CBT and its family of structured treatments.
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1876 to 1900 of 2,546Sexual addictions.
Unlabelled: The potential adverse consequences, personal distress, shame and guilt presented by patients who suffer from sexual addiction require a more in-depth understanding of the phenomenology and psychobiology of this disorder.
Methods: A bibliographic review was conducted using MEDLINE and EBSCO databases with the following keywords: "sexual addiction," "hypersexuality," "compulsive sexual behavior," "behavioural addiction," "treatment," and "addiction."
Results: Several conceptualizations of excessive nonparaphilic sexual disorder have been proposed based on the models of, respectively, obsessive compulsive disorder, impulse control disorder, out of control excessive sexual disorder, and addictive disorder. Despite the lack of robust scientific data, a number of clinical elements, such as the frequent preoccupation with this type of behavior, the time spent in sexual activities, t…
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Assessment and treatment of psychosocial comorbidities in patients with neuropathic pain.
Chronic neuropathic pain is a prevalent problem that eludes cure and adequate treatment. The persistence of intense and aversive symptoms, inadequacy of available treatments, and impact of such pain on all aspects of functioning underscore the important role of several psychosocial factors in causing, maintaining, and amplifying the perception of pain severity, coping adequacy, adaptation, impaired physical function, and emotional distress responses. Moreover, these factors have an influential role in response to treatment recommendations. In this article, we (1) review the prevalence and nature of emotional distress, (2) describe and propose methods for screening and comprehensive psychosocial assessment, and (3) review evidence supporting the potential complementary role of psychosocial treatments of patients with chronic pain. The cognitive-behavioral perspective and treatment approac…
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The role of mindfulness in positive reappraisal.
Mindfulness meditation is increasingly well known for therapeutic efficacy in a variety of illnesses and conditions, but its mechanism of action is still under debate in scientific circles. In this paper, we propose a hypothetical causal model that argues for the role of mindfulness in positive reappraisal coping. Positive reappraisal is a critical component of meaning-based coping that enables individuals to adapt successfully to stressful life events. Mindfulness, as a metacognitive form of awareness, involves the process of decentering, a shifting of cognitive sets that enables alternate appraisals of life events. We review the concept of positive reappraisal in transactional stress and coping theory, then describe research and traditional literature related to mindfulness and positive reappraisal, and detail the central role of mindfulness in the reappraisal process. With this unders…
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Anxiety in children and adolescents with autism spectrum disorders.
Anxiety and poor stress management are common concerns in clinical samples of children with autism spectrum disorders (ASD). Anxiety may worsen during adolescence, as young people face an increasingly complex social milieu and often become more aware of their differences and interpersonal difficulties. This review summarizes the state of research on the prevalence, phenomenology, and treatment of anxiety in youth with autism and related conditions such as Asperger's Disorder. Using search words autism, asperger(s), or pervasive developmental disorder and anxiety or anxious to find reports published between 1990 and 2008, this review identified 40 papers. The results of the review suggest that anxiety, whether measured categorically or dimensionally, is indeed common in children and adolescents with autism spectrum disorders and may be a source of additional morbidity. The assessment of a…
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Current theoretical models of generalized anxiety disorder (GAD): conceptual review and treatment implications.
Theoretical conceptualizations of generalized anxiety disorder (GAD) continue to undergo scrutiny and refinement. The current paper critiques five contemporary models of GAD: the Avoidance Model of Worry and GAD [Borkovec, T. D. (1994). The nature, functions, and origins of worry. In: G. Davey & F. Tallis (Eds.), Worrying: perspectives on theory assessment and treatment (pp. 5-33). Sussex, England: Wiley & Sons; Borkovec, T. D., Alcaine, O. M., & Behar, E. (2004). Avoidance theory of worry and generalized anxiety disorder. In: R. Heimberg, C. Turk, & D. Mennin (Eds.), Generalized anxiety disorder: advances in research and practice (pp. 77-108). New York, NY, US: Guilford Press]; the Intolerance of Uncertainty Model [Dugas, M. J., Letarte, H., Rheaume, J., Freeston, M. H., & Ladouceur, R. (1995). Worry and problem solving: evidence of a specific relationship. Cognitive Therapy and Researc…
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Review of sleep disorders.
