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1.
Arch Gerontol Geriatr ; 104: 104807, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36116285

RESUMO

BACKGROUND AND PURPOSE: The lack of cognitive activity accelerates age cognitive decline. Cognitive stimulation (CS) tries to enhance cognitive functioning. The purpose of this systematic review and meta-analysis was to evaluate the effects of CS on cognitive outcomes (general cognitive functioning and specific cognitive domains) in older adults (aged 65 years or older, cognitively healthy participants, or with mild cognitive impairment, or dementia). METHODS: PubMed, Scopus and Web of Science databases were examined from inception to October 2021. A total of 1,997 studies were identified in these databases, and. 33 studies were finally included in the systematic review and the meta-analysis. Raw means and standard deviations were used for continuous outcomes. Publication bias was examined by Egger's Regression Test for Funnel Plot Asymmetry and the quality assessment tools from the National Institutes of Health. RESULTS: CS significantly improves general cognitive functioning (mean difference=MD = 1.536, 95%CI, 0.832 to 2.240), memory (MD = 0.365, 95%CI, 0.300 to 0.430), orientation (MD = 0.428, 95%CI, 0.306 to 0.550), praxis (MD = 0.278, 95%CI, 0.094 to 0.462) and calculation (MD = 0.228, 95%CI, 0.112 to 0.343). CONCLUSION: CS seems to increase general cognitive functioning, memory, orientation, praxis, and calculation in older adults.


Assuntos
Terapia Cognitivo-Comportamental , Disfunção Cognitiva , Demência , Humanos , Idoso , Cognição/fisiologia , Voluntários Saudáveis
2.
J Affect Disord ; 320: 691-700, 2023 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-36206888

RESUMO

BACKGROUND: Bipolar disorder is a severe, chronic mental disorder. Treatment options are limited, with pharmacological approaches continuing to dominate. However, relapse rates remain high. Several adjunctive psychosocial interventions, mostly psychoeducation (PE) and cognitive behavioural therapy (CBT), have been trialled, but treatment innovation is still needed. In the past, brief group PE has proven as beneficial as longer individual CBT in reducing levels of depression and increasing self-management strategies. We compared the relative effectiveness of group PE to an imagery focussed cognitive behavioural therapy (ImCT). STUDY DESIGN: This was a randomised parallel group study with both daily and weekly measures. A total of 62 adult patients were randomly allocated to either ImCT or group PE. Daily, weekly and pre-and post-intervention measures were used to assess impact on (i) mood instability, (ii) overall levels of depression, anxiety and mania, and (iii) general functioning, hopelessness and imagery characteristics. A four-week baseline and 16-week follow-up period were included. RESULTS: Mood instability reduced in both conditions after intervention. Levels of mania, depression and anxiety also reduced in both conditions, but on the daily measures, depression and anxiety significantly more so in the ImCT condition. Compared with the PE condition, the ImCT condition additionally showed increased level of functioning, reduced hopelessness, and a decrease in intrusive, problematic imagery. LIMITATIONS: These findings need to be replicated in a larger trial. CONCLUSIONS: Findings suggest that ImCT is a promising new avenue for management of bipolar disorder, an area in which treatment development is urgently needed.


Assuntos
Transtorno Bipolar , Terapia Cognitivo-Comportamental , Humanos , Adulto , Transtorno Bipolar/terapia , Transtorno Bipolar/psicologia , Mania , Imagens, Psicoterapia , Ansiedade , Resultado do Tratamento
3.
Neurol Clin ; 41(1): 1-19, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36400549

RESUMO

Chronic insomnia is a clinical diagnosis fulfilled by criteria: (a) difficulty initiating or maintaining sleep, (b) inability to sleep despite having adequate opportunities, (c) having negative daytime effects due to lack of sleep, and (d) sleep difficulty not explained by other disorder-with symptoms at least three times per week during a period of 3 months. Cognitive behavioral therapy is considered a first-line treatment but can be supported with pharmacologic or digital therapeutics. When developing a patient's care plan, we should consider a "personomics" approach in which we personalize care plans as a form of sleep precision medicine.


Assuntos
Terapia Cognitivo-Comportamental , Distúrbios do Início e da Manutenção do Sono , Humanos , Distúrbios do Início e da Manutenção do Sono/diagnóstico , Distúrbios do Início e da Manutenção do Sono/terapia , Sono
4.
Neurol Clin ; 41(1): 61-76, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36400559

RESUMO

Back pain is a common condition affecting millions of individuals each year. A biopsychosocial approach to back pain provides the best clinical framework. A detailed history and physical examination with a thorough workup are required to exclude emergent or nonoperative etiologies of back pain. The treatment of back pain first uses conventional therapies including lifestyle modifications, nonsteroidal anti-inflammatory drugs, physical therapy, and cognitive behavioral therapy. If these options have been exhausted and pain persists for greater than 6 weeks, imaging and a specialist referral may be indicated.


