportamental/métodos , Infecções por Coronavirus/psicologia , Assistência à Saúde/organização & administração , Terapia Implosiva/métodos , Pneumonia Viral/psicologia , Transtornos de Estresse Pós-Traumáticos/terapia , Atitude do Pessoal de Saúde , Betacoronavirus , Continuidade da Assistência ao Paciente , Humanos , Pandemias , Cooperação do Paciente , Transtornos de Estresse Pós-Traumáticos/psicologia
20.
Interv. psicosoc. (Internet) ; 29(3): 153-164, sept. 2020. tab, graf
Artigo em Inglês | IBECS | ID: ibc-194492

RESUMO

The inconsistency in the results both internally and between of previous meta-analyses on batterer intervention program efficacy, and the publication of new batterer interventions underscored the need for an up-to-date meta-analyticalreview. A total of 25 primary studies were found from literature search, obtaining 62 effect sizes, and a total sample of 20,860 intervened batterers. The results of a global meta-analysis showed a positive, significant, and of a mediummagnitude effect size for batterer interventions, but not generalizable. Nevertheless, the results exhibited a significantly higher rate of recidivism measured in couple reports (CRs) than in official records (ORs). As a consequence, intervention efficacy measuring in CRs was null, whilst in ORs was positive and significant. As for the intervention model, positive andsignificant effects were observed under the Duluth Model and cognitive-behavioural treatment programs (CBTPs), but a higher effect size was obtained with CBTPs in comparison to the Duluth Model (under this model, interventions may have negative effects, i.e., an increase in recidivism rate). In relation to intervention length, short interventions failed to reduce recidivism in ORs and may have negative effects, while long interventions were effective in reducing recidivism rate in ORs without negative effects. Efficacy evaluations in short follow-ups were invalid as artificially boosted recidivismreduction rate. Limitations of ORs and short follow-ups as measures of the intervention efficacy and implications of results for batterer intervention are discussed


La inconsistencia interna y entre las revisiones metaanalíticas en los resultados sobre la eficacia de los programas de intervención con maltratadores, así como la publicación de nuevos estudios, pone de manifiesto la necesidad de llevar a cabo una revisión metaanalítica actualizada. Se encontró un total de 25 estudios primarios, de los que se obtuvieron 62 tamaños del efecto para una muestra total de 20,860 maltratadores intervenidos. Los resultados del metaanálisis global mostraron un tamaño del efecto promedio positivo, significativo y de una magnitud moderada para la intervención con maltratadores, pero no generalizable. Sin embargo, los resultados revelaron una tasa de reincidencia mayor medida en los informes de las parejas (IPs) que en los registros oficiales (ROs). Como consecuencia, la eficacia de la intervención medida en los IPs resultó nula, mientras que en los ROs fue positiva y significativa. En relación al modelo de intervención, se encontraron tamaños del efecto positivos y significativos con el Modelo Duluth y los programas de tratamiento cognitivo-conductuales (PTC-Cs), pero el tamaño del efecto obtenido con los PTC-Cs era significativamente mayor que con el Modelo Duluth (con este modelo las intervenciones pueden tener efectos negativos, es decir, unincremento en la tasa de reincidencia). En relación a la longitud de la intervención, las intervenciones breves fallaron en la reducción de la reincidencia en los ROs y pueden tener efectos negativos, en tanto que las intervenciones largas fueron eficaces en la reducción de la tasa de reincidencia en los ROs y no dan lugar a efectos negativos. Las evaluacionesde la eficacia de la intervención en períodos cortos de seguimiento resultaron no válidas al incrementar artificialmente la tasa de reducción de la reincidencia. Se discuten las limitaciones de la medida de la eficacia de la intervención en los ROs y en períodos cortos de seguimiento, así como las implicaciones para la intervención con maltratadores


Assuntos
Humanos , Metanálise como Assunto , Exposição à Violência/psicologia , Violência/psicologia , Teoria Psicológica , Modelos Psicológicos , Terapia Cognitivo-Comportamental/métodos , Maus-Tratos Conjugais/psicologia
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