CBT and its family of structured treatments.
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2301 to 2325 of 2,546Neuropsychological and socio-occupational functioning in young psychiatric outpatients: a longitudinal investigation.
Background: Clinical symptoms and neuropsychological deficits are longitudinally associated with functional outcome in chronic psychiatric cohorts. The current study extended these findings to young and early-course psychiatric outpatients, with the aim of identifying cognitive markers that predict later socio-occupational functioning.
Methods: At baseline, 183 young psychiatric outpatients were assessed. Ninety-three returned for follow-up (M = 21.6 years old; SD = 4.5) with an average re-assessment interval of 21.6 months (SD = 7.0), and primary diagnoses of major depressive disorder (n = 34), bipolar disorder (n = 29), or psychosis (n = 30). The primary outcome measure was cross-validated with various other functional measures and structural equation modelling was used to map out the interrelationships between predictors and later functional outcome.
Results: Good socio-occupational f…
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Wagner G, Wagner G, Penelo E, Nobis G, Mayerhofer A, Schau J, Spitzer M, Imgart H, Karwautz A (2013)MEDLINE-indexed journal, not yet read by usNeuropsychiatrie : Klinik, Diagnostik, Therapie und Rehabilitation : Organ der Gesellschaft Osterreichischer Nervenarzte und Psychiater8 citations Is technology assisted guided self-help successful in treating female adolescents with bulimia nervosa?
Objective: This study aims to evaluate the long-term outcome of new technology assisted guided self-help in adolescents with bulimia nervosa (BN).
Method: One hundred and twenty-six patients with BN (29 adolescents and 97 adults) were randomly allocated to a cognitive behavioural therapy-based self-help program delivered by the Internet or bibliotherapy, both accompanied by e-mail guidance. Outcomes were assessed at baseline, month 4, 7 and 18 including remission rates and eating disorder associated psychopathology.
Results: In all, 44% of adolescents vs. 38.7% of adults were in remission at month 7, and 55% of adolescents vs. 62.5% of adults were in remission at follow-up. Objective binge eating and compensatory behaviour improved significantly over time in both groups, with the highest decrease during the first 4 months. A significant decrease over time and no group differences have be…
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Do programs designed to train working memory, other executive functions, and attention benefit children with ADHD? A meta-analytic review of cognitive, academic, and behavioral outcomes.
Children with ADHD are characterized frequently as possessing underdeveloped executive functions and sustained attentional abilities, and recent commercial claims suggest that computer-based cognitive training can remediate these impairments and provide significant and lasting improvement in their attention, impulse control, social functioning, academic performance, and complex reasoning skills. The present review critically evaluates these claims through meta-analysis of 25 studies of facilitative intervention training (i.e., cognitive training) for children with ADHD. Random effects models corrected for publication bias and sampling error revealed that studies training short-term memory alone resulted in moderate magnitude improvements in short-term memory (d=0.63), whereas training attention did not significantly improve attention and training mixed executive functions did not signifi…
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Mindful pregnancy and childbirth: effects of a mindfulness-based intervention on women's psychological distress and well-being in the perinatal period.
This pilot study explored the effects of an 8-week mindfulness-based cognitive therapy group on pregnant women. Participants reported a decline in measures of depression, stress and anxiety; with these improvements continuing into the postnatal period. Increases in mindfulness and self-compassion scores were also observed over time. Themes identified from interviews describing the experience of participants were: 'stop and think', 'prior experience or expectations', 'embracing the present', 'acceptance' and 'shared experience'. Childbirth preparation classes might benefit from incorporating training in mindfulness.
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Sheffer C, Mackillop J, McGeary J, Landes R, Carter L, Yi R, Jones B, Christensen D, Stitzer M, Jackson L, Bickel W (2012)MEDLINE-indexed journal, not yet read by usThe American journal on addictions154 citations Delay discounting, locus of control, and cognitive impulsiveness independently predict tobacco dependence treatment outcomes in a highly dependent, lower socioeconomic group of smokers.