Assuntos
Terapia Cognitivo-Comportamental , Dor Lombar , Humanos , Dor Lombar/diagnóstico , Dor Lombar/etiologia , Dor Lombar/terapia , Diagnóstico Diferencial , Dor nas Costas/diagnóstico , Dor nas Costas/etiologia , Dor nas Costas/terapia , Anti-Inflamatórios não Esteroides
5.
Med Clin North Am ; 107(1): 143-167, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36402496

RESUMO

Cognitive-behavioral therapy (CBT) is a form of psychological treatment that is based on the underlying assumption that mental disorders and psychological distress are maintained by cognitive factors, that is, that general beliefs about the world, the self, and the future contribute to the maintenance of emotional distress and behavioral problems. The overall goal of CBT is to replace dysfunctional constructs with more flexible and adaptive cognitions. The most relevant cognitive-behavioral techniques in clinical practice are: i. Cognitive Restructuring (also known as the ABCDE method) is indicated to support patients dealing with negative beliefs or thoughts. The different steps in the cognitive restructuring process are summarized by the letters in the ABCDE acronym that describe the different stages of this coaching model: Activating event or situation associated with the negative thoughts, Beliefs and belief structures held by the individual that explain how they perceive the world which can facilitate negative thoughts, Consequences or feelings related to the activating event, Disputation of beliefs to allow individuals to challenge their belief system, and Effective new approach or effort to deal with the problem by facilitating individuals to replace unhelpful beliefs with more helpful ones. ii. Problem-Solving (also known as SOLVE) to raise awareness for specific triggers, and evaluate and choose more effective options. Each letter of the SOLVE acronym identifies different steps of the problem-solving process: Select a problem, generate Options, rate the Likely outcome of each option, choose the Very best option, and Evaluate how well each option worked. For example, a suicide attempt is reconceptualized as a failure in problem-solving. This treatment approach attempts to provide patients with a better sense of control over future emerging problems. iii. Re-attribution is a technique that enables patients to replace negative self-statements (eg, "it is all my fault") with different statements where responsibility is attributed more appropriately. Furthermore, decatastrophizing may help subjects, especially adolescents decide whether they may be overestimating the catastrophic nature of the precipitating event, and by allowing them to scale the event severity they learn to evaluate situations along a continuum rather than seeing them in black and white. iv. Affect Regulation techniques are often used with suicidal adolescents to teach them how to recognize stimuli that provoke negative emotions and how to mitigate the resulting emotional arousal through self-talk and relaxation.


Assuntos
Terapia Cognitivo-Comportamental , Transtornos Mentais , Suicídio , Adolescente , Humanos , Ideação Suicida , Objetivos , Suicídio/prevenção & controle , Terapia Cognitivo-Comportamental/métodos , Transtornos Mentais/terapia
6.
Med Clin North Am ; 107(1): 85-99, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36402502

RESUMO

Post-traumatic stress disorder (PTSD) is characterized by symptoms of re-experiencing, avoidance, negative alterations in cognition and mood, and marked alterations in arousal and reactivity following exposure to a traumatic event. PTSD can be assessed by structured interviews and screening measures in psychiatric and nonpsychiatric settings. Evidence-based psychotherapies are the first-line treatment of PTSD, with cognitive behavioral therapies, such as prolonged exposure, cognitive processing therapy, and eye movement desensitization and reprocessing having the largest body and highest quality of evidence. Serotonin reuptake inhibitors are the first-line pharmacologic treatments for PTSD and are often used in conjunction with other therapeutic interventions.


Assuntos
Terapia Cognitivo-Comportamental , Transtornos de Estresse Pós-Traumáticos , Humanos , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Transtornos de Estresse Pós-Traumáticos/terapia , Cognição
7.
Behav Modif ; 47(1): 3-45, 2023 01.
Artigo em Inglês | MEDLINE | ID: mdl-35426318

RESUMO

Studying the usefulness of contextual and cognitive transdiagnostic therapies calls for an analysis of both their differential efficacy and their specificity when acting on the transdiagnostic conditions on which they focus. This controlled trial compares the post-treatment and 3- and 6-month follow-up effects of Behavioral Activation (BA), Acceptance and Commitment Therapy (ACT) and Cognitive-Behavioral Transdiagnostic Therapy (TD-CBT) on emotional symptomatology, and analyses the role played by Experiential Avoidance, Cognitive Fusion, Activation and Emotion Regulation in the clinical change. One hundred twenty-eight patients who fulfilled diagnostic criteria for anxiety and/or depression (intention-to-treat sample) were randomly assigned to three experimental group-treatment conditions (BA, n = 34; ACT, n = 27; TD-CBT n = 33) and one control group (WL, n = 34). Ninety-nine (77.34%) completed the treatment (per-protocol sample). In the post-treatment, all therapies reduced anxiety and depression symptomatology. In the follow-ups, the reduction in emotional symptomatology was greater in the condition which produced greater and more prolonged effects on Activation. Activation appears to be the principal condition in modifying all the transdiagnostic patterns and BA was the most efficacious and specific treatment. The trial was registered at ClinicalTrials.gov NCT04117464. Raw data are available online http://dx.doi.org/10.17632/krj3w2hfsj.1.


