Cognitive behavioural therapy and mindfulness for stress and burnout: a waiting list controlled pilot study comparing treatments for parents of children with chronic conditions.

BACKGROUND: Parents of children with chronic conditions often experience a crisis with serious mental health problems for themselves as a consequence. The healthcare focus is on the children; however, the parents often worry about their children's health and future but are seldom offered any counselling or guidance. AIM: The aim of this study was to investigate the effectiveness of two group-based behavioural interventions on stress and burnout among parents of children with chronic conditions. DESIGN, PARTICIPANTS AND SETTING: After a waiting list control period (n = 28), parents were offered either a cognitive behavioural (CBT, n = 10) or a mindfulness program (MF, n = 9). RESULTS: Both interventions decreased significantly stress and burnout. The within-group effect sizes were large in both interventions (CBT, g = 1.28-1.64; MF, g = 1.25-2.20). CONCLUSIONS: Hence, the results of this pilot study show that treating a group using either CBT or mindfulness can be an efficient intervention for reducing stress levels and burnout in parents of children with chronic conditions.

The Cognitive Profile of Persons with Obsessive Compulsive Disorder with and without Autism Spectrum Disorder.

INTRODUCTION: Autistic Spectrum Disorder (ASD) is often comorbid with Obsessive Compulsive Disorder (OCD). But to what extent can obsessional symptoms in individuals with ASD be considered "genuinely" comorbid OCD - or are there other mechanisms that are related to ASD? Which mechanisms in OCD with and without ASD share common features? People with ASD have a cognitive profile characterized by "mindblindness"; the antecedent is often referred to in terms of not knowing how to perform or behave and this is the cause of discomfort. This raises the question whether individuals with ASD and comorbid OCD share the same cognitive elements of responsibility interpretation and the same fear of causing harm as individuals who merely have OCD. OBJECTIVE: The aim of the present study is therefore to evaluate the extent of responsibility interpretation in individuals with OCD alone compared with people experiencing OCD in the context of ASD. METHODS: Two instruments, the Responsibility Attitude Scale (RAS) and the Responsibility Interpretations Questionnaire (RIQ), were administered to three groups of participants: (i) individuals diagnosed with OCD (n = 32); (ii) individuals with ASD and OCD (n = 19); and (iii) non-clinical control participants (n = 23). RESULTS: Results indicate significant differences in all measures of responsibility belief (interpretation of obsession and assumption of responsibility) between the OCD-only group and the two other groups. CONCLUSION: The conclusion is that OCD in people with ASD is not as "genuine" as in people with only OCD, according to cognitive behavioral theory of OCD.

Affective Changes During Cognitive Behavioural Therapy-As Measured by PANAS.

BACKGROUND: Previous researches have indicated that self-reported positive affect and negative affect is changing in a healthy direction during Cognitive Behavioural Therapy (CBT). OBJECTIVE: The aim of the present study was to examine how affective personality is related to psychopathology before and after CBT. METHOD: A group of clients (n = 73) was measured before and after CBT, differentiated by their problem areas at pre-therapy (i.e., depressive, anxious and mixed). RESULTS: After therapy, clients experienced higher positive affect (p < .02, d=0.66), lower negative affect (p < .001, d=0.98) and there was a significant change in the distribution of affective personality regardless of problem area, χ2 = 8.41, df = 3, two-tailed p = .04, 99% CI [0.03, 0.04]. The change in the distribution was largest for the two most relevant personality types, self-actualization and self-destructive affective personality. CONCLUSION: Results indicate that CBT can achieve changes in affect and affective personality.

Effectiveness of cognitive behavioral therapy on health-related quality of life: An evaluation of therapies provided by trainee therapists.

The present study was carried out to examine the treatment effect of cognitive behavioral therapy provided by trainee therapists at a university clinic, focusing on health-related quality of life (HRQOL) optimism and symptoms. The study was conducted through a repeated measures design and included a treatment group (n = 21), which received cognitive behavioral therapy for an average of 10.7 therapy sessions and a control group (n = 14), that was put on a wait list for 8.6 weeks on average. After treatment, the treatment group improved significantly concerning general health (p = 0.028) and optimism (p = 0.027). In addition, clients improved in several areas within mental health and displayed some reduction in anxiety symptoms. Concurrently, the results also indicated some improvement within the control group, which may have been caused by the initial therapeutic contact, expectancy effects or spontaneous remission. The study concluded that cognitive behavioral therapy provided by trainee therapists may have a positive effect on areas within HRQOL and optimism.