Tobacco use disproportionately affects lower socioeconomic status (SES) groups. Current explanations as to why lower SES groups respond less robustly to tobacco control efforts and tobacco dependence treatment do not fully account for this disparity. The identification of factors that predict relapse in this population might help to clarify these differences. Good candidates for novel prognostic factors include the constellation of behaviors associated with executive function including self-control/impulsiveness, the propensity to delay reward, and consideration and planning of future events. This study examined the ability of several measures of executive function and other key clinical, psychological, and cognitive factors to predict abstinence for highly dependent lower SES participants enrolled in intensive cognitive-behavioral treatment for tobacco dependence. Consistent with predic…
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Marchand WR (2012)MEDLINE-indexed journal, not yet read by usJournal of psychiatric practice120 citations Mindfulness-based stress reduction, mindfulness-based cognitive therapy, and Zen meditation for depression, anxiety, pain, and psychological distress.
Mindfulness has been described as a practice of learning to focus attention on moment-bymoment experience with an attitude of curiosity, openness, and acceptance. Mindfulness practices have become increasingly popular as complementary therapeutic strategies for a variety of medical and psychiatric conditions. This paper provides an overview of three mindfulness interventions that have demonstrated effectiveness for psychiatric symptoms and/or pain. The goal of this review is to provide a synopsis that practicing clinicians can use as a clinical reference concerning Zen meditation, mindfulness-based stress reduction (MBSR), and mindfulness-based cognitive therapy (MBCT). All three approaches originated from Buddhist spiritual practices, but only Zen is an actual Buddhist tradition. MBSR and MBCT are secular, clinically based methods that employ manuals and standardized techniques. Studies…
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Early cognitive experience prevents adult deficits in a neurodevelopmental schizophrenia model.
Brain abnormalities acquired early in life may cause schizophrenia, characterized by adulthood onset of psychosis, affective flattening, and cognitive impairments. Cognitive symptoms, like impaired cognitive control, are now recognized to be important treatment targets but cognition-promoting treatments are ineffective. We hypothesized that cognitive training during the adolescent period of neuroplastic development can tune compromised neural circuits to develop in the service of adult cognition and attenuate schizophrenia-related cognitive impairments that manifest in adulthood. We report, using neonatal ventral hippocampus lesion rats (NVHL), an established neurodevelopmental model of schizophrenia, that adolescent cognitive training prevented the adult cognitive control impairment in NVHL rats. The early intervention also normalized brain function, enhancing cognition-associated synch…
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An affective-cognitive processing model of post-traumatic growth.
A topic that has begun to attract interest from clinical psychologists and psychotherapists is post-traumatic growth. First, we provide a general overview of the field, setting out the historical development, main concepts, measurement issues and research findings. Second, we review evidence showing that the relationship between post-traumatic stress and post-traumatic growth is likely curvilinear. Third, a new affective-cognitive processing model of post-traumatic growth will be introduced in which post-traumatic stress is understood to be the engine of post-traumatic growth. Fourth, points of clinical intervention are described showing the ways in which therapists can facilitate post-traumatic growth.
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Mirdal GM (2012)MEDLINE-indexed journal, not yet read by usJournal of religion and health3 citations Mevlana Jalāl-ad-Dīn Rumi and mindfulness.
The use of mindfulness-related methods for the treatment of a variety of psychological, somatic and interpersonal problems has increased dramatically in the last decade. Almost all mindfulness-based therapies include the practice of meditation in addition to various cognitive and/or behavioral techniques. The source of inspiration for mindfulness has traditionally been Buddhism, while Islamic thought has not been present in this development despite the similarities in philosophy and a growing need for mental health support among Muslim populations throughout the world. It is in this context that Sufism and especially Rumi's teachings seem to be promising both in terms of research on consciousness and in terms of culturally sensitive methods of healing. The aim of the present article is to highlight the commonality of mindfulness-based therapies and Rumi's religious philosophy. Introducin…
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Interpersonal problems as predictors of therapeutic alliance and symptom improvement in cognitive therapy for depression.
Background: The degree to which interpersonal problems of depressed patients improve over the course of cognitive therapy (CT) and relate to the quality of the therapeutic alliance and to symptom improvement, remains unclear.
