CBT and its family of structured treatments.
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1851 to 1875 of 2,546Post-traumatic stress disorder--a diagnostic and therapeutic challenge.
Background: In Germany, the one-month prevalence of post-traumatic stress disorder (PTSD) is in the range of 1% to 3%. Soldiers, persons injured in accidents, and victims of domestic violence increasingly seek medical help for symptoms of emotional stress. Days lost from work and monetary compensation for emotional disturbances are markedly on the rise. The term "PTSD" is commonly used uncritically and imprecisely, with too little regard for the existing diagnostic criteria. It is at risk of turning into a nonspecific collective term for emotional stress of any kind.
Methods: We selectively reviewed the literature in the PubMed database and pertinent journals, with additional consideration of the recommendations and guidelines of medical societies from Germany and abroad.
Results: The characteristic types of reactions seen in PTSD are nightmares and an intense, repetitive, intrusive "rel…
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Comorbidity of anxiety and depression in children and adolescents: 20 years after.
Brady and Kendall (1992) concluded that although anxiety and depression in youths are meaningfully linked, there are important distinctions, and additional research is needed. Since then, studies of anxiety-depression comorbidity in youths have increased exponentially. Following a discussion of comorbidity, we review existing conceptual models and propose a multiple pathways model to anxiety-depression comorbidity. Pathway 1 describes youths with a diathesis for anxiety, with subsequent comorbid depression resulting from anxiety-related impairment. Pathway 2 refers to youths with a shared diathesis for anxiety and depression, who may experience both disorders simultaneously. Pathway 3 describes youths with a diathesis for depression, with subsequent comorbid anxiety resulting from depression-related impairment. Additionally, shared and stratified risk factors contribute to the developmen…
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Disruptions in autobiographical memory processing in depression and the emergence of memory therapeutics.
Depression is characterized by distinct profiles of disturbance in ways autobiographical memories are represented, recalled, and maintained. We review four core domains of difficulty: systematic biases in favor of negative material; impoverished access and responses to positive memories; reduced access to the specific details of the personal past; and dysfunctional processes of rumination and avoidance around personal autobiographical material. These difficulties drive the onset and maintenance of depression; consequently, interventions targeted at these maladaptive processes have clinical potential. Memory therapeutics is the development of novel clinical techniques, translated from basic research, that target memory difficulties in those with emotional disorders. We discuss prototypical examples from this clinical domain including MEmory Specificity Training, positive memory elaboratio…
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A dual-systems perspective on addiction: contributions from neuroimaging and cognitive training.
Dual-systems theories explain lapses in self-control in terms of a conflict between automatic and deliberative modes of behavioral control. Numerous studies have now tested whether the brain areas that control behavior are organized in a manner consistent with dual-systems models. Brain regions directly associated with the mesolimbic dopamine system, the nucleus accumbens and ventromedial prefrontal cortex in particular, capture some of the features assumed by automatic processing. Regions in the lateral prefrontal cortex are more closely linked to deliberative processing and the exertion of self-control in the suppression of impulses. While identifying these regions crudely supports dual-systems theories, important modifications to what constitutes automatic and deliberative behavioral control are also suggested. Experiments have identified various means by which automatic processes may…
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A review of physical and cognitive interventions in aging.
Maintaining a healthy brain is a critical factor for the quality of life of elderly individuals and the preservation of their independence. Challenging aging brains through cognitive training and physical exercises has shown to be effective against age-related cognitive decline and disease. But how effective are such training interventions? What is the optimal combination/strategy? Is there enough evidence from neuropsychological observations, animal studies, as well as, structural and functional neuroimaging investigations to interpret the underlying neurobiological mechanisms responsible for the observed neuroplasticity of the aging brain? This piece of work summarizes recent findings toward these questions, but also highlights the role of functional brain connectivity work, an emerging discipline for future research in healthy aging and the study of the underlying mechanisms across th…
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Phenomenology and treatment of behavioural addictions.
Behavioural addictions are characterized by an inability to resist an urge or drive resulting in actions that are harmful to oneself or others. Behavioural addictions share characteristics with substance and alcohol abuse, and in areas such as natural history, phenomenology, and adverse consequences. Behavioural addictions include pathological gambling, kleptomania, pyromania, compulsive buying, compulsive sexual behaviour, Internet addiction, and binge eating disorder. Few studies have examined the efficacy of pharmacological and psychological treatment for the various behavioural addictions, and therefore, currently, no treatment recommendations can be made.
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Training your brain: Do mental and physical (MAP) training enhance cognition through the process of neurogenesis in the hippocampus?
