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1.
Adv Exp Med Biol ; 1305: 295-310, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33834406

RESUMO

Recently, the importance of cognitive behavioral therapy (CBT) in the treatment of depression is gradually emerging. Particularly, mindfulness meditation has various approaches related to dialectical behavioral therapy (DBT), acceptance and commitment therapy (ACT), mindfulness-based stress reduction (MBSR), and mindfulness-based cognitive therapy (MBCT), and evidence has been provided that they alleviate depressive symptoms. In particular, as MBCT increases the level of evidence in the treatment of repetitive depressive disorders, guidelines are being recommended to prevent recurrence. Mindfulness may also contribute to improving the patient's symptoms as well as improving the therapeutic relationship with the therapist. For both mindful patients and therapists, positive awareness of internal experiences can be a good way to enrich the mind and overcome depressive disorders.


Assuntos
Terapia de Aceitação e Compromisso , Terapia Cognitivo-Comportamental , Transtorno Depressivo , Atenção Plena , Transtorno Depressivo/terapia , Humanos , Recidiva , Resultado do Tratamento
2.
Adv Exp Med Biol ; 1305: 311-332, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33834407

RESUMO

Major depressive disorder (MDD) represents a key contributor to the global burden of mental illness given its relatively high lifetime prevalence, frequent comorbidity, and disability rates. Evidence-based treatment options for depression include pharmacotherapy and psychotherapy, such as cognitive behavioral therapy (CBT). Beyond traditional CBT, over 15 years ago, Hayes proclaimed a new generation of contextualistic and process-orientated so-called third wave of CBT interventions, including acceptance and commitment therapy (ACT). Using mindfulness and acceptance as well as commitment and behavior change processes, the transdiagnostic ACT approach aims to increase psychological flexibility as universal mechanism of behavior change and to build a value-driven orientation in life. ACT for MDD can be provided as either stand-alone individual, group, or self-help formats (e.g., apps) or combined with other approaches like behavioral activation. To date, a steadily growing empirical support from outcome and process research suggests the efficacy of ACT, which appears to work specifically through the six proposed core processes involved in psychological flexibility, such as defusion. In view of an ongoing interest of clinicians in "third-wave" CBTs and the important role of clients' preferences in providing therapy choices that work, the purpose of this chapter is to give a brief overview on the application of ACT in the treatment of MDD in adults.


Assuntos
Terapia de Aceitação e Compromisso , Terapia Cognitivo-Comportamental , Transtorno Depressivo Maior , Atenção Plena , Adulto , Transtorno Depressivo Maior/terapia , Humanos , Resolução de Problemas , Resultado do Tratamento
3.
Trials ; 21(1): 1023, 2020 Dec 14.
Artigo em Inglês | MEDLINE | ID: mdl-33317615

RESUMO

BACKGROUND: The prevalence of mental health disorders is increasing globally, and the prevalence of COVID-19 has made it worse. Evidence has indicated a major mental health burden and elevated anxiety associated with the new coronavirus outbreak in the general population. This study aims to evaluate an evidence-based web application (Naranj) for stress management among Iranian college students. METHODS AND DESIGN: This study aims to present a protocol related to a randomized controlled trial among Iranian college students. The study will be conducted on 100 students from two colleges of Shiraz University of Medical Sciences in Iran. The participants will be randomly assigned to the intervention and control groups. The intervention group participants will be provided with a web application, whereas the control group ones will be provided with an app unrelated to stress management. The primary outcome for this study will be the Perceived Stress Scale, and the two groups will be compared with respect to stress level and sleep quality. DISCUSSION: A web application will be developed according to psychological theories and will be scientifically approved for managing college students' stress and improving their sleep quality during the COVID-19 outbreak. TRIAL REGISTRATION: Iranian Registry of Clinical Trials IRCT20160427027647N2 . Registered on 14 May 2020.


Assuntos
Intervenção Baseada em Internet , Estresse Psicológico/terapia , Estudantes/psicologia , Terapia de Aceitação e Compromisso , Adulto , Exercícios Respiratórios , Medicina Baseada em Evidências , Humanos , Irã (Geográfico) , Ensaios Clínicos Controlados Aleatórios como Assunto , Terapia de Relaxamento , Sono , Estresse Psicológico/psicologia , Resultado do Tratamento , Universidades , Adulto Jovem
4.
Br J Clin Psychol ; 59(4): 524-551, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32944971