Methods: We analyzed data of adult outpatients (N=523) with major depressive disorder participating in a clinical trial to determine the factor structure of the Inventory of Interpersonal Problems-Circumplex (IIP-C) and to relate the observed factor scores to the quality of the therapeutic alliance and symptom improvement over the course of CT. Patients received 16-20 sessions protocol (50-60 min each) of individual CT according to the treatment manual by Beck et al. (1979).
Results: We found a three-factor structure (interpersonal distress, agency, and communion) of interpersonal problems. Interpersonal distress decreased (d=.90), but interpersonal style did not ch…
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Pre-treatment expectations in clients: impact on retention and effectiveness in outpatient substance abuse treatment.
Background: Common factors are important for the therapy outcome and also mediate the specific factors of therapy. As one of the common factors, client's expectations towards treatment have been understudied.
Aims: The aim was to examine the pre-treatment expectations of outpatient substance abuse treatment clients (N=327, 111 females, 216 males) and its impact on retention, effectiveness and satisfaction at 6-month follow-up.
Method: Dependent variables included the clients' attitudes towards the twelve-step principles and participation, medical treatment and therapists' role.
Results: An emphasis on the importance of medical treatment at baseline predicted dropping out. Similarly, it predicted a lower percent days abstinent (PDA6) at 6 months follow-up in comparison to those who did not consider medical treatment important for recovery. Percent days abstinent increased with a more posi…
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What happens in session does not stay in session: changes within exposures predict subsequent improvement and dropout.
Previous exposure therapy research has suggested potential differences in emotional processing at different points in treatment (Hayes, Hope, & Heimberg, 2008). For example, indicators of emotional processing may be more related to outcome during the later exposure sessions than during the initial session. This is consistent with a growing body of psychotherapy research highlighting the importance of timing and change processes across therapy. The current study examined whether the learning-but-not-benefiting hypothesis is observed in a group based intervention for clients with a range of anxiety disorders. It was hypothesized that activation and within session habituation during later, but not the initial exposure session, would be related to outcome, whereas activation and within session habituation during the first session would be related to dropout status. Results revealed that lowe…
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Dealing with Feelings: the effectiveness of cognitive behavioural group treatment for women in secure settings.
Background: Women in secure psychiatric settings have gender specific treatment needs. The current study examined the feasibility of a Dealing with Feelings Skills Group training for dual diagnosis women admitted to a medium secure setting.
Method: A pre-test--post-test design was used to evaluate a group programme adapted from dialectical behaviour therapy skills training.
Results: Most patients had a primary diagnosis of personality disorder. Treatment completers (n = 29) were compared with non-completers (n = 15). Clinically significant changes in treatment completers were apparent on coping response measures of positive reappraisal, problem solving and alternative rewards; on measures of anxiety and suicidality; on self-reported ability to engage in activities to reduce negative mood and to recognize mood changes. Self-harming and aggressive behaviours also reduced in the 3 months fo…
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Routine outcome monitoring in the Netherlands: practical experiences with a web-based strategy for the assessment of treatment outcome in clinical practice.
Routine outcome monitoring (ROM) is a method devised to systematically collect data on the effectiveness of treatments in everyday clinical practice. ROM involves documenting the outcome of treatments through repeated assessments. Assistants are employed who perform a baseline assessment comprising a standardized diagnostic interview, administration of rating scales and completion of several self-report measures by the patient. At fixed time intervals, assessments are repeated. Dedicated Web-based software has been developed to assist in this task. ROM informs therapists and patients on the severity of the complaints at intake, and the waxing and waning of symptoms over the course of treatment. Researchers can use ROM for effectiveness research, and managers can use it for benchmarking. The use of ROM for research is illustrated by presenting data on the diagnostic status of patients par…
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Using behavior change plans to improve medical student self-care.
Purpose: To describe an innovative approach to teaching medical students the principles and practice of health behavior change and self-care using a behavior change plan (BCP).
Method: Second-year medical students at Northwestern University Feinberg School of Medicine (n = 343) took a required Healthy Living unit in 2008 or 2009. They completed a BCP project in which they selected a personal behavior to change (exercise, nutrition, sleep, personal habits/hygiene, study/work habits, or mental/emotional health), set a goal, tracked progress, and self-assessed success. The authors employed a one-group posttest-only design to conduct a quantitative analysis and a qualitative evaluation of students' BCPs and their attitudes concerning the project.