Assuntos
Terapia de Aceitação e Compromisso , Terapia Cognitivo-Comportamental , Humanos , Resultado do Tratamento , Terapia Cognitivo-Comportamental/métodos , Transtornos de Ansiedade/terapia , Transtornos de Ansiedade/psicologia , Ansiedade/terapia , Ansiedade/psicologia
8.
Psychooncology ; 31(1): 107-115, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34425036

RESUMO

OBJECTIVE: CanCope is an internet-delivered, cognitive-behavioural intervention adapted from the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders to improve emotion regulation and support the mental health of cancer survivors. Four separate pilot studies evaluated each of CanCope's modules for (1) feasibility and participant satisfaction, and changes in (2) module-specific outcomes, and (3) global measures of emotion dysregulation and anxiety and depressive symptoms, from pre-to-post module delivery. METHODS: Eligible cancer survivors self-selected into one two-week online module designed to improve a specific aspect of emotion regulation ([1] understanding emotions, [2] mindfulness of emotions, [3] cognitive reappraisals, [4] challenging emotion-driven behaviours). RESULTS: Across modules, post-intervention surveys were completed by 17-19 participants, (58.1%-90.5% completion rate for participants who received the intervention). Each module was feasible and participants reported high satisfaction. Moderate-to-large pre-to-post effect sizes in mean differences were observed in module-specific target outcomes (p's < 0.05). Emotion dysregulation significantly decreased across modules 1 to 3 (p's < 0.05) with a non-significant decrease for module 4 (p = 0.13). Anxiety symptoms significantly decreased across all modules (p's < 0.05). Depressive symptoms significantly decreased across modules 1 and 3 (p's < 0.05), with non-significant decreases across modules 2 (p = 0.08) and 4 (p = 0.06). CONCLUSIONS: Each CanCope module demonstrated promise in targeting emotion regulation skills and supporting the mental health of cancer survivors. Randomised controlled trials are required to test the efficacy of CanCope as an intervention in its entirety.


Assuntos
Sobreviventes de Câncer , Terapia Cognitivo-Comportamental , Intervenção Baseada em Internet , Neoplasias , Transtornos de Ansiedade/terapia , Sobreviventes de Câncer/psicologia , Terapia Cognitivo-Comportamental/métodos , Humanos , Saúde Mental , Neoplasias/terapia
9.
Eur J Psychotraumatol ; 13(2): 2122528, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36325255

RESUMO

Background: A negative self-concept is characterised by dysfunctional cognitions about the self and has been suggested to be a key factor involved in the development and maintenance of posttraumatic stress disorder (PTSD). In addition, the current definitions of PTSD according to DSM-5 and the new ICD-11 diagnosis of Complex PTSD (CPTSD) include aspects of negative self-concept in their diagnostic criteria. Objective: The aim of this meta-analysis was to synthesise the currently available evidence on the effects of psychological interventions for PTSD on negative self-concept. Methods: PubMed, PsychINFO, PSYNDEX, PTSDpubs and Cochrane Library were searched for randomised controlled trials (RCTs) of psychological treatments for PTSD symptoms in adults, published up to February 2021. A systematic review and meta-analysis were conducted, with risk of bias assessed by the Cochrane Risk of Bias Assessment Tool. Results: A total of 25 RCTs (N = 2585) were included in the meta-analysis. Results showed that psychological interventions significantly improve a negative self-concept with a moderate to large controlled effect size (k = 30, g = 0.67, 95% CI [0.31, 1.02], p < .001) at post-treatment. Heterogeneity between studies was large but could not be accounted for by moderators included in the current analysis, i.e. different types of interventions (e.g. with vs. without a cognitive restructuring component, trauma-focused vs. not). Conclusions: Current treatments for PTSD are effective in reducing a negative self-concept. However, more research is needed to identify moderators of this effect and identify interventions that are most effective for reducing negative self-concept.