RESUMO

OBJECTIVE: Psychological interventions reduce the impact of psychosis, but widescale implementation is problematic. We tested the feasibility of group acceptance and commitment therapy for Psychosis (G-ACTp), delivered by frontline staff, and co-facilitated by service-user experts-by-experience (SU-EbyE), for service-users and informal caregivers (ISRCTN: 68540929). We estimated recruitment/retention rates and outcome variability for future evaluation. METHODS: Staff and SU-EbyE facilitators completed 1-day workshops, then delivered closely supervised G-ACTp, comprising four sessions (weeks 1-4) and two boosters (10 and 12 weeks). Participants recruited from adult community psychosis services were randomized to receive G-ACTp immediately or after 12 weeks, completing outcome assessments at 0, 4, and 12 weeks. Service-use/month was calculated for 1-year pre-randomization, weeks 0-12, and 5-year uncontrolled follow-up. RESULTS: Of 41 facilitators trained (29 staff, 12 SU-EbyE), 29 (71%; 17 staff, 12 SU-EbyE) delivered 18 G-ACTp courses. Participant refusal rates were low (9% of service-users [10/112]; 5% of caregivers [4/79]); 60% of those invited to participate attended ≥1 G-ACTp session (64% of service-users [39/61]; 56% of caregivers [35/63]). Randomization of facilitators and participants proved problematic and participant follow-up was incomplete (78% [66/85]; 82% of service-users [36/44]; 73% of caregivers [30/41]). Effect sizes ranged from very small to large mostly favouring treatment. Service-use reductions require cautious interpretation, as very few participants incurred costs. CONCLUSIONS: Implementation appears feasible for service-users; for caregivers, retention needs improving. Outcome variability indicated n = 100-300/arm followed up (α = 0.05, 90% power). Methodological limitations' mean replication is needed: identified sources of potential bias may be reduced in a cluster randomized design with sessional outcome completion. PRACTITIONER POINTS: Group acceptance and commitment therapy can be successfully adapted for people with psychosis and their caregivers. Implementation (training and delivery) is possible in routine community mental health care settings. Clinical and economic outcomes are promising, but replication is needed. Recommendations are made for future studies.


Assuntos
Terapia de Aceitação e Compromisso , Cuidadores/psicologia , Transtornos Psicóticos/terapia , Adulto , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Psicoterapia de Grupo , Transtornos Psicóticos/psicologia , Resultado do Tratamento
5.
Cochrane Database Syst Rev ; 8: CD007407, 2020 08 12.
Artigo em Inglês | MEDLINE | ID: mdl-32794606

RESUMO

BACKGROUND: Chronic non-cancer pain, a disabling and distressing condition, is common in adults. It is a global public health problem and economic burden on health and social care systems and on people with chronic pain. Psychological treatments aim to reduce pain, disability and distress. This review updates and extends its previous version, published in 2012. OBJECTIVES: To determine the clinical efficacy and safety of psychological interventions for chronic pain in adults (age > 18 years) compared with active controls, or waiting list/treatment as usual (TAU). SEARCH METHODS: We identified randomised controlled trials (RCTs) of psychological therapies by searching CENTRAL, MEDLINE, Embase and PsycINFO to 16 April 2020. We also examined reference lists and trial registries, and searched for studies citing retrieved trials. SELECTION CRITERIA: RCTs of psychological treatments compared with active control or TAU of face-to-face therapies for adults with chronic pain. We excluded studies of headache or malignant disease, and those with fewer than 20 participants in any arm at treatment end. DATA COLLECTION AND ANALYSIS: Two or more authors rated risk of bias, extracted data, and judged quality of evidence (GRADE). We compared cognitive behavioural therapy (CBT), behavioural therapy (BT), and acceptance and commitment therapy (ACT) with active control or TAU at treatment end, and at six month to 12 month follow-up. We did not analyse the few trials of other psychological treatments. We assessed treatment effectiveness for pain intensity, disability, and distress. We extracted data on adverse events (AEs) associated with treatment. MAIN RESULTS: We added 41 studies (6255 participants) to 34 of the previous review's 42 studies, and now have 75 studies in total (9401 participants at treatment end). Most participants had fibromyalgia, chronic low back pain, rheumatoid arthritis, or mixed chronic pain. Most risk of bias domains were at high or unclear risk of bias, with selective reporting and treatment expectations mostly at unclear risk of bias. AEs were inadequately recorded and/or reported across studies. CBT The largest evidence base was for CBT (59 studies). CBT versus active control showed very small benefit at treatment end for pain (standardised mean difference (SMD) -0.09, 95% confidence interval (CI) -0.17 to -0.01; 3235 participants; 23 studies; moderate-quality evidence), disability (SMD -0.12, 95% CI -0.20 to -0.04; 2543 participants; 19 studies; moderate-quality evidence), and distress (SMD -0.09, 95% CI -0.18 to -0.00; 3297 participants; 24 studies; moderate-quality evidence). We found small benefits for CBT over TAU at treatment end for pain (SMD -0.22, 95% CI -0.33 to -0.10; 2572 participants; 29 studies; moderate-quality evidence), disability (SMD -0.32, 95% CI -0.45 to -0.19; 2524 participants; 28 studies; low-quality evidence), and distress (SMD -0.34, 95% CI -0.44 to -0.24; 2559 participants; 27 studies; moderate-quality evidence). Effects were largely maintained at follow-up for CBT versus TAU, but not for CBT versus active control. Evidence quality for CBT outcomes ranged from moderate to low. We rated evidence for AEs as very low quality for both comparisons. BT We analysed eight studies (647 participants). We found no evidence of difference between BT and active control at treatment end (pain SMD -0.67, 95% CI -2.54 to 1.20, very low-quality evidence; disability SMD -0.65, 95% CI -1.85 to 0.54, very low-quality evidence; or distress SMD -0.73, 95% CI -1.47 to 0.01, very low-quality evidence). At follow-up, effects were similar. We found no evidence of difference between BT and TAU (pain SMD -0.08, 95% CI -0.33 to 0.17, low-quality evidence; disability SMD -0.02, 95% CI -0.24 to 0.19, moderate-quality evidence; distress SMD 0.22, 95% CI -0.10 to 0.54, low-quality evidence) at treatment end. At follow-up, we found one to three studies with no evidence of difference between BT and TAU. We rated evidence for all BT versus active control outcomes as very low quality; for BT versus TAU. Evidence quality ranged from moderate to very low. We rated evidence for AEs as very low quality for BT versus active control. No studies of BT versus TAU reported AEs. ACT We analysed five studies (443 participants). There was no evidence of difference between ACT and active control for pain (SMD -0.54, 95% CI -1.20 to 0.11, very low-quality evidence), disability (SMD -1.51, 95% CI -3.05 to 0.03, very low-quality evidence) or distress (SMD -0.61, 95% CI -1.30 to 0.07, very low-quality evidence) at treatment end. At follow-up, there was no evidence of effect for pain or distress (both very low-quality evidence), but two studies showed a large benefit for reducing disability (SMD -2.56, 95% CI -4.22 to -0.89, very low-quality evidence). Two studies compared ACT to TAU at treatment end. Results should be interpreted with caution. We found large benefits of ACT for pain (SMD -0.83, 95% CI -1.57 to -0.09, very low-quality evidence), but none for disability (SMD -1.39, 95% CI -3.20 to 0.41, very low-quality evidence), or distress (SMD -1.16, 95% CI -2.51 to 0.20, very low-quality evidence). Lack of data precluded analysis at follow-up. We rated evidence quality for AEs to be very low. We encourage caution when interpreting very low-quality evidence because the estimates are uncertain and could be easily overturned. AUTHORS' CONCLUSIONS: We found sufficient evidence across a large evidence base (59 studies, over 5000 participants) that CBT has small or very small beneficial effects for reducing pain, disability, and distress in chronic pain, but we found insufficient evidence to assess AEs. Quality of evidence for CBT was mostly moderate, except for disability, which we rated as low quality. Further trials may provide more precise estimates of treatment effects, but to inform improvements, research should explore sources of variation in treatment effects. Evidence from trials of BT and ACT was of moderate to very low quality, so we are very uncertain about benefits or lack of benefits of these treatments for adults with chronic pain; other treatments were not analysed. These conclusions are similar to our 2012 review, apart from the separate analysis of ACT.