Sleep disorders are common and may result in significant morbidity. Examples of the major sleep disturbances in primary care practice include insomnia; sleep-disordered breathing, such as obstructive sleep apnea; central nervous system hypersomnias, including narcolepsy; circadian rhythm sleep disturbances; parasomnias, such as REM sleep behavior disorder; and sleep-related movement disorders, including restless legs syndrome. Diagnosis is based on meticulous inventory of the clinical history and careful physical examination. In some cases referral to a sleep laboratory for further evaluation with polysomnography, a sleep study, is indicated.
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Hofmann SG (2008)reviewMEDLINE-indexed journal, not yet read by usClinical psychology review244 citations Cognitive processes during fear acquisition and extinction in animals and humans: implications for exposure therapy of anxiety disorders.
Anxiety disorders are highly prevalent. Fear conditioning and extinction learning in animals often serve as simple models of fear acquisition and exposure therapy of anxiety disorders in humans. This article reviews the empirical and theoretical literature on cognitive processes in fear acquisition, extinction, and exposure therapy. It is concluded that exposure therapy is a form of cognitive intervention that specifically changes the expectancy of harm. Implications for therapy research are discussed.
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Psychosocial interventions for low back pain in primary care: lessons learned from recent trials.
Study design: Workshop discussion and literature overview.
Objective: To give an overview of the main lessons learnt from recent trials on the effectiveness of psychosocial interventions for back pain in primary care.
Summary of background data: Recently, there has been a move to provide early psychosocial interventions in primary care to prevent chronic back pain. The results of most of the randomized trials, however, show only small differences between the psychosocial intervention and active control treatments in function or other outcome measures.
Methods: During Low Back Pain Forum 2006 in Amsterdam 3 subgroups debated possible explanations for these "negative" findings, focusing on (1) patient selection, (2) the intervention, or (3) assessment. These discussions were illustrated with evidence from the literature and with data from 2 randomized trials.
Results: The workshop particip…
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Complementary and alternative medicine in the treatment of anxiety and depression.
Purpose of review: There is well documented evidence for the increasing widespread use of complementary and alternative medicine in the treatment of physical and psychiatric symptoms and disorders within Western populations. Here we provide a review of the recent literature on evidence for using such interventions in the treatment of anxiety and depression.
Recent findings: With regard to herbal treatments, kava is effective in reducing anxiety symptoms and St John's wort in treating mild to moderate depression. The association of kava with hepatotoxicity, however, is a significant concern. Promising data continue to emerge for the use of omega-3 fatty acids in managing depression. Evidence for the use of acupuncture in treating anxiety disorders is becoming stronger, although there is currently minimal empirical evidence for the use of aromatherapy or mindfulness-based meditation.
Summa…
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Evidenced-based cognitive rehabilitation for persons with multiple sclerosis: a review of the literature.
Objectives: To conduct evidence-based review of cognitive rehabilitation intervention research conducted in persons with multiple sclerosis (MS), to classify level of evidence, and to generate recommendations for interventions in this area.
Data sources: An open (no year limits set) search of Medline, PsychInfo, and CINAHL (eliminating repetitions) using combinations of the following terms: attention, awareness, cognition, cognitive, communication, executive, executive function, language, learning, memory, perception, problem solving, reasoning, rehabilitation, remediation, training, and working memory. Reference sections of articles found through the sites were also searched.
Study selection: Studies were chosen based on criteria from previous evidence-based reviews such that articles are excluded from the review if (1) the study was not an intervention, (2) it was a theoretic article, …
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Passarella S, Duong MT (2008)reviewMEDLINE-indexed journal, not yet read by usAmerican journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists40 citations Diagnosis and treatment of insomnia.