Modified CBT using visualization for Autism Spectrum Disorder (ASD), anxiety and avoidance behavior--a quasi-experimental open pilot study.

In recent studies it has been suggested that Cognitive Behavior Therapy (CBT) is beneficial to people with Autism Spectrum Disorder (ASD) but that the method needs to be modified in relation to their cognitive profile. The aim of this study is to measure the effect of modified CBT, that is, using visualized language throughout the entire session for clients with ASD and anxiety and avoidance behavior. The modification of CBT in this study consists of focusing on CBT protocols for anxiety disorders and depression, while visualizing and systematizing "the invisible" in the conversation, in order for the clients to understand the social, cognitive and emotional context of self and others and how they should interact to avoid misunderstandings. ASD clients may need help to detect the invisible code of social interaction and communication. The level of anxiety and the frequency of target behavior were measured. Four assessments were made, two at the pre-assessment, and one in mid-therapy and end of therapy respectively. Generally, results suggest no improvement during pre-treatment period but a significant improvement during treatment. The values of the clients' psychological, social and occupational ability to function improved on the Global Function Rating scale. The preliminary conclusion of this pilot study indicates that the use of visualized language throughout the CBT therapy sessions is a promising modification of current CBT protocols for individuals with ASD. After manualization, larger studies with randomized controlled study designs can replicate or challenge these results.

The first 38 methadone maintenance treatment patients in Stockholm: 15-year follow-up with a main focus on detoxification from methadone.

BACKGROUND/AIMS: The present study investigated the first 38 methadone maintenance treatment (MMT) patients in Stockholm. The aim was: (i) to investigate the possible predictive factors for successful treatment termination, and (ii) the long-term outcome effects and life situation of MMT patients and those who terminated the treatment. METHODS: The patients were interviewed at the start and approximately 15 years later, and divided into four groups: (1) no withdrawal attempts, (2) forced to stop the treatment, (3) successful tapering and (4) non-successful tapering. RESULTS: The predictive factor found that Group 1 showed a lower life quality compared with Groups 3 and 4. Fifteen years later, the life situations of Groups 3 and 4 were significantly more stable. Also the subjective well-being in Group 3 was significantly higher. Over all, Group 2 showed significantly more illicit drug use compared with Group 3. The social life situation was significantly improved for all patients during the 15 years. CONCLUSION: This study confirms our earlier findings that the ultimate goal of MMT for the motivated patients with good progress should be an opiate-free life. The life situation and subjective well-being seems to be higher after successful termination of MMT.

Benzodiazepine tapering: a prospective study.

BACKGROUND: Benzodiazepines (BZD) are the most widely used sedative-hypnotics, and evidence is rapidly accumulating suggesting potential BZD dependence, association of chronic use with adverse effects and a definite abstinence syndrome produced by withdrawal. AIMS: The present investigation followed prospectively long-term BZD users over 1 year following graded BZD withdrawal in terms of clinical and withdrawal symptoms. METHODS: Clinical symptoms were measured by the Comprehensive Psychopathological Rating Scale (CPRS) and by the Newcastle Anxiety and Depression Diagnostic Index (NADDI) in a sample of BZD users over a 50-week period following graded BZD withdrawal. RESULTS: The results showed that the frequency and severity of clinical symptomatology measured by both scales significantly decreased over time. A detailed analysis of possible patterns of symptoms on both scales revealed four patterns: 1) a gradual decrease over the 50-week time period; 2) an increase in the severity of symptoms at the onset of tapering and a decrease in severity post-tapering; 3) an increase in the severity of symptoms 4 weeks after the cessation of BZD tapering; and 4) no change over the 50-week time period. Rate of BZD withdrawal was associated with CPRS ratings of global illness at admission and at end of treatment, but was not associated with duration or dosage of BZDs, type of BZD, prescriptive and/or non-prescriptive drug use prior to admission, marital status, sex or age. CONCLUSIONS: The results of the present study provide a detailed picture of the pattern of symptoms, their time course and multidimensional determinants of the BZD withdrawal symptoms.

Syntheses, Charge Separation, and Inverted Bulk Heterojunction Solar Cell Application of Phenothiazine-Fullerene Dyads.