Assuntos
Dor Crônica/terapia , Terapia Cognitivo-Comportamental/métodos , Terapia de Aceitação e Compromisso , Adulto , Afeto , Terapia Comportamental/métodos , Viés , Dor Crônica/psicologia , Intervalos de Confiança , Humanos , Medição da Dor , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
6.
Br J Clin Psychol ; 59(4): 461-479, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32715513

RESUMO

OBJECTIVES: The aim of the current study was to assess the feasibility, safety, and effectiveness of a newly developed Acceptance and Commitment Therapy (ACT) intervention developed specifically to address the unique context of pregnancy and parenthood. The intervention was delivered to women accessing a specialist Perinatal Community Mental Health Service (PCMHS). DESIGN: An open-label pilot study was conducted of an 8-week, group-delivered ACT intervention targeting women with moderate-to-severe mood and/or anxiety disorders during pregnancy and/or postpartum. METHODS: Outcomes included session attendance rates, dropout rates, crisis/inpatient service use, and standardized symptom scales. Participant's responses to open-ended questions contained in an end of therapy questionnaire were analysed using thematic analysis. RESULTS: Seventy-four women were referred to the intervention with 65 (88%) completing treatment. The median number of sessions attended was 7. No women required input from crisis/inpatient services. All reported finding the intervention helpful. The implementation of ACT in daily life, therapist support, and group processes were cited as helpful aspects of the intervention. At post-treatment, there was a significant reduction in global distress (d = 0.99) and depressive symptoms (d = 1.05), and an increase in psychological flexibility (d = 0.93). On the secondary outcome of global distress, 38% of women were classified as recovered, 31% had reliably improved, 27% remained the same, and 4% had reliably deteriorated. CONCLUSIONS: The delivery of ACT in a routine practice setting is feasible, safe, and effective. A randomized control trial (RCT) is needed to establish the efficacy and cost-effectiveness of this group-delivered ACT intervention. PRACTITIONER POINTS: Group-delivered Acceptance and Commitment Therapy (ACT) is acceptable for women with moderate-to-severe perinatal mood and/or anxiety disorders and can be feasibly delivered in a routine practice setting. The trans-diagnostic nature of ACT enables the concurrent treatment of depressive and anxiety symptoms within the same intervention which is particularly helpful in the perinatal context given the comorbidity of mood and anxiety disorders. With training and supervision, mental health practitioners without extensive education in the delivery of psychological therapies can facilitate the ACT group programme. As this was a feasibility study, there was no control group, adherence to the manual was not assessed, and the absence of a follow-up period limits our knowledge of the longer-term benefits of the ACT group programme.