Purpose: The diagnostic criteria and treatment of insomnia are reviewed.
Summary: Insomnia is most often described as a subjective complaint of poor sleep quality or quantity despite adequate time for sleep, resulting in daytime fatigue, irritability, and decreased concentration. Insomnia is classified as idiopathic or comorbid. Comorbid insomnias are associated with psychiatric disorders, medical disorders, substance abuse, and specific sleep disorders. Idiopathic insomnia is essentially a diagnosis of exclusion. A wide array of terminology exists for defining the duration of insomnia symptoms, which may add to the confusion regarding insomnia classification. Acute insomnia refers to sleep problems lasting from one night to a few weeks, whereas chronic insomnia refers to sleep problems lasting at least three nights weekly for at least one month. Diagnostic tools for identifying insomnia…
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Treatment of existential distress in life threatening illness: a review of manualized interventions.
Understanding the factors that underlie existential suffering at the end of life has become the focus of a growing body of research. A number of studies have concluded that existential questions can be distressing for some patients. Other studies have shown that existential concerns are an important dimension of quality of life and can increase a patient's risk for suicidal ideation and desire for death. Over the years, a number of psychological interventions have been developed aimed at addressing such suffering in patients with cancer. In this paper, we review the evidence supporting the importance of existential concerns in terminally ill patients, describe eight manualized interventions explicitly addressing existential themes, and evaluate the effectiveness of these interventions. Similarities and differences between each intervention are noted, and clinical and empirical considerat…
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Change is not always linear: the study of nonlinear and discontinuous patterns of change in psychotherapy.
The study of discontinuities and nonlinear change has been a fruitful endeavor across the sciences, as these shifts can provide a window into the organization of complex systems and the processes that are associated with transition. A common assumption in psychotherapy research has been that change is gradual and linear. The research designs and statistics used to study change often reflect this assumption, but some recent research reveals other patterns of change. We briefly review relevant literature on dynamical systems theory and on life transition and post-traumatic growth to highlight the significance of nonlinear and discontinuous change across areas of psychology. We describe recent applications of these ideas and methods to the study of change in psychotherapy and encourage their use to complement more traditional clinical trial designs.
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A functional analysis of danger and safety signals in anxiety disorders.
Research in experimental psychopathology indicates that predictability and controllability of threatening events mediate the development, maintenance, and modification of anxiety disorders. We propose that a more thorough analysis of predictability and controllability requires the explication of danger and safety, and those events that provide such signal functions. Although most research is concerned with the identification of signals that predict danger, relatively little attention has been given to the identification of signals that predict safety. The current manuscript outlines the functional analysis of both danger and safety signals as they relate to the various disorders of anxiety. Consideration of pharmacological treatments suggests that the modification of danger and safety signals may function only as incidental features of the intervention. The potential advantages of cognit…
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McNally RJ (2007)reviewMEDLINE-indexed journal, not yet read by usClinical psychology review203 citations Mechanisms of exposure therapy: how neuroscience can improve psychological treatments for anxiety disorders.
Exposure therapy for anxiety disorders has been one of success stories of clinical psychology and psychiatry. Nevertheless, a significant minority of patients fail to benefit from extant treatments. This clinical impasse is prompting renewed attempts to understand fear and its reduction at neural, cellular, and molecular as well as behavioral levels of analysis. The purpose of this article is to provide a review of theories of exposure therapy, including recent developments in emotional processing theory, and to discuss insights from neuroscience that promise to improve psychological treatments for reducing pathological fears.
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Social incompetence in children with ADHD: possible moderators and mediators in social-skills training.