Results: Among the 343 students, 299 (87.2%) set BCP goals related to exercise, nutrition, or sleep. BCP outcomes varied: 139 students (40.5%) achi…
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Narrative enhancement and cognitive therapy: a new group-based treatment for internalized stigma among persons with severe mental illness.
Internalized stigma has been suggested to play a major role in negative changes in identity in severe mental illness. Evidence suggests that roughly one-third of people with severe mental illness show elevated internalized stigma and that it is linked to compromised outcomes in both subjective and objective aspects of recovery. Despite substantial evidence for the impact of internalized stigma, few efforts have been made to develop professionally led treatment to address this issue. In this article, we discuss our development of a new group-based approach to the treatment of internalized stigma which we have termed "narrative enhancement and cognitive therapy (NECT)". We describe the treatment approach and offer an illustration of it by way of a case vignette.
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Rumination as a predictor of relapse in mindfulness-based cognitive therapy for depression.
Objectives: In mindfulness-based cognitive therapy (MBCT), it is proposed that training in mindfulness should reduce the tendency of formerly depressed patients to enter into ruminative thinking, thus reducing their risk of depressive relapse. However, data showing that rumination is associated with depressive relapse are lacking.
Method: In an uncontrolled study with 24 formerly depressed patients, rumination was assessed with the Ruminative Response Scale. To assess the occurrence of relapse or recurrence, the Structured Clinical Interview for DSM-IV was administered 12 months after the end of the MBCT.
Results: Rumination significantly decreased during the MBCT course. Post-treatment levels of rumination predicted the risk of relapse of major depressive disorder in the 12-month follow-up period even after controlling for numbers of previous episodes and residual depressive symptoms.
C…
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Levy RL (2011)MEDLINE-indexed journal, not yet read by usAnnals of behavioral medicine : a publication of the Society of Behavioral Medicine46 citations Exploring the intergenerational transmission of illness behavior: from observations to experimental intervention.
Background: Functional abdominal pain (FAP) of childhood is characterized by, among other things, pain with no known physiological cause, and family patterns of related disorders have been reported.
Purpose: The purpose of this paper is to trace the development of one FAP research program and highlight some of its key findings from observations of interaction patterns to intervention studies designed to test outcomes of altering these patterns.
Methods: Studies summarized include observational and experimental research.
Results: Parental response to child pain behaviors appears to be a key factor in the development and maintenance of FAP, and intervention which includes targeting changes in parental responses can decrease reports of pain and other illness behaviors.
Conclusions: Research into FAP can provide valuable information for not only FAP and other unexplained pain conditions, but…
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Prevention of marital instability and distress. Results of an 11-year longitudinal follow-up study.
Divorce and destructive couple conflict are major risk factors for many forms of dysfunction and psychopathology in the family. Couple relationship education has been offered in an attempt to reduce those risks and enhance couple outcomes. The current effectiveness study had two aims: to assess (a) the long-term effects of relationship education and (b) the ability of partners to remember the skills typically taught during the communication skills training. One hundred and one couples from two studies, in which the effectiveness of the EPL (Ein Partnerschaftliches Lernprogramm für Paare [A Learning Program for Married Couples]) was investigated, were followed-up 11 years after the training. In the first study, EPL-takers had a significantly lower divorce and separation rate (27.5%) than non-EPL-takers (52.6%). This finding was replicated in a second study, showing a 20% dissolution rate …
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Neurofeedback outcomes in clients with Asperger's syndrome.
This paper summarizes data from a review of neurofeedback (NFB) training with 150 clients with Asperger's Syndrome (AS) and 9 clients with Autistic Spectrum Disorder (ASD) seen over a 15 year period (1993-2008) in a clinical setting. The main objective was to investigate whether electroncephalographic (EEG) biofeedback, also called neurofeedback (NFB), made a significant difference in clients diagnosed with AS. An earlier paper (Thompson et al. 2009) reviews the symptoms of AS, highlights research findings and theories concerning this disorder, discusses QEEG patterns in AS (both single and 19-channel), and details a hypothesis, based on functional neuroanatomy, concerning how NFB, often paired with biofeedback (BFB), might produce a change in symptoms. A further aim of the current report is to provide practitioners with a detailed description of the method used to address some of the ke…
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Patients' and providers' perspectives on bibliotherapy in primary care.