Assuntos
Terapia de Aceitação e Compromisso/estatística & dados numéricos , Transtornos de Ansiedade/terapia , Transtornos do Humor/terapia , Psicoterapia de Grupo/organização & administração , Terapia de Aceitação e Compromisso/métodos , Adulto , Afeto , Ansiedade/terapia , Transtornos de Ansiedade/epidemiologia , Serviços Comunitários de Saúde Mental/organização & administração , Comorbidade , Estudos de Viabilidade , Feminino , Humanos , Saúde Mental , Transtornos do Humor/epidemiologia , Cooperação do Paciente , Projetos Piloto , Gravidez , Estudo de Prova de Conceito , Qualidade de Vida , Inquéritos e Questionários , Resultado do Tratamento
7.
BMC Psychiatry ; 20(1): 322, 2020 06 20.
Artigo em Inglês | MEDLINE | ID: mdl-32563244

RESUMO

BACKGROUND: Patients within psychiatric rehabilitation services have multiple, complex and enduring difficulties, and are frequently described as 'treatment resistant'. This group have diagnoses of major mental health conditions, most commonly schizophrenia, often alongside a history of complex trauma, co-morbid alcohol/ substance misuse, and cognitive impairment. There is no known effective medical treatment other than Clozapine in this patient group, however, there is preliminary evidence that mindfulness can help individuals with psychosis by improving their ability to cope with stressful internal experiences. This study aimed to determine if mindfulness practice groups are an acceptable therapeutic intervention in an in-patient rehabilitation setting. The study also aimed to monitor the well-being of those who participated. METHODS: Mindfulness practice groups were offered three times weekly on a 15-bedded rehabilitation ward in a psychiatric hospital over 5 months, and weekly in a second ward over an 18 month period. The sessions were delivered by Clinical Psychologists in accordance with adaptations for a psychosis population. Attendance data were gathered on both wards and additional measures of well-being were collected on one ward. Qualitative interviews were conducted with a sample of patients, group facilitators, and staff, to provide supplementary information about the acceptability of the intervention. RESULTS: In both wards around two thirds (65, 67%) of in-patients attended at least one group and smaller proportion (around a third) went on to attend regularly. There was no discernible impact on well-being using the Warwick-Edinburgh well-being scale. Qualitative interviews suggested a number of benefits to individuals attending as well as the potential for groups to enhance the therapeutic culture within wards. CONCLUSIONS: Clinical guidelines suggest that all patients with a diagnosis of psychosis should have access to psychological therapies, but delivering psychological therapy within an in-patient rehabilitation setting can be challenging. This preliminary feasibility study suggests that mindfulness practice groups are an acceptable intervention, and that further research to look at the effectiveness of mindfulness for symptoms of treatment-resistant psychosis is both possible and merited.


Assuntos
Terapia de Aceitação e Compromisso , Atenção Plena , Reabilitação Psiquiátrica , Transtornos Psicóticos , Estudos de Viabilidade , Feminino , Humanos , Masculino , Psicoterapia de Grupo , Transtornos Psicóticos/terapia
8.
Int. j. psychol. psychol. ther. (Ed. impr.) ; 20(2): 1889-1780, jun. 2020.
Artigo em Espanhol | IBECS | ID: ibc-192930

RESUMO

No disponible


COVID-19 confinement situation imposed to the population by the public health reasons causes a considerable reordering of daily habits in families with children. Parent-child interactions might crease and, accordingly, the opportunities to strengthen adaptive behavioral dynamics between the child and their parents and other family members. If this is not the case, problematic behavior increases and, in the context of confinement conditions, the probability of COVID-19 might also infection. Functional Analysis of Behavior is a key reference to shape child'behavior and in the same functional root, Acceptance and Commitment Therapy (ACT) is proving to be useful to build psychological flexibility in many arenas beyond the clinical one where it accumulates remarkable evidence. One of this arenas points to building flexible behavioral patterns in children both in educational and family contexts. The present work aims to apply the ACT model for managing the child's behavior and for improving psychological flexibility during family interactions in the context of following the instructions to reduce virus infection


Assuntos
Humanos , Criança , Transtornos do Comportamento Infantil/terapia , Infecções por Coronavirus/epidemiologia , Quarentena/psicologia , Terapia de Aceitação e Compromisso , Pandemias/estatística & dados numéricos , Distância Social , Sintomas Afetivos/epidemiologia , Características da Família , Relações Familiares/psicologia , Transtornos do Comportamento Infantil/epidemiologia
9.
Int J Behav Med ; 27(5): 539-555, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32394219