New neurons are produced each day in the hippocampus through the process of neurogenesis. Both mental and physical training can modify this process by increasing the number of new cells that mature into functional neurons in the adult brain. However, the mechanisms whereby these increases occur are not necessarily the same. Physical activity, especially aerobic exercise greatly increases the number of new neurons that are produced in the hippocampal formation. In contrast, mental training via skill learning increases the numbers that survive, particularly when the training goals are challenging. Both manipulations can increase cognitive performance in the future, some of which are reportedly mediated by the presence of new neurons in the adult hippocampus. Based on these data, we suggest that a combination of mental and physical training, referred to here as MAP training, is more benefic…
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The promotion of self-regulation through parenting interventions.
The capacity for a parent to self-regulate their own performance is argued to be a fundamental process underpinning the maintenance of positive, nurturing, non-abusive parenting practices that promote good developmental and health outcomes in children. Deficits in self-regulatory capacity, which have their origins in early childhood, are common in many psychological disorders, and strengthening self-regulation skills is widely recognised as an important goal in many psychological therapies and is a fundamental goal in preventive interventions. Attainment of enhanced self-regulation skills enables individuals to gain a greater sense of personal control and mastery over their life. This paper illustrates how the self-regulatory principles can be applied to parenting and family-based interventions at the level of the child, parent, practitioner and organisation. The Triple P-Positive Parent…
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The practice of exposure therapy: relevance of cognitive-behavioral theory and extinction theory.
Exposure therapy is the most effective psychological intervention for people with anxiety disorders. While many therapists learn how to implement exposure techniques through clinical training programs or instructional workshops, not all of these educational efforts include a focus on the theory underlying this treatment. The availability of treatment manuals providing step-by-step instructions for how to implement exposure makes it easier for clinicians to use these techniques with less training than they might otherwise receive. This raises questions regarding whether it is necessary to understand the theory behind the use of exposure. This article argues that knowledge of the relevant theory is crucial to being able to implement exposure therapy in ways that optimize both short- and long-term outcome. Specific ways in which theory is relevant to using exposure techniques are discussed.
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Interventions for treating obesity in children.
Childhood obesity remains an important public health concern and prevention programmes should be the priority in order to decrease the prevalence of obesity. The aim of this review is to summarize the most effective types of intervention for treating obesity in children and adolescents. A number of identified strategies used to treat childhood obesity range from lifestyle approaches, pharmacotherapy to surgical intervention. Dietary treatment of obese children and adolescents should aim to ensure adequate growth and development by reducing excessive fat mass accumulation, avoiding loss of lean body mass, improving well-being and self-esteem, and preventing cyclical weight regain. Management protocols involve behaviour modifications, family support, and lifestyle changes which are difficult to put into practice and may require multidisciplinary professional teams. The cornerstone of weigh…
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Neurobiological correlates of cognitions in fear and anxiety: a cognitive-neurobiological information-processing model.
We review likely neurobiological substrates of cognitions related to fear and anxiety. Cognitive processes are linked to abnormal early activity reflecting hypervigilance in subcortical networks involving the amygdala, hippocampus, and insular cortex, and later recruitment of cortical regulatory resources, including activation of the anterior cingulate cortex and prefrontal cortex to implement avoidant response strategies. Based on this evidence, we present a cognitive-neurobiological information-processing model of fear and anxiety, linking distinct brain structures to specific stages of information processing of perceived threat.
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Zebrack B, Isaacson S (2012)reviewMEDLINE-indexed journal, not yet read by usJournal of clinical oncology : official journal of the American Society of Clinical Oncology333 citations Psychosocial care of adolescent and young adult patients with cancer and survivors.
The delivery of quality care for adolescent and young adult (AYA) patients with cancer and survivors requires an understanding of the unique qualities of this group--the shared norms, attitudes, and beliefs that determine their behavior as well as the unique stresses they face on a day-to-day basis. All AYAs have typical concerns about being comfortable with who they are and who they want to become (identity development, including sexual identity), their bodies (body image), initiating intimate and emotional relationships, separating from parents, and making independent decisions about future goals such as career, higher education, and/or family (autonomy). Yet efforts of AYA patients with cancer and survivors to mature are often confounded by restrictions and limitations placed on them by their disease and treatment. This article promotes understanding of psychosocial challenges faced b…
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Cognitive training for impaired neural systems in neuropsychiatric illness.
Neuropsychiatric illnesses are associated with dysfunction in distributed prefrontal neural systems that underlie perception, cognition, social interactions, emotion regulation, and motivation. The high degree of learning-dependent plasticity in these networks-combined with the availability of advanced computerized technology-suggests that we should be able to engineer very specific training programs that drive meaningful and enduring improvements in impaired neural systems relevant to neuropsychiatric illness. However, cognitive training approaches for mental and addictive disorders must take into account possible inherent limitations in the underlying brain 'learning machinery' due to pathophysiology, must grapple with the presence of complex overlearned maladaptive patterns of neural functioning, and must find a way to ally with developmental and psychosocial factors that influence re…
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Hwang GC, Tillberg CS, Scahill L (2012)reviewMEDLINE-indexed journal, not yet read by usJournal of child and adolescent psychiatric nursing : official publication of the Association of Child and Adolescent Psychiatric Nurses, Inc12 citations Habit reversal training for children with tourette syndrome: update and review.