Antecedentes: El autoconcepto negativo se caracteriza por cogniciones disfuncionales sobre uno mismo y se ha sugerido que es un factor clave involucrado en el desarrollo y mantención del trastorno de estrés postraumático (TEPT). Además, la definición actual de TEPT según el DSM-5 y el nuevo diagnóstico de TEPT complejo (TEPTC) de la CIE-11 incluyen aspectos del autoconcepto negativo en sus criterios diagnósticos.Objetivo: El objetivo de este meta-análisis fue sintetizar la evidencia actualmente disponible sobre los efectos de las intervenciones psicológicas para el TEPT sobre el autoconcepto negativo.Métodos: Se realizaron búsquedas en PubMed, PsychINFO, PSYNDEX, PTSDpubs y Cochrane Library de ensayos controlados aleatorizados (ECA) de tratamientos psicológicos para los síntomas de TEPT en adultos, publicados hasta febrero de 2021. Se realizó una revisión sistemática y un meta-análisis, con riesgo de sesgo evaluado por la Herramienta Cochrane de Evaluación del Riesgo de Sesgo.Resultados: Se incluyeron un total de 25 ECA (N = 2585) en el meta-análisis. Los resultados mostraron que las intervenciones psicológicas mejoran significativamente el autoconcepto negativo con un tamaño del efecto controlado de moderado a grande (k = 30, g = 0,67, IC del 95% [0,31, 1,02], p < 0,001) después del tratamiento. La heterogeneidad entre los estudios fue grande, pero los moderadores incluidos en el análisis actual no pudieron explicarla, es decir, diferentes tipos de intervenciones (p. ej., presencia vs. ausencia de un componente de reestructuración cognitiva, centrada en el trauma vs. no centrada en el trauma).Conclusiones: Los tratamientos actuales para el TEPT son efectivos para reducir el autoconcepto negativo. Sin embargo, se necesita de más investigaciones para identificar moderadores de este efecto e identificar intervenciones que sean más efectivas para reducir el autoconcepto negativo.


Assuntos
Terapia Cognitivo-Comportamental , Transtornos de Estresse Pós-Traumáticos , Adulto , Humanos , Transtornos de Estresse Pós-Traumáticos/terapia , Terapia Cognitivo-Comportamental/métodos , Classificação Internacional de Doenças , Sobreviventes
10.
J Clin Psychiatry ; 84(1)2022 Nov 09.
Artigo em Inglês | MEDLINE | ID: mdl-36350590

RESUMO

Comorbidity is common with posttraumatic stress disorder, and alcohol use disorder (AUD) is among the most common co-occurring disorders. When viewed through the lens of avoidance behaviors, AUD can shape an individual's response to distressing trauma reminders by dulling the emotional response and promoting disengagement from the traumatic memory. Over time, this response strengthens posttraumatic distress by reinforcing the belief that traumatic memories and their emotional responses are themselves dangerous and intolerable. In turn, this belief may impede treatment progress. Concurrent trauma-focused therapy and AUD treatment can serve to establish more adaptive coping strategies. Reducing reliance on alcohol for coping while engaging safely and effectively with trauma memories allows the individual to process the memories, build tolerance to emotional distress, and ultimately reframe maladaptive trauma-related beliefs and decrease the intensity of reactions. This case presents concurrent psychopharmacology and cognitive processing therapy for co-occurring posttraumatic stress disorder and AUD. We explore how alcohol use, and emotional avoidance more broadly, become targets for change.


Assuntos
Alcoolismo , Terapia Cognitivo-Comportamental , Psicofarmacologia , Transtornos de Estresse Pós-Traumáticos , Humanos , Transtornos de Estresse Pós-Traumáticos/complicações , Transtornos de Estresse Pós-Traumáticos/terapia , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Alcoolismo/epidemiologia , Comorbidade
11.
J Med Internet Res ; 24(11): e38911, 2022 Nov 09.
Artigo em Inglês | MEDLINE | ID: mdl-36350678

RESUMO

BACKGROUND: Text mining methods such as topic modeling can offer valuable information on how and to whom internet-delivered cognitive behavioral therapies (iCBT) work. Although iCBT treatments provide convenient data for topic modeling, it has rarely been used in this context. OBJECTIVE: Our aims were to apply topic modeling to written assignment texts from iCBT for generalized anxiety disorder and explore the resulting topics' associations with treatment response. As predetermining the number of topics presents a considerable challenge in topic modeling, we also aimed to explore a novel method for topic number selection. METHODS: We defined 2 latent Dirichlet allocation (LDA) topic models using a novel data-driven and a more commonly used interpretability-based topic number selection approaches. We used multilevel models to associate the topics with continuous-valued treatment response, defined as the rate of per-session change in GAD-7 sum scores throughout the treatment. RESULTS: Our analyses included 1686 patients. We observed 2 topics that were associated with better than average treatment response: "well-being of family, pets, and loved ones" from the data-driven LDA model (B=-0.10 SD/session/∆topic; 95% CI -016 to -0.03) and "children, family issues" from the interpretability-based model (B=-0.18 SD/session/∆topic; 95% CI -0.31 to -0.05). Two topics were associated with worse treatment response: "monitoring of thoughts and worries" from the data-driven model (B=0.06 SD/session/∆topic; 95% CI 0.01 to 0.11) and "internet therapy" from the interpretability-based model (B=0.27 SD/session/∆topic; 95% CI 0.07 to 0.46). CONCLUSIONS: The 2 LDA models were different in terms of their interpretability and broadness of topics but both contained topics that were associated with treatment response in an interpretable manner. Our work demonstrates that topic modeling is well suited for iCBT research and has potential to expose clinically relevant information in vast text data.