RESUMO

BACKGROUND: Psychological processes can be manifested in physiological health. We investigated whether acceptance and commitment therapy (ACT), targeted on psychological flexibility (PF), influences inflammation and stress biomarkers among working-age adults with psychological distress and overweight/obesity. METHOD: Participants were randomized into three parallel groups: (1) ACT-based face-to-face (n = 65; six group sessions led by a psychologist), (2) ACT-based mobile (n = 73; one group session and mobile app), and (3) control (n = 66; only the measurements). Systemic inflammation and stress markers were analyzed at baseline, at 10 weeks after the baseline (post-intervention), and at 36 weeks after the baseline (follow-up). General PF and weight-related PF were measured with questionnaires (Acceptance and Action Questionnaire, Acceptance and Action Questionnaire for Weight-Related Difficulties). RESULTS: A group × time interaction (p = .012) was detected in the high-sensitivity C-reactive protein (hsCRP) level but not in other inflammation and stress biomarkers. hsCRP decreased significantly in the face-to-face group from week 0 to week 36, and at week 36, hsCRP was lower among the participants in the face-to-face group than in the mobile group (p = .035, post hoc test). Age and sex were stronger predictors of biomarker levels at follow-up than the post-intervention PF. CONCLUSION: The results suggest that ACT delivered in group sessions may exert beneficial effects on low-grade systemic inflammation. More research is needed on how to best apply psychological interventions for the health of both mind and body among people with overweight/obesity and psychological distress. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01738256, Registered 17 August, 2012.


Assuntos
Terapia de Aceitação e Compromisso , Adulto , Biomarcadores , Humanos , Inflamação , Obesidade/terapia , Sobrepeso
10.
Pediatr Clin North Am ; 67(3): 589-602, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32443997

RESUMO

Behavior and substance use addictions are increasingly prevalent in children with increased risk for substance abuse and mental health diagnoses in adulthood. This article proposes a comprehensive model of addiction to inform research on the prevention and treatment of childhood addiction, emphasizing skills training, mindfulness training, and broader treatment strategies consistent with acceptance and commitment therapy.


Assuntos
Terapia Comportamental/métodos , Comportamento Aditivo/prevenção & controle , Transtornos Relacionados ao Uso de Substâncias/prevenção & controle , Terapia de Aceitação e Compromisso , Comportamento Aditivo/psicologia , Criança , Humanos , Atenção Plena , Transtornos Relacionados ao Uso de Substâncias/psicologia
11.
Prax Kinderpsychol Kinderpsychiatr ; 69(3): 183-202, 2020 May.
Artigo em Alemão | MEDLINE | ID: mdl-32394825

RESUMO

Indicated Stress Prevention for Adolescents in the Group Setting - A manual based on Acceptance- and Commitment-Therapy Stress in adolescence has become a topic of interest in recent years. Long-term exposure to stress can play a significant role in the development and maintenance of mental disorders. Previous studies have shown that especially the more severely stressed adolescents benefit from targeted interventions. However, evidence-based treatment concepts targeting this group are scarce. In this article we introduce the first German-language treatment manual for indicated stress prevention, addressing adolescents based on Acceptance and Commitment Therapy (ACT). ACT is part of the third wave of behavioral therapies, designed for treatment across disorders, which makes it suitable for the treatment of chronic stress symptoms. Previous studies show good efficacy of the ACT-approach in the treatment of adult stress and first promising successes in treatment of adolescents in non-German-speaking countries. The focus of our training lies in practical exercises based on ACT which are conveyed by the use of metaphors, art therapy techniques, role plays and group discussions. The concept is complemented by psychoeducation on stress, mindfulness exercises and training in problem solving. Worksheets and tasks for the week facilitate the transfer into everyday life. Alongside the presentation of the treatment manual, first experiences in the implementation of the program are discussed.


Assuntos
Terapia de Aceitação e Compromisso , Estresse Psicológico/prevenção & controle , Adolescente , Alemanha , Humanos , Transtornos Mentais/complicações , Atenção Plena , Estresse Psicológico/complicações
12.
Rev. psicol. clín. niños adolesc ; 7(2): 42-49, mayo 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-193692

RESUMO

Desde una perspectiva contextual, la literatura propone que en la base de las dificultades de regulación emocional se hayan déficits en la capacidad de interpretar y reaccionar de forma adaptativa ante la experiencia interna. Existen escasas propuestas de aplicación de terapias contextuales en población adolescente con estas dificultades. Se propone un protocolo de psicoterapia breve grupal ACT para adolescentes con dificultades de regulación emocional que consiga mejorar la observación, interpretación y elección de acción ante experiencias internas desagradables. El protocolo de intervención fue aplicado desde el Sistema Público de Salud Mental de España a ocho participantes. La evaluación consistió en la aplicación de la Escala de Dificultad de Regulación Emocional (DERS-E) y el Cuestionario de Evitación Experiencial II (AAQ-II) pre y post-intervención, además del registro de las Conductas Clínicamente Relevantes (CCR) de los participantes durante el desarrollo de la terapia en grupo. Se describen los ejercicios aplicados durante las seis sesiones del protocolo, especificando el objetivo de intervención de cada ejercicio propuesto, y se detallan algunas intervenciones de terapeutas y participantes. Se observa una mejoría significativa en las puntuaciones relacionadas con componentes conductuales (impulsividad, interferencia a metas, estrategias de regulación emocional) y no significativas en las variables de clarificación emocional, además de cambios en las CCR. Los resultados plantean una reflexión sobre la necesidad de ampliar en el diseño del protocolo los ejercicios dirigidos a lograr mejorías en clarificación emocional. Es necesario valorar la efectividad de la intervención en una muestra más amplia de adolescentes