Topic: Habit reversal training (HRT) is emerging as an efficacious behavioral intervention for Tourette syndrome in children and adults.
Purpose: The purpose of this article is to review the recent literature investigating the efficacy of HRT for treating children with chronic tic disorders.
Sources: This review examines single-subject design studies and randomized, controlled trials of HRT conducted in children with chronic tic disorders since 2000.
Conclusions: Intervention built on HRT appears to be effective for decreasing tic severity in children and adolescents. Results from a recent multisite trial suggest that incorporation of functional analysis may enhance the effectiveness of traditional HRT.
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The mindful brain and emotion regulation in mood disorders.
Mindfulness involves nonjudgmental attention to present-moment experience. In its therapeutic forms, mindfulness interventions promote increased tolerance of negative affect and improved well-being. However, the neural mechanisms underlying mindful mood regulation are poorly understood. Mindfulness training appears to enhance focused attention, supported by the anterior cingulate cortex and the lateral prefrontal cortex (PFC). In emotion regulation, these PFC changes promote the stable recruitment of a nonconceptual sensory pathway, an alternative to conventional attempts to cognitively reappraise negative emotion. In neural terms, the transition to nonconceptual awareness involves reducing evaluative processing, supported by midline structures of the PFC. Instead, attentional resources are directed toward a limbic pathway for present-moment sensory awareness, involving the thalamus, ins…
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Mindfulness meditation-related pain relief: evidence for unique brain mechanisms in the regulation of pain.
The cognitive modulation of pain is influenced by a number of factors ranging from attention, beliefs, conditioning, expectations, mood, and the regulation of emotional responses to noxious sensory events. Recently, mindfulness meditation has been found attenuate pain through some of these mechanisms including enhanced cognitive and emotional control, as well as altering the contextual evaluation of sensory events. This review discusses the brain mechanisms involved in mindfulness meditation-related pain relief across different meditative techniques, expertise and training levels, experimental procedures, and neuroimaging methodologies. Converging lines of neuroimaging evidence reveal that mindfulness meditation-related pain relief is associated with unique appraisal cognitive processes depending on expertise level and meditation tradition. Moreover, it is postulated that mindfulness med…
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Young S, Thome J (2011)reviewMEDLINE-indexed journal, not yet read by usThe world journal of biological psychiatry : the official journal of the World Federation of Societies of Biological Psychiatry54 citations ADHD and offenders.
Objectives: To present the needs and psychological treatment options for offenders with ADHD.
Methods: Key papers are discussed in relation to this topic.
Results: Research suggests there is a disproportionately high number of individuals with ADHD involved with the Criminal Justice System. UK studies among offenders have indicated around 45% of youths and 24% of male adults screen positive for a childhood history of ADHD, 14% of whom have persisting symptoms in adulthood. Those with persisting symptoms have a significantly younger onset of offending and higher rate of recidivism. ADHD was the most powerful predictor of violent offending, even above substance misuse. They accounted for 8-fold more institutional aggressive behavioural disturbances (critical incidents) than other non-ADHD prisoners. Critical incidents have also been associated with personality disordered patients screening…
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Gambling disorders.
Gambling disorders, including pathological gambling and problem gambling, have received increased attention from clinicians and researchers over the past three decades since gambling opportunities have expanded around the world. This Seminar reviews prevalence, causes and associated features, screening and diagnosis, and treatment approaches. Gambling disorders affect 0·2-5·3% of adults worldwide, although measurement and prevalence varies according to the screening instruments and methods used, and availability and accessibility of gambling opportunities. Several distinct treatment approaches have been favourably evaluated, such as cognitive behavioural and brief treatment models and pharmacological interventions. Although promising, family therapy and support from Gamblers Anonymous are less well empirically supported. Gambling disorders are highly comorbid with other mental health and…
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Perfectionism as a transdiagnostic process: a clinical review.
Perfectionism is a risk and maintaining factor for eating disorders, anxiety disorders and depression. The objective of this paper is to review the four bodies of evidence supporting the notion that perfectionism is a transdiagnostic process. First, a review of the literature was conducted that demonstrates the elevation of perfectionism across numerous anxiety disorders, depression, and eating disorders compared to healthy controls. Data is presented that shows perfectionism increases vulnerability for eating disorders, and that it maintains obsessive-compulsive disorder, social anxiety and depression as it predicts treatment outcome in these disorders. Second, evidence is examined showing that elevated perfectionism is associated with co-occurrence of psychopathology. Third, the different conceptualisations of perfectionism are reviewed, including a cognitive-behavioural conceptualisat…
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Mindfulness-based eating awareness training for treating binge eating disorder: the conceptual foundation.