Assuntos
Transtornos de Ansiedade , Terapia Cognitivo-Comportamental , Criança , Humanos , Transtornos de Ansiedade/terapia , Terapia Cognitivo-Comportamental/métodos , Ansiedade/terapia , Mineração de Dados , Internet , Resultado do Tratamento
12.
BMC Health Serv Res ; 22(1): 1328, 2022 Nov 08.
Artigo em Inglês | MEDLINE | ID: mdl-36348429

RESUMO

BACKGROUND: Poor professional wellbeing and job turnover is challenging for child mental health clinics and despite an increasing interest in implementing evidence-based practices (EBPs) in mental health services, little is known about if and how using EBPs may influence therapists' professional wellbeing and turnover intention. To investigate this, we compare the average level of compassion satisfaction, burnout, secondary traumatic stress, and turnover intention between therapists trained in an EBP (Trauma-Focused Cognitive Behavioral Therapy - TF-CBT) and untrained therapists. We also explore the prevalence of and the associations between these personal and organizational outcomes. METHOD: In this cross-sectional study, the data is collected from a national sample of 373 therapists 5 years after an implementation program began (i.e., in the sustainment phase). The variables were measured by the Professional Quality of Life and the Turnover Intention Scales. The Evidence-Based Practice Attitude Scale was also used to measure therapists' attitudes toward EBPs. RESULTS: Over 70% of the respondents reported medium to high levels of burnout, secondary traumatic stress symptoms, and compassion satisfaction, whereas one-third of the respondents reported a high level of intention to leave their job in the current or near future. Higher ratings on burnout and secondary traumatic stress were significantly associated with lower compassion satisfaction and higher turnover intention. Finally, we found significantly lower degree of burnout and turnover intention along with higher compassion satisfaction among TF-CBT therapists (n = 96), compared to other therapists who were not trained in TF-CBT (n = 231). These differences could not be explained by between-group differences in age, job tenure, educational background, or therapists' attitudes towards EBPs. However, mean differences in ratings on secondary traumatic stress symptoms were not statistically significant. CONCLUSION: Although the prevalence findings are in general alarming, the present study provides the first empirical evidence for a potential positive effect of being trained in TF-CBT on therapists' wellbeing and turnover intention. We discuss these findings in the light of self-efficacy theory and the job demands-resources model.


Assuntos
Esgotamento Profissional , Terapia Cognitivo-Comportamental , Fadiga por Compaixão , Criança , Humanos , Fadiga por Compaixão/terapia , Satisfação no Emprego , Intenção , Estudos Transversais , Qualidade de Vida , Reorganização de Recursos Humanos , Esgotamento Profissional/epidemiologia , Esgotamento Profissional/terapia , Esgotamento Profissional/psicologia , Inquéritos e Questionários
13.
Gastroenterol Clin North Am ; 51(4): 723-739, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36375992

RESUMO

With growing evidence to support their efficacy, brain-gut behavior therapies are increasingly viewed as a key component to integrated care management of disorders of gut-brain interaction. However, the types of brain-gut behavior therapies differ in how and for whom they purportedly work. We provide a conceptual review of these brain-gut behavior therapies, with an emphasis on describing how (ie, mechanisms) and for whom (ie, moderators) they work as hypothesized and/or supported by evidence. Based on evidence to date, we recommend that brain-gut behavior therapies prioritize gastrointestinal-specific targets, such as gastrointestinal-specific anxiety.


Assuntos
Terapia Cognitivo-Comportamental , Síndrome do Intestino Irritável , Humanos , Síndrome do Intestino Irritável/terapia , Transtornos de Ansiedade , Encéfalo , Terapia Comportamental
14.
Ned Tijdschr Tandheelkd ; 129(11): 513-518, 2022 Nov.
Artigo em Holandês | MEDLINE | ID: mdl-36345676

RESUMO

For dental anxiety, cognitive behavioral therapy is the treatment of choice and exposure therapy is a major part of this treatment program. This article describes the underlying working mechanism of exposure therapy. Exposure should be directed toward the patient's harm expectancies. Moreover, the patient needs to be ensured that their harm expectation will not be violated, despite being challenged to the maximum. In addition, it is important that patients perform exposure exercises in as many different contexts as possible and to ensure a lot of repetition. Combining different fear-inducing stimuli during exposure sessions is also recommended. Currently, the inhibition model is the best explanatory working mechanism model and this article contrasts the new inhibition model with the older habituation model, that is still often used in clinical practice. The most important clinical implications of the inhibition model are described and illustrated with practical examples.