Contextual literature points to the fact that, on the basis of the difficulties of emotional regulation, there is a deficit to understand and react properly to the internal experience. There are few proposals for the application of contextual therapies in adolescent population with these difficulties. An ACT brief psychotherapy group protocol is proposed for teenagers with emotional-regulation difficulties. The protocol tries to achieve improvements in observation, interpretation and action choice against unpleasant internal experiences. The intervention protocol was developed in a Public Mental Healthcare System of Spain to eight participants. The assessment consisted of the application of the Emotional Regulation Difficulty Scale (DERS-E) and the Experiential Avoidance Questionnaire II (AAQ-II) pre and post-intervention, as well as the record of the Clinically Relevant Behaviors (RCCs) of the participants during the group therapy. Exercises applied during the six protocol sessions are described, specifying the clinical target of every exercise and some of the interventions of therapists and participants are detailed. There is a significant improvement in scores related to behavioral components (impulsivity, interference to goals, strategies of emotional regulation) than in variables related to emotional awareness and changes in RCCs are observed. Results point out the need of reinforcing emotional awareness exercises in the protocol. It is necessary to evaluate the effectiveness of the intervention in a larger sample of adolescents


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Terapia de Aceitação e Compromisso , Comportamento do Adolescente/psicologia , Psicoterapia de Grupo , Sintomas Afetivos/psicologia , Sintomas Afetivos/terapia , Projetos Piloto
13.
PLoS One ; 15(4): e0231380, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32271833

RESUMO

INTRODUCTION: An Australian case series study demonstrated the effectiveness of the REsilience and Activities for every DaY for people with multiple sclerosis (READY for MS), a resilience group training program based on Acceptance and Commitment Therapy, in improving quality of life in people with MS. This study aimed to evaluate the feasibility and acceptability of the Italian READY for MS program, and to preliminary assess its efficacy when compared to an active control intervention (group relaxation). METHODS: Single-blind phase II randomized controlled trial (RCT) and nested qualitative study (ISRCTN registration number: 38971970). Health-related quality of life (primary study outcome), mood, resilience, psychological flexibility and its protective factors were measured at baseline, after seven, 12 and 24 weeks. READY participants completed the purpose-built satisfaction questionnaire after 12 weeks. After trial completion, the control group also received READY. One-to-one participant interviews were conducted within three months of finishing the READY groups. RESULTS: Four intervention groups were conducted with 39 participants (20 READY, 19 relaxation). Two patients (READY) withdrew before beginning the intervention due to unexpected work commitments. Feasibility and acceptability of READY were good, with high participant engagement and satisfaction. No statistical effects of READY were detected vs relaxation. Thirty participants were interviewed (18 READY; 12 relaxation + READY). Content data analysis revealed seven overarching themes: "Attitudes towards participation"; "Perceptions of program composition"; "Program impacts on life domains"; "Program active elements"; "Program improvement trajectories"; "Program differences and similarities"; "Suggested READY improvements". CONCLUSION: READY was well accepted by MS patients with varied socio-demographic and clinical characteristics. Qualitative (but not quantitative) data provided evidence in favour of READY. Our findings will inform methodological and intervention refinements for the multi-centre RCT that will follow.


Assuntos
Esclerose Múltipla/psicologia , Avaliação de Programas e Projetos de Saúde , Resiliência Psicológica , Terapia de Aceitação e Compromisso , Adulto , Estudos de Viabilidade , Feminino , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla/patologia , Avaliação de Resultados em Cuidados de Saúde , Projetos Piloto , Pesquisa Qualitativa , Qualidade de Vida , Método Simples-Cego , Inquéritos e Questionários
14.
BMC Psychiatry ; 20(1): 155, 2020 04 07.
Artigo em Inglês | MEDLINE | ID: mdl-32264845

RESUMO

BACKGROUND: Attachment theory predicts that patients who are not securely attached may benefit less from psychological treatment. However, evidence on the predictive role of attachment in the effectiveness of treatment for depression is limited. METHODS: Explicit attachment styles, levels of attachment anxiety and attachment avoidance, as well as implicit relational self-esteem and implicit relational anxiety were assessed in 67 patients with major depressive disorder (MDD) receiving Acceptance and Commitment Therapy (ACT) or Cognitive Behavioral Therapy (CBT). ANOVA and hierarchical regression analyses were performed to investigate the predictive power of explicit and implicit attachment measures on treatment outcome. RESULTS: Explicit attachment avoidance at pre-treatment significantly predicted reduction of depressive symptoms following treatment. Reductions in attachment anxiety and avoidance from pre- to post-treatment predicted better treatment outcomes. Neither one of the implicit measures, nor change in these measures from pre- tot post-treatment significantly predicted treatment outcome. CONCLUSIONS: Our findings show that attachment avoidance as well as reductions in avoidant and anxious attachment predict symptom reduction after psychological treatment for depression. Future research should use larger sample sizes to further examine the role of attachment orientation as moderator and mediator of treatment outcome. TRIAL REGISTRATION: clinicaltrials.gov; NCT01517503.