A series of phenothiazine-fulleropyrrolidine (PTZ-C60) dyads having fullerene either at the C-3 aromatic ring position or at the N-position of phenothiazine macrocycle were newly synthesized and characterized. Photoinduced electron transfer leading to PTZ(•+)-C60(•-) charge-separated species was established from studies involving femtosecond transient absorption spectroscopy. Because of the close proximity of the donor and acceptor entities, the C-3 ring substituted PTZ-C60 dyads revealed faster charge separation and charge recombination processes than that observed in the dyad functionalized through the N-position. Next, inverted organic bulk heterojunction (BHJ) solar cells were constructed using the dyads in place of traditionally used [6,6]-phenyl-C61- butyric acid methyl ester (PCBM) and an additional electron donor material poly(3-hexylthiophene) (P3HT). The performance of the C-3 ring substituted PTZ-C60 dyad having a polyethylene glycol substituent produced a power conversion efficiency of 3.5% under inverted bulk heterojunction (BHJ) configuration. This was attributed to optimal BHJ morphology between the polymer and the dyad, which was further promoted by the efficient intramolecular charge separation and relatively slow charge recombination promoted by the dyad within the BHJ structure. The present finding demonstrate PTZ-C60 dyads as being good prospective materials for building organic photovoltaic devices.

Effectiveness of cognitive behavioral therapy: An evaluation of therapies provided by trainees at a university psychotherapy training center.

At the psychotherapy training center at Karlstad University, a study was carried out to examine the levels of symptom change and satisfaction with therapy in a heterogeneous population of clients treated using cognitive behavioral therapy (CBT) by less experienced trainee therapists with limited theoretical education. The clients received an average of 11 therapy sessions. The results suggested that CBT performed by less experienced trainee therapists can be effective. According to client estimations, a statistically significant reduction in symptoms, measured using the Symptoms Checklist, was achieved for seven of nine variables (p ≤ .006), as well as a significant increase in satisfaction with life (p ≤ .001). Also, the pre- and posttherapy measurements using the Montgomery-Åsberg Depression Rating Scale showed a statistically significant improvement in the clients' condition. According to the therapists' estimations, 64% (SD = 32.01) of the clients experienced a significant improvement in their condition. In addition, the results of a survey of client satisfaction demonstrated that the clients were very pleased with the therapy received. Also the therapists were, to a great extent, satisfied with the treatment process itself, including the supervision received, and very satisfied with the client alliance. A correlation analysis between the clients' perceived level of improvement and therapist satisfaction showed a strong correlation between the two variables (r = .50, p < .005). By including the Comparative Psychotherapy Process Scale (CPPS) in our study it was possible to measure trueness to therapy form. An analysis of the CPPS results confirmed that the form of therapy used at the training site was more strongly CBT than psychodynamic interpersonal treatment (p ≤ .001). The CBT subscale score indicated that the therapy was characteristic of CBT, confirming that the interventions used in the therapy belong to the CBT genre.

Should mood during intravenous alcohol administration be studied as a bi- or unipolar phenomenon? a pilot study.

In this study, alcohol was administered intravenously to study whether its effects on mood should preferably be studied as a bi- or unipolar phenomenon. This was studied in a double-blind, placebo-balanced, design on six healthy male volunteers. Of the three bipolar aspects of mood (calmness, activity, and pleasantness), only calmness was significantly affected by intravenous alcohol. In contrast, there were significant differences between alcohol and placebo for five of the six unipolar indexes. This support the hypothesis that subjective effects of alcohol on mood are preferably studied with self-ratings that allows positive and negative aspects to be analyzed separately. Further, our data suggest that the effects of alcohol are primarily on negative aspects of mood rather than on positive.

Withdrawal from methadone maintenance treatment. Reasons for not trying to quit methadone.

Although factors associated with successful termination of methadone maintenance treatment (MMT) have been well studied, the question of why certain methadone patients try to taper off methadone while others do not is still unanswered. Those patients who wish to continue MMT should of course be allowed to stay in treatment. However, even if only a small portion of the MMT patients wish to quit maintenance treatment, they should be offered all possible support by the treatment staff to maximize the possibility of a successful outcome. In the present study, we compared two groups of well-functioning MMT patients with respect to background factors, methadone-related factors, drug-related factors and psychological characteristics: one group consisted of patients who were trying to terminate their MMT (group 1) and the other group consisted of patients who were not trying (group 2). Each of the groups contained 25 well-rehabilitated subjects matched by age, gender and the number of years in MMT. The results show that the patients who were not trying to terminate MMT (in comparison to group 1) were not influenced by others to try to quit methadone, had a long history of opiate use as well as mixed drug use prior to MMT, had a higher methadone dose and reported a lower degree of anticipated abstinence symptoms. According to the statements of the subjects in group 2, the most important reason for not quitting treatment was the belief that they needed the methadone. The fact that they knew others who had failed to quit MMT and low confidence in succeeding were other common answers. Further, our results suggest that patients who were satisfied with their overall drug situation were less inclined to make a withdrawal attempt.