Assuntos
Ansiedade , Terapia Cognitivo-Comportamental , Humanos , Medo/psicologia
15.
BMJ Open ; 12(11): e061453, 2022 11 02.
Artigo em Inglês | MEDLINE | ID: mdl-36323482

RESUMO

INTRODUCTION: Excessive internet use can lead to problems for some individuals. The WHO has introduced Gaming Disorder in the International Classification of Diseases-11 (ICD-11). Previous research has shown that other internet applications can cause serious mental health problems as well. It is important to provide measures of prevention, early intervention and therapy for internet use disorders (IUDs). METHODS AND ANALYSIS: The study 'Stepped Care Approach for Problematic Internet use Treatment' is a randomised, two-arm, parallel-group, observer-blind trial. The aim of the study is to investigate if a stepped care approach is effective to reduce symptom severity for IUD. The sample is primarily recruited online with a focus on employees in companies with support of health insurances. After screening, the stepped care approach depends on the success of the previous step-that is, the successful reduction of criteria-and comprise: (1) app-intervention with questionnaires and feedback, (2) two telephone counsellings (duration: 50 min) based on motivational interviewing, (3) online therapy over 17 weeks (15 weekly group sessions, eight individual sessions) based on cognitive-behavioural therapy. A follow-up is conducted after 6 months. A total of 860 participants will be randomised. Hierarchical testing procedure is used to test the coprimary endpoints number of Diagnostic and Statistical Manual of Mental Disorders, fifth edition and ICD-11 criteria. Primary analysis will be performed with a sequential logit model. ETHICS AND DISSEMINATION: The study has been approved by the Ethics Committees of the Universities of Lübeck (file number: 21-068), Mainz (file number: 2021-15907) and Berlin (file number: 015.2021). Results will be reported in accordance to the CONSORT statement. If the approach is superior to the control condition, it may serve as part of treatment for IUD. TRIAL REGISTRATION NUMBER: DRKS00025994.


Assuntos
Terapia Cognitivo-Comportamental , Entrevista Motivacional , Telemedicina , Humanos , Uso da Internet , Berlim , Internet , Resultado do Tratamento , Ensaios Clínicos Controlados Aleatórios como Assunto
16.
Health Technol Assess ; 26(42): 1-174, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-36318050

RESUMO

BACKGROUND: Up to 10% of children and young people have a specific phobia that can significantly affect their mental health, development and daily functioning. Cognitive-behavioural therapy-based interventions remain the dominant treatment, but limitations to their provision warrant investigation into low-intensity alternatives. One-session treatment is one such alternative that shares cognitive-behavioural therapy principles but has a shorter treatment period. OBJECTIVE: This research investigated the non-inferiority of one-session treatment to cognitive-behavioural therapy for treating specific phobias in children and young people. The acceptability and cost-effectiveness of one-session treatment were examined. DESIGN: A pragmatic, multicentre, non-inferiority randomised controlled trial, with embedded economic and qualitative evaluations. SETTINGS: There were 26 sites, including 12 NHS trusts. PARTICIPANTS: Participants were aged 7-16 years and had a specific phobia defined in accordance with established international clinical criteria. INTERVENTIONS: Participants were randomised 1 : 1 to receive one-session treatment or usual-care cognitive-behavioural therapy, and were stratified according to age and phobia severity. Outcome assessors remained blind to treatment allocation. MAIN OUTCOME MEASURES: The primary outcome measure was the Behavioural Avoidance Task at 6 months' follow-up. Secondary outcomes included the Anxiety Disorder Interview Schedule, Child Anxiety Impact Scale, Revised Children's Anxiety and Depression Scale, a goal-based outcome measure, Child Health Utility 9D, EuroQol-5 Dimensions Youth version and resource usage. Treatment fidelity was assessed using the Cognitive Behaviour Therapy Scale for Children and Young People and the One-Session Treatment Rating Scale. RESULTS: A total of 274 participants were recruited, with 268 participants randomised to one-session treatment (n = 134) or cognitive-behavioural therapy (n = 134). A total of 197 participants contributed some data, with 149 participants in the intention-to-treat analysis and 113 in the per-protocol analysis. Mean Behavioural Avoidance Task scores at 6 months were similar across treatment groups when both intention-to-treat and per-protocol analyses were applied [cognitive-behavioural therapy: 7.1 (intention to treat), 7.4 (per protocol); one-session treatment: 7.4 (intention to treat), 7.6 (per protocol); on the standardised scale adjusted mean difference for cognitive-behavioural therapy compared with one-session treatment -0.123, 95% confidence interval -0.449 to 0.202 (intention to treat), mean difference -0.204, 95% confidence interval -0.579 to 0.171 (per protocol)]. These findings were wholly below the standardised non-inferiority limit of 0.4, which suggests that one-session treatment is non-inferior to cognitive-behavioural therapy. No between-group differences in secondary outcome measures were found. The health economics evaluation suggested that, compared with cognitive-behavioural therapy, one-session treatment marginally decreased the mean service use costs and maintained similar mean quality-adjusted life-year improvement. Nested qualitative evaluation found one-session treatment to be considered acceptable by those who received it, their parents/guardians and clinicians. No adverse events occurred as a result of phobia treatment. LIMITATIONS: The COVID-19 pandemic meant that 48 children and young people could not complete the primary outcome measure. Service waiting times resulted in some participants not starting therapy before follow-up. CONCLUSIONS: One-session treatment for specific phobia in UK-based child mental health treatment centres is as clinically effective as multisession cognitive-behavioural therapy and highly likely to be cost-saving. Future work could involve improving the implementation of one-session treatment through training and commissioning of improved care pathways. TRIAL REGISTRATION: This trial is registered as ISRCTN19883421. FUNDING: This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 42. See the NIHR Journals Library website for further project information.