Assuntos
Terapia de Aceitação e Compromisso , Terapia Cognitivo-Comportamental , Depressão , Transtorno Depressivo Maior , Ansiedade/terapia , Depressão/terapia , Transtorno Depressivo Maior/terapia , Humanos
15.
Behav Ther ; 51(1): 162-177, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-32005334

RESUMO

There is a major public health need for innovative and efficacious behavioral and cognitive interventions for smoking cessation. This randomized controlled trial evaluated the efficacy of an acceptance and commitment therapy (ACT) smartphone application in augmenting ACT group treatment for smoking cessation. One hundred fifty adults smoking 10 or more cigarettes per day were randomly assigned to 6 weekly group sessions of behavioral support, ACT, or ACT combined with the smartphone application. Access to the app was provided from the start of the in-person treatment until the 6-month follow-up assessment. Participants were encouraged to make their quit attempts after the third session, and the posttreatment assessment occurred 3 weeks later. Measures of smoking status and ACT processes were obtained at baseline, posttreatment, and 6-month follow-up. Biochemically verified quit rates in the combined, ACT, and behavioral support groups were 36% (p = .079 relative to ACT; p = .193 relative to behavioral support), 20% (p = .630 relative to behavioral support) and 24% at posttreatment, as compared with 24% (p = .630 relative to behavioral support), 24% (p = .630 relative to behavioral support) and 20% at follow-up. There was no significant difference (p = > .999) in the primary outcome of biochemically verified 7-day point-prevalence abstinence at 6-month follow-up between the combined and ACT groups. The combined group reported significantly greater smoking reduction, acceptance and present-moment awareness than the behavioral support group at posttreatment, but not at follow-up. There were no significant differences between the groups in positive mental health. Contrary to hypotheses, the ACT group did not display significant improvements in positive mental health or ACT processes relative to the behavioral support group at posttreatment or follow-up. Implications and directions for future research are discussed.


Assuntos
Terapia de Aceitação e Compromisso/métodos , Aplicativos Móveis , Smartphone , Abandono do Hábito de Fumar/métodos , Fumar/terapia , Adulto , Terapia Combinada/métodos , Terapia Combinada/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fumar/psicologia , Abandono do Hábito de Fumar/psicologia , Adulto Jovem
16.
Adv Exp Med Biol ; 1191: 291-329, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32002935

RESUMO

Anxiety disorders are an enormous societal burden given their high lifetime prevalence among adult populations worldwide. A variety of anxiety disorders can be successfully treated with psychological treatments such as cognitive behavioral therapy (CBT), mindfulness-based cognitive therapy (MBCT), and acceptance and commitment therapy (ACT), either as stand-alone individual or group treatment or as adjunctive treatment to pharmacotherapy. Furthermore, a growing body of evidence suggests that therapist-guided Internet-delivered CBT (iCBT) and, to some degree, digitalized mindfulness- and acceptance-based interventions may be an efficacious complement to traditional face-to-face therapy. In view of the current advances regarding the integration of traditional and innovative treatment approaches, this chapter provides an overview on the theory and evidence base for different delivery modes of CBT-related interventions for specific phobia, panic disorder, agoraphobia, social anxiety disorder, and generalized anxiety disorder in adults. Finally, implications for clinical practice and research will be derived, and future directions for the psychological treatment of anxiety disorders will be outlined.


Assuntos
Terapia de Aceitação e Compromisso , Transtornos de Ansiedade/psicologia , Transtornos de Ansiedade/terapia , Terapia Cognitivo-Comportamental , Atenção Plena , Humanos , Transtornos Fóbicos/psicologia , Transtornos Fóbicos/terapia , Resultado do Tratamento
17.
J Psychosoc Nurs Ment Health Serv ; 58(3): 14-18, 2020 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-31971598

RESUMO

Substance use disorders (SUDs) are prevalent and carry a high mortality rate. SUDs are chronic health conditions resulting from a chemical imbalance in the brain. However, recovery from SUDs is possible. There are several evidence-based nonpharmacological therapies for SUDs, including cognitive-behavioral therapy, acceptance and commitment therapy, dialectical behavioral therapy, mindfulness-based interventions, and eye movement desensitization reprocessing. Many patients are not aware of, or do not receive, these therapies. Nurses can use simple strategies within the therapy models when working with patients with SUDs. In addition, nurses are in a prime position to educate patients about these evidence-based therapies and refer patients to therapists or advanced practice nurses with training and expertise in these nonpharmacological treatments. [Journal of Psychosocial Nursing and Mental Health Services, 58(3), 14-18.].