This paper reviews the conceptual foundation of mindfulness-based eating awareness training (MB-EAT). It provides an overview of key therapeutic components as well as a brief review of current research. MB-EAT is a group intervention that was developed for treatment of binge eating disorder (BED) and related issues. BED is marked by emotional, behavioral and physiological disregulation in relation to food intake and self-identity. MB-EAT involves training in mindfulness meditation and guided mindfulness practices that are designed to address the core issues of BED: controlling responses to varying emotional states; making conscious food choices; developing an awareness of hunger and satiety cues; and cultivating self-acceptance. Evidence to date supports the value of MB-EAT in decreasing binge episodes, improving one's sense of self-control with regard to eating, and diminishing depressi…
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Rationale for the application of exposure and response prevention to the treatment of anorexia nervosa.
Objective: Anorexia nervosa (AN) is a life threatening and difficult to treat illness with a high relapse rate. Current treatments are inadequate and new approaches to treatment are needed.
Method: We review the data on anxiety in AN, the relationship between anxiety disorders and AN, and the use of Exposure and Response Prevention in treatment.
Results: The overlap between AN and anxiety disorders suggest a model of AN in which baseline anxiety features yield eating related fears, avoidance behaviors, and ritualized safety behaviors that promote the underweight state and the perpetuation of the disorder. We propose an Exposure and Response Prevention treatment to prevent relapse in AN.
Discussion: Overlap between AN and anxiety disorders suggests that Exposure and Response Prevention may be a new and beneficial approach to preventing relapse in individuals with AN.
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Understanding and treating insomnia.
Sleep disturbance is intricately entwined with our sense of well-being, health, emotion regulation, performance and productivity, memory and cognitive functioning, and social interaction. A longitudinal perspective underscores the conclusion that persistent sleep disturbance, insomnia, at any time during the life span from infancy to old age has a lasting impact. We examine how insomnia develops, the evidence for competing explanations for understanding insomnia, and the evidence about psychological and behavioral treatments that are used to reduce insomnia and change daytime consequences. There are new directions to expand access to treatment for those who have insomnia, and thus a critical analysis of pathways for dissemination is becoming increasingly important.
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A novel theory of experiential avoidance in generalized anxiety disorder: a review and synthesis of research supporting a contrast avoidance model of worry.
An important emphasis of the literature on generalized anxiety disorder (GAD) has been to achieve a greater understanding of the function of emotion (e.g., avoidance, dysregulation) in the etiology and maintenance of this disorder. The purpose of the following paper is to propose a new way of conceptualizing emotional sequelae in GAD by detailing the Contrast Avoidance Model of Worry. In presenting this model, we review theory and data that led to our current position, which is that individuals with GAD are more sensitive to feeling emotionally vulnerable to unexpected negative events, and that worry (the key pathological feature of GAD) is employed to prolong and maintain a negative emotional state thereby avoiding an unexpected negative emotional shift, or contrast experience. We also discuss implications for treatment given the presence of a new target for emotional exposure technique…
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Therapy-relevant factors in adult ADHD from a cognitive behavioural perspective.
Adult individuals with attention-deficit hyperactivity disorder (ADHD) have been suffering from this neurobiological and highly heritable disorder chronically since childhood. Resulting from their longstanding neuropsychological impairments, such as attentional problems, emotional instability, and disinhibition, they are familiar to a multiplicity of negative life outcomes and underachievement. Furthermore, a large part of this population suffers from psychiatric comorbidity. This accumulation of negative experiences has an impact on therapy-relevant factors such as the individual's self-esteem, self-efficacy, development of core beliefs/schemas, and coping strategies. Based on negative beliefs about the self, individuals confronted with difficult situations develop maladaptive coping strategies, for instance avoidance and procrastination. These strategies lead to maintenance and reinfor…
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Psychological and interpersonal dimensions of sexual function and dysfunction.
Introduction: There are limited outcome data on the etiology and efficacy of psychological interventions for male and female sexual dysfunction as well as the role of innovative combined treatment paradigms.
Aim: This study aimed to highlight the salient psychological and interpersonal issues contributing to sexual health and dysfunction, to offer an etiological model for understanding the evolution and maintenance of sexual symptoms, and to offer recommendations for clinical management and research.
Methods: This study reviewed the current literature on the psychological and interpersonal issues contributing to male and female sexual dysfunction.
Main outcome measure: This study provides expert opinion based on a comprehensive review of the medical and psychological literature, widespread internal committee discussion, public presentation, and debate.
Results: Medical and psychological …
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