A phobia is an intense, ongoing fear of an everyday object or situation. The phobia causes distress and the person with the phobia avoids that object or situation. Many children and young people have phobias that affect their daily lives. Cognitive­behavioural therapy helps by changing what people do or think when they have a phobia and is the most common treatment approach. However, cognitive­behavioural therapy is expensive, takes time and is not always easy to get. Different treatments are needed to help children and young people with specific phobias. One such therapy is one-session treatment, which works in similar ways to cognitive­behavioural therapy but takes place over one main 3-hour session. Our study, called ASPECT (Alleviating Specific Phobias Experienced by Children Trial), compared these two treatments to examine whether or not one-session treatment is as effective as cognitive­behavioural therapy. Overall, 274 children and young people aged 7­16 years from 26 sites nationally helped with our research, of whom 268 received either cognitive­behavioural therapy or one-session treatment. The results at 6 months found that one-session treatment and cognitive­behavioural therapy worked as well as each other for treating phobias in children and young people. We also found evidence that one-session treatment is cheaper than cognitive­behavioural therapy. We spoke with children and young people, their parents/guardians and the therapists of the single-session treatment, and we found one-session treatment to be acceptable for their needs. Future research could explore how to make one-session treatment more easily available for children and young people with specific phobias because it can save time and money, and works just as well as cognitive­behavioural therapy.


Assuntos
COVID-19 , Terapia Cognitivo-Comportamental , Transtornos Fóbicos , Adolescente , Criança , Humanos , Terapia Cognitivo-Comportamental/métodos , Análise Custo-Benefício , Pandemias , Qualidade de Vida
17.
Artigo em Inglês | MEDLINE | ID: mdl-36360766

RESUMO

We develop a protocol for assessing the impact of an intervention aimed at improving sleep quality among university nursing students. The study is designed as a pilot randomized controlled trial to be applied during the 2022-23 academic year and is registered at Clinical Trials Gov website (NCT05273086). A total of 60 nursing students will be recruited from a Spanish university. They will be divided into two groups: (30) intervention group and (30) control group. The intervention group will attend two cognitive-behavioural therapy sleep programme sessions focused on knowledge of anatomical structures involved in sleep, chronotype, synchronization, and good sleeping habits. Subjective and objective sleep quality will be assessed before and after the intervention for both groups. In addition to sleep quality, socio-demographic parameters, physical activity, lifestyle habits, and anthropometric measures will be considered prior to intervention. Finally, a satisfaction questionnaire will be applied for posterior analysis. This study is an innovative, relevant intervention that aims to improve sleep quality among university nursing students. Both the approach and the use of objective and subjective validated outcome measurements are key features of this study.