Assuntos
Terapia de Aceitação e Compromisso , Terapia Cognitivo-Comportamental , Atenção Plena , Enfermagem Psiquiátrica , Transtornos Relacionados ao Uso de Substâncias/terapia , Prática Avançada de Enfermagem , Humanos , Serviços de Saúde Mental
18.
Body Image ; 32: 155-166, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32000093

RESUMO

Body image problems are central aspects of eating disorders (ED), and risk factors both for the development of and relapse into an ED. Acceptance and commitment therapy (ACT) aims at helping patients accept uncomfortable internal experiences while committing to behaviors in accordance with life values. The aim of the present study was to compare the effectiveness of a group intervention, consisting of 12 sessions, based on ACT to treatment as usual (TAU) for patients with residual ED symptoms and body image problems. The study was a randomized controlled superiority trial. Patients with residual ED symptoms and body image problems were recruited from a specialized ED clinic in Sweden. The final sample consisted of 99 women, randomized to ACT or TAU. At the two-year follow-up, patients who received ACT showed a significant greater reduction in ED symptoms and body image problems and received less specialized ED care than patients in TAU. In conclusion, ACT was superior in reducing ED symptoms and body image problems.


Assuntos
Terapia de Aceitação e Compromisso , Insatisfação Corporal , Transtornos da Alimentação e da Ingestão de Alimentos/terapia , Adulto , Feminino , Seguimentos , Humanos , Suécia , Resultado do Tratamento
19.
Lancet Gastroenterol Hepatol ; 5(3): 316-328, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31859185

RESUMO

This Review summarises recent pharmacological and upcoming alternative interventions for children with functional abdominal pain disorders (FAPDs). Pharmacological targets include prokinetics and drugs affecting gastric accommodation to treat postprandial distress and nausea. Similarly, anti-inflammatory agents, junctional protein regulators, analgesics, secretagogues, and serotonin antagonists have a therapeutic role for irritable bowel syndrome. Non-pharmacological treatments include peripheral electrical nerve field stimulation to the external ear, gastric electrical stimulation, dietary interventions such as low fructose and fibre based diets, and nutraceuticals, which include probiotics, prebiotics, and synbiotics. Newer psychological advances such as exposure-based cognitive behavioural therapy, acceptance and commitment therapy, and mindfulness meditation are being investigated for paediatric functional pain. Lastly, alternative therapies such as acupuncture, moxibustion, yoga, and spinal manipulation are also gaining popularity in the treatment of FAPDs.


Assuntos
Dor Abdominal/tratamento farmacológico , Síndrome do Intestino Irritável/tratamento farmacológico , Náusea/tratamento farmacológico , Período Pós-Prandial/efeitos dos fármacos , Dor Abdominal/fisiopatologia , Dor Abdominal/terapia , Terapia de Aceitação e Compromisso/métodos , Acupuntura/métodos , Adolescente , Analgésicos/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Criança , Pré-Escolar , Terapia Cognitivo-Comportamental/métodos , Dietoterapia/métodos , Suplementos Nutricionais/estatística & dados numéricos , Estimulação Elétrica/métodos , Feminino , Humanos , Masculino , Manipulação da Coluna/métodos , Atenção Plena/métodos , Moxibustão/métodos , Prebióticos/estatística & dados numéricos , Probióticos/uso terapêutico , Angústia Psicológica , Secretagogos/uso terapêutico , Antagonistas da Serotonina/uso terapêutico , Simbióticos/administração & dosagem , Resultado do Tratamento , Ioga , Adulto Jovem
20.
Behav Modif ; 44(1): 70-91, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-30117327

RESUMO

The purpose of this study was to examine acceptance and commitment therapy (ACT) as a standalone treatment for trichotillomania in a randomized controlled trial of adults and adolescents. Participants consisted of a community sample of treatment seeking adults and adolescents with trichotillomania. Of the eligible 39 participants randomized into treatment and waitlist groups, 25 completed treatment and were included in the final analysis. Treatment consisted of a 10-session ACT protocol. Multiple mixed models repeated measures analyses were utilized to evaluate changes in trichotillomania symptom severity, daily number of hairs pulled and urges experienced, and experiential avoidance from pretreatment to posttreatment. Findings indicated significant changes in symptom severity and daily hairs pulled, but not daily urges experienced or psychological flexibility. However, psychological flexibility saw a 24.5% decrease in the treatment group and reduced from clinical to subclinical levels on average. This study suggests that ACT alone is an effective treatment for adults and adolescents with trichotillomania. Outcomes appear to be similar to trials that combined ACT and habit reversal training (HRT).


Assuntos
Terapia de Aceitação e Compromisso , Tricotilomania/terapia , Adolescente , Adulto , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Resultado do Tratamento , Tricotilomania/diagnóstico , Tricotilomania/psicologia , Adulto Jovem
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