Children with attention-deficit/hyperactivity disorder (ADHD) often encounter problems in social interactions with peers and are confronted with peer rejection and social isolation. The most common approach to social problems in children is social skills training. This intervention concept represents a variable mixture of cognitive-behavioral intervention elements. In this article the outcome of social skills training (SST) for children with ADHD is reviewed. Four experimental SSTs are detected and analyzed for potential mediators and moderators of treatment efficacy. Candidate mediators (social cognitive skills, parenting style and medication-induced reduction of key symptoms) are discussed within an empirical and theoretical context. Candidate moderators (subtype, comorbidity, gender and age) are evaluated for their empirical support. It is argued that, although fragmented, there is am…
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Psychotherapy of obsessive-compulsive disorder and spectrum: established facts and advances, 1995-2005.
Dropout rates and refractory cases persist, for reasons that remain unexplained. There are few predictor variables and few innovative approaches to deal with them. New treatment approaches must be developed to improve treatment response even for the responders. Studies show that symptoms are reduced minimally (30% 50%). No new ways of dealing with treatment-refractory cases have been developed. Studies now include more co-morbid cases, however, and their inclusion may account for some of the lack of progress in improvement rates. It needs to be seen whether patients who have one or more comorbid conditions do as well as patients who do not have comorbidity and whether the number or type of comorbid disorders accounts for treatment response. Perhaps better results would be seen with pure OCD cases. Certainly results now are more generalizable to clinical practice. Now it is important to l…
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Posttraumatic stress disorder: a state-of-the-science review.
This article reviews the state-of-the-art research in posttraumatic stress disorder (PTSD) from several perspectives: (1) Sex differences: PTSD is more frequent among women, who tend to have different types of precipitating traumas and higher rates of comorbid panic disorder and agoraphobia than do men. (2) Risk and resilience: The presence of Group C symptoms after exposure to a disaster or act of terrorism may predict the development of PTSD as well as comorbid diagnoses. (3) Impact of trauma in early life: Persistent increases in CRF concentration are associated with early life trauma and PTSD, and may be reversed with paroxetine treatment. (4) Imaging studies: Intriguing findings in treated and untreated depressed patients may serve as a paradigm of failed brain adaptation to chronic emotional stress and anxiety disorders. (5) Neural circuits and memory: Hippocampal volume appears to…
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A biopsychosocial model as a guide for psychoeducation and treatment of depression.
Effective treatment of severe or chronic unipolar depression requires the combination of pharmacological and psychotherapeutic interventions, and demands a theoretical paradigm integrating biological and psychosocial aspects of depression. Supported by recent research, we propose in our article a biopsychosocial diathesis-stress model of depression. Its basic aim is psychoeducational: to provide therapists, patients, and their environment a constructive conceptual framework to understand depressive complaints, vulnerability, and stress. The core of the model consists of the concept of psychobiological vulnerability, which is determined by risk factors-of a biogenetic, psychological, somatic, and societal nature-and by protective factors. Life events with an idiosyncratic, stress-inducing value interact with this vulnerability, triggering severe or chronic distress that affects the indivi…
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Hypochondriasis: conceptualization, treatment, and relationship to obsessive-compulsive disorder.
Once considered exclusively as a problem secondary to other mental dis-orders (ie, mood disorders), HC is now known to occur quite often as a pri-mary diagnosis. A frequent drain on medical resources, patients who have HC can be viewed as suffering essentially from an anxiety disorder in which intense fear is focused on the possibility that they might be seriously physically ill or that such illness is imminent. The processes that contribute to the development and maintenance of such health anxiety consist largely of beliefs, assumptions, and behavioral responses that, although internally consistent with the perception of health-related threat, are erroneous and highly maladaptive in that they prevent the correction of erroneous perceptions of threat. There is growing evidence that this conceptualization leads to effective reduction in HC symptoms through cognitive-behavioral and pharmac…
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Effects of D-cycloserine on extinction: translation from preclinical to clinical work.