Assuntos
Terapia Cognitivo-Comportamental , Estudantes de Enfermagem , Humanos , Qualidade do Sono , Sono , Exercício Físico , Ensaios Clínicos Controlados Aleatórios como Assunto
18.
Artigo em Inglês | MEDLINE | ID: mdl-36360919

RESUMO

The COVID-19 pandemic has negatively affected students' mental health, and it is important to implement mental health management strategies. The purpose of this study was to present current findings on the implementation of remote mental health interventions in students during the pandemic. The PubMed and Web of Science electronic databases were searched and, from a total of 174 articles, 106 records were excluded according to the inclusion criteria and 23 were assessed as full texts. After the full-text screening, 12 studies were included in the review. The included publications were randomized clinical trials focused on remote mental support interventions among students from 10 countries, representing both genders, and were in the average age range of 17-55 years with an overall number of 892 participants. The included studies covered the effectiveness of strictly psychotherapeutic programs, such as cognitive-behavioral therapy (CBT) and dialectical behavior therapy (DBT), as well as other techniques such as mindfulness, laughter therapy, the brain wave modulation technique (BWM-T), and physical activity-based interventions. This narrative review provides an overview of studies with a wide range of types of remote mental health support interventions. Each of the forms of intervention analyzed in this review resulted in positive changes in students' mental health, which indicates hope for widespread help via various forms of intervention implemented remotely.


Assuntos
COVID-19 , Terapia Cognitivo-Comportamental , Humanos , Feminino , Masculino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , COVID-19/epidemiologia , Pandemias , Estudantes/psicologia , Terapia Cognitivo-Comportamental/métodos , Saúde Mental , Ensaios Clínicos Controlados Aleatórios como Assunto
19.
Artigo em Inglês | MEDLINE | ID: mdl-36361052

RESUMO

The aim of the study was to develop and evaluate cognitive behavioral therapy for insomnia (CBT-I) among college students with irritable bowel syndrome (IBS). We randomly assigned 60 college students with IBS comorbid insomnia to the experimental group who received CBT-I for 90 min once a week for 4 weeks and the control (non-CBT-I) group. Participants completed self-report measures of insomnia severity, pre-sleep arousal, sleep-related dysfunctional cognitions, maladaptive sleep habits, IBS symptom severity and IBS quality of life (QOL) at baseline, after intervention, and at 3-month follow-up. Sleep pattern, GI symptoms during sleep and Interleukin-6 (IL-6) and C-Reaction Protein (CRP) were measured at baseline and after intervention. The experimental group showed significant decreases in insomnia severity, sleep onset latency, total time in bed, pre-sleep arousal, GI symptoms during sleep, sleep-related dysfunctional cognitions, maladaptive sleep habits, and IBS symptom severity, compared with the control group. This group also showed significant increases in sleep efficiency and IBS QOL compared with the control group. No significant differences were observed between the levels of IL-6 and CRP of both groups. CBT-I for college students with comorbid IBS and insomnia was effective in reducing insomnia, IBS symptom severity, and IBS QOL.


Assuntos
Terapia Cognitivo-Comportamental , Síndrome do Intestino Irritável , Distúrbios do Início e da Manutenção do Sono , Transtornos do Sono-Vigília , Humanos , Distúrbios do Início e da Manutenção do Sono/epidemiologia , Distúrbios do Início e da Manutenção do Sono/terapia , Síndrome do Intestino Irritável/epidemiologia , Síndrome do Intestino Irritável/terapia , Qualidade de Vida , Interleucina-6 , Estudantes , Resultado do Tratamento
20.
Ageing Res Rev ; 82: 101777, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36336171

RESUMO

Dementia prevention research has progressed rapidly in recent years, with publication of several large lifestyle intervention trials, and renewed interest in pharmacological interventions, notably for individuals with Alzheimer's disease biomarkers, warranting an updated review of results and methodology. We identified 112 completed trials testing the efficacy of single-domain pharmacological (n = 33, 29%), nutritional (n = 27, 24%), physical activity (n = 18, 16%) and cognitive stimulation (n = 13, 12%), or multidomain (n = 22, 20%) interventions on incident dementia, or a relevant intermediate marker (e.g. cognitive function, biomarkers or dementia risk scores) in people without dementia. The earliest trials tested pharmacological interventions or nutritional supplements, but lifestyle interventions predominated in the last decade. In total, 21 (19%) trials demonstrated a clear beneficial effect on the pre-specified primary outcome (or all co-primary outcomes), but only two (10%) were large-scale (testing blood pressure lowering (Syst-Eur) or multidomain (FINGER) interventions on incident dementia and cognitive change in cognitive function, respectively). Of the 116 ongoing trials, 40% (n = 46) are testing multidomain interventions. Recent methodological shifts concern target populations, primary outcome measures, and intervention design, but study design remains constant (parallel group randomised controlled trial). Future trials may consider using adaptive trials or interventions, and more targeted approaches, since certain interventions may be more effective in certain subgroups of the population, and at specific times in the life-course. Efforts should also be made to increase the representativeness and diversity of prevention trial populations.


Assuntos
Doença de Alzheimer , Terapia Cognitivo-Comportamental , Disfunção Cognitiva , Humanos , Disfunção Cognitiva/prevenção & controle , Cognição , Doença de Alzheimer/prevenção & controle , Estilo de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto
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