Bibliotherapy is a form of self-administered treatment in which structured materials provide a means to alleviate distress. Although the treatment has evidence of effectiveness, evaluations of bibliotherapy have typically focused on outcomes, and the perspectives of both the client and the service provider have been understudied. In the present study, eleven users of a bibliotherapy scheme were interviewed regarding their experiences of bibliotherapy. In addition, five referring practitioners to the scheme were also interviewed. Thematic analyses revealed three super-ordinate themes in the transcripts: participants' personal experiences of the bibliotherapy scheme factors that facilitate change and the influence of the professionals involved. The implications of these findings for bibliotherapy schemes are considered.
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Less food for thought. Impact of attentional instructions on intrusive thoughts about snack foods.
Intrusive thoughts about food may play a role in unhealthy eating behaviours. Food-related thoughts that capture attention can lead to craving and further intrusive thoughts (Kavanagh, Andrade, & May, 2005). We tested whether diverting attention to mental images or bodily sensations would reduce the incidence of intrusive thoughts about snack foods. In two experiments, participants reported their thoughts in response to probes during three 10min periods. In the Baseline and Post-task period, participants were asked to let their mind wander. In the middle, Experimental, period, participants followed mind wandering (Control), thought diversion, or Thought Suppression instructions. Self-directed or Guided Imagery, Mindfulness-based Body Scanning, and Thought Suppression all reduced the proportion of thoughts about food, compared to Baseline. Following Body Scanning and Thought Suppression, …
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A meta-analysis of interventions for bereaved children and adolescents.
The main objective of this review was to provide a quantitative and methodologically sound evaluation of existing treatments for bereavement and grief reactions in children and adolescents. Two meta-analyses were conducted: 1 on controlled studies and 1 on uncontrolled studies. The 2 meta-analyses were based on a total of 27 treatment studies published before June 2006. Hedges's g and Cohen's d were used as measures of effect size and a random-effects model was applied. Results yielded small to moderate effect sizes. Interventions for symptomatic or impaired participants tended to show larger effect sizes than interventions for bereaved children and adolescents without symptoms. Promising treatment models were music therapy and trauma/grief-focused school based brief psychotherapy.
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Factors explaining children's responses to intravenous needle insertions.
Background: Previous research shows that numerous child, parent, and procedural variables affect children's distress responses to procedures. Cognitive-behavioral interventions such as distraction are effective in reducing pain and distress for many children undergoing these procedures.
Objectives: The purpose of this report was to examine child, parent, and procedural variables that explain child distress during a scheduled intravenous insertion when parents are distraction coaches for their children.
Methods: A total of 542 children, between 4 and 10 years of age, and their parents participated. Child age, gender, diagnosis, and ethnicity were measured by questions developed for this study. Standardized instruments were used to measure child experience with procedures, temperament, ability to attend, anxiety, coping style, and pain sensitivity. Questions were developed to measure paren…
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Reach Out Central: a serious game designed to engage young men to improve mental health and wellbeing.
Reach Out Central (ROC) is a serious game drawing on the principles of cognitive behaviour theory that has been designed to improve the mental health and wellbeing of young people, particularly men. ROC was developed over a 3-year period from 2003 to 2006, in consultation with young people aged 16-25 years who use the Reach Out mental health website http://www.reachout.com). ROC was launched online in September 2007. A traditional and viral awareness campaign was designed to engage young men, particularly "gamers". In the first month after launch, ROC had 76 045 unique website visits, with 10 542 new members (52% male) joining Reach Out. An independent online evaluation involving 266 young people aged 18-25 years was conducted between August 2007 and February 2008 to examine psychological wellbeing, stigma and help seeking in ROC players. Overall results indicated that ROC was successful…
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