Administration of benzodiazepines or serotonin reuptake inhibitors in combination with behavior therapy for the treatment of many anxiety disorders has generally lead to only modest gains. In this article we suggest that pharmacotherapy aimed not at treating the symptoms of anxiety but instead aimed at improving the learning that takes place in exposure therapy might actually improve the effectiveness of exposure therapy. This idea was based on animal work showing that the partial N-methyl-D-aspartate (NMDA) agonist D-cycloserine (DCS) facilitated extinction of fear when given either before or shortly after exposure to fearful cues, reduced return of fear that is normally seen when extinction training is followed by stress, and led to generalized extinction, where DCS given in combination with exposure to one fearful cue led to extinction to another cue previously paired with the same av…
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Sleep homeostasis in primary insomnia.
Three main factors, hyperarousal, circadian dysrhythmia, and homeostatic dysregulation, are thought to underlie chronic insomnia. To date, most of the empirical work has focused on the issue of hyperarousal and very little work has been undertaken on the issue of sleep homeostasis. In the present paper, we review the five lines of evidence which may be used to support the proposition that sleep homeostasis is altered in Primary Insomnia. These include findings pertaining to Slow Wave Sleep density, level of daytime sleepiness, sleepiness following sleep deprivation, recovery sleep following sleep deprivation, and response to sleep restriction therapy. In addition, we provide a discussion regarding how hyperarousal and circadian factors may interact with altered sleep homeostasis, and suggestions for further inquiry.
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Sleep disturbances in patients with post-traumatic stress disorder: epidemiology, impact and approaches to management.
Subjective reports of sleep disturbance indicate that 70-91% of patients with post-traumatic stress disorder (PTSD) have difficulty falling or staying asleep. Nightmares are reported by 19-71% of patients, depending on the severity of their PTSD and their exposure to physical aggression. Objective measures of sleep disturbance are inconsistent, with some studies that used these measures indicating poor sleep and others finding no differences compared with non-PTSD controls. Future research in this area may benefit from examining measures of instability in the microstructure of sleep. Additionally, recent findings suggest that sleep disordered breathing (SDB) and sleep movement disorders are more common in patients with PTSD than in the general population and that these disorders may contribute to the brief awakenings, insomnia and daytime fatigue in patients with PTSD. Overall, sleep pro…
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Ehntholt KA, Yule W (2006)reviewMEDLINE-indexed journal, not yet read by usJournal of child psychology and psychiatry, and allied disciplines152 citations Practitioner review: assessment and treatment of refugee children and adolescents who have experienced war-related trauma.
Background: Increasingly clinicians are being asked to assess and treat young refugees, who have experienced traumatic events due to war and organised violence. However, evidence-based guidance remains scarce.
Method: Published studies on the mental health difficulties of refugee children and adolescents, associated risk and protective factors, as well as effective interventions, particularly those designed to reduce war-related post-traumatic stress disorder (PTSD) symptoms, were identified and reviewed. The findings are summarised.
Results: Young refugees are frequently subjected to multiple traumatic events and severe losses, as well as ongoing stressors within the host country. Although young refugees are often resilient, many experience mental health difficulties, including PTSD, depression, anxiety and grief. An awareness of relevant risk and protective factors is important. A phas…
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Developmental issues in school-based aggression prevention from a social-cognitive perspective.
Contemporary research on the development and prevention of aggressive behavior in childhood and adolescence emphasizes the importance of social-cognitive factors such as perceptual biases, problem-solving skills, and social-moral beliefs in the maintenance of aggression. Indeed, school-based social-cognitive intervention approaches have been identified as best practices by the Centers for Disease Control and Prevention. However, because child age is an important covariate of both intervention effectiveness and social-cognitive ability, school-based prevention program designers should keep in mind a number of issues identified through developmental research. In this paper, we review the social-cognitive model of aggressive behavior development as applied to prevention programming. We then discuss some of the ways in which the broader developmental research base can inform the design of ag…
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